Botulinum Toxin Therapies for Orofacial Pain and Dental Esthetics
Advantages, Disadvantages, Contraindications and Side Effects

As with any other drug, there are certain advantages, disadvantages, contraindications, precautions and side effects that must be considered with the use of BTX.

The following are advantages of BTX use:^6,10

• Minimally invasive
• Psychological benefit to the patient

The following are disadvantages of BTX use:⁶

• Short-term solution
• Asymmetrical/unnatural appearance due to improper injection technique
• Cost
• Possibility of viral disease transmission due to human albumin

The following are contraindications/precautions for use of BTX:^2,3,4,7

• Sensitivity to any botulinum toxin, human albumin, or saline solution
• Pregnant women and nursing mothers
• Children under 12 as it could impact nerve growth
• Neuromuscular disorders such as myasthenia gravis or muscular dystrophy
• Patients with impaired hemostasis or taking aspirin therapy
• Cardiovascular disorder
• Pre-existing infection at the injection site
• Skin infections such as eczema or psoriasis
• Those taking aminoglycoside antibiotics, quinine, chloroquine or calcium channel blockers as these may potentiate the effect of BTX therapy
• Emotionally disturbed individuals especially after the age of 65

The following are side effects of BTX use:^2,3,4

• Systemic effects:
  • Anxiety
  • Dizziness
  • Drowsiness
  • Nausea
  • Sweating
  • Fever/chills
  • Allergic reaction like rash or hives
  • Headache
  • Pharyngitis
  • Dysphagia
  • Facial pain
  • Flu-like symptoms
  • Hoarseness
• Local effects:
  • Pain
  • Redness
  • Tingling
  • Weakness
  • Bruising
  • Swelling
  • Tenderness
  • Bleeding
  • Muscle atrophy, especially with long-term use