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New Albany, IN cosmetic dentist J. Michael Williams facilitates a comprehensive approach to improving patient smiles with Botox and Derma Filler procedures in addition to cosmetic dental treatments.
No one likes the look of wrinkles or sagging skin especially when they mar the look of a smile that has been newly improved by teeth whitening, veneers, implants or other dental procedures.
Cosmetic dentist J. Michael Williams has an answer for his dental patients who want to look their best by minimizing mouth lines, lifting a drooping lip or smoothing the skin of nasal labial folds that may appear even more visible after a dental procedure has improved the look of their teeth.
Williams, who practices in New Albany, IN, said a person’s smile is not only dramatically affected by their teeth, but by the wrinkles, appearance of their lips and folds around their mouths.
That’s why Williams has become a member of the American Academy of Facial Esthetics. He has taken three levels of training offered by the academy and treats patients who express interest in Botox or Derma Fillers, an injectable gel that restores the skin’s volume and smooths wrinkles.
Williams believes in taking a comprehensive approach to helping patients improve their smiles. He has dubbed it a “neck up makeover,” which means that, in addition to improving their teeth, he studies patients’ lips and faces, and might treat them with Botox or Derma Fillers.
He also has built relationships with local hair salons and a nearby Sephora store and refers patients who are interested in getting a new cut or hair color or makeup to complement their new smiles.
Nearly 60 percent of Williams’ patients are women, and often they are open to the idea of the neck up makeover.
“Not all people have an eye or can visualize what hair styles look or colors of makeup look good on them,” he said. “This can help them see the possibilities.”
Williams first tested the idea of doing a neck up makeover for a patient for whom he was providing a new set of dentures. She was in her late 40s, had been taking care of her elderly mother, and had little time or money to spend on her appearance.
“She signed a contact with me that said we’re going to the makeover,” he said. “The contract stated that we were going to let her have some say-so, but we wanted to give her the best look we could.”
He worked closely with the dental lab that made her dentures, and reached out to a hair stylist and cosmetician, both of whom offered their services for free to give the woman a makeover.
Williams took before and after pictures and used them in ads. He also discovered that networking with hair salons and cosmeticians could be a way to build his business – a practice that he has since continued.
“I’m marketing and trying to build a network with them,” Williams said.
He keeps a video of the makeover on a TV in his waiting room, and also has brochures available on Botox and Derma Fillers for patients to look at. He finds that patients increasingly are asking him about their teeth and about what else they can do to improve their appearance.
“I have a lot of patients asking me questions (about cosmetic procedures),” he said. “I’m becoming a lip man. My goal is to become a lip expert.”
He said the skills of cosmetic dentistry transfer easily to those of used doing Botox and dermalfillers.
“In dental school I learned the anatomy of the head and neck better than my friends in medical school did,” he said.
Dentists also are at ease using a needle.
“I have a needle in my hand every single hour of every single day,” he said. “I’m able to provide an experience for a patient where they don’t feel any pain.”
He does all of the Boxtox and Derma Fillers procedures himself unlike at some plastic surgeons’ or dermatologists’ offices where staff other than the doctor may do them.
“I’m not delegating it to a nurse,” he said.
Williams said his training with the American Academy of Facial Esthetics has been extensive, and he now serves as a mentor to others.
“I go to classes where people are learning about Botox and Derma Fillers and help with the hands-on portion of the class,” he said.
When necessary, he will refer a patient to a physician.
“I can’t correct some things,” he said. “Sometimes I need to say, ‘You need to go to a plastic surgeon.’”
Williams said his wife, Jean, first encouraged him to think a bit outside of the box by offering the Botox and Derma Fillers procedures.
“She wanted to do this,” he said. “She wants to look good. She’s first in line to get everything done.”
He said he is fascinated by TV makeover shows, and has focused on being able to understand and provide solutions for the concerns his patients may have about their appearance.
“I believe what’s in a person’s heart is the most important thing,” he said. “But why not look your best?”
Studies find Botox can reduce nighttime bruxism
Studies find Botox can reduce nighttime bruxism
By Rabia Mughal, Contributing Editor, DrBicuspid.com
May 9, 2012 — Botox injections can provide relief to patients who suffer from nocturnal bruxism, or teeth grinding, according to two studies presented last month at the American Academy of Neurology’s (AAN) annual meeting.
Bruxism is probably the most common sleep disorder, occurring in up to 15% of the population, noted researchers from the University of Texas Health Science Center in Houston (UTHSC) who examined the effects of injecting onabotulinumtoxin A (Botox) into patients’ muscles of mastication. There is no established treatment other than bite guards to limit dental damage.
“Dental appliances help prevent tooth damage, but have not been shown to reduce the actual bruxism,” said study author William Ondo, MD, a professor of neurology at the UTHSC, told DrBicuspid.com.
Relaxes the muscles
To test the safety and efficacy of administering Botox injections into the masseter and temporalis muscles of patients with nocturnal bruxism, they conducted a double blind, placebo injection controlled trial with 23 subjects (19 women). Almost all reported temporal-mandibular pain.
This is the first placebo controlled trial of botulinum toxin for bruxism to incorporate sleep data, according to Dr. Ondo. The study was supported by an unrestricted grant from Allergan, makers of Botox.
“This is a very encouraging treatment for a very common problem.”— William Ondo, MDPatients underwent a baseline/screening overnight sleep study. They were then randomized to receive botox or placebo into the bilateral masseter (60u/side) and temporalis muscles (40u/side). Thirteen study participants received the Botox injections, while the other 10 were randomized to placebo.
All the participants were tested four weeks later to determine if the injections had any effect on their bruxism and quality of sleep. The primary efficacy points were clinical global impression (CGI) and visual analogue scale (VAS) of change. The researchers also looked at change in sleep study data, including masseter placed electrodes, pain scales, sleep scales, and adverse events.
They found that CGI (p < 0.05) and VAS of change (p < 0.05) favored the Botox group. There were no significant differences between the two groups on the second scales. Adverse events were limited to two subjects with a cosmetic change in their smile.
The researchers allowed study participants to get open label follow-up injections of Botox. The mean duration to open label follow-up injection was 107 days in those randomized to Botox versus 40 days in those randomized to placebo.
Botox effectively and safely improved nocturnal bruxism in this small pilot trial, but multicenter trials are needed to confirm these results, the study authors concluded.
“Regardless of the etiology of bruxism, it is mediated by muscle contractions that move the jaw,” Dr. Ondo said. “Botulinum toxin simply relaxes/weakens those muscles, so it is not surprising that it was beneficial.”
While larger multicenter trials are needed to confirm these results, “we feel this is a very encouraging treatment for a very common problem,” he added.
Recommended dosage?
This is an exciting study that once again verifies the benefit of Botox injections for dental uses, according to Louis Malcmacher, DDS, president of the American Academy of Facial Esthetics (AAFE). Members of the AAFE have been using Botox for the last few years to successfully treat bruxism, clenching, TMJ syndrome, and facial pain, he added.
The one issue he raised was that Botox dosage should not be standardized.
“The American Academy of Facial Esthetics recommendations for Botox injections in the masseter and temporalis is to start with the lowest dose possible to achieve the desired effects based on the size of the masseter and temporalis muscles, the intensity of contraction, and the symptoms that the patient is experiencing,” he told DrBicuspid.com.
In another study presented at the AAN meeting found that Botox injections can be used in with anoxic brain injury of which severe bruxism is a frequent complication.
The study, which included four female patients between the ages of 23 to 63, was conducted at the Henry Ford Health System. The patients were seen between November 2003 and August 2011.
All four patients received Botox injections in the bilateral masseter and/or temoporalis muscles. Between 50 and 100 units of Botox were injected during each visit.
All patients responded positively to the injections, and there were no reported side effects, according to the researchers.
“Onabotulinumtoxin A injections are an efficacious and valuable treatment for patients with severe bruxism post anoxic brain injury,” concluded the authors.
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This is exciting, wanted to share with all of you!
A small but exciting study presented at the American Academy of Neurology’s annual meeting that found Botox may treat nighttime teeth grinding.
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Study: Oral Cancers Take Financial Toll
April 26, 2012 via DrBicuspid.com by Donna Domino, Features Editor
The cost of treating individuals with oral, orapharyngeal, and salivary gland cancers is significant, particularly for patients who undergo all three forms of treatment, according to a new study by Delta Dental of Michigan’s Research and Data Institute. And for many that is only the beginning of the financial impact of the disease.
The project, which involved Thomson Reuters, Delta Dental of Wisconsin, Vanderbilt University, and the University of Illinois at Chicago College of Dentistry, began in March 2010. It is the first retrospective data analysis of a large number of head and neck cancer patients in the U.S. analyzing direct and indirect costs and comparing those costs to a matched comparison group, according to the authors (Head Neck Onc, April 26, 2012).
Using data from the 2004-2008 Thomson Reuters MarketScan Databases: Commercial Claims and Encounters Database, Medicare Supplemental and Coordination of Benefits Database, Medicaid Multi-State Database, and the Health Productivity and Management Database, the researchers retrospectively analyzed claims data of 6,812 OC/OP/SG patients with employer-sponsored health insurance, Medicare, or Medicaid benefits.
They found that, on average, total annual healthcare spending during the year following diagnosis was $79,151, compared with $7,419 in a group comprising similar patients without these cancers. They also found that the average cost of care almost doubled when patients received all three types of treatment: surgery, radiation, and chemotherapy.
Healthcare costs were higher for oral cancer patients with commercial insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303), and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01), the study found. Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of care, from $96,520 in the Medicare population to $153,892 in the commercial population.
“The results of this research are significant in helping us to fully understand the cost burden of these three particular head and neck cancers on patients and health care providers,” stated Jed Jacobson, DDS, MS, MPH, chief science officer at Delta Dental and a lead contributor to the study, in a press release. “To our knowledge, this is the first study of its kind.”
One of the big problems with oral cancer is that it is uncovered so late in the disease that the chances of survival are terrible, he added.
“So the key is early detection and diagnosis,” Dr. Jacobson said. “In the last decade, we have seen a flurry of activity in new science and technology with the promise of being able to find it earlier. The problem is, should I as a purchaser of healthcare buy this benefit? The answer is often return on investment: if I spend a dollar on this new technology, do I save anything relative to finding the cancer earlier? So we need to know what oral cancer costs.”
Social, psychological, economic impact
The project examined other factors also, including:
• Indirect costs associated with these cancers from diagnosis, treatment, and recovery, such as absenteeism, worker productivity, and the disabling and disfiguring side effects of treatment
• The cost burden of oral cancer on taxpayers who fund Medicaid and Medicare
• The comparative value of preventive care for these oral cancers versus treatment
“Most oral cancers require costly and disfiguring medical intervention, and even then the five-year survival rate is approximately just 60%,” Dr. Jacobson said. “Yet when the cancer is detected early, the survival rate increases to 83%. This study allows us to get a better handle on the cost impact these diseases have and how we can combat them better.”
Head and neck cancers have always piqued the interest of health care providers, patients, and insurers because of the high-morbidity, high cost of care, and high-mortality rates associated with them. Yet, it has largely remained an unexplored area when it comes to research and backing up these conclusions.
“The actual study of the social, psychological, and economic impacts of these cancers has been understudied,” states Dr. Joel Epstein, former professor of oral medicine and diagnostic sciences at the University of Illinois in Chicago, now adjunct professor, director of oral medicine at City of Hope in Duarte, CA. “These are the reasons we decided to conduct this important research and be able to shed more light on the cost burden of treating head and neck cancer.”
By including screening as part of regular dental exams, dentists and hygienists have the opportunity to detect these cancers early, decreasing morbidity and mortality, the study authors noted. In addition, educational programs to raise awareness among health care providers and programs instructing individuals on self-examination may result in earlier detection and greatly reduce the high cost and mortality of oral and head and neck cancers.
“The information [in this study] will be a great asset in determining the cost-effectiveness of any new technologies and early detection systems that could potentially help decrease costs, and more importantly, lower the mortality rate of these cancers down the road,” Dr. Jacobson concluded.
However, while the findings of this study are important, it does not address the additional financial burden many oral cancer survivors face after treatment, noted Brian Hill, executive director of the Oral Cancer Foundation.
“If you look at the financial consequences in this economy, by not finding this disease early, the morbidity associated with treatments is significant,” he told DrBicuspid.com. “But also, treatment is just the beginning of the financial cascade of events. There are larger consequences to the economy. It isn’t just about survival, but other long-term consequences insurance wise, personally, and at the government level also due to long-term disability.”
Botox May Treat Nighttime Teeth Grinding
April 26, 2012 via MyHealthNewsDaily.com
NEW ORLEANS — Botox may help prevent teeth grinding at night, results from a small study suggest.
In the study, patients with nighttime teeth grinding, or nocturnal bruxism, who were given Botox injections reported greater improvement in their condition compared to those given a placebo.
The findings suggest Botox could be used to treat nighttime teeth grinding, a common condition for which there is no established treatment, said study researcher Dr. William Ondo, a professor of neurology at the University of Texas Health Science Center at Houston. Although dental guards are used to prevent damage to teeth, they do not prevent the grinding itself, Ondo said.
However, larger studies are needed to confirm the results, Ondo said. The new study was presented here Wednesday (April 25) at the American Academy of Neurology’s annual meeting.
Nighttime teeth grinding
Up to 15 percent of people experience nocturnal bruxism, though many are unaware they have the condition and find out only when they’re told by their partner or a dentist. Nocturnal bruxism can damage teeth, and has been associated with headaches and pain in the jaw area, Ondo said.
In the study, 23 patients with nocturnal bruxism were randomly assigned to receive a Botox injection or a placebo injection. To be included in the study, patients were tested in an overnight sleep study to confirm they had nocturnal bruxism.
Thirteen people received the Botox injection in the temple and jaw, and 10 received the placebo. Four weeks later, participants rated the severity of their condition – whether they felt better, worse or about the same as before the study. Oftentimes, patients had input from their partners.
Participants who received Botox did not experience significant changes in their sleep patterns, or in the severity of headaches. Two patients experienced a cosmetic change in their smile.
Botox contains botulinum toxin, a protein produced by the bacteria Clostridium botulinum. The drug is thought to work by blocking nerve signals to the muscles, thus relaxing them.
FDA approval?
Botox is not officially approved by the Food and Drug Administration as a treatment for nocturnal bruxism, but because the drug is approved for other uses, it can be used “off label” as a treatment for nighttime teeth grinding. In fact, Ondo said he has been using it in his patients with nocturnal bruxism for 20 years.
If the companies that manufacture botulinum toxin want the drug officially approved by the Food and Drug Administration for treatment of nocturnal bruxism, they would need to conduct their own, large trials to submit to the agency, Ondo said.
The current study was funded with a grant from Allergan, which makes Botox.
Follow MyHealthNewsDaily staff writer Rachael Rettner on Twitter @RachaelRettner.
AHA statement: No causative link found between periodontal disease and heart disease
By Jean Williams, ADA News staff
The scientific evidence does not establish that gum disease causes or increases rates for heart disease or stroke, according to the American Heart Association in a new scientific statement published April 18 online in its journal, Circulation.
The statement is based on the review of more than 500 journal articles and studies, which did not confirm a causative link between periodontal disease and atherosclerotic vascular disease.
The ADA Council on Scientific Affairs agrees with the AHA’s conclusions in the statement, which were drawn by a committee of experts, including dentists, cardiologists and infectious diseases specialists.
“There’s a lot of confusion out there,” said Dr. Peter Lockhart, CSA representative to the AHA committee and co-chair of the writing group that authored the statement. Dr. Lockhart is a professor and chair of oral medicine at the Carolinas Medical Center in Charlotte, N.C.
“The message sent out by some in health care professions that heart attack and stroke are directly linked to gum disease can distort the facts, alarm patients and perhaps shift the focus on prevention away from well-known risk factors for these diseases.”
The writing group, also co-chaired by Ann F. Bolger, M.D., concluded that heart disease and periodontal disease often coincidentally occur in the same person due to risk factors of smoking, age and diabetes mellitus common to both diseases.
Doctors have suspected a causative link between heart disease and gum disease for more than a century. But statements implying a cause and effect relationship between the diseases are “unwarranted,” the statement’s authors said.
Although several studies suggest a stronger relationship between periodontal disease and heart disease, those studies did not account for the common risk factors, noted the AHA statement.
“Much of the literature is conflicting, but if there was a strong causative link, we would likely know that by now,” said Dr. Lockhart. He said that a long-term study would be needed to prove causality but such a study isn’t likely to be imminent.
In addition to sharing risk factors that may lead to the coincidental appearance of the diseases in an individual, periodontal disease and atherosclerotic vascular disease both produce markers of inflammation such as C-reactive protein, the authors noted.
“Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes,” the statement concludes.
View the AHA’s statement “Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?” online.