STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 50

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: 200 Stoma Edu J. 2017;4(3): 200-207