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Does Botulinum neurotoxin type A treatment for sialorrhea change oral health?

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Abstract

Objectives

Botulinum neurotoxin type A (BNT-A) intrasalivary gland injections in patients with neurological disorders have been known to effectively treat hypersalivation. However, oral health can be compromised with increasing the dose. The aim of this study was to find out the therapeutic effect of low-dose, ultrasonography-controlled BNT-A injections into the bilateral parotid and submandibular glands on oral health in the treatment of sialorrhea.

Material and methods

Twenty patients diagnosed with Parkinson’s disease (PD), amyotrophic lateral sclerosis (ALS), and other neurological disorders, including stroke or birth trauma, received BNT-A injections with salivary tests before and 1 month after the injections. Drooling was evaluated using subjective scales and objective assessment of salivary flow rate and oral health (salivary composition and cariogenic bacterial counts).

Results

A significant decrease was found in salivary flow rate at 1- and 3-month follow-up in the BNT-A treated group. There was no significant change in salivary composition or cariogenic bacterial counts.

Conclusion

BNT-A injections according to the current protocol can effectively manage sialorrhea while maintaining oral health.

Clinical relevance

Oral health can be considered the mirror of general human health, as the cause of many diseases. Saliva plays a crucial role in protecting the oral cavity. The present study is of high clinical relevance because, although earlier research has proved the effect of Botulinum neurotoxin type A injections on reduction in saliva flow, data about the risks of the treatment method to the oral condition through affecting saliva composition has so far been missing.

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Authors roles

The study was conceived and designed by Janne Tiigimäe-Saar, Pille Taba, and Tiia Tamme. Acquisition, analysis, and interpretation of the data were performed by Janne Tiigimäe-Saar. Critical revision of the manuscript was made by Pille Taba and Tiia Tamme.

Author information

Authors and Affiliations

  1. Department of Maxillofacial Surgery, Tartu University Hospital, Puusepa 8, Tartu, 51014, Estonia

    Janne Tiigimäe-Saar & Tiia Tamme

  2. Department of Stomatology, University of Tartu, Puusepa 8, Tartu, 51014, Estonia

    Janne Tiigimäe-Saar & Tiia Tamme

  3. Department of Neurology and Neurosurgery, University of Tartu, Puusepa 8, Tartu, 51014, Estonia

    Pille Taba

Authors
  1. Janne Tiigimäe-Saar
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  2. Pille Taba
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  3. Tiia Tamme
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Corresponding author

Correspondence to Tiia Tamme.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

The study was supported by grant 3.2.1001.11-0017 of the EU European Regional Development Fund and by grant IUT2-4 of the Estonian Research Council (ETF 9255 2012–2015).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. (State Agency of Medicines reference number is 15-024. Research Ethics Committee of the University of Tartu Protocol nr is 247/M-1.)

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) (Goetz et al., 2008).

Part I: non-motor aspects of experiences of daily living

Item 2.2: SALIVA & DROOLING: Over the past week, have you usually had too much saliva during when you are awake or when you sleep?

  • 0: Normal: Not at all (no problems).

  • 1: Slight: I have too much saliva, but do not drool.

  • 2: Mild: I have some drooling during sleep, but none when I am awake.

  • 3: Moderate: I have some drooling when I am awake, but I usually do not need tissues or a handkerchief.

  • 4: Severe: I have so much drooling that I regularly need to use tissues or a handkerchief to protect my clothes.

Table 1 Comparison of salivary characteristics before and 1 month after the injections
Full size table
Table 2 Saliva consistency before and 1 month after the injection according to assessment of patients, p = 0.004
Full size table
Table 3 Amount of bacteria before and 1 month after BNT-A injections
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Tiigimäe-Saar, J., Taba, P. & Tamme, T. Does Botulinum neurotoxin type A treatment for sialorrhea change oral health?. Clin Oral Invest 21, 795–800 (2017). https://doi.org/10.1007/s00784-016-1826-z

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  • DOI: https://doi.org/10.1007/s00784-016-1826-z

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