Re: Botox - an interesting post!

From: Alexander Vasserman DDS., BS. (purple543210_at_yahoo.ca)
Date: 06/09/04 

Date: 9 Jun 2004 10:32:02 -0700

"Joel M. Eichen, D.D.S."

Is there a contact phone number?
Or is it walk in?

 <joeleichen@yahoo.com> wrote in message news:<m1bcc09e38qk9o7foaf9ag5f22h1078jt2@4ax.com>...
> Here ya go .....
>
>
> QUOTE>>>
>
>
> i am sooo going to this:
>
>
> Subject: Botox for Dentistry Course
>
>
> BOTOX FOR DENTISTRY:
> THE NEW PARADIGM
> Saturday, July 10th, 2004
> Regent Beverly Wilshire
> 9500 Wilshire Blvd., Beverly Hills, CA 90212
>
> Most patients are unwilling to have comprehensive dental treatment for
> transient conditions like TMD.
>
> FACT: Patients are very willing to spend discretionary income on
> cosmetic products and procedures to improve their appearances.
>
> FACT: Loss of facial wrinkles is a side-effect of headache and
> dentofacial treatment with Botox.
>
> FACT: Dentists are in a unique position to sell treatments that
> patients desire.
>
> FACT: More than $750,000,000 was spent on Botox to treat wrinkles in
> the USA during 2003.
>
> FACT: Dentists deserve a piece of this!
>
> Find out why BOTOX is a very effective treatment for dento facial
> pain.
>
> Learn the most effective injection technique on LIVE PATIENTS.
>
> See how BOTOX can dramatically increase the profitability of your
> practice.
>
>
>
>
>
> Presented by
> Howard Katz, DDS
> is the creator of the patents for the use of Botox in dentistry. He's
> the Co-founder and President of Dentox, Inc., founder of The
> Dento-Facial Treatment Center of San Diego, and Co-founder of Novalar
> Pharmaceuticals.
>
>
> Andy Blumenfeld, MD
> is the Co-creator of the dental applications for Botox and Co-founder
> of Dentox, Inc. He has treated the most patients for peri-cranial pain
> in the world. Dr. Blumenfeld lectures nationally and internationally
> on the Advanced techniques using Botox for Cosmetics, Headaches and
> Dentofacial pain. He was Chief of Neurology at Kaiser Permanete, San
> Diego.
>
>
>
>
>
>
>
>
>
>
> Cover the cost of this course in less than 15 minutes treatment time!
> You cannot afford to miss this exciting, cutting edge program!
>
>
>
>
>
>
>
> www.detox.com
>
>
>
>
>
>
>
>
>
> Name:_________________________________________
>
>
> Address:________________________________________
>
>
> City:___________________State:_____Zip:__________
>
>
> Specialty:______________________________________
>
>
> Phone:_________________________________________
>
>
> Credit: ___Visa ___Mastercard ___American Express
>
>
> Card Number: __________________________________
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>
> Exp. Date:_____________Signature:________________
>
>
>
>
>
>
> Registration fee*:
> $975 Dentists & Physicians
> $495 Nurses & Assistant (Only available to nurses & assistants
> attending with a dentist/physician, or with a letter from the
> dentist/physcian)
> $495 Residents (Must have letter from Department Chair)
>
> *Register before June 17 and receive 10% discount on registration fee
>
> Cancellations: Refundable minus $175 handling fee
>
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>
> To register, fax completed form to 949-631-9800, mail to Marquis
> Conferences,
> 440 62nd Street, Newport Beach, CA 92663, or call 949-675-9300.
>
>
>
>
> --------------------------------------------------------------------------
>
>
>
>
> 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?
> >
> >
> >
> >
> >
> >
> >
> > <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
> >> Engl J Med. 1991;324:1186-1194.
> >>
> >> 4. Naumann M, Yakovleff A, Durif F, BOTOX CD Prospective Study
> >> Group. A randomized, double-masked, crossover comparison of the
> >> efficacy and safety of botulinum toxin type A produced from the
> >> original bulk toxin source and current bulk toxin source for the
> >> treatment of CD. J Neurol. 2002; 249:57-63.
> >>
> >> 5. Brashear A, Gordon MF, Elovic E, et al, for the Botox
> >> Post-Stroke Spasticity Study Group. Intramuscular injection of
> >> botulinum toxin for the treatment of wrist and finger spasticity after
> >> a stroke. N Engl J Med. 2002;347:395-400.
> >>
> >> Temporomandibular Disorders (pp. 40-49). Philadelphia: Saunders.
> >> (Israel, H. A., Diamond, B., Saed-Nejad, F., & Ratcliffe, A. (1999).
> >> The relationship between parafunctional masticatory activity and
> >> arthroscopically diagnosed temporomandibular joint pathology. Journal
> >> of Oral and Maxillofacial Surgery, 57 (9), 1034-9.
> >>
> >> 7. Goadsby PJ, Lipton RB, Ferrari MD. Migraine?current
> >> understanding and treatment.
> >> N Engl J Med. 2002; 346:257-270.
> >>
> >> 8, Aesthetic Botulinum A Toxin in the Mid and Lower Face and Neck
> >> .Jean Carruthers MD, Alastair Carruthers MD
> >>
> >> Glaros, A. G. Tabacchi, K. N., & Glass, E. G. (1998). Effect of
> >> parafunctional clenching on TMD pain. Journal of Orofacial Pain, 12,
> >> 145-152.
> >>
> >> and hearing loss Bubon, M. S. (1995). Documented instance of restored
> >> conductive hearing loss. Functional Orthodontist, 12, 26-9.
> >>
> >> 5. Freund B, Schwartz M, Symington JM: The use of botulinum
> >> toxin for the treatment of temporomandibular disorders: preliminary
> >> findings. J Oral Maxillofacial Surgery 1999 Aug; 57(8): 916-20;
> >> discussion 920-1
> >>
> >> 6. Freund B, Schwartz M, Symington JM: Botulinum toxin: new
> >> treatment for temporomandibular disorders. Br J Oral Maxillofacial
> >> Surgery 2000 Oct; 38(5): 466-471.
> >>
> >> 7. Christensen, G. J. (1999). Destruction of human teeth.
> >> Journal of the American Dental Association, 130, 1229-30.
> >>
> >> 8. Mcguire, M. K., & Nunn, M. E. (1996). Prognosis versus
> >> actual outcome: III. The effectiveness of clinical parameters in
> >> accurately predicting tooth survival. Journal of Periodontology, 67,
> >> 666-674.
> >>
> >> 9. Implants in the partially edentulous patient: restorative
> >> considerations. CDA Journal, 25, 867-871.
> >>
> >> 10. Perl, M. L. (1994). Parafunctional habits, night guards, and
> >> root form implants. Implant Dentistry, 3, 261-3.
> >>
> >> 11. Rangert, B., et al. (1995). Bending overload and implant
> >> fracture. A retrospective clinical analysis. International Journal of
> >> Oral Maxillofacial Implants, 10, 326-
> >>
> >> 12. Pertes, Richard A. & Attanasio. Ronald (1992). Internal
> >> Derangements. In Kaplan, A. S. and Assael, L. A.
> >> Temporomandibular Disorders. Philadelphia: Saunders, pp. 142-164.
> >>
> >> 14. Tongue Protrusion Dystonia: Treatment With Botulinum Toxin P.
> >> DAVID CHARLES, MD, THOMAS L. DAVIS, MD, KATHLEEN M. SHANNON, MD,
> >> MATTHEW A. HOOK, BS, and JOHN S. WARNER, MD, Nashville, Tenn.
> >>
> >> 15. Aesthetic Botulinum A Toxin in the Mid and Lower Face and
> >> Neck
> >> Jean Carruthers MD, Alastair Carruthers MD
> >>
> >> 16. Aesthetic Botulinum A Toxin in the Mid and Lower Face and Neck
> >> Jean Carruthers MD, Alastair Carruthers MD
> >>
> >> 17. Freund B, Schwartz M, Symington JM.
> >>
> >> J Oral Maxillofacial Surgery. 1999 Aug; 57(8):916-20; discussion
> >> 920-1.
> >>
> >>
> >>
> >> The use of botulinum toxin for the treatment of temporomandibular
> >> disorders: preliminary findings.
> >>
> >> 18. Mandel, L. & Tharakan, M. (1999). Treatment of unilateral
> >> masseteric hypertrophy with botulinum toxin: case report. Journal of
> >> Oral and Maxillofacial Surgery, 57, 1017-1019.
> >>
> >> 19. Freund B, Schwartz M, Symington JM: Botulinum toxin: new
> >> treatment for temporomandibular disorders. Br J Oral Maxillofacial
> >> Surgery 2000 Oct; 38(5): 466-471.
> >>
> >> 20. "dentistry" means the diagnosis or management of conditions
> >> of the mouth of a person, the performance of any invasive or
> >> irreversible procedure on the natural teeth or the parts of a person's
> >> body associated with their natural teeth or the provision to a patient
> >> or the insertion or intraoral adjustment of artificial teeth or dental
> >> appliances for a patient;
> >>
> >> 21. David Demko: Age trends create emphasis on Cosmetic Dentistry.
> >> Senior World, Age Venture News Service
> >>
> >>
> >>
> >> 22. H .Gobel et al. Botulinum Toxin A is effective in cases of
> >> oromandibular dysfunction even if previous bite splint therapy has
> >> proved unsuccessful. Cephalalgia 2001; 21(4):514-515 (1 Page).
> >>
> >>
> >>
> >> References
> >> 1. Lipton RB, Scher AI, Kolodner K, Liberman J, Steiner TJ,
> >> Stewart WF. Migraine in the United States: epidemiology and patterns
> >> of health care use. Neurology. 2002; 58:885-894.
> >>
> >> 2. Castillo J, Muñoz P, Guitera V, Pascual J. Epidemiology of
> >> chronic daily headache in the general population. Headache. 1999;
> >> 39:190-196.
> >>
> >> 3. Ferrari MD. The economic burden of migraine to society.
> >> Pharmacoeconomics. 1998; 13:
> >> 667-676.
> >>
> >> 4. Hu XH, Markson LE, Lipton RB, Stewart WF, Berger ML. Burden of
> >> migraine in the United States: disability and economic costs. Arch
> >> Intern Med. 1999;159:813-818.
> >>
> >> 5. Silberstein SD, Winner PK, Chmiel JJ. Migraine preventive
> >> medication reduces resource utilization. Headache. 2003; 43:171-178.
> >>
> >> 6. Silberstein SD, Goadsby PJ. Migraine: preventive treatment.
> >> Cephalalgia. 2002;22:491-512.
> >>
> >> 7. Goadsby PJ, Lipton RB, Ferrari MD. Migraine?current
> >> understanding and treatment.
> >> N Engl J Med. 2002; 346:257-270.
> >>
> >> 8. Gallagher RM, Kunkel R. Migraine medication attributes
> >> important for patient compliance: concerns about side effects may
> >> delay treatment. Headache. 2003; 43:36-43.
> >>
> >> 9. Dolly O. Synaptic transmission: inhibition of neurotransmitter
> >> release by botulinum toxins. Headache. 2003; 43(supp1):16-24.
> >>
> >> 10. Jankovic J, Brin MF. Therapeutic uses of botulinum toxin. N Engl
> >> J Med. 1991;324:1186-1194.
> >>
> >> 11. Naumann M, Yakovleff A, Durif F, BOTOX CD Prospective Study
> >> Group. A randomized, double-masked, crossover comparison of the
> >> efficacy and safety of botulinum toxin type A produced from the
> >> original bulk toxin source and current bulk toxin source for the
> >> treatment of CD. J Neurol. 2002; 249:57-63.
> >>
> >> 12. Brashear A, Gordon MF, Elovic E, et al, for the Botox Post-Stroke
> >> Spasticity Study Group. Intramuscular injection of botulinum toxin for
> >> the treatment of wrist and finger spasticity after a stroke. N Engl J
> >> Med. 2002;347:395-400.
> >>
> >> 13. BOTOX [prescribing information]. Irvine, California: Allergan,
> >> Inc.; 2002.
> >>
> >> 14. Binder WJ, Brin MF, Blitzer A, Schoenrock LD, Pogoda JM.
> >> Botulinum toxin type A (BOTOX) for treatment of migraine headaches: an
> >> open-label study. Otolaryngol Head Neck Surgery. 2000; 123:669-676.
> >>
> >> 15. 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.
> >>
> >> 16. Smuts J, Baker M, Smuts H, Stassen J, Rossouw E, Barnard P.
> >> Prophylactic treatment of chronic tension-type headache using
> >> botulinum toxin type A. Euro J Neurol. 1999;6(suppl 4):S99-S102.
> >>
> >> 17. Kokoska MS, Glaser D, Burch CM, Hollenbeak CH. Botulinum toxin
> >> injections for the treatment of frontal tension headache. J Headache
> >> Pain. 2004. In Press.
> >>
> >> 18. Schmitt WJ, Slowey E, Fravi N, Weber S, Burgunder JM. Effect of
> >> botulinum toxin A injections in the treatment of chronic tension-type
> >> headache: a double-blind, placebo-controlled trial. Headache. 2001;
> >> 41:658-664.
> >>
> >> 19. Brin M, Brashear A, Mordaunt J. Effect of botulinum toxin type A
> >> (BTX-A) therapy on pain frequency and intensity in patients with
> >> cranio-cervical dystonia. [Abstract] Cephalalgia. 2003; 23:743.
> >>
> >> 20. Pascual J. Influence of botulinum toxin treatment on previous
> >> primary headaches in patients with craniocervical dystonia. [Abstract]
> >> Cephalalgia. 2003; 23:705.
> >>
> >> 21. Galvez-Jimenez N, Lampuri C, Patino-Piccirilo R, Hargreave M.
> >> Dystonia and headaches: the response to botulinum toxin therapy.
> >> [Abstract] Cephalalgia. 2003; 23:760.
> >>
> >> 22. Blumenfeld A. Botulinum toxin type A as an effective prophylactic
> >> treatment in primary headache disorders. Headache. 2003; 43:853-860.
> >>
> >> 23. Troost BT. Botulinum toxin type A (BOTOX®) in the treatment of
> >> migraine and other headaches. Exp Rev Neurotherapeutics. 2004;
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> >>
> >> 24. Cui M, Khanijou S, Rubino J, Aoki KR. Subcutaneous administration
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> >>
> >> 25. Aoki KR. Evidence for antinociceptive activity of botulinum toxin
> >> type A in pain management. Headache. 2003; 43(suppl 1):9-15.
> >>
> >> 26. Ishikawa H, Mitsui Y, Yoshitomi T, et al. Presynaptic effects of
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> >> pigmented rabbit iris sphincter and dilator muscles. Jpn J Ophthalmol.
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> >>
> >> 27. Welch MJ, Purkiss JR, Foster KA. Sensitivity of embryonic rat
> >> dorsal root ganglia neurons to Clostridium botulinum neurotoxins.
> >> Toxicon. 2000; 38:245-258.
> >>
> >> 28. 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.
> >>
> >> 29. Blumenfeld AM, Binder W, Silberstein SD, Blitzer A. Procedures
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> >>
> >> 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.

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