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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.

Teeth grinding or bruxism can be a common occurrence at one time or another for many adults. In fact, it is actually more common in children. It is believed that about 30% of all children grind or clench their teeth. Luckily, most kids usually move past grinding or clenching by the time they are a teenager.

Why Do Children Grind Their Teeth?

Kids grind their teeth for similar reasons that adults do. Below you will find a list of the most common causes:

-Stress.

-Jaw Growth.

-Response To Pain (earache or toothache).

-Malocclusion.

-Result Of Losing Teeth.

-Allergies.

How To Tell If Your Child Is A Teeth Grinder?

Many children who grind their teeth in their sleep have no idea they are doing it. In fact, upon waking in the morning they feel no jaw, facial, neck, or shoulder pain. It is usually a parent or sibling who notices it first. However, some children will experience some or all of the symptoms listed above.

What Can Teeth Grinding Do To Your Child’s Dental Health?

Teeth grinding can cause a host of dental complications including:

-Fractured Teeth.

-Abnormal Wear To Crowns Of Teeth.

-Increased Temperature Sensitivity.

-Gum Tissue Recession.

-Jaw Misalignment.

Treatment For Teeth Grinding

Treatment usually includes close monitoring of a child’s teeth grinding. If the teeth grinding continues then a custom made mouthguard may be necessary to protect the teeth from further damage. If the grinding is from stress it is important to talk to your children to see what might be bothering them. Stress induced bruxism can be avoided, however, by talking with kids regularly about their feelings and helping them deal with stress.

Bruxism Conclusion

If you notice your child is grinding his/her teeth bring them in for a complete dental evaluation with your dentist. This will ensure there is no damage and give you the ability to coordinate a good plan going forward.

As we age many changes occur in our bodies including our teeth. Our teeth shift and move over time due to many forces that we control and ones we do not. These forces include tongue movements, lips pushing against our teeth, and how our teeth come together. Below we will review some of these forces in greater detail.

Forces Attempting To Move Our Teeth

-Tongue Habits. The most common is an abnormal tongue thrust. Our tongue places pressure on our teeth through eating, swallowing, and talking. We do not even realize how often our tongue presses against our teeth. If you swallow, you will realize that your tongue presses against your upper teeth. For most of us, this is not an issue but for others with a powerful tongue thrust, this can cause tooth movement over time.

-Lip Habits. The forces that your lips apply to your teeth can actually cause your teeth to move.  A good example is tucking your lower lip behind your upper teeth.  This is especially common in younger children and people who bite their lips when they get nervous. The forces over time can cause those teeth to shift outward.

-Frenum Issues. The frena is the attachment between your lips and tongue to the gum tissues attached to the teeth. The one on the inside by your tongue is called a lingual frenum. The other two are on the inside of your lips and called a labial frenum. The lingual frenum generally does not affect the teeth but can affect eating, speech, and swallowing as it can constrict tongue movement. The labial frenum can play a part in moving the front two teeth apart. To alleviate this your dentist or oral surgeon can remove the labial frenum surgically.

-Forces From Our Teeth. Our teeth are in a constant state of pressure from each other.  Normally when you bite together, your teeth touch and rest in a certain position.  This position is known as centric occlusion.  Normally, the top teeth oppose the bottom teeth and keep them in line. However, if you lose a tooth or a tooth becomes badly damaged from trauma or tooth decay space opens up. The teeth on either side of the lost tooth move, as will the tooth that opposes it. For example, if you lost a lower tooth, the tooth on the upper jaw that normally hits it would start to grow down slightly to fill in the space and the adjacent teeth to the lost tooth would start to lean in towards the empty gap.

-Genetics. Our body is hardwired with a set of instructions and our genetics determine if our teeth will be straight or not.

-Tooth Decay. If left untreated, your tooth will eventually break down changing its shape and size. This will open space up causing our teeth to shift into that space. Also, a tooth restored improperly can also change the tooth’s relationship to the other teeth causing changes as well.

-Age. As we age, the area between the teeth starts to wear away. When this happens, the enamel begins to thin out. And, because the lower teeth are inherently thinner, they wear out faster. The more wear and tear on the lower teeth, the less able they are to withstand the force of the top teeth when biting down, resulting in shifting.

-Teeth Grinding (Bruxism). Teeth grinding forces the lower jaw forward and puts tension on the upper teeth. The continual thrusting affects the position of the upper arch, pushing it out of alignment.

Conclusion

As you can see, there are many different forces that are constantly acting on your teeth that could cause them to move. It is important to treat those forces that you can control. See your dentist if you feel your teeth are shifting to avoid future issues.

Stress is the body’s internal and external reaction to a change that requires a physical, mental or emotional response. Stress can come from any situation or thought that makes you feel frustrated, angry, nervous, or anxious.

Too much stress is known to be bad for us but did you know that stress can also cause issues to your dental health?

Dental Issues That Can Be Caused By Stress

Poor Dental Hygiene

When a person is under stress they tend to lose focus on basic habits and this includes being diligent with maintaining their dental hygiene. If you do not take care of your dental hygiene, your dental health as well as your general health will begin to suffer. This is especially true if you already suffer from periodontal disease as skipping any part of your dental hygiene program can worsen the periodontal disease. Another issue with being under stress is your nutrition changes. Most people dealing with stress tend to develop very unhealthy eating habits. This can include snacking on larger than normal amounts of sugary foods and drinks. These changes will increase your risk for tooth decay.

A good way to combat stress in your life is to maintain a routine of regularly exercising. Exercising regularly can help you relieve some of that stress and give you an extra energy boost. Exercise will also boost your immune system which is always a plus.

Teeth Grinding (also called Bruxism)

One of the main reasons why people grind their teeth is due to stress. Bruxism can occur day or night but it is usually a subconscious act. Stress is not the only cause of bruxism but it does make it worse. Some of the dental issues associated with bruxism include:

-Headaches

-Ear Pain

-Worn Down Teeth.

-Temporomandibular Joint (TMJ) Issues

-Sensitive Teeth

-Chipped or cracked teeth

-Receding gums or teeth with notches in them at the gum line

Your dentist may recommend a night guard to wear while you sleep to minimize the damage caused to your teeth. Usually, if stress is the cause the bruxism will stop when the stressor is removed.

Mouth Sores

Mouth sores come in many forms. These can include:

-Canker sores. These are small ulcers with a white or grayish base and bordered in red.  There has been vigorous debate regarding what causes canker sores. Some believe it is an immune system issue, bacteria, or even a virus. Consensus is that stress can increase the risk of them showing up. Canker sores are not known to be contagious.

Canker sores generally last about 7-10 days. Spicy foods as well as highly acidic foods should be avoided as they tend to irritate the sores. One of the best forms of relief comes from a dentist prescribed medicine called Debacterol. This medicine is applied directly to the sore and can reduce symptoms as well as the length that the sores are present.

-Cold sores (or fever blisters). These sores are caused by the herpes simplex virus and are highly contagious. Cold sores are blisters that are filled with fluid that often appear on or around the lips. They can also appear under the nose or around the chin area. Emotional stress can trigger an outbreak. Other triggers include fever, a sunburn, or skin abrasion.

Cold sores often heal on their own in about a week’s time. Treatment is available, including over-the-counter remedies and prescription antiviral drugs. Ask your doctor or dentist if either could help you. It is important to start treatment as soon as you feel or notice the cold sore forming. The sooner you start treatment the effects of the cold sore will be reduced.

Periodontal Disease

Stress can lead to depression. And studies have shown that patients who are depressed have twice the risk of a poor outcome from periodontal disease treatment compared to those who are not in a depressed state. You can not make depression or the stress disappear, of course. But most experts agrees that learning healthy coping strategies can help reduce the risk of periodontal issues getting worse.  Also, people who are depressed tend to have poor overall hygiene and that includes dental hygiene.

Conclusion

Keep in mind we all have stress during the course of our day. Developing proper techniques for dealing with that stress can make a world of difference in the maintanence of our dental health as well as our overall health. As always, see your dentist regularly for dental examinations along with professional cleanings to ensure you keep your smile as healthy as can be!

Remember, eating a balanced diet, seeing your dentist regularly, and good oral hygiene help reduce your risks of periodontal disease. Make sure you brush twice a day and floss daily.