Clinic uses of botox
Clostridium Botulinum

Author: Sissi Marchese
Date: 21/01/2011



In Dentistry, the botulin injections’ use it has been studied very well in Germany, at Heidelberg University in different cases:

  • relapsing dislocations of the TMJ
  • bruxism
  • masseter’s hypertrophy
  • muscle-tensive headache
  • muscles’ hyperactivity with facial cronic pain

In all these forms pharmacologic treatments didn’t result successful.

In the particular case of cronic dislocation, the traditional therapies : plaques, sclerosant injections up to surgical interventions didn’t result decisive and even presented serious risks.

The botulin therapy consists in injections of the serum in lateral pterygoid muscles: one dose every three months.

The only risk is the anticorpal production.

In addition, the botulin, if injected in facial mimic muscles, causes a reduction of the contractile activity softening in this way expression wrinkles, which are caused by the mimic muscles’ contraction, between the eyebrows, around the eyelashes, and crow’s feet.



Study about nocturnal bruxism

In dentistry, botulin is often used to cure bruxism when the other conventional treatments don't have any effects, like myorelaxants, which are commonly adopted.
In fact, bruxism therapy nowadays is not precisely defined yet and dentists know well that whether plaques or splints or bite and even all psychological therapies tending to stress control, are often poorly effective and not longlasting. If it is difficult to cure the motivating reason that causes the muscle activity, on the other hand it’s extremely easy to modulate its activity. So this idea led to the use of Botulin Toxin A (TBA) which was already suggested for the correction of this pathology, but with very variable dosages.
The results were rewarding and there were not proved important side effects.

Study of the Safety and Efficacy of Botox in Bruxism


A smile is considered a gummy smile when the gums of the superior dental arch are excessively and antiesthetically exposed.

This is an example:


  • orthodontic therapy
  • periodontal surgery followed sometimes by applications of restorations (facets or capsules).

These procedures, even if they are correct, on the other hand have considerable costs as for the time as for economy, in addition to the real surgical action.

In the last years in the USA it has been tested an alternative method which producted considerable results: the botulin.


  • minor costs
  • no invasiveness
  • almost immediacy of effects

If injected in small doses in the muscle which is responsible of the overcontraction and the upper lip’s raising markedly reduces gums exposition without damaging a “natural smile”.


"Orbicular muscle of the mouth " which concurs to form the wrinkles around mouth. When the group of muscles that raise up the upper lip are contracted in order to smile, it may happens that the orbicular, which is linked to these, tends to be stretched so much by these muscles that exposes gum amply.


The orbicular muscle is anaesthetized by the use of the botulin toxin. This toxin, inoculated in the bridge of the nose takes effect in this muscle making it less tonic.


  • Because of relaxing, lip becomes a little longer
  • The levator lips’ muscles don’t manage to raise it totally
  • So gums exposition is reduced
  • If after a first dose of BTA the wanted result is not managed, it is possible to correct it with a second session in 15 days from the first surgery.
    The effects of the treatment last about four/six months and then all comes back like before.
    This method works very well even for the lifting of the tip of the nose when it is too much “flabby”, if the dentist acts on a muscle near the orbicular which is called “depressor muscle of septum of nose”.

Studies about gummy smile:



Instructions for the treatment with botulin
Botulin can correct only the wrinkles and the lines caused by the mimic muscles’ action and not if they are caused by the skin aging (skin photoaging) or if they are very marked wrinkles. In these cases botulin could be associated with other treatments like the fillers for example.

With the Botulin could be treated these blemish and pathologies:

  • Forehead wrinkles (horizontal wrinkles)
  • Eye wrinkles
  • Mouth wrinkles (around the mouth)
  • Glabellar wrinkles and lines (between the eyebrows)
    This is a trial about it
  • Crow’s feet (wrinkles around eyes)
    "This is a trial about it":
  • Expression wrinkles
  • Rejuvenation of the face

How works the treatment

The botulin treatment is

  • Day hospital, without hospitalization
  • Without anaesthesia, and last about 30 minutes
  • Injected with a small syringe in controlled quantity in the mimic muscles, so that from which arise the expression wrinkles

Before scheduling Botox injections, this is the procedure

  • medical history and physical exam.
  • medication use. The patient may need to stop using certain medications before the Botox
    procedure. These include blood-thinning medications, such as aspirin, aspirin-containing medications, clopidogrel (Plavix), warfarin (Coumadin) or heparin.
  • avoid deodorant use for 24 hours before treatment.
  • avoid foods or activities that may make sweat more, such as hot foods or exercise, for 30 minutes before the procedure.

Before the treatment

  • to numb the area where the injection will be given.

During the treatment

  • thin needle to inject tiny amounts of Botox into specific muscles
    The number of injections needed depends on many factors, including the extent of the area being treated.

After the treatment

  • bruising or other minor local side effects from the injection.
    To minimize the risk of later bruising, it is recommended that patients discontinue any non-essential medications or dietary supplements that can cause thinning of the blood:
  1. Aspirin (2 weeks prior)
  2. Non-steroidal anti-inflammatory medications (ibuprofen, naproxen, etc)
  3. Fish oil supplements
  4. Vitamin E
  5. Gingko and ginseng
  6. Red wine
  • resume normal daily activities right after the procedure.
  • not to rub or massage the treated areas. This can cause the toxin to migrate to a different area.
  • After a Botox injection, a reduction in the appearance of wrinkles may be noticed as early as 2 days with the maximum effect in 2 weeks. The effect from Botox slowly wears off over a period of 3–4 months.

    h3. Side effects and contraindications of Botulin

There are not particular contraindications or complications.

  • rare allergic reactions, and it is recommended not to inject it during the pregnancy, or if the patient has neuromuscular problems.
  • Rarely there could be a ptosis or a lowering of the upper eyelid, along 3-4 weeks and so reversibile
  • Pain and bruising at the injection site
  • Redness
  • Itching
  • Headache
  • Nausea
  • Temporary muscle weakness
  • Increased body sweat
  • Doctors generally recommend against using Botox into pregnant women or breast-feeding, since the effects on the baby aren't known.

Example of complications in periocular rejuvenation

After the treatment with botulin

The face after the perfusion appears slightly red where the injection was carried out, but for a few minutes.
Occasionally there could be a bruise that, however, tends to reabsorb in a few days. There may be only slight burnings for the first two days.
It is possible to paint already after 10 minutes from the perfusion of botulin, and it could expose to the sun after about ten days. The recovery of all normal activities is immediate.

Duration of the results

The perfusions of botulin toxin begin to have significant results after about 8 days from the treatment, together with the relaxation of the frown muscle, and achieve after a month the maximum efficacy. The results last for other 4-5 months, and then gradually disappear.


Other benefits

The effects of BOTOX injections on emotional experience

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