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Medical Forum / General / Dentistry / March 2007Seeking TMJ Dentist who uses Botox in the Wash DC metro area
Need recommendation Seeking TMJ Dentist who uses Botox in the Wash DC metro area Why Botox? What treatments have you tried and with what level of success? Steve > Need recommendation > Seeking TMJ Dentist who uses Botox in the Wash DC metro area > Why Botox? > [quoted text clipped - 4 lines] >> Need recommendation >> Seeking TMJ Dentist who uses Botox in the Wash DC metro area Splints with no success Probably not an NTI though.....right? 'horseshoes' just don't measure up. :-) Steve > Splints with no success > Probably not an NTI though.....right? > [quoted text clipped - 4 lines] > > > Splints with no success There are some cases that are responding well to a combination of NTI and Botox injections. This is probably something that should/could be discussed here in smd. As for success with Botox alone? I don't know about that but I'm sure someone out there does. Webby With most cases, I still think the NTI should come first. If that isn't enough, then add the botox. Of course Jim and a few others may be able to recognize patients that need both from the start. I wouldn't be able to separate those cases without trial and error (plus I'm not trained to use Botox anyway). Steve > There are some cases that are responding well to a combination of NTI > and Botox injections. This is probably something that should/could be > discussed here in smd. As for success with Botox alone? I don't know > about that but I'm sure someone out there does. > > Webby Steve, The issue of using Botox comes down to several factors. The first being it's use for treating TMD's (trigeminally mediated disorders) is an off-shelf use and is not going to be covered by any form of insurance that I am aware of. So it's strictly a cash expense out of pocket for the patient. The going rate is somewhere around 12.50$ USD per unit. Typically the patient would have 20 to 50 units injected in each side of the temporalis and 10 to 50 units on each side of the masseter. So you can see the expense can be high, but the results are indeed substantial. You would not want to treat a patient without proper parafunctional control, and when you combine these two therapies the results are truly significant. The second is training and certification. We just held a one day Botox® Dental course here in San Diego, taught by Andrew Blumenfeld, MD- the worlds leading expert in the use of botulinum toxin and so training is available. I would be happy to offer more to this discussion as I am able, but we're quite busy following our wrap-up (we also held a two-day ABC's of TMD's with Dr's Boyd & Glassman). Steve drop me an e-mail if this type of course might interest you. We have many courses scheduled throughout this year in various cities across the US and we will be adding some more to the calendar once we can make some decisions on cities/dates. TD > With most cases, I still think the NTI should come first. If > that isn't enough, then add the botox. [quoted text clipped - 13 lines] >> >> Webby > Steve, > [quoted text clipped - 3 lines] > am aware of. So it's strictly a cash expense out of pocket for the patient. > The going rate is somewhere around 12.50$ USD per unit. It was my understanding that Medicare *might* pay for part of this expense. And having said that, it is also my "understanding" that if Medicare pays for something, the traditional insurance also will. I also "understand" that this probably has something to do with who delivers the care. I'm thinking that "who" delivers the care probably needs to be someone "certified". Is this the case? Webby > Typically the patient would have 20 to 50 units injected in each side of the > temporalis and 10 to 50 units on each side of the masseter. So you can see [quoted text clipped - 32 lines] > >> > >> Webby I only know that to use botox for TMD's and migraine it is an off-label use. I will research the matter and see if I can find any additional info. >> Steve, >> [quoted text clipped - 62 lines] >> >> >> >> Webby >I only know that to use botox for TMD's and migraine it is an off-label >use. [quoted text clipped - 69 lines] >>> >> >>> >> Webby Who in the DC are does this? > >I only know that to use botox for TMD's and migraine it is an off-label > >use. [quoted text clipped - 71 lines] > > > Who in the DC are does this? The idea of a "TMJ Dentist" is somewhat disturbing. And the idea of a "TMJ Dentist" using Botox for "TMJ" is a big red flag until proven otherwise. What to you want the Botox to "treat"? Webby >I only know that to use botox for TMD's and migraine it is an off-label >use. [quoted text clipped - 69 lines] >>> >> >>> >> Webby Who in the DC are does this? > Probably not an NTI though.....right? > [quoted text clipped - 4 lines] > > > Splints with no success I have seen one case that responded well to botox...with relief from symptoms for about 4 months with each series of injections. This prompted me to read up, and I found results are mixed, but the positive results seem to outweigh the negative. I don't believe the FDA has approved the use of Botox for TMJ treatment, but there are some good results. That said, I might opt for a go with an NTI or at the very least, care with another doc before trying injections. Not a knock against prior care, but there are many varied approaches to TM therapy, so a couple of tries with different docs may be a good plan. T > > Why Botox? > > [quoted text clipped - 6 lines] > > Splints with no success Hmmm. I know who to ask. Webby In article <tmjiatroepidemic-4D4954.07205025022007@news.phx.highwinds-media.com>, > > > Why Botox? > > > [quoted text clipped - 10 lines] > > Webby So..... I asked. And I was told that a post concerning Botox and dentistry will be forthcoming asap! Now that's service ... and with a smile no less!!! Webby > In article > <tmjiatroepidemic-4D4954.07205025022007@news.phx.highwinds-media.com>, [quoted text clipped - 19 lines] > > Webby An interesting question. I cannot personally recommend anyone in the DC area as I don't know of anyone. Buddy Luv are you willing to travel if necessary? And by travel, I mean California? Because this is a complicated subject I will need to time to prepare a post. I don't have time this morning, but I will get to it this afternoon. TD > > In article > > <tmjiatroepidemic-4D4954.07205025022007@news.phx.highwinds-media.com>, [quoted text clipped - 28 lines] > > TD I don't know where the OP went. But I would like to see some up to date info on the subject of the NTI and Botox as a treatment. W. >> > In article >> > <tmjiatroepidemic-4D4954.07205025022007@news.phx.highwinds-media.com>, [quoted text clipped - 34 lines] > > W. NTI & Botox: One way to measure results of parfunctional control with and without adjunctive botox is by using JVA (joint vibration analysis). I am going to reference the results of one case. The patient was asked to clench as hard as they could "without" an NTI in place in the three bursts with the results being measured in microvolts of temporalis and masseter activity. Without NTI: R-Temporalis - 207.3 mv L-Temporalis - 153.9 mv R-Temporalis - 144.1 mv L-Temporalis - 271.4mv With NTI: R-Temporalis - 42.3 mv L-Temporalis - 67.6 mv R-Temporalis - 50.1 mv L-Temporalis - 126.3 mv With NTI and Botox-A: R-Temporalis - 16.4 mv L-Temporalis - 3.3 mv R-Temporalis - 21.0 mv L-Temporalis - 23.8mv Typically we see a 75% reduction of microvolt emg on a patient with proper parafunctional control, and as you can see by the numbers above this was pretty close to that, if not better. With the addition of botox injections you can see the added benefit. A patient at rest usually has about 2.0mv of temporalis activity. Now if you would like to use this as a model to ask additional questions I will be happy to answer as best I can. TD |
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