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      Toxin yet not toxic: Botulinum toxin in dentistry

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          Abstract

          Paracelsus contrasted poisons from nonpoisons, stating that “All things are poisons, and there is nothing that is harmless; the dose alone decides that something is a poison”. Living organisms, such as plants, animals, and microorganisms, constitute a huge source of pharmaceutically useful medicines and toxins. Depending on their source, toxins can be categorized as phytotoxins, mycotoxins, or zootoxins, which include venoms and bacterial toxins. Any toxin can be harmful or beneficial. Within the last 100 years, the perception of botulinum neurotoxin (BTX) has evolved from that of a poison to a versatile clinical agent with various uses. BTX plays a key role in the management of many orofacial and dental disorders. Its indications are rapidly expanding, with ongoing trials for further applications. However, despite its clinical use, what BTX specifically does in each condition is still not clear. The main aim of this review is to describe some of the unclear aspects of this potentially useful agent, with a focus on the current research in dentistry.

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          Human in vivo evidence for trigeminovascular activation in cluster headache. Neuropeptide changes and effects of acute attacks therapies.

          Peter J Goadsby, Lars Edvinsson (1994)
          Cluster headache is a rare very severe disorder that is clinically well characterized with a relatively poorly understood pathophysiology. In this study patients with episodic cluster headache fulfilling the criteria of the International Headache Society were examined during an acute spontaneous attack of headache to determine the local cranial release of neuropeptides. Blood was sampled from the external jugular vein ipsilateral to the pain before and after treatment of the attack. Samples were assayed for calcitonin gene-related peptide (CGRP), vasoactive intestinal polypeptide (VIP), substance P and neuropeptide Y. Attacks were treated with either oxygen inhalation, sumatriptan or an opiate. Thirteen patients were studied of whom 10 were male and three female. All had well-established typical attacks of cluster headache when blood was sampled. During the attacks external jugular vein blood levels of CGRP and VIP were raised while there was no change in neuropeptide Y or substance P. Calcitonin gene-related peptide levels rose to 110 +/- 7 pmol/l (normal: < 40) while VIP levels rose to 20 +/- 3 pmol/l (normal: < 7). Treatment with both oxygen and subcutaneous sumatriptan reduced the CGRP level to normal, while opiate administration did not alter the peptide levels. These data demonstrate for the first time in vivo human evidence for activation of the trigeminovascular system and the cranial parasympathetic nervous system in an acute attack of cluster headache. Furthermore, it is shown that both oxygen and sumatriptan abort the attacks and terminate activity in the trigeminovascular system.
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            BOTULINUM TOXIN

            P K Nigam, Anjana Nigam (2010)
            Botulinum toxin, one of the most poisonous biological substances known, is a neurotoxin produced by the bacterium Clostridium botulinum. C. botulinum elaborates eight antigenically distinguishable exotoxins (A, B, C1, C2, D, E, F and G). All serotypes interfere with neural transmission by blocking the release of acetylcholine, the principal neurotransmitter at the neuromuscular junction, causing muscle paralysis. The weakness induced by injection with botulinum toxin A usually lasts about three months. Botulinum toxins now play a very significant role in the management of a wide variety of medical conditions, especially strabismus and focal dystonias, hemifacial spasm, and various spastic movement disorders, headaches, hypersalivation, hyperhidrosis, and some chronic conditions that respond only partially to medical treatment. The list of possible new indications is rapidly expanding. The cosmetological applications include correction of lines, creases and wrinkling all over the face, chin, neck, and chest to dermatological applications such as hyperhidrosis. Injections with botulinum toxin are generally well tolerated and side effects are few. A precise knowledge and understanding of the functional anatomy of the mimetic muscles is absolutely necessary to correctly use botulinum toxins in clinical practice.
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              Capsaicin-stimulated release of substance P from cultured dorsal root ganglion neurons: involvement of two distinct mechanisms.

              John Purkiss, Mary Welch, Sarah Doward … (2000)
              Capsaicin, the pungent component of "hot" chili peppers, selectively activates a distinct population of primary sensory neurons responsive to noxious stimuli. Many of these fibres express neuropeptides including the tachykinin, substance P. Using cultured dorsal root ganglion neurons, we found that capsaicin (10 microM) stimulated a 2-fold increase in release of substance P in the absence of extracellular Ca(2+). Elevated potassium (75 mM) was unable to induce release under these conditions. The introduction of Ca(2+) enhanced capsaicin-induced release and brought about a robust response to potassium. Preincubation of cells with botulinum neurotoxin A (100 nM) completely blocked potassium-induced release but the capsaicin response, in the absence of Ca(2+), was unaffected. However, toxin treatment dramatically reduced capsaicin-stimulated release in the presence of Ca(2+). It is concluded that capsaicin induces release of substance P from dorsal root ganglion neurons via two mechanisms, one requiring extracellular Ca(2+) and the intact synaptosomal-associated protein 25 kDa (SNAP-25), and the other independent of extracellular Ca(2+) and not involving SNAP-25.
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                Author and article information

                Contributors
                M.S. Archana
                Journal
                Journal ID (nlm-ta): Saudi Dent J
                Journal ID (iso-abbrev): Saudi Dent J
                Title: The Saudi Dental Journal
                Publisher: Elsevier
                ISSN (Print): 1013-9052
                ISSN (Electronic): 1658-3558
                Publication date PMC-release: 21 December 2015
                Publication date (Print): April 2016
                Publication date (Electronic): 21 December 2015
                Volume: 28
                Issue: 2
                Pages: 63-69
                Affiliations
                Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Goa, India
                Author notes
                [* ]Address: Goa Dental College and Hospital, Bambolim, Goa 403202, India. Tel.: +91 0832 22459815, mobile: +91 09845407358, +91 09503947766.Goa Dental College and HospitalBambolimGoa403202India archanam_s@ 123456yahoo.com
                Article
                Publisher ID: S1013-9052(15)00080-2
                DOI: 10.1016/j.sdentj.2015.08.002
                PMC ID: 4957535
                PubMed ID: 27486290
                SO-VID: 12081b6d-42da-4f53-98e7-6df8ec9ab6b0
                Copyright © © 2015 The Author
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 4 April 2014
                Date revision received : 11 March 2015
                Date accepted : 23 August 2015
                Categories
                Subject: Review Article

                Keywords: btx, botulinum neurotoxin,snare, soluble n-ethylmaleimide-sensitive factor attachment protein receptor,snap-25, synaptosomal-associated protein,mpds, myofacial pain dysfunction syndrome,emg, electromyography,tgf-β1, transforming growth factor β-1,acetylcholine,neurotoxin,neurotransmitters,oro-facial disorders
                Data availability:
                Keywords: btx, botulinum neurotoxin, snare, soluble n-ethylmaleimide-sensitive factor attachment protein receptor, snap-25, synaptosomal-associated protein, mpds, myofacial pain dysfunction syndrome, emg, electromyography, tgf-β1, transforming growth factor β-1, acetylcholine, neurotoxin, neurotransmitters, oro-facial disorders

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