Leveraging Botox in Dentistry

Last month we taught a wonderful, two-day dental course on Botox and dermal filler for the dental practice. When we first announced the course, we heard a lot of you asking “What does Botox have to do with dentistry?”

It’s true. Most people associate Botox with treating wrinkles and hiding the signs of aging. There’s definitely a huge market for that service; but think about what Botox really does. It treats muscles by temporarily weakening their ability to forcibly contract. A side effect can be the reduction of wrinkles in the skin associated with the contraction of the targeted muscle or muscle group.  

But step back and think beyond the esthetic benefits of treating “crow’s feet” or the “11s” to take a few years off a patient’s appearance. What dental conditions can you think of that could improve by reducing the abilities of certain facial muscles to fully contract?

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The most obvious: TMD and its associated symptoms, such as myofascial pain and headaches. How many patients have you seen who don’t respond to bite splint/appliance therapy, regardless of its design or style. The same can be said of other, more aggressive treatments for occlusion. 

I’ve been working with Botox on patients for quite some time and every one of them experiences at least some level of symptom relief when I use Botox in the masseter and temporalis muscles. I always let them know that the procedure works best in conjunction with occlusal therapy but understand that not every patient will be compliant with traditional treatment. Also, we know many patients can’t afford (either financially or emotionally) what they really need — full-mouth rehabilitation. 

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I’ve had many patients return to my office two weeks after their initial injections with tears of joy thanks to the relief they’ve experienced after years, even decades, of suffering. There aren’t many things we do in dentistry that bring that level of satisfaction from our patients. It’s a wonderful gift we can give. 

Of course, the treatment is temporary, which can be both an advantage and a disadvantage. It typically lasts three to four months, so no long-term harm can be done. The patient will need continued therapy to sustain the relief. Over time, if treatment is consistent, the muscles will weaken, and the benefits may last longer. With regular treatments over an extended time, the patient may be able to stop the injections altogether. 

 A second scenario where Botox can help: The gummy smile. Most of these patients aren’t good candidates for esthetic crown lengthening and show sufficient enamel. A simple solution is a few units of Botox in each levator labii superiors muscle, and possibly some more units in the upper portion of the orbicularis oris muscle. I recommend starting conservatively, then upping the dose until the patient is happy with the amount of drop in the lip and reduction of gingival display. Once again, we’re able to provide a wonderful solution to patients who may have been suffering with the condition for years. 

These are just two ways we can use Botox to better serve our dental patients. In early 2019, I’ll be discussing dermal fillers and how we can use them with esthetic cases. 

About Dr. Benjamin Nemec

Dr. Nemec was born and raised in Corpus Christi, Texas and attended the University of Texas at Austin for his undergraduate studies. He received his Doctorate of Dental Surgery degree from The University of Texas Health Science Center - San Antonio in 1998 and promptly moved back to Austin to begin his private practice career.  He has focused his dental practice around his unique patient communication and relationship growth systems, as well as the benefits of the most modern techniques and services available to his clients.  He has utilized CEREC since February, 2003, Galileos 3D CBCT since October, 2010 and Botox/Dermal Fillers since April, 2012.  Then he became a certified trainer for Patterson Dental and Dentsply Sirona in 2007.  As his career advanced, both in private practice and as a trainer/lecturer for these wonderful ‘patient-friendly’ systems, techniques and technologies, he's greatly enjoyed sharing his experiences with other dentists as well as helping them incorporate these advancements into their practices so that they develop the same passion and success for providing excellent dentistry that I he has received.