Undoubtedly, aesthetics has gained a prominent place in our society. The dentist responsible for returning the smile to his patients has been directly involved in the responsibility of satisfying that need.
Once again dentistry has in its hands new tools to broaden the spectrum of action.
Botulinum toxin and hyaluronic acid are substances usually associated with their aesthetic effects, although they also have very interesting therapeutic applications when considering a dental treatment plan.
Hyaluronic acid
Hyaluronic acid is a natural polymer, it is a group of polysaccharides present in the connective tissue of vertebrate beings called glycosaminoglycans. It can be found in the human body in connective tissue, in synovial fluid in the skin, and in the aqueous and vitreous humor.
It can also be found in the lungs, brain and muscles, in lower concentrations in the liver and blood plasma.
The application of this product provides filling and hydration to the tissues. It is used to treat atrophic scars, small skin defects and improves facial contour. It is an ideal substance because with a minimal application it has a long-lasting result.
The material is organic and totally resorbable. The effect is immediate, its average duration is 6 months to 1 year.
Applications in Dentistry:
– lip filler
– Mental sulcus filler
– Increased lip volume
– Filling scars
– Filling perioral wrinkles
– Reposition of commissures
– papilla filling
– Increased volume of the gingival margin
It often complements orthodontic treatments where it is not possible to obtain an adequate closure of the lips, or oral rehabilitation when, despite having achieved correct dental function, the frame of the smile does not accompany with adequate harmony.
Collateral damage
Complications from the use of hyaluronic acid-based fillers can occur due to lack of experience, incorrect technique, or the product itself.
Side effects can be divided into early or late.
Early Side Effects
Erythema or edema: it is generally an immediate response and occurs due to the response to the injury and the hydrophilic properties of the product, due to the density of the product or due to incorrect placement on the skin.
Ecchymosis: occurs due to the perforation of small vessels at the application site. There will be a risk of increased bleeding if there is perforation of deeper vessels.
Necrosis: It is a rare complication but there are cases that occur due to accidental placement in the artery.
There are registered cases with the application of hyaluronic acid in the glabella area and nasolabial region.
Infection: it is not a very common adverse effect, but it can occur due to improper technique. It can be caused by bacteria or viruses.
There is a reported case of infection where the product or the application site was contaminated with mycobacterium chelanae (Rousso Pitman 2010).
Nodules: usually observed in short or medium terms, whitish papules appear. It happens most of the time due to poor application technique. The skin may take on a bluish color. In general, remission is spontaneous.
Late Side Effects
Granuloma: it has a very low incidence and occurs between 6 and 24 months after application. For treatment, hyaluronidase can be used in a concentration of 50U/ml.
If it does not remit, the indication is its surgical removal.
Allergic reactions: the incidence of allergic appearance is 0.1%. The appearance can be between 3 and 7 days later, clinically edema erythema appears, hyperemia in the course of application.
Botulinum toxin
Botulinum toxin has been known in medicine since 1973 in primates. In the late 1970s it was introduced as a therapeutic agent for the treatment of strabismus. Since then, therapeutic applications have been expanded in different fields.
Ophthalmology: where it is used in cases of blepharospasm associated with facial dystonia. This is a therapy that is 90% successful.
Aesthetic: It is extremely effective in the combination of other aesthetic modalities, such as dermal filler, laser, peeling and surgery.
Hyperhidrosis: hyperhidrosis, mainly in the armpits, palms, feet and face, is one of the most common conditions treated with botulinum toxin. Effectively reduces sweating without major side effects and improves quality of life.
Hyperhidrosis: hyperhidrosis, mainly in the armpits, palms, feet and face, is one of the most common conditions treated with botulinum toxin. Effectively reduces sweating without major side effects and improves quality of life.
Headache: Botulinum toxin has been extensively studied for headaches and migraines. The pains do not disappear but the duration and frequency decrease considerably.
Urology: Another indication for botulinum toxin is overactive bladder, which affects approximately 16% of men and 17% of women in the United States. It improves considerably by decreasing the activity of the neurogenic detrusor muscle, reducing incontinence. They are also considered as effective therapy against BPH benign prostatic hyperplasia, without any systemic side effects.
In the medical field, it is known for its effective treatment to eliminate the expression of aging.
It is a protein, derived from the bacterium Clostridium Botulinum. Its action is to block nerve endings, prevents the release of acetylcholine and thus muscle contraction. The muscle relaxes because it undergoes denervation. The effect takes 2 to 4 days to appear, reaching its maximum expression after 15 days of application. This action is reversible, its effect lasts from 3 to 6 months
Studies show that botulinum toxin type A has the possibility of therapeutic use in dentistry in areas related to the oral cavity and face. Most studies show that the effects are mostly beneficial.
The dentist has knowledge about head and neck structures because he must treat pathologies of the face and oral cavity conservatively and know the use of botulinum toxin.
The cosmetic procedures are optional, improving the final results of the treatments, but the therapeutic ones are necessary to apply, otherwise the preservation of the stomatognathic system is omitted.
Applications in Dentistry:
– gummy smile
– Bruxism
– Sialorrhea
– Facial asymmetry
– Elevation of commissures
– orofacial pain
– Wrinkles around the mouth
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The middle and lower third of the face have a significant number of muscles. The anatomy must be deeply understood and low doses applied. Plan the execution perfectly and in small steps. The points may be asymmetrical for the correction of gummy smile associated with the action of botulinum toxin.
Conclusion:
The aesthetic and therapeutic results obtained with the application of botulinum toxin and hyaluronic acid on the face are beneficial for multiple specialties in dentistry.
Its use requires adequate training, and knowing its scope must be considered in the treatment plan. There is currently a vast bibliography that supports the results.