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Botulinum toxin (BoNT-A), or “Botox“, has been used for quite some time as a cosmetic aid in physicians and dentists offices. It can be utilized to make us look and feel younger. Did you know that botox has many other medical uses? It turns out that botox can be used to aid in therapy for many dental, facial pain disorders. It has been reported that approximately 16% of dentists in North America now use BoNT-A in their offices for cosmetic and therapeutic applications.

Botox acts by inhibiting the release of acetylcholine. Acetylcholine depolarizes the motor end plate of the muscle and will cause a muscle contraction. By inhibiting the release of acetylcholine, Botox effectively will either reduce the intensity of the contraction of the muscle or will eliminate the contraction altogether, depending on the amount of Botox used. Essentially, BoNT-A neurotoxin causes a temporary muscle paralysis. Each treatment can usually last between 3-6 months as the muscle initiates new acetylcholine receptors and the growth of branches from the neurons to form new synaptic contacts. Gradually the muscle returns to its full function and with no side effects at all.

Botox And Dental Medicine

Botox can be used for the following disorders:

-Temperomandibular Joint Disorder (TMD) and Facial Pain Management – TMD is a very difficult disorder to treat since its symptoms are varied and complex. The goal of treatment in TMD has been to provide non -invasive, reversible treatment options. Surgery is an option, although rarely used, due to limited success. Botox gives the dentist the ability to relieve TMD and facial pain symptoms for a short period of time (from weeks – months for each treatment). In TMD and facial pain disorder, there are muscular trigger points that radiate outward through the nerve bundles. The  injection of Botox into these trigger point areas, “freezes ” the ability of the muscle  by paralyzing it for a while, can help relieve the intensity of the TMJ muscle contractions. The relief can last up to three months. For trigger point injections, it makes much more sense to use Botox because the effects will last for three months and you are actually helping relieve the intensity of the contraction of the muscle, which is usually in spasm.This temporary muscle paralysis makes Botox a great tool in the treatment and management of TMD and facial pain disorders. The use of Botox products in TMD and facial pain management therapy can give us a totally new insight as to helping these patients who have had trouble getting relief previously.

-Teeth Clenching (Bruxism) – This treatment becomes somewhat tricky as the dose is very important here. Too much botox into the area of the mastication muscles can paralyze these muscles and disrupt a person’s ability to chew and speak. Too small a dose and it has little to no effect. The proper dose will reduce the intensity of the muscles contraction, allowing the patient to still be able to chew and speak properly. When done correctly, the patient will see relief from facial pain and limit the damage done by the teeth clenching, as the force is no longer there to do damage to oral tissues. Using the right amount of Botox will decrease the intensity of contractions of the muscles of mastication as well as give you full ability for chewing, eating properly, and speaking. The relief afforded to patients by Botox can help eliminate facial pain, greatly reduce their TMD symptoms and can significantly help the other associated treatments of periodontal disease by removing bruxism from the equation of treatment.

-Orthodontics – Our muscles play a huge role in where our teeth line up. Following orthodontic therapy some patients teeth will relapse and this may be due to placement of that individual’s musculature. Many patients have an over active mentalis muscle that often causes relapse of the teeth and may cause spasm of the muscles. Botox gives us the ability to reduce these spasms and contractions allowing for limited relapse following orthodontic treatment.

-Treatment of Migraine, and other Headaches – Generally, migraines have been a source of the unknown for many patients. Migraines have multiple symptoms beyond just headaches. These can include nausea, dizziness, and even light sensitivity. The use of Botox can relieve these symptoms. The placement of a few well placed injections around the temples, forehead, and neck/shoulder area can ease these symptoms by preventing the pain signals to reach the nerve bundles on the head and neck. This can also relieve severe headaches in the forehead region, if you suffer from them frequently. This can get quite expensive but for those suffering it can be well worth the cost to feel pain free again.

-Controlling Excess Saliva Production (also called sialorrhea) – The more common term for this is drooling. While there are other treatments for this, botox gives the ability to stop the excessive salivary production by injecting into the parotid and submaxillary glands. Again, this treatment is very dose specific. Too high a dose can disrupt a person’s chewing ability and also lead to dry mouth (xerostomia).

-Facial Asymmetry – In many of us, the muscles of the face may be asymmetrical leading to an imbalanced look to the face. Botox can restore that symmetry by balancing the facial muscles. Eyebrow lift, or depression of the brow can be enhanced with properly placed botox.

-Gummy Smile – This is shown as a smile that shows too much gum tissue. This usually is the result of the lip rising too high when smiling. Injecting Botox into the upper lip weakens the retractor muscles of the upper lip so that it won’t raise as high and your smile will seem better-balanced.

-Trigeminal Neuralgia- This extremely painful condition can be brought about by something as simple as air blowing on your face. Freezing a few select muscles on the affected side of the face can bring relief from extreme pain, and piece of mind. Not having to worry about accidentally setting off the facial pain can give you your life back.

Botox and Dentistry Conclusion

As with any botox application, training is critical. The dentist placing the injections should be well versed in not only a person’s anatomy but also in the use of the right dosing of the botox. Too little and there will be no relief from symptoms while too much botox can lead to disabling effects. Botox gives patients and dentists new possible treatments that can lead to better lives for all of us.

Osteoporosis is a disease of bones that leads to a decreased density of bone and subsequent increase in risk of fracture. Osteoporosis causes bones to become weak and brittle. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.

Osteoporosis affects millions of people all over the world. It affects men and women of all races. Women are 4x more likely to develop osteoporosis. Research has shown that post-menopausal white and Asian women are at highest risk. Medications, healthy diet and weight-bearing exercise can help prevent bone loss and strengthen already weak bones. There is recent research showing that women who drink wine in moderation tend to have higher bone density than those who abstain from alcohol.

How Do I Know If Dental Implants Are An Option?

The first step is to get your osteoporosis under control and limit the further effects of the disease. This includes seeing a physician to prescribe the proper medications, diet, and exercise routine. The next step is to see your implant dentist for a full evaluation. This evaluation will include your overall health, your oral health, as well as the degree of your osteoporosis.

Some considerations before having dental implants placed include:

-State Of Oral Health. A major factor in the failure of dental implants is the presence of periodontal disease. With a patient already being compromised with osteoporosis this becomes doubly important that the patient be periodontal disease free.

-Strength, Density, And Volume Of Bone Tissue. You need to have some good quality bone left to have an implant last, healing will be prolonged, so volume of bone is extremely important.

-Medications. This includes medications you are taking for osteoporosis as well as other medications which could counteract those medications. Bisphosphanates have been long known to keep the body from reabsorbing bone tissue, but they also appear to affect your ability to heal after a dental implant procedure. Biphosphonates can increase the risk of biphosphonate-induced osteonecrosis of the jaw (also called BONJ). When BONJ occurs, the bone tissue actually begins to die due to inadequate blood supply.

-Is The Patient A Smoker? Smoking has long been a failure factor in dental implants as well as bone loss. Nicotine is a vaso constrictor so blood supply to the bones in the jaw can be compromised.

-Presence Of Systemic Disease. This can include a decreased immune system or diabetes. Good health is important for good healing.

If you have been diagnosed with osteoporosis, dental implants may still be an option. If osteoporosis has affected other parts of your body, it might not necessarily have caused decrease in jawbone mass or breakdown of these tissues. Recent research (International Journal of Oral and Maxillofacial Implants, Vol 21: 349) has shown a lowered success rate in patients with osteoporosis but the difference was less than 2%. The general success rate for dental implants is about 97% whereas the success rate in this limited study was 95%. The study also showed that bone grafting was successful as well.

Conclusion

Dental implants have long been the treatment of choice for tooth loss. For those who have been told it is not an option the effects can be devastating. The recent research gives hope to those who previously were told that it was not an option. Each individual needs to be evaluated on a case by case basis taking all factors into account before delving into placement of dental implants. If you are missing teeth or about to lose them, contact your dentist for a dental implant evaluation.

Hope All Have A Safe and Happy 4th of July!!

Dental bonding is a common cosmetic dentistry procedure that can make minimal and maximum changes to your smile. The beauty of dental bonding is it generally can be completed in a single appointment and may or may not need dental anesthesia and is less expensive than porcelain restorations. . This cosmetic dentistry procedure involves reshaping and blending teeth. Bonding utilizes tooth colored materials that can be bonded to teeth to change shape, color, and length. This same material can also be used to fully cover the front surface (called a composite veneer). 

Dental Bonding Procedure

Dental bonding can be used to restore function to a tooth that has tooth decay or just to add a cosmetic change. What is involved in the dental bonding procedure?

-Preparation. Very little preparation is necessary for dental bonding, especially in the case of a chipped tooth. Anesthesia is usually not even needed unless the dental bonding is needed to restore a deeply damaged or traumatized tooth, a fracture close to the nerve, a sensitive tooth, or a tooth damaged by a tooth decay. Your dentist will need to roughen up the surface and clean the edges to prepare the area to accept the dental bonding.

-An acidic etching gel (phosphoric acid) is applied to the tooth being treated to ready the surface for bonding of the dental composite. The gel opens up microscopic tubules which allows for proper bonding to the natural tooth surface.

-A liquid conditioning agent is applied to the tooth which wets the surface and again facilitates bonding.

-Your dentist will then choose the proper shade of dental composite to match the tooth being worked on but also the surrounding teeth.

-The dental composite is then formed and shaped so that it will fit into the necessary treatment area can restore the natural contours and function of the tooth. Multiple layers of dental composite are applied. This allows for a stronger end product.

-A special UV light is held over the dental composite. This light hardens and cures the dental composite. Each layer will be cured within seconds.

-After the material has cured, your dentist will adjust the material to remove any excess and bring it to a high polish. This will also be the time your dentist will ensure the bite (or occlusion) is correct. Adjustments may be made to bring the teeth into proper alignment. The final shaping and polishing is one of the most important parts of the process. It is important to blend the composite resin properly to get a result that looks and feels like your natural tooth structure.

-The entire dental bonding procedure usually between 30 minutes to an hour for each tooth. If done properly, dental bonding should not be noticeable to anyone. It should match your existing tooth structure perfectly.

-Going forward to maintain the dental bonding, you will want to be diligent about your dental hygiene. This should include brushing and flossing regularly.

What Can Dental Bonding Do For You?

Dental bonding is a popular cosmetic dentistry procedure, but can also be used to restore teeth that have tooth decay. Dental bonding can do the following:

-Repair cracks or chips in teeth.

-Close gaps in between teeth.

-Cover stains or discolorations.

-Cover exposed roots thus eliminating or decreasing tooth sensitivity.

-Change length or shape of teeth.

Dental Bonding Conclusion

A dentist has many tools to restore your teeth but none more important than dental bonding. It is a versatile cosmetic dentistry procedure that can restore your smile to its natural form and function.