Procedures
&
Expectations
TMD: Temperomandibular disorder
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Manifests with facial pain, joint sounds, and headaches.
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A muscle relaxant applied into the muscles of mastication
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Viable alternative to invasive procedures
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The clenching effect can be reduced
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A small percentage of force is used for chewing, essentially no effect on this (Nayyar, Kumar, Nayyar, & Singh 2014)
Aesthetic Concerns:
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For gummy smiles, nasolabial folds, to create proportion
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Can be used for lip deformities
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Fillers can be injected into interdental papilla to fill the space
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Usually lasts roughly 8 mos +(Nayyar, Kumar, Nayyar, & Singh 2014)
Bruxism:
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Injection directly into temporalis and masseter muscles
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Roughly 100 units can be administered
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Has been proven successfully on a patient with a brain injury and severe bruxism (Nayyar, Kumar, Nayyar, & Singh 2014)
Dental Implants:
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Injection into the masticatory muscles
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For therapeutic and to allow proper osteointegration
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This reduces overloading of dental implants (Nayyar, Kumar, Nayyar, & Singh 2014)
Masseteric Hypertrophy:
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Masseteric hypertrophy results in a swollen jaw or misshapen
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30 units per side into the masseter muscle
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Reduction approximately 30%
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3 injection sites into the masseter (Nayyar, Kumar, Nayyar, & Singh 2014)
Oromandibular Dystonia:
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Involuntary spasms
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Distorted oral position and function
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Difficulty speaking, swallowing, eating
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Improvement with injection of botulism type A into the masseter
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Roughly 65% increase in functions (Nayyar, Kumar, Nayyar, & Singh 2014)
Pre-Procedure Preparation:
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Can come in sterile units
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Can come in vacuum dried powder that is mixed with sodium chloride prior to injection
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Preferred syringes are 1.0ml
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Gauge preference is between 26-30
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Used within 4 hours
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Starting with a small dose and work upwards as needed
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Muscles should not be paralyzed entirely
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Males generally require a larger dose
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Temporary relief and symptoms can return (Srivastava, Sanjeev, Kharbanda, Smriti, Pal, Shah, and Vinit 2015)