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Botox first gained Food and Drug Administration approval in 1991. Since then, it has had a role in various fields of medicine, including dentistry. The procedure is relatively simple but providing this treatment in any field requires precision and a profound understanding of Botox and the Botox injection procedure.

This guide is intended as a reference for dental practitioners already providing Botox and those considering adding it.

General Information About Botox in Dentistry

Botox, also referred to by its generic term onabotulinumtoxinA or botulinum toxin, is classified as a nerve disruptor that affects the muscle in proximity to the injection site.

In dentistry, Botox is used to treat TMD and symptoms associated with the disorder, such as migraines. It is a treatment for both myofascial and atherogenic TMD. Additionally, it may treat other causes of maxillofacial pain, such as clenching and grinding.

Botox functions by inhibiting the release of acetylcholine, a neurotransmitter sent throughout the central nervous system.

Botox only affects the motor neurons or the ones required for motion. It does not have any effect on sensory neurons, which are necessary to feel pain and temperature.

Once Botox enters the body and prohibits the release of acetylcholine, it relaxes the muscle at the injection site.

When Botox relaxes the muscle fibers and stops nerve transmission, the facial muscles are not able to grind or clench, which may be beneficial for people with TMD or those who have maxillofacial pain.

As mentioned above, Botox and other similar name-brand drugs for onabotulinumtoxinA—as well as those for abobotulinumtoxinA and incobotulinumtoxinA—consist of a neurotoxin that originates from the bacteria that causes botulism. However, once separated and purified in a laboratory, the bacteria has therapeutic and aesthetic uses.

While some patients notice a difference over the course of the initial few days after treatments, others will not notice a difference until a week or two after the injection.

This injectable drug works for three to four months before patients require another treatment.

Although countless dermatologists, medical spas, and cosmetic surgeons offer Botox to reduce the appearance of fine lines and wrinkles, it is not as commonly used in dentistry. The American Academy of Facial Esthetics approximates that less than 8% of dentists throughout the nation provide this option. The dentists who do offer Botox provide cutting-edge treatment for those suffering from TMD.

Laws Surrounding Botox in Dentistry

Laws vary from state to state regarding who is allowed to take the course to become certified to administer Botox and who can offer it at their practice.

In California, dentists must complete training on how to administer Botox before they may offer the treatment at their facility. Additionally, dentists in California can only supply Botox for medical purposes, such as to relieve TMD, bruxism, and maxillofacial pain. Although dental practitioners cannot provide Botox as an option for aesthetic purposes, they can inform their patients that it may help reduce wrinkles and fine lines at the injection site.

In Arkansas, there are not any regulations in place for dentists offering Botox. In fact, the state only loosely regulates materials, fillers, and Botox in dental practices.

Delaware’s Board believes they have no jurisdiction over the use of Botox and Dysport, as these do not directly focus on dental health. However, practitioners must receive proper training to legally administer Botox.

Florida’s laws allow dentists to administer Botox as long as they receive proper training. Its uses must be limited to the face and neck. Cosmetic procedures in dentistry are becoming more common practice in Florida.

Dentists in West Virginia can only use Botox once they complete a residency in oral and maxillofacial surgery with accreditation from the American Dental Association. These dentists may only apply it to the maxillofacial region of a patient’s face.

These are only a few regulations. You must research your state’s laws before offering Botox, or you could be subject to legal implications.

Discussing Botox for Dental Purposes with Patients

First and foremost, you must be empathetic with your patients. Let them know that you understand the struggles of TMD and other similar issues. Let them know you recognize the seriousness of how disruptive symptoms can be to a person’s life. You want to gain the person’s trust before recommending the Botox injection procedure as part of a treatment plan.

The next step is suggesting Botox and explaining the treatment and its process. Generally, patients are a bit thrown off by the term botulism toxin. Therefore, it is best to describe it as a “nerve disruptor,” or another similar term.

When discussing Botox’s composition, it is necessary to explain that the purification of bacteria makes it safe for use in the medical field.

Patients may also inquire about the side effects. Common side effects of this drug include muscle weakness and fatigue.

Once a patient understands the benefits and the risks, you will need to explain what they can expect during the process. For instance, the needle is small, generally the same size as an insulin syringe. It is injected in the shallow portion of the muscle tissue. The pain associated with the injection is minimal, similar to that of a standard injection.

Patients also may want to know about the number of injections necessary. This figure varies from patient to patient and can depend on the severity of their issue, as well as the muscles targeted.

Important Practices for Administering Botox

Proper administration of Botox begins by making the patient comfortable. Often, dental procedures and Botox cause patients anxiety on their own. Combining the two only amplifies dental anxiety for many patients.

At this stage, it is important to ask if the patient has any questions or concerns going into the procedure and to take the time to address these appropriately. Patients may wonder about the procedure’s duration, which is generally anywhere from 10 to 30 minutes, depending on the number of injections.

A patient who is getting Botox for the first time may also wonder about the injection sites. These may vary based on the goal of the procedure and the patient’s specific condition. Generally speaking, injection spots include either or both the temporalis and masseter muscles.

Until you know how a patient responds, making the least number of injections possible is the safest route. This leads to fewer side effects.
As with any injection, you should clean the skin first to prevent infection.

At this stage, you will determine the appropriate units per injection. The dosage necessary for Botox for dental issues is higher than for aesthetic procedures, ultimately increasing the patient’s risk of side effects.

As part of a standard Botox injection procedure, you have to convert the units of the dosage since needles and increments of Botox do not align.

Though math is an essential aspect of medicine, it can be cumbersome. Moreover, it leaves room for errors. With Botox needles specially designed for the Botox injection procedure (explained more in-depth in the upcoming section), you can eliminate this step and simplify the injection procedure.

The product arrives as a clear substance in 100 unit bottles that must be mixed to form the medication. It is not ready to be administered until it is activated by 2.5 ml of saline, per the FDA.

Once prepared, you fill the needle with the mixture as you would any other injectable substance. The needle is the same kind used for any other subcutaneous injection.

The next step of the Botox injection process is administering the medication. As previously mentioned, patients tend to require multiple injections to see optimal results.

Patients may be concerned about the amount of pain they will experience. It is important to put their minds at ease since the injection is only temporarily painful. It feels like a sting or bug bite and only lasts during administration. Many patients have more fear about whether the injection will be painful than they do about the injection itself.

After injections, patients will not notice an immediate effect. The majority do not experience side effects immediately following their injection, but it is important to inspect the site for any signs of an allergic reaction.

If the patient expresses any immediate pain, it is safe to apply a topical analgesic to the region to temporarily relieve discomfort. A cold compress works as well.

Advise the patient to remain upright for at least four hours after the Botox injection. This reduces the likelihood of medication spreading throughout the body. Therefore, the risk of more serious side effects and complications are decreased.

Patient education is a vital component of the last portion of the appointment. Side effects are more likely due to the higher dosage of Botox given for TMJ.

You must advise patients about potential side effects that are normal and how to reduce their discomfort. For instance, a cold compress may relieve pain, redness, or bruising. Acetaminophen is the recommended pain reliever following Botox injections. Over-the-counter NSAIDs are not recommended due to blood-thinning properties.

Urge patients to avoid rubbing, massaging, or touching injection sites. Touching the areas in any manner encourages the Botox to migrate to other parts of the body, thus increasing the chances of a serious reaction.

Common side effects of Botox for TMJ include:

Respiratory infection
Flu-like symptoms
Rash at the injection site

Over-the-counter medications may help manage symptoms. All symptoms should dissipate within the first few days following treatment.

It’s also possible for the patient to have muscle weakness or a reaction at the injection site. These symptoms should subside within the first week.

More serious complications could occur, such as:

Pain that increasingly worsens
Difficulty chewing
Functional impairments
In addition, a patient may develop a fixed smile, meaning they may appear to be continuously smiling. This, unfortunately, may last six to eight weeks.

Before patients leave your office, remind them to refrain from consuming large quantities of alcohol for the 24 hours following their procedure. Additionally, the patient should avoid blood thinners for the first 24 hours. Patients should also abstain from strenuous physical activity for the first 24 hours.

When scheduling future treatments, make sure to space appointments far enough apart. Stress the importance of your patients contacting you if any serious side effects occur and if any symptoms (aside from a fixed smile) last for longer than one week. Notify the patient about the symptoms of a serious allergic reaction and what to do in the event that one occurs.

Unfortunately, there isn’t an anti-serum to combat patients’ side effects. Once you give the injection, it takes time to fully run its course.

Improving the Botox Injection Process by Considering UniTox

UniTox is a needle specifically for the Botox injection procedure. Although it uses the same needle as a traditional subcutaneous needle, these special Botox needles have a unique measurement system.

Since Botox is given in units that don’t match up precisely to the standard tick marks on a needle, practitioners must use a mathematical equation to determine proper dosing. With UniTox Botox needles, the math is already complete. You merely follow standard dosing protocols.

These needles are the only ones that have received FDA approval as far as syringes for Botox are concerned. Each UniTox Botox needle has clear markings at the 5, 10, 15, and 20 Botox unit marks. These needles can be used with any of the refined forms of botulinum toxin, including Dysport, Xeomin, Vistabel, and Azzalure.

Botulinum toxin given for aesthetic purposes has a long history. However, more and more users are becoming known, including in the dental industry, where it benefits patients with TMD and other maxillofacial pain. With the proper Botox injection training and technique, your patients can receive optimal results.