HOF: UM OLHAR ALÉM DA ESTÉTICA
HOF: UNA MIRADA MÁS ALLÁ DE LA ESTÉTICA
REGISTRO DOI: 10.69849/revistaft/ra10202408221542
Pedro Guimarães Sampaio Trajano dos Santos1
Yasmin Cristina de Souza Freitas2
Rodolfo Scavuzzi Carneiro Cunha3
Paula Andréa de Melo Valença4
Ailton Coelho de Ataíde Filho5
Fabiana Moura da Motta Silveira6
Eudoro de Queiroz Marques Filho7
Manoel Arthur Dias de Oliveira Antonino8
Luciano Barreto Silva9
Abstract
Objective: To discuss orofacial harmonization, showing that it is an area that goes beyond aesthetics, addressing several functions of botulinum toxin within various dental treatments, citing examples of problems in which this toxin can be used as a treatment. Methodology: Research was conducted to obtain information through the following databases: Science Direct, CAPES Periodicals Portal, PROSPERO, CAPES Periodicals Portal, Research, Society and Development, The Cochrane Library, Google Scholar and gray literature. The search for the descriptors used in this article was carried out on the platform: BVS/BIREME and DeCs. Results: Our research found scientific foundations that point to the potential of botulinum toxin, which performs a range of benefits when used in dentistry. Conclusion: Botulinum toxin type ”A” can be used in the treatment of: trigeminal neuralgia, temporomandibular dysfunction, sialorrhea, headaches, facial dystonia, hyperhidrosis and in pre-dental implants.
Keyword: Botulinum Toxins; Temporomandibular Joint Dysfunction Syndrome; Hyperhidrosis; Trigeminal Neuralgia; Sialorrhea.
Resumo
Objetivo: Discutir sobre a Harmonização Orofacial, mostrando que se trata de uma área que vai além da estética, abordando sobre diversas funções da toxina botulínica dentro de diversos tratamentos odontológicos, citando exemplos de problemas em que essa toxina pode ser usada como tratamento. Metodologia: Foram realizadas pesquisas para obtenção de informações por meio das seguintes bases de dados: Science Direct, Portal de Periódicos CAPES, PRÓSPERO, Portal de Periódicos CAPES, Research, Society and Development, The Cochrane Library, Google Scholar e literatura cinzenta. A busca pelos descritores utilizados neste artigo foi realizada na plataforma: BVS/BIREME e DeCs. Resultados: Nossa pesquisa encontrou fundamentos científicos que apontam o potencial da toxina botulínica, que desempenha uma gama de benefícios quando utilizada na odontologia. Conclusão: A toxina botulínica do tipo ”A” pode ser usada em tratamentos de: neuralgia do trigêmeo, disfunção temporomandibular, sialorréia, dores de cabeça, distonia facial, hiperidroses e no pré implante dentário.
Palavras-chave: Toxinas Botulínicas; Síndrome da Disfunção da Articulação Temporomandibular; Hiperidrose; Neuralgia do Trigêmeo; Sialorréia.
Resumen
Objetivo: Discutir la Armonización Orofacial, mostrando que es un área que va más allá de la estética, abordando las diferentes funciones de la toxina botulínica dentro de los diferentes tratamientos odontológicos, citando ejemplos de problemas en los que se puede utilizar esta toxina como tratamiento. Metodología: Se realizó una investigación para la obtención de información a través de las siguientes bases de datos: Science Direct, CAPES Journal Portal, PROSPERO, CAPES Journal Portal, Research, Society and Development, The Cochrane Library, Google Scholar y literatura gris. La búsqueda de los descriptores utilizados en este artículo se realizó en la plataforma: BVS/BIREME y DeCs. Resultados: Nuestra investigación encontró fundamentos científicos que apuntan al potencial de la toxina botulínica, la cual tiene una serie de beneficios cuando se utiliza en odontología. Conclusión: La toxina botulínica tipo ”A” puede utilizarse en tratamientos de: neuralgia del trigémino, disfunción temporomandibular, sialorrea, cefaleas, distonía facial, hiperhidrosis e implantación predental.
Palabras clave: Toxinas Botulínicas; Síndrome de Disfunción de la Articulación Temporomandibular; Hiperhidrosis; Neuralgia del Trigémino; Sialorrea.
1. Introduction
Dentistry has been improving in recent years, developing new forms of treatment, new procedures, and with this, new specialties have emerged. The specialty called Orofacial Harmonization is a recent area, having its practice regularized in 2019 by the CFO, spreading within the dental field, being increasingly practiced by dental surgeons and sought after by the population, who seek HOF procedures with the aim of obtaining a “harmonious face” (Federal Council of Dentistry, 2019; Cavalcanti et al., 2017).
Today’s society lives in a time where beauty standards are increasingly imposed, where people seek more procedures to change some structure of their face, motivated by digital influencers, everyday friends or even family members, who directly influence by giving examples of procedures that the person “needs to do”, indirectly when they point out the person’s “defects”, which weighs on the person’s psychological and emotional state, who then seeks some procedure that can change this personal characteristic, which is seen as a “defect” by people immersed in social standards, which determine what is “beautiful” and what is “ugly” (Wen & Shen, 2016; Sarwer & Crerand, 2004).
Thus, the HOF area has been increasingly sought after by many people seeking orofacial procedures, being an area that is currently in ”fashion”, mainly because it is a specialty that presents ”expensive” procedures, bringing a good monetary response to the dental surgeons who perform these mechanisms. The fact that HOF is an area that is currently making a lot of money, a portion of the dentists who seek to perform these procedures only aiming to perform aesthetic procedures to obtain money, however, orofacial harmonization is a specialty that goes far beyond aesthetics, which has a range of procedures that have applications in various problems, dysfunctions and conditions that bring harm to the oral health of people within society, allowing many patients to have effective treatment through certain procedures in the area. Thus, it is seen that the specialty called ”Orofacial Harmonization” deals with aesthetics but goes far beyond that, it has alternative treatments for various problems that affect the oral structure, thus, the objective of this narrative literature article is: to discuss Orofacial Harmonization, showing that it is an area that goes beyond aesthetics, addressing various functions of botulinum toxin within various dental treatments, citing examples of problems in which this toxin can be used as a treatment.
2. Methodology
This study is a narrative literature review, so it was necessary for an article to serve as support to structure, guide and serve as instruction, with Rother’s study (2007) being the manuscript that was used to indicate how the methodology and development of the text should be. This study was combined with the use of information available on websites and databases such as: Science Direct, CAPES Journal Portal, PROSPERO, CAPES Journal Portal, Research, Society and Development, The Cochrane Library, Google Scholar and gray literature. The search for the descriptors used in this article was researched on the platform: VHL /BIREME and DeCs.
3. Results
3.1 Orofacial Harmonization
The Federal Council of Dentistry, also known as CFO, regulated the practice called ‘’Orofacial Harmonization’’ as a specialty in January 2019, through resolution CFO 198/2019. The CFO stated in its 2nd article that Orofacial Harmonization is defined as a set of procedures performed by the dentist within his/her area of expertise, and is a practice responsible for the functional and aesthetic balance of the face (Conselho Federal de Odontologia, 2019).
The specialty ‘’Orofacial Harmonization’’, better known as ‘’HOF’’, emerged recently through scientific developments carried out by several dentists and dentistry researchers, emerging in the same way as other specialties emerged. Thus, it is seen that orofacial harmonization contributes to dentistry within its area and in other specialties, creating an integrated working relationship, with areas such as temporomandibular dysfunction and orofacial pain and the oral and maxillofacial specialty (Bertoz et al., 2020; Santos et al., 2024).
The area of orofacial harmonization is a set of procedures that seek to bring balance to the face of people who have a problem, or who seek to modify something in their facial structure, seeking a more harmonious face, based on the facial characteristics of each respective patient. The objective of HOF is to evaluate the main complaints of patients, and then perform a careful anamnesis, analyzing the entire structure of the face, to then outline what would be the best treatment and procedure for the given person, in a way that maintains the patient’s health and safety (Cavalcanti et al., 2017; Von André & Bonassoni, 2016).
3.2 Botulinum toxin
Botulinum toxin, also known as TB, is a type of toxin produced by an anaerobic gram-positive bacterium, through its sporulation, known as Clostridium botulinum (Sposito, 2009). It was discovered in 1895, a year marked by the botulism outbreak (Fujita, 2019). Botulinum toxin works through a mechanism of action that is basically to determine transient flaccid neuromuscular paralysis, through chemical denervation (Vasconcellos et al., 2019). This toxin can be found in eight different serotypes: type A, B, C, D, E, F and G (Santos et al., 2015; Santos et al., 2024).
The first country to produce botulinum toxin type A (BoNT/A) during World War II was the United States of America, in response to suspicions that the Germans had used this biological weapon, until the Soviets also produced large stocks of BoNT/A as a biological weapon. Other countries such as Iraq, Syria, Iran and North Korea are among those suspected of having been involved in this type of production, until in 1995, Iraq admitted to having produced 19,000 liters of concentrated botulinum toxin, an amount that would have been capable of killing the entire world population at the time three times over. Some people at the time believed that around 10,000 liters of this concentrate had undergone transformations to become biological weapons and were packaged for distribution (Hicks et al., 2015).
Botulinum toxin type A, after being injected, is transported to the neuromuscular junction, until it is internalized in the presynaptic cholinergic terminals. Within the cytosol, the light chain cleaves the soluble NSF-associated protein receptors (SNAREs) and the plasma membrane proteins SNAP-25 and syntaxin, which contain the SNARE complex. SNARE is a central molecule for the mechanism responsible for mediating the fusion of synaptic vesicles together with the presynaptic plasma membrane, which will trigger the release of the neurotransmitter acetylcholine in the presynaptic nerve endings. However, flaccid paralysis may occur if the SNARE complex is inhibited; in addition, recovery will occur when new nerve endings appear, which will reestablish other synaptic contacts (Gooriah & Ahmed, 2015).
3.3 Botulinum toxin applied in dental treatments
3.3.1 Temporomandibular dysfunction
According to the American Academy of Orofacial Pain, temporomandibular dysfunction (TMD) can be classified into two groups: myogenic TMD, which is associated with muscle disorders, and arthrogenic TMD, which is related to joint disorders. There are several factors that need to be analyzed for the diagnosis of temporomandibular dysfunction, considering that it has a multifactorial etiology and can be influenced by psychological, systemic, genetic, and structural factors. (Calis et al., 2019).
Although the pathologies related to temporomandibular dysfunction are not completely understood, the initial symptom is related to pain in the orofacial region. In preliminary studies, botulinum toxin has been successfully used to treat several types of pain syndrome, including TMD, myofascial pain, trismus, hypermobility, masseter and temporal hypertrophy, and headache (Schwartz et al., 2002).
Botulinum toxin type A has proven to be an alternative treatment when conventional methods are ineffective (Queiroz et al., 2017). The action of botulinum toxin type A does not involve temporary chemical denervation of skeletal muscles, as it prevents the release of acetylcholine at motor nerve endings, leading to the attenuation of muscle contraction (Santos et al., 2017).
3.3.2 Facial dystonia
Botulinum toxin has been shown to be an effective tool in the management of facial dystonia, a neuromuscular condition characterized by involuntary contractions of facial muscles. This section explores the mechanism of action of BTX. In the case of facial dystonia, botulinum toxin interferes with the neuromuscular pathways responsible for involuntary muscle contractions, alleviating the symptoms associated with the condition (Jankovic, 2009). Treatment with this toxin for facial dystonia involves injecting the toxin directly into the affected muscles. The protocol varies depending on the severity of the dystonia and the individual’s response to treatment. In general, injections are performed every 3 to 6 months, and the dosage is adjusted based on clinical evaluation and patient response (Brin, 2004).
BXT has also been shown to be effective in cases of secondary facial dystonia, such as postictal facial paralysis and dystonia resulting from surgical procedures. In a study published in the Journal of Neurology, Neurosurgery, and Psychiatry, patients with postsurgical facial dystonia experienced substantial relief of symptoms after treatment with botulinum toxin (Giladi et al., 2003). Side effects are generally mild and include pain at the injection site, temporary muscle weakness, and occasionally facial asymmetry (Jankovic & Orman, 2009).
3.3.3 Hyperhidrosis
Hyperhidrosis is a condition that affects 3% of the adult population, where there is an overproduction of sweat due to the patients’ hyperfunctional sweat glands. It can be associated with hereditary, occupational, emotional and even social factors. Hyperhidrosis can affect specific areas of the body, or be localized, and can occur on the scalp, face, armpits, palms of the hands, groin and soles of the feet, being more common in the armpits. Conventional treatments such as the use of antiperspirants, iontophoresis or sympathectomy are not effective in more severe cases, or are very risky (Strutton et al., 2004).
Botulinum toxin type A has emerged as a safe and effective treatment for hyperhidrosis, by blocking the release of acetylcholine in presynaptic membranes. One of the most common procedures for applying TBA in aesthetic practice is the intradermal injection technique, which has been shown to provide benefits in terms of improving skin texture and facial rejuvenation.
The intradermal or subdermal injection technique, also known as “micro-dosing,” involves the use of a lower concentration of TBA than the traditional formulation for the intramuscular injection technique, which is injected in several tiny aliquots over the treated body areas. Applications must be handled by trained professionals and must be preceded by the Minor test, which will determine the intensity of hyperhidrosis and the most affected areas. It is known that, despite being a safe and effective treatment, it is necessary to perform applications after the toxin’s period of action, since its duration varies between 4 and 6 months, depending on the physiology of the treated person’s body (Kim et al., 2009; Heckmann et al., 2001).
3.3.4 Headaches
Botulinum toxin, often associated with the treatment of neuromuscular and aesthetic disorders, has gained significant recognition in the management of headache, particularly in chronic forms of the condition. This section reviews the scientific evidence and current protocols for the use of botulinum toxin in the treatment of headache.
It works by inhibiting the release of neurotransmitters, such as acetylcholine, at nerve endings. This inhibition reduces the excitatory activity of neurons involved in pain transmission. In the context of headache, botulinum toxin may help to interrupt pain circuits and reduce local inflammation, thereby alleviating the intensity and frequency of attacks (Dodick et al., 2011).
This toxin is widely used in the treatment of chronic migraine. Clinical studies have shown that administration of botulinum toxin can significantly reduce the frequency of migraine attacks. According to a placebo-controlled study published in the Journal of the American Medical Association, a reduction of 8 to 9 headache days per month was reported after 24 weeks of treatment (Aurora et al., 2010). However, side effects such as pain at the injection site, temporary muscle weakness and, rarely, eyelid ptosis should be monitored. (Schmidt et al., 2015).
3.3.5 Dental surgery and implants
Before dental implants are performed, many patients can benefit from pre-surgical Botox treatment. After multiple implants have been placed or when immediate-load implants are placed, the osseointegration process may be impeded by excessive forces in patients with parafunctional habits. Overloading of the implants is responsible for causing implant failures due to loosening of their components or prevention of osseointegration. The prophylactic use of Botox in injections applied to the muscles promotes muscle relaxation, which can benefit the implant procedure, allowing the osseointegrated implants to improve.
Parafunctional tightening usually causes excessive force, which prevents healing and reconnection between the gums and the bone in the mouth, which can cause trauma. Thus, Botox used in low doses can potentially limit the clenching and its intensity, thus allowing the traumatized tissues to heal, and can function as a “pharmaceutical splint” when used in high doses, which would limit muscle contraction before resetting and during rehabilitation after a facial bone fracture, such as a mandibular condyle fracture. The prophylactic use of Botox injections applied to the masticatory muscles can be extremely important and have a range of benefits, triggering fracture consolidation within a more stable environment (Rao et al., 2011).
3.3.6 Trigeminal neuralgia
Orofacial pain, ‘’trigeminal neuralgia’’, is the facial neuralgia best known to society and is the most debilitating. Neuralgia of the V nerve is also known by the term ‘’Fortherghill’s disease’’, ‘’prosopalgia dolorosa’’ and by the French expression ‘’tic douloureux’’ (tic douloureux), as it is a health condition that triggers pain attacks that are usually accompanied by brief easy spasms or tics (Teixeira, 2009; Frizzo et al., 2004; Bertoli et al., 2003). Trigeminal neuralgia is considered one of the most unbearable, severe and serious pains in medicine, which in many cases can even lead to suicide (Costa et al., 2006), belonging to the group of chronic pain conditions (Quesada et al, 2005).
Thus, it is seen that neuralgia is a serious problem and needs to be treated, with botulinum toxin type A being an example of a possible treatment, working by interfering in the release of the neurotransmitter acetylcholine, responsible for muscle contractions and secretion from sweat and salivary glands (Maturana & Camargo, 2001), basically acting to inhibit the exocytotic release of acetylcholine from motor nerve terminals, triggering a decrease in muscle contractions, preventing the muscle from receiving the message and then contracting, relieving muscle pain and providing relief from the pain caused by neuralgia and certain cases (Zúñiga et al., 2013). This mechanism means that muscle spasms begin to have their activity interrupted or reduced after the use of type A TXB. However, studies state that after a certain period, new axon endings will sprout, resuming neuromuscular transmission (Sposito, 2019).
3.3.7 Sialorrhea
Excessive saliva production is called “sialorrhea,” a problem that is determined by a production that exceeds the patient’s ability to swallow saliva or to keep this amount within the oral cavity. Most disorders that impair orofacial movement or swallowing function end up resulting in saliva leakage (ptyalism) (Narayanaswami et al., 2016). Sialorrhea is defined as a lack of control of oral secretions, which gives rise to an accumulation of saliva within the oral cavity, while ptyalism is the occurrence of its extravasation outside the cavity (Cardoso, 2017). Ptyalism and sialorrhea can occur in isolation or together, due to increased salivary production, an efferent pathway function of the parasympathetic nervous system, and the failure of mechanisms responsible for eliminating saliva from the oral environment, as occurs, for example, in dysphagia and postural changes that trigger exaggerated flexion (Lakraj et al., 2013).
People who have sialorrhea most often develop perioral irritation, perioral infections, impaired hygiene, social isolation, speech interference, dehydration, foul odor, and cracks (Scully et al., 2009). This health problem has several forms of treatment, with the aim of controlling excessive salivation, procedures such as: radiotherapy, drugs with anticholinergic effect, surgery, anti-reflux medication, and the newest form of treatment through the use of botulinum toxin applied to the salivary glands (Vashishta et al., 2013). TXB will act on the cholinergic peripheral nerve terminal, preventing the release of acetylcholine and will connect to the terminal of the motor plate, in the exclusive receptors located in the membrane of the nerve ending. After that, the toxin will be internalized through endocytosis to the endosome and then to the cytosome. After this internalization, the light chain of the molecule will be free within the cytoplasmic space of the nerve ending. Once in the cell cytoplasm, this light chain will break down the fusion proteins, which will enable the release of acetylcholine into the synaptic cleft. This segment as a whole will generate functional chemical denervation, causing a selective reduction in muscle contraction (Santos et al., 2022). Thus, botulinum toxin will trigger a decrease in salivary production, through the mechanism that prevents the release of acetylcholine in the presynaptic neurosecretory junctions of the salivary glands (Franck et al., 2018).
3.3.8 Gummy smile
Facial aesthetics has been much discussed in recent years and is something that society treats with great importance, especially when talking about an “aesthetic face”, which is directly related to the smile, which is composed of: gums, lips and teeth (Pedron et al., 2010; Hwang et al., 2009). A smile considered aesthetically pleasing is formed by these elements arranged in adequate proportions, with the exposure of the gingival tissue with a limit of 3 mm. However, a portion of the population ends up having a gingival exposure greater than 3 mm, being a smile considered as unaesthetic, called a “gummy smile”, something that affects the psychological and emotional state of a portion of patients (Indra et al., 2011; Mazzuco & Hexsel, 2010). Some factors make up the group of possible causes of a gummy smile, including: gingival hyperplasia, anterior dentoalveolar extrusion, short lip, altered passive eruption, excessive vertical growth of the maxilla and upper lip hyperactivity, with some cases of gummy smiles directly linked to these factors (Silva, 2008; Marson & Silva, 2009).
TXB works by blocking the transmission of hyperactive nerve impulses from muscles that received the application of the toxin, selectively blocking the release of acetylcholine at the neuromuscular junction, preventing muscle contraction for a certain period of time (Polo, 2008). The activity of a smile is determined by a group of facial muscles, such as the zygomaticus minor and major, the orbicularis oris, the risorius, the levator labii superioris and alae nasi, and the angle of the mouth. Within this muscle group, the levator labii superioris and alae nasi and the zygomaticus major and minor are responsible for performing the function of lip elevation, and are the muscles that should be injected with botulinum toxin type A. These muscles have their fibers converging in the same area, which gives rise to a triangle, becoming a point of choice that includes the three muscles in a single point, being the best place to apply the toxin in just one injection. When the botulinum toxin is applied, it will probably spread within an area of 10 to 30 mm, creating the effective range, a point located laterally to the wing of the nose. After being applied, the toxin will reduce the contraction of the muscles responsible for raising the upper lip, triggering a decrease in gingival exposure (Hwang et al., 2009; Pedron, 2014).
4. Discussion
A gummy smile affects many people in society, linked to different factors, which often negatively affects the emotional state of the patient who has this characteristic, at a time when many believe that it is neither harmonious nor aesthetically pleasing, which causes most people to stop smiling and isolate themselves socially, for fear of not being accepted in the environment in which they live, thus introducing the botulinum substance as an option that treats not only the aesthetic side of the patient, but that will give the person with a gummy smile the desire to smile and interact with other people without fear of being looked at badly or rejected.
Temporomandibular dysfunction is a dysfunction of the temporomandibular joint that is quite common and affects the quality of life of the person affected by TMD, living with pain and discomfort that in most cases intensifies over time, with botulinum substance being an example of a muscle-relaxant treatment that will relieve muscle pain, which is highly effective and has the potential to reduce or eliminate this problem.
Trigeminal neuralgia is an orofacial pain that causes so much pain in the patient who has this problem that it often leads the person to commit suicide, which shows how important it is to research alternative treatments that work in treating this condition. Thus, BXT type A comes in as an option, which seeks to alleviate the symptoms of pain that are of an extreme level, revealing how useful this toxin can be to treat something that, in addition to relieving pain, can save the life of someone who might try to take it away if there was no solution, with the toxin being extremely essential in the lives of people with neuralgia.
Headaches are common symptoms in society, which occur in various pathologies or are caused by other problems. However, some people, due to other factors, end up having this pain recurrently, disrupting the course of daily activities and relational development, with botulinum toxin type A as a treatment option, bringing quality of life to the patient. Another positive point of using this substance in the treatment of headaches is in patients with allergies or other problems that can worsen through the use of medication, being an effective option.
Sialorrhea, which is the excessive production of saliva, is present in several diseases, causing problems that have negative effects on health and the social area, since most people with hypersalivation tend to isolate themselves, so as not to be the subject of jokes, prejudice or bad looks, entering BXT type A as an option that will treat this excess saliva produced and that will bring back to the patient the desire to relate in a way that does not make them afraid. Botulinum toxin can even be used in patients who are going to have implants, as a way of enhancing the chances of bone-implant integration, benefiting muscle relaxation so that there is better rehabilitation which increases the chances of the implant being well integrated into the patient’s bone.
Hyperhidrosis is an exaggerated production of sweat, which can cause bad odors that bother both the person with this problem and those around them, and facial dystonia is the involuntary contraction of the facial muscles, bothering the patient. Both have aesthetic problems, but they go beyond that. They usually cause social isolation, due to fear of not being well accepted within a society that has established standards of beauty and appearance, and that often rejects people who go against this line, and in this case, they are people with health problems who sometimes cannot get treatment due to lack of financial access, being judged and pointed out in an unacceptable way. TXB is something that goes far beyond bringing “aesthetics” to the patient, but is a form of treatment that improves the health of the organism, benefits the emotional state and often saves the life of a patient who is going through moments of self-denigration.
5. Conclusion
Dentistry has been improving more and more over the years, new techniques, technologies and innovative therapies have been developed by researchers who are concerned with the various problems that affect oral health, which in addition to causing harm to the structure of the mouth, can end up influencing other areas of the body, because the organism is connected, which means that many diseases that settle in the human body may have started in the mouth and entered the bloodstream, spreading and harming health as a whole.
With the objective of establishing good oral health, research is advancing with new therapeutic forms, with Botulinum Toxin type A being an example of a substance that is derived from a bacteria, which is widely used in the treatment of problems such as TMD, sialorrhea, gummy smile, trigeminal neuralgia, surgeries and dental implants, facial dystonia, headaches and hyperhidrosis. Thus, BXT type A is a therapeutic alternative in dental treatments, having great efficacy and potential within the specific treatments in which it fits, being a great ally to the dental surgeon, enabling him to improve the health of his patients.
Thus, HOF is a specialty that is often only seen as an area that addresses the aesthetic side, a side that seeks to give people the opportunity to modify their facial appearance for something they believe to be more beautiful, which is also important because HOF allows people to achieve procedures that bring happiness and love for their appearance that they have dreamed of, bringing back people who previously isolated themselves due to various factors attributed to the respective problem that is affecting their health, reestablishing the emotional state of patients who have negative thoughts and desires, being an area that deals with aesthetics but that goes beyond that, at the moment in which through this article, it was seen that botulinum toxin type A can be used in several different types of treatments within dentistry, being able to rehabilitate people who go through situations of intense pain among other symptoms, being HOF something that not only takes care of aesthetics but also treats serious health problems.
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1ORCID: https://orcid.org/0009-0001-5720-603X
Faculdade de Odontologia do Recife, Brazil
E-mail: pedroguimaraessampaio@gmail.com
2ORCID: https://orcid.org/0009-0004-4419-334X
Faculdade de Odontologia do Recife, Brazil
E-mail: yasmim.cristina.freitas18@gmail.com
3ORCID: https://orcid.org/0000-0001-7110-848X
Faculdade de Odontologia do Recife, Brazil
E-mail: scavuzzi@gmail.com
4ORCID: https://orcid.org/0000-0002-1433-5632
Faculdade de Odontologia do Recife, Brazil
E-mail: valensa@gmail.com
5ORCID: https://orcid.org/0000-0002-8105-4259
Faculdade de Odontologia do Recife, Brazil
E-mail: ailtonataide@hotmail.com
6ORCID: https://orcid.org/0000-0001-8905-2373
Faculdade de Odontologia do Recife, Brazil
E-mail: fabianamottamsn@hotmail.com
7ORCID: https://orcid.org/0000-0001-9794-0311
Faculdade de Odontologia do Recife, Brazil
E-mail: eudoromarques@hotmail.com
8ORCID: https://orcid.org/0009-0004-4944-4160
Faculdade de Odontologia do Recife, Brazil
E-mail: manoelarthur84@hotmail.com
9ORCID: https://orcid.org/0000-0002-1508-4812
Faculdade de Odontologia do Recife, Brazil
E-mail: lucianobarreto63@gmail.com