Dental Botox: The Healing Poison

This paper discusses the history of botulinum, later branded Botox or BONT-A, a toxic poison common in foods, and how it is now being used therapeutically for many dental conditions.

Several journals, websites and magazine sources were used to better understand the different conditions and those afflicted by these conditions and how Botox injections are used to help manage pain and muscle control. There is an increasing number of studies that show the benefits and efficacy of botulinum as an alternative treatment with less adverse effects and more compliance among patients with special needs like Parkinson’s, cerebral palsy, ADHD, and brain injury.

The four dental conditions focused on in this paper for Botox dental fillers are hypersalivation, bruxism, temporomandibular joint disorder and oromandibular dystonia with regards to their treatment, side effects and contraindications.

Most of the public is familiar with Botox as a common filler to reduce or eliminate wrinkles and fine lines from aging. What many are not aware of are the variety of uses of Botox for other conditions and pain management that can easily be treated in the dental office.

Botox is derived from a poison; therefore, it is important to understand where it comes from, what forms can be used, and how it interacts with our bodies. Botulinum toxin is a protein produced from the bacterium Clostridium botulinum. It prevents the release of acetylcholine and can cause muscle paralysis. There are 8 types of botulinum but only two are used in medicine, type A and B, while type H is considered the deadliest substance in the world with only 2 ng injected can cause death in an adult.

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In the early 1800s, a German writer, Justinus Kerner discovered botulism and through experiments on himself, animals and a sausage, he had observed that small amounts of the toxin would affect the muscles but not the sensory or mental functions. His suggestion that it may be used in the future for therapeutic purposes might have him perceived by some as the first to discover the healing properties of this poison. During WWII it was experimented and studied as a possible weapon by Edward Shantz where he was able to crystalize it. Later, Dr. Allen B Scott and some colleagues, injected a monkey’s extraocular muscles with botulinum type A and had his first human trial patient in 1977 to treat strabismus, an eye muscle disorder. During the 1980-1990s Dr. Scott’s patent had been purchased and the brand name Botox was born. In 1992 Dr. Carruthers of Canada, was having great results reducing wrinkles and many new medical problems were being treated including migraines, hyperhidrosis, and cervical dystonia. (Krasen, M. 2014)

The many different therapeutic uses for Botox range from overactive bladder, hyperhidrosis (excessive sweating), strabismus (eyes) and severe neck spasms to chronic migraines. For the purposes of this paper, we will be looking at the therapeutic dental uses such as bruxism, temporomandibular joint disorder (TMD), hypersalivation, oromandibular dystonia (OMD), and masseteric hypertrophy. Many of these conditions are common in patients with Parkinson’s disease, autism, and cerebral palsy who are normally treated with medications that may have discomforting side effects or use of appliances that the patient may not be very compliant with; therefore, Botox injections can be a more effective and easy application for these special needs patients. (Krattenmaker, K., KO, T. Y., & Sefo, D. 2017)

Hypersalivation, or sialorrhea, is a condition that is common with many special needs patients that causes drooling and overactive salivation or inability to swallow the saliva adequately as in Parkinson’s or cerebral palsy. This can be very embarrassing socially for a person as well as cause skin conditions to the face and mouth. The current treatment options are medications that have adverse side effects or surgery, but with Botox patients can receive positive effects for 3-6 months with no major side effects. (Krattenmaker, K, et.al 2017) (Awan, K.H. 2017)

Bruxism and masseteric hypertrophy is another area that affect not only special needs patients but many young and older adults. Constant clenching and grinding of the dentition can damage the tooth structures, cause severe pain in the jaw and muscles of the face, and TMJ. The treatment is intraoral appliances and/or muscle relaxers, but many patients are either unable (special needs) to be compliant with the appliance, or cannot tolerate the medications, while others have pain so severe that these methods do not work. Botox injections are an option to help reduce the pain in the muscles, while reducing side effects for some, but with the understanding that patients must continue treatments every few months to maintain the effects. (Krattenmaker, K, et.al 2017) There is still some belief that more studies need to continue on the safety and use of Botox for bruxism. (Awan, K.H. 2017)

Temporomandibular joint disorders are probably one of the most uncommon diseases of the masticatory muscles with symptoms of headaches, neck pain, clicking or popping in the joint, and ear pain that can contribute to significant facial and cranial pain in severe cases. I personally am afflicted with this disorder and have been since the age of 10. I have been through every type of therapeutic remedy for this except surgery including; soft night guards, hard occlusal guards, soft/hard combination guards, behavior therapy, muscle relaxants, acupuncture, orthodontics, and neuromuscular repositioning which has been the most effective. I still have severe migraines, insomnia, jaw pain, and crepitus but I have learned to manage it and this paper is informative for me about Botox for an option. The injections are placed in the pterygoid, temporalis and masseter muscles and may only have lasting effects for 3 months depending on the patient and the level of the condition. (Kharbanda, S., Srivastava, S., Pal, U., & Shah, V. 2015)A picture of typical TMD injection sites is included below. (Kharbanda, S., et.al 2015) (Mor, N., Tang, C., & Blitzer, A. 2015) “However, administration of Botox into the pterygoid muscles may bring about a ‘fixed’ smile because of the dissemination of the toxin into the superficial facial muscles” (Awan, K.H. 2017 p.22)

Oromandibular dystonia, or the involuntary and repetitive muscle spasms of many of the oral and facial muscles. Patients who suffer from OMD can have soft tissue trauma, bruxism, trouble with dysphagia, dysarthria, breathing, and mastication, which can have devastating effects on their quality of life, nutritional intake, psychological and social perceptions. There are many medications to help manage the spasms like anti-convulsant, benzodiazepine, and cholinergic which can have very bad side effect like seizures, muscle weakness, confusion, and motor disturbances. (Krattenmaker, K. et.al, 2017) There have been some cases that show positive results from Botox injections used for OMD in the pterygoid muscle and others, but some feel more studies need to be done. Others have reported a high success rates, but all agree that treatment would need to be repeated to maintain results.

Although there are many studies showing positive results for many of the conditions discussed in the paper, I must agree with many of the sources that more studies and information is needed. One study found that a women who had Botox injections for cosmetic purposes in her cheek region 6 years prior, later developed a secondary infection and swelling in her face after having a bridge recemented in that area. The study stated that it was related to infected dermal filler and the patient had to be placed on antibiotics, have an incision and drainage and surgical removal of the filler. (Ramzi, A. A., Kassim, M., George, J. V., & Amin, A. 2012) There are many things we may still not know about this poison and of course what are the options for creating a filler that is not a poison? What about the question of the muscles going into atrophy from too many treatments of Botox, or the body building antibodies to the botulinum and it not being as effective or as long lasting? There are still many questions to be answered regarding this healing poison, but for now, it seems to be advantageous for a large number of people who suffer with severe pain and special needs conditions that can be managed more effectively.

Bibliography

1. Awan, K. H. (2017). The therapeutic usage of botulinum toxin (Botox) in non-cosmetic head and neck conditions – An evidence-based review. Saudi Pharmaceutical Journal, 25(1), 18–24. https://doi.org/10.1016/j.jsps.2016.04.024
2. Azam, A., Manchanda, S., Thotapalli, S., & Kotha, S. B. (2015). Botox Therapy in Dentistry: A Review. Journal Of International Oral Health, 7((Suppl 2)), 103–105. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4672850/
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