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Overview
Recent articles from The New York Times  , WebMD , and Health Day News report that Botox (botulinum-A neurotoxin) may be effective in treating patients with trigeminal neuralgia, based on the findings of a small, unblinded pilot study in the October 25 issue of Neurology. 1
Trigeminal neuralgia, or tic douloureux, is an intense facial pain caused by irritation of the trigeminal nerve, a cranial nerve with sensory branches that pass through the face and jaw. Current treatment options for trigeminal neuralgia include anticonvulsant medications such as carbamazepine (Tegretol) or phenytoin (Dilantin), which are not always effective and have side effects, and surgical interventions.
In the published study, a Brazilian and American research team investigated the therapeutic use of Botox in 13 patients with trigeminal neuralgia. Ten days post-treatment, the patients reported significant reductions in pain and most were reportedly symptom-free after 20 days. Sixty days after treatment, four patients no longer required preventive medication, and the others had their medication reduced by more than half.
Although the results of this pilot study are promising, large-scale randomized clinical trials on the therapeutic use of Botox for trigeminal neuralgia are needed to confirm the results, determine the duration of the effects, and more carefully assess any adverse events. As noted by the study authors, a placebo-controlled clinical trial is required to confirm their results. This is consistent with the findings of a recent systematic review, which identified no randomized controlled trials in this area and presented no definitive conclusions on administering Botox for the treatment of rare head and neck pain syndromes. 2
The ADA has not taken a specific position on dentists administering Botox; however, a number of state dental boards have or are in the process of developing policy for its use. All dentists who are considering using Botox for treatment of dental conditions should consult their state dental board to determine if this falls within the scope of practice in their respective state and, if so, what specific requirements are necessary.
Endnotes
1 Piovesan EJ, Tieve HG, Kowacs PA, Della Coletta MV, Werneck LC, Silberstein SD. An open study of botulinum-A toxin treatment of trigeminal neuralgia. Neurology 2005;65:1306-1308.
2 Sycha T, Kranz G, Auff E, Schnider P. Botulinum toxin in the treatment of rare head and neck pain syndromes: a systematic review of the literature. J Neurol. 2004 Feb;251 Suppl 1:I19-30.
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The Journal of the American Dental Association
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Science in the News is a service by the American Dental Association (ADA) to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.
Document Posted November 2005
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(“Nip/Tuck” section)
