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Treating Hyperhidrosis Without Pain

The intense heat we are seeing in most parts of Europe this summer may exacerbate symptoms of hyperhidrosis (excessive sweating). 2% of the population are affected and may feel great discomfort in private and social settings. This condition can affect any part of the body but is usually seen in the axillae (axillary hyperhidrosis), palms (palmar hyperhidrosis) and soles (plantar hyperhidrosis).

Fortunately, hyperhidrosis is easily and safely treated with botulinum toxin (Botox) injections. Botulinum toxin provides longer-lasting results than topical treatments while still being minimally invasive.

While excessive sweating can occur in different areas of the body, the common factor is that toxin injections in these areas are almost always painful. Thanks to innovative technological developments, there is a way to treat hyperhidrosis in a more pleasant way. By using thinner needles and robotically assisted syringes like Juvapen, the flow of injection is slow, consistent and perfectly regulated – making the procedure significantly less painful. Patients have shown strongly increased satisfaction compared to a manual injection. With these techniques, bruising and swelling, especially in the axillary zone, have been reduced to a minimum.   

How to ? 

For treating axillary hyperhidrosis, 50 units of toxin per armpit, subdivided into 25 subdermal injections of 2 units is recommended. For palmar hyperhidrosis a treatment of 50U to 100U is recommended. Depending on the size and extent of plantar hyperhidrosis, approximately 40-60 injections of 80 to 120U is recommended. The onset of effects commences 2-4 days after the treatment, peaking about two weeks after. Effects last between six to eight months.  

Sources:

Image: Hagerstown. n.d. What It’s Like to Get Botox for Sweating – Hagerstown. [online] Available at: <https://www.hagerstownderm.com/botox-sweating-hagerstown/> [Accessed 27 July 2022]. 

Doft, M., Hardy, K. and Ascherman, J., 2012. Treatment of Hyperhidrosis With Botulinum Toxin. Aesthetic Surgery Journal, 32(2), pp.238-244. 

Healthline. n.d. Botox for Sweating: How It Works, Cost, Targeted Areas, and Risks. [online] Available at: <https://www.healthline.com/health/botox-for-sweating> [Accessed 25 July 2022]. 

Scamoni, S., Valdatta, L., Frigo, C., Maggiulli, F. and Cherubino, M., 2012. Treatment of Primary Axillary Hyperhidrosis with Botulinum Toxin Type A: Our Experience in 50 Patients from 2007 to 2010. ISRN Dermatology, 2012, pp.1-5. 

Heckmann, M., 2005. Low-Dose Efficacy of Botulinum Toxin A for Axillary Hyperhidrosis. Archives of Dermatology, 141(10), p.1255. 

Toxin Injections: The Most Effective Treatment for Bruxism?

Several new applications of botulinum toxin for therapeutic purposes have recently been proven effective. While some are still considered off-label, new market authorizations are growing, with the recent example of France just approving Botox® for new therapeutic purposes.  

Image: Sleepmedres.org. n.d. [online] Available at: <https://www.sleepmedres.org/m/makeCookie.php?url=/m/journal/view.php?number=116>

One of the common conditions which toxin can help treat is bruxism. Tan et al, (2000) first postulated that toxin was safe and effective in the treatment of severe bruxism through the reduction of muscular activity. In recent years, this notion gained much significance; multiple studies have been conducted to test and understand the efficacy of toxin on bruxism.  

What is Bruxism?

Bruxism is a condition of repetitive activity of the masticatory muscles causing a patient to grind or clench their teeth. Bruxism manifests itself into two categories: awake bruxism and nocturnal bruxism where the patient clenches their teeth in their sleep. Bruxism can often be severe, leading to jaw disorders, migraines or damaged teeth, and abnormalities of the orofacial structure.  

Treatments for Bruxism

Treatments for bruxism include addressing the perceived underlying causes such as stress and anxiety. This is done through practising relaxation techniques and improving sleep. Furthermore, it is recommended that patients avoid smoking and drinking, and eating hard foods or chewing gum in the case of tooth or jaw pain. Various clinical drugs have been investigated in their efficacy in alleviating bruxism symptoms, but have been shown to not be entirely effective. In fact, the recommended modalities of treatment have not been proven to be entirely effective as they do not solve the problem, instead aiding in the management of symptoms. 

Toxin for Bruxism

The positive impact of toxin on bruxism occurs when toxin acts on the neuromuscular junction. This reduces the contraction of the muscle, lowering biting pressure up to 20%-30%.  Furthermore, a reduction of up to 30% of the masseter muscle can be expected. To address bruxism, the injection should occur around 1.5 cm from the lower border of the mandible. Injecting into facial nerves should be avoided. Literature provides evidence that 20-30 units injected on each side are efficient. Each mandible should be injected three to five times with 5 to 10 BU (Botox dosage) per injection. Nonetheless, a standardized dosage does not yet exist. 

A 2019 peer review of 68 studies found that toxin injections successfully reduce the frequency of episodes and decrease the maximum occlusal force generated, thus decreasing original symptoms. The authors further claim that toxin is a safe and effective treatment for patients with bruxism, especially in patients with severe bruxism.  However, the therapeutic effect on the masseter muscle comes into effect only about three weeks after treatment.  

Aside from treating bruxism, injecting toxin in the masseter muscles has the alternative effect of slimming and contouring the lower face. The toxin inhibits the clenching of the jaw, thus, transforming a square jaw into a more oval, feminine shape. 

Juvapen Expert for Bruxism

It is especially important that the practitioner masters the injection technique when treating bruxism as the wrong depth or location might result in an injection into the facial nerves potentially leading to chewing and talking disorders. With Juvapen Expert administering the exact dosage, the practitioner can focus its attention solely on technique to ensure a concise treatment.  

Juvapen Expert, video credit: Dr Munir Somji, UK

Mayo Clinic. 2022. Bruxism (teeth grinding) – Symptoms and causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/bruxism/symptoms-causes/syc-20356095#:~:text=Bruxism%20(BRUK%2Dsiz%2Dum,a%20sleep%2Drelated%20movement%20disorder.> [Accessed 12 July 2022]. 

Kwon, K., Shin, K., Yeon, S. and Kwon, D., 2019. Application of botulinum toxin in maxillofacial field: part I. Bruxism and square jaw. Maxillofacial Plastic and Reconstructive Surgery, 41(1).

Fernandez-Nunez, T., Amghar-Maach, S. and Gay-Escoda, C., 2019. Efficacy of botulinum toxin in the treatment of bruxism: Systematic review. Medicina Oral Patología Oral y Cirugia Bucal, 24(4), pp.416-424.

Asutay, F., Atalay, Y., Asutay, H. and Acar, A., 2017. The Evaluation of the Clinical Effects of Botulinum Toxin on Nocturnal Bruxism. Pain Research and Management, 2017, pp.1-5. 

nhs.uk. n.d. Teeth grinding (bruxism). [online] Available at: <https://www.nhs.uk/conditions/teeth-grinding/> [Accessed 12 July 2022]. 

Kwon, K., Shin, K., Yeon, S. and Kwon, D., 2019. Application of botulinum toxin in maxillofacial field: part I. Bruxism and square jaw. Maxillofacial Plastic and Reconstructive Surgery, 41(1). 

Dalmedo, V., 2017. Management of masseter hypertrophy and bruxism with Botulinum Toxin A. [online] The PMFA Journal. Available at: <https://www.thepmfajournal.com/features/features/post/management-of-masseter-hypertrophy-and-bruxism-with-botulinum-toxin-a> [Accessed 13 July 2022]. 

TAN, E. and JANKOVIC, J., 2000. TREATING SEVERE BRUXISM WITH BOTULINUM TOXIN. The Journal of the American Dental Association, 131(2), pp.211-216. 

Events & Congresses: where to meet us this June

• IMCAS World Congress in Paris from June 3rd to 5th (booth MB35, Level 2)

• FACE Conference in London from June 17th to 18th (booth 3)

• Botulinum Toxin Summit in Corsica from June 17th to 18th

Traditional syringe vs. Dentapen, a clinical trial

There is a constant search for new techniques to avoid the invasive and painful nature of injections. This paper shows how spectacular pain reduction is achieved with the new Dentapen. Patients were asked to rate the level of pain experienced during the injections. Read the full paper by following this link.

Fernández-Castellano, E.R.; et. al. Pain Experienced during Various Dental Procedures: Clinical Trial Comparing the Use of Traditional Syringes with the Controlled-Flow Delivery Dentapen® Technique. Medicina 2021, 57, 1335. https://doi.org/10.3390/medicina57121335

Going to AMWC ? We’ll see you there

Join us in Monaco starting March 31 to learn from the best in the game and see the industry’s latest trends. We would like you to join us at booth G16 (Diaghilev hall) during this year’s Anti Ageing Medicine World Congress. Discover Juvapen Expert and the upcoming Fillersafe in a world exclusive.

How do you guarantee less painful injections ?

The Pitié Salpêtrière Hospital in Paris recently led a study on the pain experienced with botulinum toxin injections. 60 patients with facial palsy have been separated in two groups: 30 patients in the Juvapen group and 30 patients in the standard technique group. Authors have concluded that Juvapen is a less painful injection technique than the standard technique. Read the full study or extract by following this link.

Retrograde injections with Juvapen

What is the retrograde injection technique ?
When injecting toxin, it has been clinically proven to allow optimal muscle response. Authors have used a robotic syringe, Juvapen, in order to perform this advanced technique. A new way to inject in aesthetics ! Find out more by reading the full paper on PubMed.

Featured in The Telegraph

London, October 2021. Would you get botox by a robot?

“The drawback to injecting with a traditional syringe is that the doctor has to watch the graduation of the syringe to know how much is being injected, while concentrating on the needle depth and site of injection. The Juvapen Expert automatically controls the dose so there’s less room for error. This new technology is particularly useful for micro-dosing, an increasingly preferred method for a natural-looking effect.”

Meet the world’s first robotic syringe designed to prevent ‘botched Botox’

https://www.telegraph.co.uk/beauty/skin/would-get-botox-robot/

IOL robotics unveiled at the 2021 ESCRS

The European Society of Cataract & Refractive Surgeons’ 39th Congress will see the unveiling of our latest robotic technology. Join us in Amsterdam starting October 9th to witness it firsthand.

IDS: save the new date

The world’s leading trade fair for the dental sector will be taking place 22-25 September in Cologne. Our team is excited to physically meet dentists and industry partners from all over the world! Find us in hall 3, booth E 021 and discover the new Dentapen, now delivering improved intraligamentary injections.