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Affinity Dental Care – Botox in Dentistry

Botox was first approved in 1989 to treat two eye-muscle disorders, blepharospasm (uncontrollable blinking) and strabismus (crossed eyes). Botox is a Botulinum neurotoxin protein produced by the bacterium Clostridium botulinum. The same toxin can cause a life-threatening type of food poisoning called Botulism. It is most recognized as a wrinkle-reducing treatment. When used in a small amount, it may help treat symptoms of myofascial pain-related temporomandibular joint (TMJ) disorders in the head and neck region. There are several Botulinum neurotoxins in the market: Botox, Dysport, Xeomin, Jeuveau, and Myobloc. Besides Botox’s use for wrinkles removal, it is approved for eleven therapeutic indications, including chronic migraine, overactive bladder, leakage of urine (incontinence) due to overactive bladder caused by a neurologic condition, cervical dystonia, spasticity, and severe underarm sweating (axillary hyperhidrosis). Because of its ability to inhibit the motor neurons and desensitize the nociceptive pathways, Botox in dentistry has been used to treat TMJ disorders in some people effectively. In a few studies, Botox could significantly decrease pain and increase mouth movements for three months following treatment. However, this treatment for TMJ disorders is experimental. The U.S. Food and Drug Administration (FDA) has not approved Botox for use in TMJ disorders.

However TMJ-related myofascial disorders are caused by tensed muscles and can express as:

– Sore cheeks and jaw

– Limited or painful jaw opening

– The bulge in your face

– Pain around your neck and ears

– Headaches or migraines

– Clenching and grinding your teeth (bruxism)

– Ringing in your ears

– Shoulder pain

– Facial pain

Botulinum toxin inhibits the release of the neurotransmitter acetylcholine (ACh) from the neuromuscular junctions in skeletal muscles. Because ACh causes muscle contraction, the inhibition of the release help the muscles to stop sustained contraction and relax.

Before the injection, the myofascial trigger points were located by palpation of the masticatory muscles (usually undergoing spasm with a bulge visually on the face or neck, which is also very tender when touched). The Botox is then injected into the sites identified as the trigger points.

Because it is not officially approved for treating TMJ-related symptoms, I do not recommend Botox in dentistry unless other nonsurgical treatments have failed. The other therapies that should be considered first are:

– medications such as pain relievers and anti-inflammatories

– occlusion adjustment/balance to relieve premature contact of certain teeth

– muscle relaxants

– physical therapy

– oral splints or mouth guards

– relaxation techniques

Botox may help treat the following TMJ disorder symptoms that are caused by muscle spasms and hyperactivity:

– jaw tension

– headaches due to teeth grinding

– lockjaw in cases of severe stress

– severe bruxism

The improvement usually starts on the 3rd day of injection and peaks at three months. The injections should be repeated at three months intervals to decrease the symptoms. Sometimes, the injections must be repeated every three months for a few years.

People who have had Botox treatment for TMJ can expect to return to regular activities as soon as they leave the office. However, you should remain upright and avoid rubbing or massaging the injection sites for several hours after treatment. This helps prevent the toxin from spreading to other muscles.

Botox has a very high safety margin but has possible side effects. The most common side effects of Botox for TMJ treatment are:

– Temporary eyelid droop

– Headache or flu-like symptoms

– Dry or watering eye

– Drooping on one eyelid, eyebrow or side of the mouth

– Drooling

– Nausea

– A “fixed” smile lasting six to eight weeks

After the injection, the patient may experience the following in the first few days:

– Pain

– Redness at the injection site

– Muscle weakness

– Bruising at the injection site

The pain can be eased with a cold pack or numbing cream on the first day of injection. Botulinum should be avoided by pregnant women, nursing mothers, and people with an allergy to proteins in cow’s milk.

In addition to Botox in dentistry, I also utilize adjunctive therapies to treat the underlying causes of the disorder. Some simple, non-invasive treatments like the following can be very effective:

– Mouth splint and night guard

– Head and neck exercise

– Yoga, deep breathing, meditation, or massages

– Eliminate bad posture, slumping or slouching

– Recognize when you are clenching your teeth and work to relax your jaw

– Avoid chewing on gum, biting your nails, or eating too many tough or sticky foods

We provide you with all your treatment options at Affinity Dental Care. You may benefit from a combination of treatments, or you may need to try several treatments before finding one that works. Let’s work together to keep your smile the best it can be.

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