Re: Botox - an interesting post!

From: Joel M. Eichen, D.D.S. (joeleichen_at_yahoo.com)
Date: 06/08/04 

Date: Tue, 08 Jun 2004 17:11:53 -0400

On 8 Jun 2004 11:25:46 -0700, purple543210@yahoo.ca (Alexander
Vasserman DDS., BS.) wrote:

>"Joel M. Eichen, D.D.S."
>
>Botox may be the answer for patients who have muscle splinting and
>parafunction resulting from nuerological origin.
>Very interesting.
>Are there any classes available on the use of botox with intramuscular
>injections?
>
>

YUP, let me see if I can get that for you ......

>
>
>
>
>
> <joeleichen@yahoo.com> wrote in message news:<iof8c0tucto2nkq0rlqt4vv5tav15ec6tp@4ax.com>...
>> This message is not flagged. [ Flag Message - Mark as Unread ]
>>
>> From: webmaster@dentaltown.com Add to Address Book
>> To: joeleichen@yahoo.com
>> Subject: RE: Has anyone taken this course - Botox for Dentistry
>> Date: Sun, 6 Jun 2004 17:55:02 -0700
>>
>>
>> On June 6, 2004 at 5:54:59 PM 'howard' posted....
>>
>>
>> Howard,
>>
>> I am unable to send this article to your site (your site will not
>> accept it). Please can you post it with my permission?
>>
>> Regards
>>
>> Howard Katz DDS
>>
>>
>>
>>
>> CAN BOTULINUM TOXIN A (BOTOX) SAVE YOUR TEETH AND ENHANCE YOUR SMILE?
>>
>>
>>
>> By Howard Katz DDS
>>
>>
>>
>> Modern dentistry has trained the general public to demand and accept
>> innovative treatments from their neighborhood dentist. There was a
>> time when you had a toothache you would go to a dentist to pull your
>> tooth out - that is all they were trained to do. Dentists have not
>> always performed the specialized, sophisticated treatments that they
>> do today like restore and replace teeth with implants, root canal
>> treatments, crowns and cosmetic dentistry, straightening teeth with
>> invisible braces. As successful treatments became more predictable
>> and acceptable more and more general dentists performed them.
>>
>>
>>
>>
>>
>> Dental disease is caused by two predominate causes. Treatments have
>> been designed to combat the effects of these:
>>
>> A) micro-organisms that destroy
>> dental hard tissue and provoke the immune system to destroy gums and
>> bone
>>
>> B) Excessive muscle forces that
>> predispose to wear and breakdown of the teeth, gums, bone and the
>> tissues of the TMJ.1 In this article the methods of using Botulinum
>> Neurotoxin A as an adjunctive treatment used to control muscle
>> function that cause and contribute to disease are discussed.
>>
>>
>>
>> The damage caused by excessive biting forces and dental trauma is
>> being treated with intra- oral appliances, occlusal adjustments,
>> sophisticated dental restorations and/or surgery. These are all
>> excellent treatment options but they are not for every patient. While
>> occlusion used to be regarded as the main cause of disease affecting
>> the masticatory system, muscular and psychological factors are as
>> important. Precise differentiation of the individual causal
>> etiological factors is generally not possible. The term Temporo
>> Mandibular Dysfunction is used to cover every disease affecting the
>> normal masticatory function. Unfortunately there is no common
>> treatment for every cause of TMD because it encompasses too many
>> different disease entities. These separate diseases have to be
>> isolated and then treated.
>>
>> The dental profession has always prided itself in that the focus of
>> oral healthcare has been based on prevention. The focus of treatment
>> should be in the prevention and reduction of these destructive habits
>> Extra-capsular TMD is often transient and the least invasive treatment
>> options are usually best used to begin treatment. Orthognathic
>> surgery, orthodontics and a neuromuscular rehabilitation of the
>> occlusion are invasive, irreversible and expensive for the majority of
>> patients. There is no guarantee to the patient that these major
>> treatments will be effective. Sophisticated restorations are not only
>> very technique sensitive; they involve the removal of additional
>> healthy tooth material. The most esthetic, conservative restorations
>> may not withstand the forces applied to them. There is also a
>> reluctance to have perfectly healthy teeth prepared for ceramic or
>> gold restorations when the teeth are esthetically pleasing and
>> asymptomatic.
>>
>>
>>
>> Intra-oral splints can be very effective in preventing excessive wear
>> and enabling the jaw to function in the most relaxed posture. Yet
>> there is a very low compliance with intra-oral splints and other
>> protective removable appliances worn over the teeth even when they are
>> effective. Patients do not like to have appliances in their mouths
>> impeding normal function like eating and speaking. Less than one in
>> five patients will wear a prescribed appliance as prescribed by their
>> treating dentist.
>>
>> Many dentists have bleach trays and comfortable intra-oral devices for
>> their own mouths that they do not use as often as they should. Why
>> should our patients be any different?
>>
>>
>>
>> The continued use of analgesics, narcotics, steroids and
>> anti-inflammatories for associated dento-facial symptoms is not ideal,
>> nor conducive to health. There are many unwarranted side-effects.
>> Certain patients like airline pilots, air-traffic control personnel,
>> surgeons, military personnel and anyone else operating heavy machine
>> equipment should not be taking narcotics. Yet patients will opt for
>> this despite the inherent risks and danger because of their ease of
>> use.
>>
>>
>>
>>
>>
>>
>>
>> An extremely effective way to prevent damage and to enhance treatment
>> to dental hard tissue and restorations would be to de-program the
>> muscles responsible for excessive destructive forces and other
>> gnathalogically related diseases.
>>
>>
>> THE NEW PARADIGM:
>> There is clearly a pronounced need to improve the options available
>> for preventive treatment of muscle generated dental disease, which
>> requires effective, safe agents that have minimal side effects, are
>> well-tolerated for long-term use, and that eliminate or reduce the
>> need to use other irreversible treatments or medications.
>> Intramuscular injections of Botulinum toxin type A (BTX-A) have been
>> increasingly used throughout the US as a novel approach to preventive
>> treatment that may provide effective, safe, and well-tolerated
>> long-term relief of intractable symptoms in patients who have failed
>> conventional approaches to treatment. The public does not yet
>> associate Botulinum neurotoxin A with their dentist but they very soon
>> and enthusiastically will. Dentists are skilled in the anatomy of the
>> lower facial anatomy and chewing apparatus. They are also prolific
>> injectors. Dentists have the advanced training in recognizing and
>> treating force related dental problems. This reduces the risk of
>> side-effects associated with unskilled injectors and injection
>> technique.
>>
>>
>>
>>
>>
>> Background
>> Botulinum neurotoxins
>> There are seven botulinum neurotoxin serotypes (A, B, C, D, E, F, and
>> G), produced by Clostridium botulinum, all of which inhibit
>> acetylcholine release, though their intracellular target proteins, the
>> characteristics of their actions, and their potencies vary
>> substantially.2 At the neuromuscular junction, the inhibition of
>> acetylcholine release by BTX-A blocks or reduces contraction of
>> muscles, an effect which has been used therapeutically in disorders
>> characterized by overactive muscle activity such as cervical dystonia
>> (CD), blepharospasm,3,4 and spasticity.5
>>
>>
>>
>>
>>
>>
>>
>>
>>
>> Botulinum toxin A (Botox) is the muscle relaxant that has been
>> popularized in the elimination of facial lines.6
>> Botulinum toxin type A (BOTOX®; Allergan, Inc.; Irvine, CA) is
>> currently approved for the treatment of blepharospasm, strabismus, and
>> CD.7 Binder and colleagues, treating patients for facial lines, noted
>> improvement of migraine symptoms after BTX-A injections.8 This
>> discovery led to further investigation in clinical trials of BTX-A
>> preventive treatment of migraine and other dento-facial diseases
>> including TMD.
>>
>> Btx A has been proven to successfully eliminate or reduce excessive
>> clenching by de-sensitizing spindle cells within tense muscles, the
>> main cause of force related dental disease, when injected into the
>> chewing muscles. Parafunctional clenching to the extent that it
>> affects oral function causes damage to oral tissues is usually
>> transient. For this reason aggressive irreversible treatments should
>> be avoided. Particularly where compliance is a problem, Botulinum
>> toxin A (Botox) offers this option.
>>
>>
>>
>> Preventative control of biting parafunctions and excessive forces on
>> the chewing apparatus will be the most significant paradigm in dental
>> treatment since local anesthetic and the dental drill. Dentists will
>> have the ability to reduce the need for major aggressive treatments
>> that involve surgery or drilling many teeth. "Surgical procedures that
>> alter anatomic relationships without addressing factors contributing
>> to pathogenesis may be more prone to failure and recurrence of [TMD]
>> symptoms. It is clear that excessive loading on articular tissues is
>> one of the causative factors that must be identified and addressed by
>> all clinicians treating patients with TMJ pathology? 2
>>
>> The public does not yet associate Botulinum neurotoxin A with their
>> dentist but they very soon and enthusiastically will. Dentists are
>> skilled in the anatomy of the lower facial anatomy and chewing
>> apparatus. They are also prolific injectors. Dentists have the
>> advanced training in recognizing and treating force related dental
>> problems. They are also very familiar with facial anatomy. It will be
>> possible to teach dentists fairly easily how to treat their patients
>> with BTX A and how to avoid the major side-effects. These are caused
>> predominately by incorrect injection technique. This reduces the risk
>> of side-effects associated with unskilled injectors.
>>
>>
>>
>> ADMINISTERING BTX-A FOR PREVENTIVE DENTALLY RELATED CONDITIONS
>> Patient selection:BTX-A therapy is appropriate for patients for whom
>> other preventive treatments and medications are poorly tolerated or
>> contraindicated, for those refractory to other treatments, for those
>> in special patient populations, as well as for those who simply prefer
>> this treatment. Contraindications to the use of BTX-A include
>> sensitivity to toxin or neuromuscular disorders such as myasthenia
>> gravis or Eaton-Lambert syndrome.
>>
>> Pretreatment Procedures
>> Informed consent
>> Once an appropriate patient is selected for BTX-A treatment, the
>> dentist should set reasonable treatment goals. Patients should first
>> be told that the use of BTX-A as preventive treatment is off-label
>> use; that while there is clinical evidence to support its use as a
>> preventive agent, investigation is ongoing. Patients should also be
>> told that the optimal effects of BTX-A treatment may not be
>> experienced for at least 1 week and will begin to wear off after
>> approximately 3 months, and that multiple treatment cycles may be
>> needed to achieve an optimal therapeutic effect.22, 23 Galvez-Jimenez
>> N, Lampuri C, Patino-Piccirilo R, Hargreave M. Dystonia and headaches:
>> the response to botulinum toxin therapy. [Abstract] Cephalalgia. 2003;
>> 23:760.
>>
>> Blumenfeld A. Botulinum toxin type A as an effective prophylactic
>> treatment in primary headache disorders. Headache. 2003; 43:853-860.
>>
>> The known side effects of BTX-A treatment should also be made clear;
>> these include possible injection-site pain, headache, rash, bruising,
>> or ptosis. Informed consent should be obtained.
>> Identifying injection sites: Once treatment is ready to commence,
>> patients should indicate the anatomical locations of the head most
>> frequently affected by pain or muscles tender to touch. The treating
>> dentist should be able to identify the anatomical areas of tenderness
>> and sites that produce pain on palpation (including the frontalis,
>> temporalis, masseter, pterygoids, posterolateral neck and shoulder
>> regions) and examine the face and neck to assess symmetry.
>> Preparation of BTX for Injection
>> One neurotoxin type A (BOTOX®) and one type B (MYOBLOC®; Elan
>> Pharmaceuticals) are available in the United States. The majority of
>> the evidence has been based on using the type A toxin. Lyophilized
>> BTX-A, available in vials containing 100 U, should be diluted with 2
>> or 4 mL of preservative-free 0.9% saline, which yields a preparation
>> of 5.0 or 2.5 U per 0.1 mL, respectively. BTX Injection Sites
>> The injection sites commonly used for BTX-A treatment of dental
>> related conditions are the glabellar and frontal regions, the
>> temporalis muscle, the masseter, the depressor anguli oris, the
>> pterygoid muscles, and the cervical paraspinal region. Blumenfeld AM,
>> Binder W, Silberstein SD, Blitzer A. Procedures for administering
>> botulinum toxin type A for migraine and tension-type headache.
>> Headache. 2003; 43:884-891 Patients should be placed in a sitting or
>> supine position for injection of the frontal and temporal regions, and
>> a sitting position for injection of the posterior neck region and
>> trapezius. It appears most of the adverse events associated with BTX-A
>> injections are related to the technique and skill of the injector.
>> Correct injection technique helps minimize adverse events and optimize
>> treatment outcomes. The precise anatomical location, optimal choice of
>> injection site within a particular muscle, dosages, and volumes used
>> should all be considered carefully. Bilateral injections are advisable
>> in the case of unilateral headache or TMD pain as unilateral injection
>> can lead to the development of symptoms on the other side of the face.
>>
>> Safety and Tolerability of BTX-A
>> BTX-A has an excellent safety and tolerability profile. There are
>> generally no systemic effects from treatment. The reported effects,
>> which are usually minimal and transient, include blepharoptosis
>> (droopy upper eyelid) and muscle weakness at injection sites.16 Evers
>> S, Rahmann A, Vollmer-Haase J, Husstedt I-W. Treatment of headache
>> with botulinum toxin A - a review according to evidence-based medicine
>> criteria. Cephalalgia. 2002; 22(9):699-710.
>>
>> 22,31 Silberstein S, Mathew N, Saper J, Jenkins S, for the BOTOX
>> Migraine Clinical Research Group. Botulinum toxin type A as a migraine
>> preventive treatment. Headache. 2000; 40:445-450.
>>
>> Proper injection techniques can minimize adverse effects such as
>> ptosis.29 Durham PL, Dacy R, Cady R. Regulation of calcitonin
>> gene-related peptide secretion from trigeminal nerve cells by
>> botulinum toxin type A: implications for migraine therapy. Headache.
>> 2004;44:35-43.
>>
>>
>>
>> Post injection Procedures
>> Instructions to patients
>> Patients should be informed that wheals or blebs at the injection
>> sites will disappear within approximately 2 hours. They should not
>> massage these wheals especially in the forehead as this may cause
>> ptosis. BTX-A?induced relief of headache and TMD symptoms may take
>> several weeks to reach its maximal benefit and the response to
>> injection may change over time. Patients should be informed that they
>> may achieve a greater therapeutic effect with repeated treatments.
>> Blumenfeld A. Botulinum toxin type A as an effective prophylactic
>> treatment in primary headache disorders. Headache. 2003;
>> 43:853-860.Troost BT. Botulinum toxin type A (BOTOX®) in the treatment
>> of migraine and other headaches. Exp Rev Neurotherapeutics. 2004;
>> 4:27-31.
>>
>> The effects of BTX-A injections wear off typically by 3 to 4 months
>> and repeat injections will be necessary.
>>
>> Approaching insurers
>> BTX-A use for dental disease treatment is off-label. Discussion should
>> take place with insurers regarding reimbursement. An example of the
>> types of patients typically deemed appropriate for BTX-A preventive
>> treatment by insurers is given in the list below. To build a case that
>> a specific patient is suitable for BTX-A preventive treatment, a
>> letter explaining the need of specific patient to receive BTX-A
>> together with published clinical data will need to be sent to the
>> insurer.
>>
>>
>>
>> Patients Typically Deemed Appropriate by Insurers for BTX-A Preventive
>> Treatment of Headache
>>
>> Intractable migraine headaches and /or TMD at least twice a month
>> Chronic daily headaches of 15 headache days per month
>> Headache causing disability lasting three or more days
>> 3 or more failed trials of at least 3 preventive pharmacological
>> therapies and other dental treatments with or without concomitant
>> behavioral and physical therapies
>> Abortive medications are required more than twice a week.
>> Abortive medications and treatment are contraindicated due to
>> coexisting medical conditions
>> The occupation or physical health of the patient contra-indicates
>> conventional treatment
>>
>>
>>
>>
>> POTENTIAL DENTAL USES
>> The following are dental conditions that may be successfully treated
>> using Botulinum toxin A (Botox): Teeth, gum, cartilage and bone do
>> not regenerate, and, a full complement of teeth is essential for
>> overall health. Damage to these tissues can be prevented and the
>> success of reparative dental therapies can be predictably enhanced
>> using Botulinum toxin A (Botox)
>>
>>
>>
>>
>>
>>
>>
>> Patients suffer from facial pain 4 caused by muscle spasm when the
>> relaxed posture of the mandible does not match the occlusion. This is
>> one of the many causes of Tempero Mandibular Disorder TMD. This pain
>> is exacerbated with parafunctional clenching (when the patient forces
>> their teeth for long periods of time for no apparent reason.) When
>> Botulinum toxin A (Botox) is injected into the muscles of mastication
>> and forehead, this clenching reflex (theoretically initiated by
>> sympathetically innervated spindle cells) is often eliminated.5, 6
>> This allows the muscles to relax appropriately and the pain dissipates
>> as the freeway space re-appears. The forces created by excessive
>> grinding and clenching of the teeth without food in the mouth are many
>> times greater those the forces required to masticate food. These
>> excessive forces damage the teeth, bone, joints and gums 7 Because a
>> very small percentage of available force is required to masticate
>> food, muscle function is not weakened sufficiently to have any effect
>> on chewing and swallowing.
>>
>>
>>
>> Tooth decay is more prevalent in clenchers because excessive forces
>> cause micro-fractures and abfracturing of enamel especially around
>> existing restorations. This may be followed by accelerated decay and
>> gingival recession.8
>>
>> Botulinum toxin A (Botox) can be used to reduce these very common
>> dental conditions especially with patients who brux or clench
>> excessively while not being able to maintain ideal dental hygiene.
>>
>>
>>
>>
>>
>>
>>
>> Excessive parafunctional forces created by clenching the jaws impede
>> healing and re-attachment of gum and bone in the mouth following
>> trauma. Low doses of Botulinum toxin will limit the parafunctional
>> clenching. Reduction in clenching intensity will allow traumatized
>> tissue to heal.
>>
>>
>>
>> Higher doses can be used as a ?pharmaceutical splint? limiting muscle
>> contraction before resetting and during rehabilitation after fracture
>> of the facial bones e.g. when the condyle of the mandible is broken.
>>
>>
>>
>> Parafunctional clenching contributes to periodontal trauma. Limiting
>> the clenching before and after periodontal surgery will benefit
>> healing. The use of a splint is often contra-indicated when the teeth
>> should be functional during healing. However with significant bone
>> loss excessive forces may jeopardize dental stability and contribute
>> to additional tooth loosening. The use of Botulinum toxin may be used
>> to control these potential destructive forces. The same applies in the
>> patient with bone loss associated with either advanced periodontal
>> disease or osteoporosis, and a strong bite. Bite force is not
>> diminished with reduced alveolar bone support.
>>
>>
>>
>> Implant patients will benefit from pre-surgical Botulinum toxin A
>> (Botox). After multiple implants or immediate loaded implants are
>> placed osseo-integration can be prevented or impeded by excessive
>> functional and parafunctional forces. Overloading the implants results
>> in implant failure by loosening of the implant components or
>> prevention of osseo-integration. Nishimura, R. D., Beumer, J, 3rd,
>> Perri, G. R., Davodi, A. (1997) 9, 10, 11
>>
>>
>>
>>
>>
>> Occlusal rehabilitation patients will benefit from Botulinum toxin A
>> (Botox). Botulinum toxin A can be used to verify that the correct
>> diagnosis has been made. This will also convince patients that their
>> toothache is muscular and not pulpal in origin. This should be done
>> before rushing into a major irreversible treatment "At best, we are
>> only managing signs and symptoms to the best of our ability within the
>> framework of the patient's ability to cope with the disorder? 12 The
>> best thing we can do for our clenching patients, then, is to help them
>> control parafunctional habits and thereby minimize the chances of
>> temporomandibular and dental complications.
>>
>>
>>
>> Long-term temporization or a functional oral orthotic is used before
>> occlusal reconstruction to ensure that the treating dentist has
>> positioned the mandible comfortably reset the occlusion correctly and
>> that vertical dimension is maintained. Often the ideal position varies
>> vastly from the desired position in all three dimensions. These
>> prostheses will be better tolerated and the patient will be more
>> compliant with the use of Botulinum toxin A (Botox).
>>
>>
>>
>> Orthodontic treatments on patients that are clenchers, have a deep
>> bite or crossed bite are prolonged if the vertical component of
>> muscular force is greater than the force of the fixed or removable
>> appliance. 13These cases often require the use of removable functional
>> retainers in combination with regular fixed braces in an attempt to
>> control the component of vertical force. Orthodontic treatment time
>> will be reduced and the patients will be far more comfortable and
>> functional (eating, speaking, swallowing) with the use of Botulinum
>> toxin A (Botox) especially if clenching is reduced.
>>
>>
>>
>> An overactive genioglossus muscles protrudes the tongue between the
>> teeth while swallowing, referred to as a tongue thrust. The force of
>> the tongue prevents the front teeth from erupting into occlusion or
>> separates the teeth so that they don?t meet when the jaw closes. Low
>> doses of Botulinum toxin A (Botox) into these muscles will prevent a
>> tongue thrust and allow the teeth to erupt into occlusion. 14
>>
>>
>>
>>
>>
>> Gummy smiles may be caused by over-contraction of the upper lip
>> muscles, obicularis oris and levator anguli oris. This cannot always
>> be corrected with osseous and gingival re-contouring. The upper lip
>> muscles can be proportionately weakened with Botulinum toxin A (Botox)
>> so as not to expose the upper gums when smiling. 15
>>
>>
>>
>> Overactive depressor anguli oris muscles tend to give individuals a
>> sad or annoyed _expression weakening these muscles allows these
>> individuals to appear to have a happier disposition.
>>
>>
>>
>> The depressor muscles of the lips together with an over closed
>> vertical dimension of the bite pulls the outer corners of the mouth
>> downwards and creates a deep skin fold or crease. Patients with
>> vitamin deficiencies and those that drool into these creases develop
>> angular cheilitis. Botulinum toxin A (Botox) can be used to weaken the
>> depressor muscles allowing the deep skin fold to disappear. The
>> elimination of this skin fold prevents saliva pooling and allows the
>> saliva to rapidly evaporate. This allows the skin to dry eliminating
>> the angular cheilitis caused by the prolonged moisture.
>>
>>
>>
>>
>>
>> The jaw closing muscles are much stronger than the jaw opening
>> muscles. When the closing muscles remain semi-contracted or in spasm,
>> mouth opening is limited.17
>>
>>
>>
>> This limits:
>>
>> Oral hygiene: neither the patient, dentist or hygienist is able to
>> perform necessary hygiene to prevent oral disease
>>
>> Dental treatment: necessary dental treatment including x-rays cannot
>> be done
>>
>> Eating: the teeth cannot be separated sufficiently to bite an apple or
>> a sandwich
>>
>> Kissing: passionate kissing is associated with a wide open mouth.
>>
>> Shouting out loud: is difficult with limited opening
>>
>> The mouth can usually open much wider when Botulinum toxin A (Botox)
>> is given into jaw closing muscles.
>>
>>
>>
>>
>>
>>
>>
>> Patients who are chronic jaw clenchers present with masticatory muscle
>> hypertrophy. Overworked masseters tend to overdevelop causing the
>> cheeks to swell out. When Botulinum toxin A (Botox) is given into
>> these muscles, clenching is reduced and the enlarged masseters shrink.
>> 18
>>
>>
>>
>>
>>
>> Habitual clenchers are more prone to snoring and sleep apnea. When
>> Botulinum toxin A (Botox) is given into the masticatory muscles that
>> hold the jaw in a retruded position it enables the patients jaw to
>> move forward slightly during sleep. This will open the airway
>> sufficiently to reduce snoring.
>>
>>
>>
>> There are probably many other indications that will develop over time.
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>> THE MARKET POTENTIAL FOR THE DENTAL OFFICE
>>
>>
>>
>> The use of Botulinum toxin A (Botox) in the dental office offers a
>> reversible alternative to the more aggressive procedures like full
>> mouth reconstruction, orthodontics and orthognathic surgery. It also
>> may offer an alternative to wearing an oral splint.22
>>
>>
>>
>> Regular bi-annual visits had already fostered a trust between patients
>> and their dentist. With this trust relationship already in place,
>> patients will accept Botulinum toxin A (Botox) as they do accept their
>> bonding, braces and bleaching in the dental office. Many conditions
>> that contribute to TMD are successfully treated with Botulinum toxin A
>> (Botox) injections into the muscles of the forehead and masticatory
>> muscles.19 Dentists will be able to inject their patients with limited
>> additional training compared to their medical colleagues. Their
>> treatment time with the patient will be very productive because the
>> injections take a matter of minutes to perform. Dentists who elect to
>> use Botulinum toxin can schedule many patients requiring this form of
>> treatment on the same day. This eliminates wasting any expensive
>> unused Botulinum toxin A (Botox).
>>
>>
>>
>> The Dental Boards of the majority of states will allow the use of
>> Botulinum toxin A (Botox) provided its usage (treatment of a dentally
>> related disease or condition) is covered by the their Dental Practice
>> Act. 20
>>
>>
>>
>> When the dentist feels confident in the administration of Botulinum
>> toxin A (Botox) then the use of Botulinum toxin A (Botox) in the
>> dental office will surpass all other medical and cosmetic offices.
>> 220 million Americans are already visiting their dental office
>> annually. We are living in the Age of Anxiety where 70% of the entire
>> population suffers from stress and grind their teeth, 75 % of the
>> entire population suffers from gum disease, 55% of the population
>> snores, 65% of the population requires braces, 15% of the population
>> require implants, the entire population wants their teeth to last a
>> lifetime and look younger.
>>
>>
>>
>> As we enter the 21st century, the care of a rapidly aging population
>> may be the greatest challenge the dental profession will face in the
>> coming years, says the American Dental Association. More than 50,000
>> Americans per day are reaching the age of 50 years. By 2020, the
>> segment of the U.S. population aged 65 to 74 years is expected to grow
>> 74 percent. The aging baby-boomers want to be functional, look good
>> and feel good.21 Many of these dental patients are already having
>> Botox cosmetic treatments elsewhere. It is important to space Botox
>> treatments at least 4 months apart for it to work effectively.
>> Headache, TMD, dental and cosmetic treatments involve injecting into
>> similar areas and therefore should be done for multiple benefits at
>> the same visit.
>>
>> As a result the ability to make patients look younger will have
>> tremendous implications for the future of oral care. The dental
>> professional?s traditional role once centered around the eradication
>> of disease ... now finds itself on the threshold of enhancement of
>> appearance. This includes cavity reduction, educating the public about
>> the importance of good oral hygiene and the strides made toward
>> reducing the number of teeth lost to gum disease. In the mid 1990?s
>> dentistry changed from a needs based profession to a desired based
>> profession. Society realized that the youthful appearance of straight
>> white unworn teeth could be acquired only at their dental office. Most
>> dentists already consider themselves smile estheticians.
>>
>> Society places an increasing priority on a healthy and attractive
>> smile, and as a result, the value of one's teeth has taken on a
>> greater importance. Advances in the area of cosmetic dentistry now
>> offer the dental profession new opportunities in restorative
>> procedures that have the potential to reverse the signs of dental
>> aging, thereby making patients look younger. The removal of healthy
>> enamel to place veneers is more invasive, problematic, irreversible
>> and technique sensitive then the use of BTX A will ever be.
>>
>> .
>>
>>
>>
>> As the teeth are worn down or extracted the lower half of the face
>> collapses because there is no framework of teeth and bone to support
>> muscle and skin, the face looks tired, haggard and older. The cosmetic
>> surgeon can tighten the facial muscles and skin over a smaller face.
>> Only the dentist has the ability to repair and replace the worn down
>> and missing teeth so that the face retains its correct and true
>> proportion.21
>>
>>
>>
>>
>> The use of Botulinum toxin A (Botox) combined with a multitude of
>> health and cosmetically beneficial therapies will place the dentist in
>> a unique position to provide comprehensive functional and cosmetic
>> maintenance.
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>> References:
>>
>> Castaneda, R. (1992). Occlusion. In A. S. Kaplan & L. A. Assael (Eds).
>> 2. Dolly O. Synaptic transmission: inhibition of neurotransmitter
>> release by botulinum toxins. Headache. 2003; 43(supp1):16-24.
>>
>> 3. Jankovic J, Brin MF. Therapeutic uses of botulinum toxin. N
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