Dental Applications for Botox

By Catherine M. Fascilla, D.D.S.

Botox, as familiar to us today as Kleenex, wasn’t in the dictionary a mere two generations ago. It was only in April 2002 that it was approved for cosmetic use to remove unsightly frown lines between the eyes and to smooth facial wrinkles. It has since become the most commonly performed, minimally inva-sive cosmetic procedure in North America. While once only afforded by the rich and famous, today it’s widely accessible to those with even modest financial means.

Let’s look back a bit at its history. Botox is the trade name for Botulinum toxin A, a neurotoxin. Botulinum toxin was first discovered almost two hundred years ago in 1820 by a German scientist study-ing rotten pork. Seventy years later, another scientist investigating food poisoning found seven different strains of botulinum toxins and identified four which are harmful to humans. Strain A was discovered in the 1950’s to relax hyperactive muscles and by the 80’s it was approved for medical treatment and was used for everything from eyelid twitches and facial spasms to cerebral palsy. Around this time, it got its more user-friendly name “Botox”.

The pivotal breakthrough came in 1987 when two married Canadian doctors realized its wrinkle-fighting properties. They noticed that their patients who were receiving injections for facial spasms were also losing their frown lines. Today Botox may be synonymous with wrinkle removal but increasingly more dentists are using it for dental treatment.

Botox is essentially a muscle relaxer. It works by inhibiting the release of acetylcholine, the chemical that our body produces that causes muscle contraction. Botulinium toxin A blocks acetylcholine, interrupting the contraction process of the muscle, and causes a temporary muscle paralysis lasting up to three months. Gradually the muscle will return to full function with no side effects whatsoever.

The most common use of Botox in the dental office is in the treatment of Temporomandibular joint disorders ( a.k.a. TMJ or TMD). This is a clinical label for any pain of the jaws and facial muscles that is often also associated with headaches, earaches, and pain in the neck and spine. By administering typi-cally half of the dosage of Botox needed to smooth wrinkles, dentists are finding that these agents give significant pain relief to their patients.

Another common use in dentistry is in the treatment of bruxism, the term that refers to both clenching and grinding of the teeth. Most bruxism occurs at night while sleeping and is very destructive to tooth structure. It can exacerbate periodontal disease and cause facial pain and headaches. With bilat-eral injections to the master and temporals muscles and using the right dose, Botox will reduce the inten-sity of the contractions of these muscles of mastication, while at the same time maintaining full competen-cy for chewing, eating and speaking.

Dentists have cosmetic uses for Botox as well. A high lip line can cause a person to show way too much gum tissue when they smile. In the past the only way to correct that condition was with surgery to remove the excessive gum tissue and bone, followed by veneers or crowns to improve the appearance of the teeth that now have their root surfaces exposed. Treatment is costly, uncomfortable and takes several visits to complete. However, the results are long lasting and very esthetic. With Botox therapy and lip augmentation with dermal fillers, the upper lip can be enhanced to make it fuller and the muscles surrounding the lip are relaxed enough to keep the upper lip from rising so high as to expose so much of the gums. When done correctly, the patient still has full ability to speak, chew and kiss. The results are almost immediate and accomplished in just one visit. The cost of treatment is initially much lower but treatment is temporary and must be repeated 2-3 times per year.

These are just a few of the applications of Botox used in the dental setting. As time goes on and more dentists get on board, they will no doubt discover other creative ways to use Botox. It is remarkable to think that two hundred years ago a rotten pig could have such an enduring legacy.

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