Use of Botulinum Toxin in Orofacial Clinical Practice

Abstract

Introduction: Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine’s release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT’s efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more. Aim: This study’s aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT’s efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies. Materials and methods: We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia. Results: We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles). Discussion: The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.

Çocuklarda Kötü Ağız Alışkanlıkları ve Tedavi Yöntemleri

“…Bruksizm için mevcut tedavilerden kas gevşeticiler kas aktivitesini azaltmayı, splintler dental ve TME yapılarını korumayı yani semptomları en aza indirmeyi hedeflemektedir. Botoks tedavisi de bruksizmde yer alan masseter, temporal ve lateral pterygoid kaslarındaki aktiviteyi azaltmaya dayanan etkili bir tedavi seçeneğidir ve aynı zamanda ağrıyı azaltan analjezik etkiye de sahiptir (50). Ancak botoksun çocuklarda kullanımı sınırlıdır.…”

The Use of Botulinum Toxin A in the Management of Trigeminal Neuralgia: a Systematic Literature Review

“…Botulinum toxin is a neurotoxic protein and a powerful tool in therapeutics, which is seen in the growing numbers of use. Botulinum toxin (BT) is produced by the Clostridium bacterium family [ 11 ].…”

“…In dentistry, controlled clinical trials have demonstrated the great efficiency in pathologies such as bruxism, TMJ disorders, neuropathic pain and more [ 11 ].…”

“…Botulinum toxin is a neurotoxic protein and a powerful tool in therapeutics, which is seen in the growing numbers of use. Botulinum toxin (BT) is produced by the Clostridium bacterium family [11]. Botulinum drugs are a complex mixtures of compounds which consist of BNT (exists in 7 different types named from A to G), non-toxic proteins and excipients (stabilizers like human serum albumins, sugars included and buffers may be found as well to calibre the PH value).…”

“…From this, it is possible to conclude that BT might be useful in 70% of patients with TN [14]. In dentistry, controlled clinical trials have demonstrated the great efficiency in pathologies such as bruxism, TMJ disorders, neuropathic pain and more [11]. The hypothesis of this systematic review is that BT-A has no impact on TN patients.…”