What is Botox?
Botox is a protein that is extracted from Botulinum toxin (BoNT) which is produced by a specific kind of bacterium called Clostridium Botulinum. The protein works at the neuromuscular junction, where the nerve endings meet the muscle cells. Here, this neurotoxin prevents the nerve from causing muscle contraction, overuse and spasm of the muscle it was injected in. This in turn leads to a temporary reduction in muscle activity.
The medical history of Botulinum Toxin A (BoNTA) began over 120 years ago when the toxin was first identified. There are several types of botulinum toxin types A and B that are used in medicine and dentistry to treat various conditions. The name Botox is a registered trademark and name for one of four commercially available botulinum toxin type A preparations: Botox® (onabotulinumtoxinA), Dysport® (abobotulinumtoxinA), Xeomin® (incobotulinumtoxinA), and Jeuveau® (prabotulinumtoxinA).
What are the Benefits of using Botox in Dentistry?
In the past, Botox was considered a cosmetic treatment for fine lines, wrinkles and crow’s feet. Recently, the muscle-relaxing properties of Botox have proven beneficial and therapeutic for treatment of TMJ pain and discomfort, bruxism (clenching and grinding), chronic migraine and headaches, jaw recontouring, gummy smile correction, denture wear in edentulous patients and many more dental conditions. Below are the most common cosmetic and therapeutic Botox dental treatments performed at our dental practice.
Therapeutic Dental Botox Treatments
Just as Botox treatment temporarily relaxes muscles to minimize fine lines and wrinkles, the injections can relax the masticatory muscles of the jaw that are responsible for clenching and grinding.
Clenching and grinding are considered a parafunctional oral activity, meaning it is unrelated to normal oral functions such as chewing, swallowing and talking. This activity includes hyperfunction of the muscles of mastication, especially the masseter muscle and can lead to worn or loose teeth, broken teeth or restorations, delaminated veneers and crowns, hypersensitive teeth, tenderness or pain in the muscles, headaches, etc. Botox injections in the masticatory muscles can help tone down the muscle hyper activity and can be a great addition to patients already wearing a night guard appliance.
In many patients with a TMJ disorder the discomfort experienced comes from hyperactivity of the muscles of mastication that are responsible of chewing and moving the lower jaw. Injectables, such as Botox can help reduce TMJ symptoms and facial pain, by reducing the force of contraction of these muscles.
Any muscle in the body that is overused will hypertrophy, and increase in mass and size to meet its new demand. Patients with hypertrophic masseter muscle, which lies on the side of your jawline, bilaterally, will have a square looking jaw, and the masseter will feel rock hard when you bite down on your back teeth. Using Botox to treat the hyperactive muscle will slenderize the jaw line and soften the face contour, giving the face a more heart shaped, feminine and symmetrical look.
Botox has been successfully used for treating hyperactive and hypermobile upper lip that reveals excessive gum display during smiling. When injected, Botox will relax the muscles of the upper lip and reduce lip mobility to reveal a more pleasing smile. Botox provides minimally invasive and fast acting solution for symptoms that might otherwise require extensive treatment or even surgery.
How does Botox help with dentures?
Patients who have been edentulous for a while may find it difficult to wear dentures due to repositioned and hyperactive muscles in the oral region. Botox injections can help with the muscle tone and retraining of the muscles to enable easier and more successful transition to a denture.
Cosmetic Botox in the Dentist Office
Perhaps, none of these medical conditions apply to you, but you are interested in turning the clock back for few years. Botox is a simple, safe and only FDA approved secret weapon to looking and feeling younger.
Facial muscles are muscles that control facial expression. They are also known as the mimetic muscles. They generally originate from the surface of the skull bone and are the only muscles in the body that insert (attach) on the skin of the face. When they contract, the skin moves and the face emotes. As we age, these muscles will cause the skin to wrinkle at right angles to the muscles’ action line.
In cosmetic applications, botulinum toxin is used for the reduction and softening of these facial wrinkles. It is the only neurotoxin that is FDA approved to temporarily improve appearance of moderate to severe forehead lines, frown lines, and crow’s feet in adults. In addition, Botox is also used to treat bunny lines, radial lip lines, brow lift, peach pit chin, lifting the sagging mouth corners etc.
What is the right age to start cosmetic Botox treatments?
Botulinum Toxin A injectables work best on dynamic wrinkles that occur in younger adults, before the wrinkle sets into the skin. Dynamic wrinkles occur when you make facial expressions and they are ‘quiet’ when the face is not mimicking. With age and over time, these dynamic lines etch into the skin, and turn into a static wrinkle that is visible even when the face is at rest. Botox treatment weakens the muscle contraction which then lessens the overlying dynamic wrinkle.
For patients who do not have static creases in the skin yet (usually late 20s and 30s, sometimes early 40s), Botox can be considered an early and effective treatment to not only eliminate the dynamic lines but also to prevent static lines from developing as well.
For patients who already have wrinkles at rest, usually after your 40s or 50s, Botox can be an excellent way to soften those creases in the skin and prevent them from deepening further. Sometimes repeated Botox applications or secondary treatment options are going to be needed to completely remove deeply set static wrinkles.
Are Dentists Qualified to Give Botox?
Absolutely! General dentists are equally, if not more so, skilled as practitioners to administer Botox injections today.
Dentists go through advanced facial anatomy training, and they have extensive knowledge of facial, oral, masticatory (chewing) muscles and other facial structures which allows them to deliver Botox safely. They also use needles daily and know how to make injections as painless as possible.
The Massachusetts Board of Dentistry allows dentists to administer Botox and dermal fillers as part of their dental setting as long as it is within the scope of their practice and they have obtained the additional, proper training in this field. Given their skills, experience and overall knowledge of facial anatomy, dentists are the perfect professionals for safely administering Botox injections.
What are the Common Side Effects of Botox?
The side effects depend on the injection site and may include:
- Occasional mild temporary redness at the injection site;
- Occasional mild temporary swelling;
- Rare mild bruising;
- Occasional tingling sensation;
- Very rare - Droopy eyelid;
- Very rare - nausea, fatigue, flu-like symptoms;
- Rare asymmetry.
Who Should Not Get Botox?
- Pregnant and lactating women;
- People with hypersensitivity to any ingredient, including Albumin 9 Human blood product or prior Botulinum Toxin A preparation;
- Patients with neurological disorders, such as Amyotrophic Lateral Sclerosis (ALS), Myasthenia Gravis, Lambert-Eaton Syndrome;
- People with fly or cold symptoms;
- Patients with infection or dermatitis in areas to be injected;
What to Expect Before and During the Botox Appointment?
If possible, 10 days prior to procedure avoid: NSAIDS, ASA, Fish oil, Omega 3’s, Flax seed oil, Vitamin E, Ginko Bilboa, Licorice, CoQ10, Cayenne, Ginger.
Treatment sessions are usually 30 minutes long with no down time for the patient. The areas of injections are first marked, then documentation photos are taken for reference, followed by disinfection of the area and a applying a numbing cream for few minutes before the injection is administered.
Some areas of the face will respond more quickly than others to treatment. Final results may take up to 10-14 days. We recommend the first follow up to be scheduled at two weeks, so the effects can be treatment can be made and the dose adjusted.
What to Expect After a Botox Treatment?
Patients can immediately return to light activity, including work, but should avoid strenuous exercise for 24 hours. Avoid rubbing the injection site in the first 24 hrs as the neurotoxin can spread in areas it was not intended to treat. Makeup and skin care products can be applied as desired, but it is advisable to avoid glycolic or Retin A products for one day. If headache occurs, take Tylenol or Motrin as needed.
How Long do the Effects of Botox Last?
The Botulinum toxin A produces only a temporary muscle weakness and its effects can last anywhere between 3-6 months depending on the muscle they are injected to.