Botox in Dentistry

Botox is a neurotoxin derived from clostridium botulinum and it functions by inhibited acetylcholine release, preventing muscle contraction at and around the site of injection. Dermal fillers are substances injected to enhance volume and fullness. They are composed of an ingredient such as hyaluronic acid and calcium hydroxyapatite. Both materials are utilized by dentists to treat temporomandibular disorders, bruxism, clenching, masseter hypertrophy, fine lines, wrinkles, radial lip lines, a gummy smile and even black triangles between teeth.




Temporomandibular Joint Disorders


Traditional TMD treatment modalities are costly and invasive. They can involve occlusal adjustments, surgery or even intraoral appliances. Botox can relax the muscles that amplify TMJ disorders.


Bruxism


Botox can conservatively relax muscles around the TMD to reduce biting force. This can reduce the intensity of bruxing and associated tooth wear but does not impair the ability to chew food. Injection into the temporalis and masseter can help reduce the bruxing force. Frequent jaw clenchers can benefit from a masseteric Botox injection as a way to reduce hyperactivity. The muscle usually decreases in size as activity reduces.


Gummy Smile



A common method to treat gummy smiles is a gingivectomy, but Botox injected into the upper lip can reduce exposure of gums upon smiling. This is useful in cases where there is insufficient tooth structure to support a gingivectomy or a patient wants to undergo a less invasive procedure.


Fine Lines and Wrinkles


Botox is helpful for smoothing out facial wrinkles in the forehead, between and around the eyes and in other spots. This is the most common minimally invasive cosmetic procedure done in North American and accounts for a quarter of cosmetic procedures done annually.


Considerations


Botox is not permanent, so the patient should be financially competent to repeat the procedure if they desire long-term results. The exact timeline depends upon the patient’s metabolism.


Recent research has pointed to a connection between sleep apnea and teeth grinding. For this reason, treating bruxism of clenching disorders with Botox would treat the symptoms, but also warrants investigation of deeper systemic anomalies.


Botox is contraindicated in patients with muscle weakness as in Myasthenia Gravis, patients with any existing skin diseases or those with uncontrolled diabetes or severe auto-immune disease. It should not be utilized in patients’ certain allergies or those utilizing certain medications. It is contraindicated for pregnant patients.


Botox use over time can lead to muscle atrophy and fillers can stretch out underlying soft tissue, requiring consistent upkeep to maintain a full appearance. There are potential side effects to Botox such as asymmetric results and bruising.


Despite certain complications and contraindications, Botox and filler services are an essential part of any modern dental practice.


Common Medical Contraindications for Botox


• Botulism

• ALS

• Peripheral motor neuropathy

• Myasthenia gravis

• Skeletal muscle disorders

• Progressive muscle weakness with carcinoma

• Double vision or blurred vision

• Ptosis

• Decreased lung function

• Hoarseness

• Trouble breathing

• Underlying health conditions

• Difficulty swallowing

• Known allergy to botulinum toxin



Sources:


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316364/

https://www-clinicalkey-com.ezp1.lib.umn.edu/#!/content/playContent/1-s2.0-S1042369908001106?returnurl=null&referrer=null

https://www.researchgate.net/publication/302484818_Botox_and_dermal_fillers_use_in_dentistry

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086949/



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