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Botulinum toxin, 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.

Botox As A 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 so varied. The goal of treatment in TMD has been to provide non -invasive, reversible treatment options. Surgery is an option, although rarely utilized, due to it’s limited success. Botox for TMJ gives the dentist the ability to relieve TMD and facial pain symptoms for a short period of time (weeks to months per 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. This temporary muscle paralysis makes Botox a great tool in the treatment and management of TMD and facial pain disorders.

Teeth Clenching (Bruxism) – Bruxism treatment with Botox 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.

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.


As with any botox application, training is critical. The injector 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 doctors a new world of possible treatments that can lead to better lives for all of us.

AAAHH!! The dreaded brain freeze  (also called an ice cream headache)…we have almost all experienced it when drinking an ice cold drink or eating ice cream way too fast.

Brain Freeze Marielaina Perrone DDS

The Dreaded Brain Freeze!

But, did you know that the dreaded brain freeze is actually considered a short duration headache? Do you know what causes brain freeze or how to stop it?

What Is A Brain Freeze?

A brain freeze is a form of  cold stimulus headache. The medical term for this type of headache is sphenopalatine ganglioneuralgiaThe brain freeze occurs when something cold touches the roof of our mouths (also called the palate). The sudden onset change in temperature of the tissue stimulates nerves to cause rapid dilation and swelling of blood vessels. There is an attempt by the body to direct blood to the area and warm it back up. The dilation of the blood vessels triggers pain receptors, which release pain-causing prostaglandins, increases sensitivity to further pain, and produces inflammation, while sending signals through the trigeminal nerve to alert the brain to the problem. The trigeminal nerve can sense facial pain, strangely the brain interprets the pain signal as coming from the forehead. When the body senses pain in a different area than the source this is called “referred pain”.

Generally, the headache appears in about 10 seconds after placement of cold in the mouth and usually lasts around 20 seconds, although some people may experience much longer instances of pain. The sensation can become intense and hit fast as nerve endings go into overdrive. Only about a third of the population ever experience brain freeze from eating or drinking something cold, though most people are susceptible to a related headache from sudden exposure to a very cold climate.

Can Brain Freeze Be Prevented?

Since the brain freeze is caused by the rapid chilling and subsequent warming by the body, there are a few ways to help prevent brain freeze. They are as follows:

Brain Freeze Marielaina Perrone DDS-Eating ice cream or drinking cold drinks slower instead of rushing through.

-After drinking or eating something cold use your tongue to warm the top of your mouth. This can alleviate the onset of brain freeze.

-Tilting your head back for about 10-15 seconds allows blood flow to equilibrate and not rush to the area as quickly.

-Drink a liquid that has a higher temperature than whatever caused the brain freeze.


A brain freeze is not really a serious issue but it is annoying. Recent research has also shown that those who experience migraines seem to be more susceptible to brain freeze. This can possibly lead research teams to develop new medications that help prevent or treat the vasodilation that is causing the headaches. These drug therapies could  lead to significant advances in many peoples lives.

dental care multiple sclerosis

How Multiple Sclerosis Works

Multiple Sclerosis (also just simply referred to as MS)  is an autoimmune disease in which the body attacks the nerve fibers of the  brain and spinal cord. Multiple Sclerosis is a progressive disease. This later results in demyelination of the nerve fibers and  paralysis. Demyelination is the general term for diseases of the nervous system.  Demyelination occurs when the myelin sheath (covering of nerve fibers) gets damaged. This in turn results in disorders or impairments in muscle functions, cognition and sensation. For reasons unknown, it mostly affects adults living in the northern hemisphere. Canada has one of the highest rates of Multiple sclerosis in the world.

Multiple sclerosis is just one form of demyelination and also the most common  type. Other diseases include Acute Disseminated Encephalomyelitis and Transverse Myelitis. The disorder was first described by Jean-Martin Charcot in 1868.

Specific symptoms of multiple sclerosis can include:

-Muscle spasms

-Trouble maintaining a good balancing

-Easily fatigued

-Difficulty walking

-Difficulty moving the arms or legs and tremors in the arms or legs.

Additional symptoms include constipation, the need for frequent urination, loss of bladder control, double vision, vision loss, facial pain, depression and hearing loss. These symptoms can occur intermittently and can intensify during times of stress, sun exposure, fever or when taking a hot bath.

Multiple Sclerosis Risk factors

These factors can increase your chances of developing multiple sclerosis:

-Age. multiple sclerosis can develop at any age, but generally affects people between the ages 16-55.

-Sex. Women are more than 2-3X as likely as men are to have multiple sclerosis.

-Familial history. If a parent or sibling has had multiple sclerosis, you are at an increased risk of developing the disease.

-Infections. A variety of viruses have been linked to multiple sclerosis, including Epstein-Barr (infectious mononucleosis).

-Ethnicity. White people, particularly those of Northern European descent, are at highest risk of developing multiple sclerosis. People with ethnic backgrounds of Asian, African or Native American descent have the lowest risk.

-Climate Factors. Multiple sclerosis is much more prevalent in locations with temperate climates. This includes Canada, the northern United States, New Zealand, southeastern Australia and Europe.

Vitamin D. Having low levels of vitamin D and low exposure to sunlight is associated with a greater risk of multiple sclerosis.

-Autoimmune Disease Link. A slightly higher risk of developing multiple sclerosis is possible if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.

-Smoking. Smokers who experience an initial event of symptoms that may signal multiple sclerosis are more likely than nonsmokers to develop a second event that confirms multiple sclerosis.

Treatment for multiple sclerosis includes taking medications to slow the progression of the disease. These include interferon, natazalizumab, methotrexate, azathioprine, cyclophosphamide or steroids. Amantadine may be taken for fatigue, antidepressants may be taken to control mood and behavior, and cholinergic medications can soothe urinary problems. Physical therapy, relaxation and exercise may also be used to manage multiple sclerosis.

One of the parallel connections between multiple sclerosis and the patient’s oral health is loss of muscle control. A patient with MS experiences a harder time brushing their teeth depending on the muscles involved in the patients MS. Due to poor muscle control sometimes MS patients can only achieve what is considered poor brushing. Those suffering from severe multiple sclerosis symptoms will need help from family and loved ones to simply clean their teeth.

dental care in multiple sclerosisMultiple sclerosis patients may also have a difficult time simply relaxing in the dentist’s chair. This makes it very difficult for the dentist to do a thorough dental examination as well as to conduct any needed dental procedures. For this reason, it is imperative to keep Multiple Sclerosis patients in the chair for as little time as possible. Appointments should be as short as possible. Multiple breaks of 5-10 minutes per half hour of treatment should be given. It is also recommended to schedule early morning appointments as this is usually the least stressful part of the day. This is all to lessen the discomfort on the patient. Stress, fatigue, and muscle spasms may also play an important factor in chair time.

Patients suffering from multiple sclerosis are not advised to wear dentures. Muscle spasticity makes it difficult to wear dentures comfortably. The reason is due to the patients uncontrollable muscle spasms. Experiencing uncontrollable spasms could potentially result in dislodgement of the dentures or even swallowing of the denture.

Multiple sclerosis patients need regular dental care not only for reasons mentioned above but there are other factors. Tooth decay, halitosis, or periodontal disease can also occur at higher rates in these patients. All of these can easily be avoided with proper hygiene.

Multiple sclerosis may also cause pain in a specific tooth. This causes the patient to seek care on what is essentially a healthy tooth. This is caused by Trigeminal Neuralgia and is probably the most intensely painful multiple sclerosis related symptom. This can occur in the lower part of the face and is usually an intense, sharp pain. Luckily, this is rare with only about 4% of Multiple Sclerosis patients experiencing this type of pain.

There is no cure for Multiple Sclerosis. Dentists have a few set rules for management of patients with MS:

1. Maintain oral function. Allow patient to be as self sufficient as they can for as long as possible.

2. Keep patient healthy so they do not develop other disorders or diseases that could complicate their MS.

3. Maintain a person’s cosmetic appearance so they do not develop self esteem issues which will further accelerate their decline via depression.

If you have noticed, one of the primary concerns of dentists is for the patient to be able to maintain their own oral hygiene. This is achievable especially with patients whose condition has not yet reached its worst. In cases where this is not possible, family members or care givers are trained to assist the patient.

Lastly, maintaining positive attitude towards life is very important. There are a lot of people suffering from diseases and ailments worse than multiple sclerosis. If the dentist, patient, and family work together a Multiple Sclerosis patient can live free of dental worries their entire lives.