When therapy remains as much in the shadows as diagnosis: an evaluation of methodological and terminological uncertainties in muscle trigger point injections.

OBJECTIVE

This letter responds to the recent study article by Shaaban et al. published in Clinical Oral Investigations in 2025 ( https://doi.org/10.1007/s00784-024-06051-0 ), which reported the efficiency of intraoral botulinum-A toxin (BTX-A) injection guided by ultrasound for trigger points (TrPs) in the masseter muscles.

MATERIALS AND

METHODS

We discuss the diagnostic protocol adopted in the study, the absence of specific criteria to confirm the presence of TrPs either during palpation or ultrasound evaluation, the paucity of information regarding the identified TrPs and the BTX-A doses associated with them, and the terminological confusion surrounding TrP injections.

RESULT: The diagnostic approach employed in the study revealed certain inconsistencies. The dearth of data concerning the reported cumulative BTX-A dose impedes the comparability of the findings of this study. Both intra- and extra-oral injections described in the article do not conform to the definition of TrP injections.

CONCLUSION

The ambiguities in the methodology and terminological inconsistency can lead to significant bias when evaluating the efficacy of TrP injections, and may cause conceptual confusion in the literature.

CLINICAL RELEVANCE: Our critique emphasizes the necessity of transparent studies and standardized terminology to adequately assess the potential role of TrPs in masticatory muscle disorders and the effectiveness of injections targeting these structures. In the absence of such clarity, the reproducibility of therapeutic outcomes remains limited, potentially compromising clinical decision-making and patient care.