MAXILLOFACIAL SURGERY
Effective applications of botulinum toxin in dentistry and
in head and neck surgery
Roman Šmucler 1a,2,3a , Andrej Jenča 3b , Janka Jenčová 3c
Department of Stomatology, Medical Faculty, Charles University, Prague, Czech Republic
Asklepion- Laser Centre Prague, Prague, Czech Republic
3
Department of Stomatology and Maxilofacial Surgery, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovak Republic
1
2
DDS, PhD, CSc, Associate Professor
DDS, PhD, Clinical Professor
c
DDS, PhD, Assistant Professor
a
b
Received: July 02, 2017
Revised: August 03, 2017
Accepted: August 28, 2017
Published:August 28, 2017
Academic Editor: Constantinus Politis, MD, DDS, MM, MHA, PhD, Professor & Chairperson, KU Leuven, Leuven, Belgium
Cite this article:
Šmucler R, Jenča A, Jenčova J. Effective applications of botulinum toxin in dentistry and in head and neck surgery. Stoma Edu J. 2017;4(3):200-207.
Abstract
DOI: 10.25241/stomaeduj.2017.4(2).art.5
Background: Botulinum toxin A and B is approved for the treatment of many diseases, and we can read
many papers experimenting with other possibilities. The use of botulinum toxin is a relatively new option
with little or no pre-gradual training in dentistry.
Objective: This article aims to summarise current knowledge in this emerging field.
Data Sources: A search of MEDLINE, EMBASE, bibliographies of published systematic reviews was
performed, as well as of the Cochrane trial registries between 1966 and June 10, 2016.
Study Selection: Randomized controlled trials comparing botulinum toxin A with placebo or other
interventions were preferred, but for many emerging indication we used non-randomized studies as well
to inspire further studies.
Data Extraction: Data were abstracted and quality assessed by 1 reviewer.
Data Synthesis: We have little-randomised data to quantify the effect of botulinum toxin in a majority of
indications in dentistry precisely.
Conclusion: The rapid development of the botulinum toxin application brings new possibilities for
treatment by dentists alone or in cooperation with other specialists. Besides the above-verified evidence-
based indications, there are new and new case studies quickly appearing that need to be monitored and
possibly applied. But we have very few randomised studies to make final guidelines in many indications,
so further scientific works are really needed. Botulinum toxin should be part of undergraduate and
postgraduate teaching.
Keywords: botulinum toxin, dentistry, dermatology, neurology, psychiatry.
1. Introduction
Botulinum toxin, a neurotoxic protein, the
exogenous product of anaerobic microorganism
Clostridium botulinum, has been known for long
as the redoubtable “sausage poison” (but very
rare). Due to the mechanism of the botulinum toxin
action, e.i. blocking the release from nerve ending of
the neurotransmitt er acetylcholine, it was first used
as the solution for spastic, cerebral and other rare
syndromes in neurology. Subsequently expanded
to ophthalmology, it has completely changed
aesthetic dermatology and eventually helped to
cause the emergence of a new medical discipline,
non-surgical aesthetic medicine. It has become one
of the fastest growing therapeutic modalities in
history. The global markets for Botulinum products
are estimated to be close to three billion dollars. 1
The botulinum toxin application as an aesthetic
procedure has become so popular that unskilled
people often provide it, be it unqualified nurse
practitioners, briefly trained cosmetic or spa
physicians or only superficially trained physicians
assistants.
The high elegance of this method is that there is
virtually a zero risk of permanent consequences
(provided that it is carried out by qualified
professionals and we accept a legal definition of risk
equal to 1:200). 2 However, due to the rising number
of unqualified applications, there is an increase in
the frequency of complications not only in the
absolute number but also in the relative incidence. 2
A relatively new field covers applications in Oral
*Corresponding author:
Assoc. Prof. MUDr. Roman Šmucler, PhD, DDS, CSc, Department of Stomatology, Medical Faculty, Charles University, Londýnská 39, CZ-12000 Prague 2, Czech Republic
Phone: +420 234 716 500, Fax: +420 234 716 521, e-mail: [email protected]
200
Stoma Edu J. 2017;4(3): 200-207
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