Botox: Overview and Applications

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Botox, which is also known as Botulinum toxin (BTX), is a drug (a form of neurotoxic protein) produced by the bacterium Clostridium botulinum and other related species. It can be manufactured commercially for a variety of cosmetic, research, and medical applications. There are two main commercial types–botulinum toxin types A and B. This is the same bacterium linked to the potentially fatal disease known as botulism and exposure in large amounts can be lethal. Here is an overview of Botox and its applications.

Botox injections work by paralyzing, weakening, or immobilizing certain muscles. Moreover, it can also act as a blocking agent on certain nerves. The effects of BTX may last from three to 12 months, depending on the course and location of treatment. The most common side effects are pain, bruising, or swelling at the injection site. Additional side effects that may be encountered include headache, nausea, and flu-like symptoms. Moreover, injections involved in the face may also cause temporary drooping eyelids. Furthermore, patients should not use Botox if they are pregnant, new mothers, or breastfeeding.

Botox is administered locally in therapeutic dental medicinal doses to treat any problem where inappropriate muscle contraction is present, foster controlled muscle relaxation, and relieve the pain associated with conditions such as TMD or TMJ (Temporomandibular Joint Disorders) disease. While the exact cause of TMD is not known, it is believed that injury to the jaw, joint, and/or muscles of the head and neck, as the result of whiplash or trauma, can lead to TMD. Additional causes can also include arthritis in the joint, stress, grinding or clenching of teeth, as well as movement of the soft cushion and/or disc between the ball and socket of the joint.

Medical applications of Botox include treatment for chronic migraines, upper motor neuron syndrome, bruxism (teeth grinding/jaw clenching), focal hyperhidrosis (excessive sweating), strabismus (cross-eyed), and blepharospasm (uncontrolled muscle contraction or twitch of the eyelid). When injected in small doses, Botox can effectively weaken or immobilize a muscle for a short period of time (three to four months). Moreover, it also can be used in the treatment of dystonias and spasms. For instance, Botox has proven effective in the treatment of cervical dystonia, which is a neurological disorder characterized by severe shoulder and neck muscle contractions, as well as conditions such as overactive bladder.

In this overview of Botox and its applications, cosmetic applications of BTX include the treatment of facial blemishes, creases, and wrinkles. While Botox is the most widely recognized brand name of the toxin, there are also other brand names, namely Xeomin, Myobloc, and Dysport. Each of these products vary in some form–particularly in regards to dosage–so they are not interchangeable applications.

Botox may also prove beneficial in alleviating a condition known as gummy smile. Gummy smiles are not the result of oversized gums or small teeth, as some may believe, but rather facial muscles that are too strong. It can be treated via injecting small doses of BTX into five places around the upper lip, or into the band above the chin, so the top lip does not lift as high while smiling.

It is also important to note in this overview of Botox and its possible applications, BTX has been recognized as a potential bioterror agent. This is because it can be absorbed via the mucous membranes, eyes, respiratory tract, and skin. The effects of BTX are readily distinguishable from those involving nerve agents because Botulinum toxin symptoms develop relatively slowly (over several days), while nerve agent effects are generally much more rapid (within minutes) and may be instantaneous. Moreover, evidence also suggests that nerve exposure (simulated by injection of atropine and pralidoxime) will increase mortality by enhancing BTX’s mechanism of toxicity.

While it is the same bacterium linked to the potentially fatal disease known as botulism and exposure in large amounts can be lethal, Botox has a number of positive as well as adverse applications. It can be manufactured commercially for a variety of cosmetic, research, and medical applications. Some of these applications can be very beneficial for patients from a pain management standpoint and other medical uses. As with most drugs and toxins, there are benefits as well as drawbacks associated with its usage.

By Leigh Haugh

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GLV–Leigh Haugh

Mayo Clinic
Migraine Trust
National Institutes of Health

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