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TMD/TMJ - Botox®
Benefits of Dentox® (Botox® for Dentistry)
The most common benefit of Dentox® is the reduction in the number of clenching events and their intensity. This will reduce the destruction
of your teeth, gums and jaw joint, and reduce the discomfort and pain in your face and chewing muscles. A beneficial side-effect is the smoothing
of lines between the brows and in the forehead Because the muscles are unable to contract, Botox may prevent new wrinkles from forming. Other
benefits are that only the injected areas are effected and results are often seen within 24 - 48 hours.
Another possible benefit is that the botulinum toxin does not stay in the body indefinitely, so if there is an adverse effect, or a mistake
made, it is only temporary. There is also the likely possibility that with frequent treatments, the injected muscles will atrophy allowing the
patient to go longer and longer between treatments.
What can I expect at the initial consultation?
At the initial consultation your doctor will first determine if you are an appropriate candidate for Botox® and if indeed it is the best
treatment for the results you desire.
You should also discuss your medical history with your doctor. He/she will assess if you are allergic or hypersensitive to any ingredient in
Botox®. Furthermore, it is imperative that you disclose all medications, vitamins, herbs, and supplements you currently take. These substances
could hinder or intensify the potency of the Dentox® or cause bleeding and bruising at the injection sites.
Botox Injection - The Procedure
Botox is a simple, non-surgical procedure. The doctor will have you contract the muscle area to be treated so he/she can determine appropriate
injection sites. He may use an electronic muscle locating device (EMG) to locate the targeted muscle site precisely. Then, targeted injected areas
may be numbed with an ice pack or a topical numbing agent. Anesthesia may or may not be used. Finally, the doctor will administer several tiny
injections of Botox® directly into the muscle. Only the injected areas will be "paralyzed." It will not affect anywhere else in your body.
How long is the procedure?
The length of the procedure depends on the number of injections needed as determined by the doctor. Still, it is reasonable for the procedure to be
completed within 10-30 minutes.
What, if any, hospital stay is required?
Because the procedure is non-surgical and often done right in the doctor's office, there is no hospital stay required.
Will I need a driver?
NO. Botox® will not limit your driving ability.
How much pain is there?
The pain associated with this procedure is due to the injections, but it is generally minimal and brief. Some patients have likened it unto a "bug bite"
or "prick." Pain can be reduced by proper injection techniques and by numbing proposed injection sites with a cold pack or anesthetic cream. If
you are scared of needles the doctor may offer you nitrous oxide or even an oral sedative.
What can I expect afterwards?
Muscle tenderness will start to disappear almost immediately. Wrinkles begin to disappear within 24 - 48 hours after the injections, and the patient may
continue to see the wrinkles diminish up to one week after the procedure. There may be mild temporary bruising, numbness, or redness around the injection
sites. You will not look 20 years younger, but you may find that you look more natural and relaxed (or less sad and angry). A small number of patients
reported no noticeable difference in the reduction of their wrinkles.
What is the recovery like?
Because the procedure is non-surgical and non-invasive, it is highly likely that the patient can return to normal activities immediately. However,
to avoid spreading the toxin to other muscles, patients should not rub or massage the area injected, and remain upright for several hours. Physical
activity should also be limited for a time.
What is the long-term outcome?
Results of Botox® generally last up to four months. Patients should wait at least three months between treatments. There is also the likely
possibility that with repeated treatments, the injected muscles will atrophy allowing the patient to go longer and longer between sessions. Do not
have Botox® treatments elsewhere because they may weaken the affects of Botox® in your body.
With more and more injections, there is a chance of growing resistant to Botox®. Your body may develop antibodies that would cause treatments
to become less effective over time. This resistance can be minimized by using the lowest dose possible and extending the intervals between sessions.
It is best to limit your Botox® injections to one office. Your dentist may be able to take care of all your Botox® needs.
How long do the results last?
Your chewing muscle discomfort will disappear for up to four months. The smooth, diminished appearance of the wrinkles will last up to four months.
Results may last longer with subsequent treatments due to muscle atrophy. If another treatment of Botox® is not administered, facial or chewing
muscle discomfort may return. Facial lines will return to their "pre-treatment" appearance.
Who is an ideal candidate?
Botox® may or may not be the best treatment for the results you desire. An ideal candidate meets the following conditions:
- Between the ages of 18 and 65
- Has a dento-facial problem caused by parafunctional muscle activity
- Does not object to the disappearance of his/her wrinkles
- Is looking for a non-surgical solution
- Is looking for a temporary solution
- Is knowledgeable about the procedure
- Is realistic in expectations
- Is in good physical and psychological health
- Is not pregnant or nursing
The above criteria are not comprehensive. Be sure to discuss with your doctor if you are an ideal candidate for Botox® and if it is the best
treatment plan for your desired results.
Other important information:
With the FDA's approval of Botox®, it has become increasingly popular to administer it in social settings and/or non-medical facilities, sometimes
without trained personnel. Although, this can help reduce the costs for patients, they should be aware of some of the concerns. First of all, it is
imperative to have a qualified, trained doctor or dentist administer the injections. Next, the environment needs to be sterile and equipped to handle
any adverse effects. A physician's office or clinical setting is best. Finally, adherence to post-treatment instructions is key, and these may be
neglected in a social/party-like atmosphere. It goes without saying that alcohol should not be a part of any medical procedure.
Some other restrictions are that Botox® injections cannot be performed if there is any infection at the injection sites, if you are
hypersensitive to any ingredient in the botulinum toxin type A, or if you are pregnant or nursing. There is an increased risk with patients
that have any neuromuscular disorders.
Risks, Limitations & Possible Complications
As with any medical procedure there are possible risks and side effects. Since this is a non-surgical procedure, the risks and possible
complications are infrequent, minimal and temporary. The most common reported side effects are headaches, respiratory infection, flu syndrome,
temporary eye-lid droop, and nausea.
Less commonly reported effects are pain, redness at spot of injection, and muscle weakness. These symptoms are thought to connected
with the injection and occur within the first week. There could also be bruising at the injection site. The lips are used more than the
forehead for common activities such as chewing, kissing, and talking. Therefore injections around the mouth are less useful and can have
more potential inconvenient effects. These every day activities may become more difficult and too much Botox® around the mouth can
result in drooling.
Another limitation to Botox® injections is that there is a possibility of developing antibodies that would render the treatments
less and less effective over time. This resistance could be delayed by using the lowest effective dose possible over the longest intervals of time.
Botox® injections should be avoided during pregnancy and lactation.
Botox® Costs:
Depending on the number of injections and the doctor, treatment can cost anywhere from $500 to $1500.
Choosing a Dentist or Doctor:
Any health care professional can administer Botox® injections. However, a Botox® certified dentist, facial plastic surgeon,
neurologist, or dermatologist is recommended. He/she should be experienced in botulinum toxin injections and have an intricate understanding of
facial anatomy and physiology.
Click here for a medical paper outlining the use of Botox® in dental applications (In Adobe Acrobat PDF format.
Click here for Acrobat Reader.)
Should you have additional questions, please ask your doctor.
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