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Oral Pain > Botox > Flashcards

Botox Flashcards

1
Q

When can general dentists use Botox?

A
  • Botox & dermal fillers
    • tx functional or aesthetic dental conditions
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2
Q

Botulinum Toxin (BTX)

A
  • Most potent neurotoxin
    • natural
  • Produced by Gram (+) anaerobic bacteria→Clostridium Botulinum
  • 3 antigen subtypes
    • A, B, C1, D, E, F, G, H
  • Incubation Period:
    • 18-36 hr after ingestion
  • Heat Labile
    • denatured by cooking
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3
Q

How does Botulism occur?

A
  • Ingest contaminated food
  • Toxin → peripheral cholinergic nerves
    • Blocks acetylcholine release
  • Results:
    • Bilateral symmetric descending neuroparalytic illness
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4
Q

What types of Botulism occurs in humans vs animals?

A
  • Humans:
    • Types: A, B, E, F(rare)
  • Animals:
    • C & D
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5
Q

Type A Botulinum Toxin

A
  • most common for cosmetics
  • 3 forms:
    • Botox
    • Dysport
    • Xeomin
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6
Q

Type B Botulinum Toxin

A
  • 1 form
    • MyBloc
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7
Q

What does each vial of BOTOX contain?

A
  • Clostridium botulinum Type A
    • 100 units (U)
  • Albumin Human
    • 0.5 milligrams
  • Sodium chloride
    • 0.9 mg
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8
Q

Botox MOA: (w/Botox & no Botox)

A
  • BTXA inhibits release of acetylcholine (Ach)
    • at neuromuscular junction
  • Large Dose=complete paralysis
    • Therapeutic Dose: Partial activity
  • NO BOTOX:
    • Ach released→ Muscle Contraction
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9
Q

Botox Therapy: Systemic Side Effects

A
  • Anxiety
    • Dizziness, Drowsiness, headache, Dry mouth, Dry Eyes
  • Pharyngitis
    • dysphagia (difficulty swallowing)
    • facial pain
    • flu-like symptoms
  • Can’t focus eyes
    • drooping eyelid/eyebrow
    • double/blurred vision
    • Sensitive to light
  • Indigestion
    • Nausea
    • Swearting
    • Fever
    • Chills
    • Allergic rxn
      • Rash
      • itching
  • Dyspnoe
    • chest tightness
    • face edema
    • hoarse voice
    • Respiratory infection
    • anaphylaxis
    • urticaria
    • erythema multiforme
    • No bladder control
    • No Strength
    • paralysis
    • seizures
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10
Q

Botox Therapy: Local Side Effects

A
  • Muscle soreness
  • Partial muscle weakness (temporary)
  • Muscle Atrophy
    • prolonged use of botox
    • reversible if discontinued
  • Redness
  • tingling
  • bruising
  • swelling
  • bleeding
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11
Q

Botox: Contraindications

A
  • Aminoglycoside antibiotics
  • aspirin
  • chloroquine
  • calcium channel blockers
  • quinine
  • Pregnant or Nursing women
  • Children
  • Cardiovascular Disorders
  • Neuromuscular disorders
    • Myasthenia Gravis
  • Impaired Hemostasis
  • Pre-existing infection at injection site
  • Skin Infections
    • Eczema
    • psoriasis
  • 65+ -Emotional
  • Botulinum hypersensitivity
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12
Q

What are the uses of Botulinum toxin type A in Dentistry

A
  • Bruxism
  • Facial Nerve palsy/paresis
  • Gummy Smile
  • Headache
  • Migraine
  • Massetric Hypertorphy
  • Mandibular Spasm
  • Muscle retraining during Ortho
  • Myofascial Pain
  • Oromandibular Dystonia (OMD)
  • oral surgery-Implants
  • Salivary Gland Disorders
  • Trigeminal Neuralgia
  • Postherpetic Neuralgia
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13
Q

Myofascial Pain

A
  • Muscle Pain & tenderness
    • Mastication Muscles
    • Trigger point/Band Muscles
  • Botox
    • reduces hyperactivity
    • temporary alleviate pain & dysfunction
      • Results: Inconclusive (due to etiology)
        • Myositis=cause of pain
          • can’t treat w/Botox
          • lacks anti-inflammatory
        • not always muscle hyperactivity
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14
Q

Bruxism

A
  • Severe Bruxism
    • inject masseter muscles
    • Therapeutic response: 19 weeks
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15
Q

Oromandibular Dystonia (OMD)

A
  • movement disorder
    • involuntary spasms & muscle contractions
  • difficulty speaking, swallowing, and eating
  • Forms: Muscle injected
    • Jaw-Closure dystonia
      • Bilateral Masseter muscles
    • Jaw-Opening Dystonia
      • Lateral pterygoids
    • Lingual Dystonia
      • Tongue muscles
  • Recommended dose: 30 U per side
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16
Q

Massetric Hypertrophy

A
  • Enlarged masseter muscles
    • Asymptomatic
      • unilateral or bilateral
  • Inject Masseter Muscle
    • 100 U of BTXA
17
Q

Mandibular Spasm

A
  • Semicontracted or muscle spasms that close jaw
  • Trismus→ Difficulty Eating
    • Masseter M.
      • 25 U
    • Temporalis M
      • 10 U
18
Q

Gummy Smile

A
  • Excess gums
    • due to hyper-fxnal upper lip muscles
      • Nasalis
      • orbicularis oculi
      • levator labii superioris
      • Levator labii superiors alaeque nasi
      • levator anguli oris
      • Zygomaticus major
  • Recommended Dose of BTX:
    • Levator labii superiori & Zygomaticus→ 2.5 U
    • Orbicularis Oculi → 1.25 U
19
Q

Dental Implants and Jaw/Oral Surgery

A
  • Implant failure due to:
    • No osseointegration
    • Parafunctional habits
  • Maxillofacial fractures (Zygomatic & Condylar)
    • require hardware to overcome masticatory muscle forces: prevent callus formation
    • Prophylactic injection: 100 U BTXA
      • bilateral masseter muscle
      • 12-48 before surgery
      • Reduce forces
  • Periodontal Surgery
    • BTX reduce perio trauma due to excessive muscular function
20
Q

Headache and Migraine

A
  • BTX
    • Decrease muscle contraction by
      • prevent ACh release from presynaptic terminal
    • Inhibits neurotransmitter transmission at gamma motorneurons in muscle spindle
      • decreases muscle activity
    • Enter CNS and modulate pain by:
      • inhibit release of substance P from trigeminal nerve endings
    • Reduce parasympathetic outflow
      • leads to analgesia
      • Chronic Headaches
  • Doses of BTX:
    • Headache and migraine:
      • Range: 10-150 U
      • Cluster Headache:
        • 24- 150 U of BTXA or
        • 1200 U BTXB
21
Q

Trigeminal & Postherpetic Neuralgia

A
  • Trigimenal Neuralgia
    • BTX:
      • inhibits:
        • exocytosis of ACh and other neurotransmitters
        • release of NE and ATP from postganglionic sympathetic nerve endings:
          • Analgesic effect
          • Reduces central and peripheral sensitization
    • Dose: 20-50 U
      • trigger zone or masseter m.
  • Postherpetic neuralgia
    • alternate tx modality
    • Dose: 15 U intradermally
      • inhibits release of:
        • formalin-induced glutamate
        • substance P
        • CGRP
      • direct effect: Sensory neurons
        • Indirect effect: CNS
      • Pain decreases to mild & tolerable levels in 1st week
22
Q

Facial Nerve Palsy/paresis

A
  • Paresis=Incomplete Loss of Facial N fxn
    • Paralysis=complte loss
  • Unilateral Palsy
    • affects balance b/w R & L side of face
    • Causes Asymmetry
  • BTXA Dose: 10-80 U
    • intra-muscular
    • contralateral lower facial muscle
      • weakens & restores facial symmetry
    • Side effect: Drooling
23
Q

Salivary Gland Disorders

A
  • BTX
    • block cholinergic parasympathetic secretomotor fibers of salivary gland
    • Tested in:
      • sialorrhea
      • Frey’s Syndrome
24
Q

Retraining Muscles during Ortho Treatment

A
  • prevent relapse of ortho in patients w/stronger muscle activity
    • mentalis m.
  • Reduced intensity of muscle post treatment & overtime
  • retrained to more physiologic movement

Oral Pain (13 decks)

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