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Botox and Dermal Fillers

What happens to the facial areas around the mouth as people age? If dentists do an amazing job of giving people young, healthy and beautiful looking teeth while ignoring the bigger picture, we would be limiting our esthetic potential. The bigger picture is to extend our work from an intraoral perspective to a connection with facial aesthetics. Dentists are more familiar with this connection than any other healthcare practitioner.

Botox and dermal fillers are commonly used to soften the perioral areas and other parts of the face, giving them a fresher, more juvenile look. They provide a perfect harmonization with esthetic dentistry and can help make that smile shine more.

Dentists are more familiar with this connection than any other health care practitioner.

Botulinum toxin

Botox (trade name) is injected into the facial muscle, affecting and blocking only the neurotransmitters between the motor nerves that innervate the muscle. That means there is no loss of sensory feeling while paralyzing the muscle’s ability to contract the dynamic motion that causes wrinkles and pathological muscle movements.  

The most common areas for soothing wrinkles are the forehead, between the eyes or glabellar region, around the corners of the eyes — “crow’s feet” — and radial lip lines.

Botox is a minimally invasive procedure that has also shown medically therapeutic uses in muscle-generated dental diseases such as temporomandibular disorders (TMD), pathological clenching, masseter hypertrophy, bruxism (teeth grinding), difficulties adjusting to dentures, high lip line or “gummy smile” and orthodontic cases where facial muscle retraining is necessary.

TMD can be treated with intraoral appliances, occlusal adjustments, dental restoration, or surgery. All are invasive, irreversible, and expensive procedures, making Botox a common treatment due to its benefits and costs. 

For some esthetic procedures, conservative restorations may not withstand parafunctional forces such as clenching or grinding being continually applied. So unless the parafunction can be eliminated, they are considered inadvisable for patients with bruxism or pathological clenching. Since botulinum toxin can reduce the muscles’ parafunction enough to reduce the bruxing without affecting normal chewing, it’s an esthetic procedure available to patients with these conditions. 

One of the most challenging esthetic problems is known as “black triangles,” caused by food particles accumulating in the spaces between teeth. Botulinum toxin can be applied to the papills closing the interdental space. This treatment lasts about eight months or longer before having to be reapplied. 

Dermal fillers 

Hyaluronic acid (trade names Restylane® and Juvéderm®) and calcium hydroxylapatite fillers (Radiese®) are used as dermal fillers. They plump up or add volume in facial areas that have lost collagen and fat, such as deep nasolabial folds (laugh lines), oral commissures (sagging skin around the mouth), lips and marionette lines. 

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