Botox is a natural purified protein that is used to temporarily relax muscles. The extracted protein “Botulinum Toxin” which is available in the market is a purified toxin of a bacteria called Clostridium Botulinum. It is interesting to know that the idea for a possible therapeutic use for botulinum toxin was first developed by the German physician Justinus Kerner (1786-1862). He concluded that the toxin acted by interrupting signal transmission within the nervous system, leaving sensory transmission intact. He called the toxin a “sausage poison,” because it was observed that illness followed ingestion of spoiled sausage. In 1870, John Muller, another German physician, coined the name “botulism” (from the Latin root botulus, which means “sausage”). In 1949, Burgen was the first to discover that the toxin was able to block neuromuscular transmission. Different strains of this protein were identified and one strain was initially approved by the US Food and Drug Administration (FDA) in 1989 under the trade name Botox® (Allergan, Inc, Irvine, Calif) for the treatment of spasm of the eyelids, uncontrolled eyelid movements and other eye muscle issues. Botulinum toxin is in fact the first toxin to be accepted for therapeutic uses. In 2002 it was FDA approved for severe frown lines and then FDA approved for crow’s feet in 2013. Since the first therapeutic use till today, the spectrum of its medicinal applications has widened.
Botulinum toxin may be used for a variety of disorders ranging from pain management to the treatment of tremors and tics, to the improvement of the appearance of dynamic facial wrinkles. Historically, the widespread use of botox for cosmetic reasons began in 1995. Since then many other uses have been discovered, including the treatment of excessive axillary sweating, uncontrolled eye twitching, Prophylaxis of headaches in adult patients with chronic migraines, carpal tunnel affecting the hand wrist joint,
incontinence (Overactive bladder associated with a neurologic condition, depression, trigeminal neuralgia and many other medical conditions.
In the past, its use in dentistry has been focused on relaxing overactive muscles around the jaw joint that cause chronic jaw pain. Its use however, was extended in dentistry for the treatment of conditions, such as abnormal clenching, myogenic temporomandibular disorder (TMJ Disorder), trismus (muscle spasm) and the associated headaches, as a new option for symptom relief in patients in whom conventional treatments are not effective.
Most people are surprised to learn their dentist administers botox because in the past only medical professionals where qualified to do so. However, dentists with some extra special training and their understanding of facial anatomy and proficiency with injections makes them ideal botox providers. Botox, when used to improve esthetics, falls into the category of “Facial Rejuvenation”, along with other procedures such as Dermabrasion and Dermal Fillers. When properly administered, it relaxes overactive muscles that cause wrinkles, creating a smoothed, improved, and more youthful appearance. Patients who are concerned about their dental health and their smile also care about the way they look. This allows dentists to target muscles around the mouth, face, and neck, changing not only the look of a smile but also of the rest of the face.
The horizons of botox treatment options in dentistry are broadening rapidly and are gaining momentum. It has been documented to be successful in a variety of conditions offering a transient, reversible, relatively safe treatment option to many conditions of interest to a dental practitioner. Dental surgeons with minor skill enhancement can actually widen the perspective of alternative, minimally invasive options to refractory conditions or invasive protocols.
Although several brands of muscle relaxant botox injections exist, they each contain the same active ingredient, Botulinum Toxin A. Out of all the preparations available in the market, Botox® has received maximum approvals worldwide and is the most commonly used. They contain sterile proteins that inhibit muscle contraction, reducing its strength. Accordingly, botox main use in dentistry is to the following procedures;
Jaw joint disorders, known as “Temporomandibular joint disorders (TMDs)” usually present with symptoms and signs such as face muscles pain, lower jaw movement pain, jaw deviation upon mouth opening and/or joint sounds such clicking or popping sounds. Botox which is a biologic toxin which inhibits skeletal muscle contractions is used for the treatment of the uncontrolled hyperactivity of certain facial masticatory muscles and TMD symptoms.
Your jaw joint acts as a hinge for your mouth, letting you eat and talk freely. When you have TMJ disorder, you may experience:
• Sore cheeks and jaw
• Teeth clenching or grinding
• Neck and shoulder pain
• Tension headaches
• And much more
Botox once used for TMJ disorders, is injected into the different muscles depending on your symptoms. The injections will cause the jaw muscles to have a limited function which brings pain relief and decrease TMJ symptoms. Typically when we do TMJ botox we’ll do some injections at the lower jaw bones at the masseter region, and as well as for upper corners of the head at the temporalis (or the temple), which for most patients are the biggest triggers of pain. We may also inject other areas depending on your symptoms. Botox inactivates the nerve endings that cause muscles to contract, eliminating involuntary contractions in the jaw. The constant workout of facial muscles in daily activity and sleep slowly remove the botox, and that’s why repetition of an injection may be needed in about 4-6 months later.
Botox works by weakening the large muscles that moves the jaw, mainly the muscle known as the masseter muscle. Botox relaxes the muscle significantly, which reduces or eliminates involuntary grinding and clenching, dental tooth structure damage and other mouth and out of the mouth pains. Botox injections can be further used at the temporal muscle which is a very large fan shaped muscle found within the area of the red circle in the image on the right. It is one of the four closing muscles of the jaw. Botox injections in the temporal area reduces or even eliminates the morning headaches and all in all improve sleeping quality, associated related neck and shoulder pain and overall one’s well-being.
Although some improvement can be felt within a day or two of treatment, it usually takes several days to feel relief. People who get Botox treatment for TMJ can expect to return to their regular activities as soon as they leave their our office
Botox for TMJ disorder may change the face shape – in a positive way, of course! When the jaw muscles are tensed and overworked as a consequence of teeth grinding for prolonged hours during sleeping, it may cause your face to look wider. Besides the above mentioned benefits of Botox use, it slims your face and restores youthfulness. Many would consider this a cosmetic bonus on top of therapeutic relief.
Heavy clinchers/grinders can sometimes have their lower face wider due to excessive muscle contractions that cause enlargement/hypertrophy of the masseter or jaw muscles. As with any muscle that enlarges with exercise, these muscles also get enlarged and since they are located in the face area, the face will also look enlarged at its lower angles. One may not be aware of this enlargement because it is a slowly developing process and/or even correlate it the grinding habit. Since Botox® and Dysport® work by weakening the muscle that it is injected into, the muscle will eventually become smaller by the mere fact that it is no longer in involuntary excessive use and contraction. The amount of Botox® or Dysport® used for the jaw sculpting procedure is usually significantly more than that used to smooth out wrinkles on the face. When Botox® or Dysport® is injected into the muscles, the grinding or clenching will cease within a week. However, the aesthetic/cosmetic effect of the jaw slimming injections usually takes approximately 3-4 weeks before one notices an obvious reduction in the width of the jaw and will continue to take effect in weeks 4-8. Not everyone is a good candidate for this procedure because they may not have prominent jaw muscles The “jaw slimming” effect lasts 4-5 months in which sometimes a repeat injection session in cases where grinding recurs will be required at that time in order to maintain the visual effect. Sometimes the use of a night mouth guard excludes the need for a Botox injection and also leads to jaw tapering effect, but on a longer period of use.
It is well understood that “Beauty lies in the Eyes of the Beholder”.
Gummy smile is not a medical problem as much as it is a personal issue of concern to some people, while it may not be of any concern to others. It appears on an individual when a person smiles and a large portion of the gums can be seen. An ideal smile will only have 2 millimeters of gum showing with the upper lip sitting just above the top teeth. Individuals that have 3-4 millimeters showing appear to have a
gummy smile . There are several causes of having a
gummy smile ;
• An overactive “hypermobile” upper lip- causes a
gummy smile when the lip moves too much.
• A short thin upper lip- A short upper lip will not cover the upper teeth and the gingiva.
• Vertical maxillary excess VME- This happens when there is an overgrowth of the upper jaw
• Wear of teeth and compensatory eruption
• An excessive overbite (anterior over-eruption)
• Altered passive eruption- This happens when the teeth do not make it fully out of the gums.
• Altered active eruption- This happens when the teeth do not make it fully out of the bone.
Muscle relaxants (Botox anti-wrinkle injections) are the simplest
gummy smile treatment option when the issue is related to overactive muscles surrounding the lips. When injected into the right area, they temporarily weaken the muscle, which lifts the lip too high, with the results lasting approximately 6 months. It is however proven, that once the procedure is performed at young ages and repeated few times, a neuromuscular adaption to the new lip position often happens eliminating the need for constant botox injection repetition.
You should think that botox use is the least invasive yet a short-term solution for a
gummy smile management. There are many
causes for a gummy smile and provided that the cause is an overactive upper lip muscle and/or an overextended upper jaw bones, botox use is very beneficial in such conditions and is in fact be the only non-surgical approach to the case management. Botox temporarily paralyzes the elevator muscles inside your upper lip to prevent those muscles from significantly lifting your upper lip to expose excessive amounts of gum tissue. Botox is not usually a permanent solution for a
gummy smile , but usually requires repeated injections over time. Botox is also a good way to get a sneak preview of the results of other surgical procedures such as
lip repositioning surgery.
Depending on the extent of the gums exposed, we will decide on the dosage of muscle relaxant required. The injections are then placed on both sides of the nose, to affect the muscles that move the lip. These muscles will be prevented from contracting as significantly, which causes the upper lip to relax and extend over the excess gum that shows when you smile.
Some patients may experience a slight sting during the injection, which is very mild and only lasts a couple of seconds. The skin may be red or bleed immediately afterwards, followed by a tingling or itching sensation for several minutes. Results will usually take several days to begin taking effect, with the full outcome taking up to 2 weeks to be completely evident. A review appointment is recommended at this stage to determine if another dose will be necessary to increase the effects.
What are the Risks of Muscle Relaxant Injections?
Muscle relaxant injections are a safe and effective treatment, but all medications do carry the potential to cause side effects, most in rare cases. We will discuss these with you after thoroughly assessing your health and medical history before treatment, which will minimize the risk of complications occurring by knowing it is safe for you to undergo this treatment.
• The most common problems occur from the injection itself as opposed to the product, which can include redness, bruising, swelling and possible skin infection.
• If not placed properly, the injection can affect a muscle in a location other than those it was supposed to, or may relax the muscle too much. This means potentially your smile and the way your mouth moves can be affected, which is why it is important to choose a dentist with plenty of experience providing this treatment.
• The muscles injected can be sore for a few days after the injections
• Botox can cause temporary partial weakening of the muscles injected
• When Botox is used for a long time, it may cause atrophy of the muscles injected. This is especially true in female patients taking medications for osteoporosis therapy. This atrophy is reversible if the therapy is discontinued.
• There have been reports of temporary side effects such as flu-like symptoms, palpitations, tingling sensations, or nausea. These side effects are rare and usually go away within 1-2 days.
• Extremely rare complications can include allergic reactions, flu-like symptoms or headaches.
• One of the biggest problems with Botox injections for TMJ is that it can interfere with the diagnosis process. While some dentists just listen for clicks and pops in your jaw to diagnose TMJ and immediately offer Botox as sole first line treatment, we tend to perform a comprehensive diagnostic approach to find out as many details of your problem as possible. In our comprehensive diagnosis process, we utilize a scientific approach that provides us with verifiable, objective data that will guide successful treatment.
If you’re out there suffering from TMJ pain or clenching and grinding, similar to many people, or complaining of a gummy smile, just know there are different things we can do to help you here at
Dr. Raed M. Abutteen Dental Center. One of the best parts about Botox is it’s very pain-free, very quick (whole process takes about 5 or so minutes), and you can really see real quick results. Chemo-denervation using botulinum toxin is useful in many of the conditions of dentistry. It should noted however, that the controlled use of this therapy is more important rather than its radical use as is happening in many clinics.
At Dr. Raed M. Abutten Dental Center, we stay at the cutting edge of technological and surgical developments to offer our patients the best possible recommendations, treatments, experience and outcomes. Visit us and note the difference.
