Unlocking the Hidden Potential: Botox Therapy in Dentistry Revealed

Botox, known for its wrinkle-smoothing superpowers, has transcended the realm of cosmetic surgery and stepped into the dental spotlight. Dentists, armed with their keen eye for facial harmony and precision, have embraced Botox as a multifaceted tool to not only enhance your smile but also restore youthful radiance to your face. Who knew your dentist could be the secret keeper of your fountain of youth?

In this captivating journey through the world of dentistry, we'll unravel the surprising ways Botox therapy is being woven into dental practice. From erasing fine lines and wrinkles around the mouth to relieving the discomfort of temporomandibular joint (TMJ) disorders, dentists are proving that they're not just smile architects but also masters of facial rejuvenation.

Botox is a neurotoxin derived from Clostridium Botulinum which acts by producing temporary chemical denervation of skeletal muscle by inhibiting the release of acetylcholine from nerve ending leading to flaccid paralysis. Hence, ultimately, a transient dose-dependent weakening of muscle activity is seen. The most common type of this toxin used is Botulinum Toxin Type A (BTA). Let's look at a few cosmetic and therapeutic indications of botox.

COSMETIC APPLICATIONS OF BOTULINUM TOXIN

1. FACIAL WRINKLES

A notorious topic of discussion among the celebrities and the general public, Botox first came to light after successfully treating signs of aging on the face temporarily around the eyes, lips, chin, neck, on the forehead and to uplift the eyebrows. It was considered as a superpower in the field of dermatology and researchers further discovered the other applications of BT.

2. HYPERTROPHY OF TEMPORALIS AND MASSETER

Temporalis and Masseter are two of the four main muscles of mastication that support the temporomandibular joint by elevating the mandible in order to close the mouth. They also help in clenching the jaw and parafunctional uses of the jaws. Hypertrophy of these muscles cause chronic facial pain that may limit mouth opening. Injecting BTA causes relaxation of these muscles. 

3. DENTOFACIAL ESTHETICS

In the treatment of black triangles, gingivectomy or orthognathic surgery may prove to be invasive. Derma fillers with BT volumizes the interdental papilla and reverts it back to its normal state.

4.  GUMMY SMILE

Gummy smile or in simpler words, excessive gum display in maxilla upon smiling is caused because of hyper-functional upper lip elevator muscle especially levator labii superioris alaque nasi. The most common treatment nowadays for the correction of gummy smile is by performing Le Fort 1 maxillary osteotomies with impaction of skeletal vertical maxillary excess and gingivectomies. Weakening of activity of the muscles and limiting the muscular over-contraction will reduce the over-exposure of maxillary gums. 

5. DROOPING OF CORNERS OF THE MOUTH

Hyper-activity of the depressor anguli oris can be lessened with injection of BTA in balanced doses. The site of injection is usually in the trajectory of the nasolabial fold to the jaw line.

THERAPEUTIC APPLICATIONS OF BOTOX

1. TEMPOROMANDIBULAR DISORDERS

Temporomandibular disorders are described as a group of diseases that affect the general health of the temporomandibular joint and the muscles of mastication as a result of it. This lead to derangement of masticatory functions and occlusion. These set of disorders manifest with facial pain, clicking of the joint, headache, preauricular pain, neck pain and limit excursive jaw movements. The etiologic factors that cause them are oromandibular dystonia, excessive clenching of teeth, psychomotor behavior, etc. The most common treatment options include physiotherapy, exercise, pharmacotherapy and oral appliances. However, a much less invasive therapy in the form of BTA injection has been doing rounds for the past few years which replaces the role of muscle relaxants like Diazepam that provides satisfactory relief to the muscular tenderness and pain for a longer period of time. 

2. BRUXISM

Bruxism or habitual nocturnal eccentric grinding of teeth is one of the causes behind the development of TMJ disorders. This kind of joint damage gives rise to headaches, derangement of TMJ,  difficulty in speaking, chewing or swallowing and periodontal problems. 

The most effective way of treating this problem is by asking the patient to use a nightguard or an oral appliance made to protect the teeth from clenching. But this solution is only temporary since it does nothing to stop the habit. Administration of BT injection will relax the muscles of mastication and provide instant relief to the patient.

3. DENTAL IMPLANTS

After multiple immediate implants or implant supported overdentures, precautions are taken to prevent overloading of implants that may hinder the osseointegration or cause loosening of the implant components. This may lead to implant failure. In patients with parafunctional habits, such condition is more likely to occur. Hence, prophylactic use of Botox achieves muscular relaxation that allows better prognosis after implant placement.

4. MAXILLOFACIAL SURGERY

In patient who have undergone maxillofacial surgery, they might have multiple fixation sites to overcome the masticatory forces. Overloading of the muscles around those can prevent callus formation leading to the failure of the surgery. To limit para-functional clenching, use of Botox is considered. High doses of BTA can play the role of a "pharmaceutical splint". Since the teeth have to remain functional during healing after a periodontal or maxillofacial surgery, use of a conventional splint is contraindicated. 

5. BELL'S PALSY

Injection of BTA proved to be successful in treating two complications of Bell's Palsy- Facial asymmetry (Facial Synkinesis) thus improving facial expression improving and Hyperlacrimation (Crocodile Tears) by injecting BTA into the lacrimal gland at both rest and in voluntary movements. 

6. TRIGEMINAL NEURALGIA

BT is one of the least invasive treatment of Trigeminal Neuralgia over other common therapies. BT has also proven to be useful in management of facial pain in the maxillofacial regions like Cervical Dystonia, Chronic facial pain, etc that is associated with excessive masticatory forces. 

7. SIALORRHEA AND SALIVARY GLAND DISORDERS

Sialorrhea or excessive salivation is a result of poor oral and facial muscle control. The drooling is controlled by injecting BT in the parotid and submandibular glands. BT has also shown good improvement in gustatory sweating (Auriculotemporal/Frey's Syndrome)

8. OTHER THERAPEUTIC USES OF BOTULINUM TOXIN

• Treatment of Recurrent dislocation of mandibular condyle by injecting BT into the lateral pterygoid
• Prevent relapse of orthodontic treatment in patients with strong muscular activity
• In cancer and palliative therapy to improve movement disorders and spasm 
• In patients struggling to get used to a new set of dentures due to irregular and uncoordinated muscle activity
• Treating Ranula

LIMITATIONS OF BOTOX

While treating a patient with an injection of BT, we have to keep the following relative contraindications in mind:

• Pregnancy and Lactation
• Neuromuscular Diseases like Myasthenia Gravis, Eton-Lambert Syndrome
• Motor Neuron Diseases
• Concurrent Usage of Amino glycosides
• Sensitivity to Toxin

ADVERSE EFFECTS OF BOTOX 

• Allergic reactions
• Rashes and itching
• Headache
• Neck or back pain
• Muscle stiffness
• Difficulty in swallowing
• Shortness of breath
• Nausea
• Diarrhea
• Stomach pain
• Loss of appetite
• Injection site reactions
• Sore throat
• Runny nose
• Ringing in ears
• Increased sweating

That's it, folks! We hope you liked this article about one of the recent advances in dentistry and do reach out to us if you would like to comment or make a suggestion. :)