Botulinum neurotoxin Type A (BTX) is the most commonly used form of a purified exotoxin protein produced by Clostridium botulinum, which is a Gram-positive, rod-shaped, spore-forming and strictly anaerobic bacterium. Botulinum toxin, however, can also be produced by Clostridium butyricum and Clostridium baratii. All three Clostridium bacteria are commonly found on plants and in soil, water and animal intestinal tracts. They are the same organisms that cause the food poisoning known as botulism. The Type A toxin is one of seven toxins produced by different strains of the bacterium and one of the two serotypes commercially available and approved by the FDA for human use.1,2,3 Type A is the most popular as there is less pain associated with the injection and has a slower onset of action with a longer paralysis.4 Botulinum neurotoxin Type B is also available and is only approved for use in cases of cervical dystonia.5 Cervical dystonia is also known as spasmodic torticollis, a rare neurological disorder characterized by involuntary muscle contractions in the neck that cause abnormal movement and postures of the neck and head. Type F is used only for patients who are resistant to serotypes A and B.3,4 BTX has transient, nondestructive, dose-dependent and localized actions, with minimal systemic side effects. Due to those characteristics, BTX is experiencing increased use in dentistry.2
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