Botulinum Toxin – Cosmetic or Therapeutic?

Botulinum Toxin (BTX) is popular for its anti-wrinkle effects, but it is becoming increasingly noted as an adjuvant treatment for head and neck pain.

What is BTX?
BTX is an exotoxin, a chemical, produced by a particular type of bacteria called Clostridium botulinum. It has multiple serotypes, ordered from A to G, with serotype A (BTX-A) being the most readily available.

What is it used for?
Australian Public Assessment Report for Botulinum toxin, type A, was recently published by Therapeutic Goods Administration (TGA). TGA is part of the Australian Government Department of Health and is responsible for regulating medicines and medical devices. Presently, Botox® (Allergan Australia Pty Ltd), is approved for many uses including cervical dystonia (spasmodic torticollis), focal spasticity of upper and lower limbs, prevention of headaches in adults with chronic migraine, among others. Any use for Botox® beyond that listed on TGA is considered ‘Off-label’ and requires special discussion with the client and clinician before considering its use.

How does it work for wrinkles?
It weakens skeletal muscle preventing muscle contractions and hence wrinkles.How does it work for pain?
BTX has been used for its ability to inhibit various neurotransmitters, chemicals that can signal pain. It may reduce pain in the region of injection.

How does it work for clenching and grinding?
As an off-label use, a clinician may use their judgement to suggest BTX treatment in multiple conditions associated with parafunction such as clenching, grinding, pain in jaw, or jaw joint disorders. Primary action would be weakening of muscle and reducing pain.

Is it safe?
BTX is toxic, and due to its toxicity, is used locally and not systemically. It is a naturally occurring toxin and is responsible for clinical syndrome of botulism. The safety data is positive, with no evidence of serious liver toxicity, haematological toxicity, serious skin reaction. There was a rare case of slightly higher incidence of cardiovascular adverse effects with active treatment in an elderly, but the risk was also related to the stress of invasive procedure and associated anaesthetic.

Can I become immune to it?
There is a risk of developing neutralising antibodies, but this reduced when doses are minimal and treatments are separated in time.

To find out more or refer a patient, please contact our friendly team.

Dr Sachin Kulkarni
Orofacial Pain
BOHDSc. (Hons) Grad. Dip. Dent. (Griffith) MANZAOP