The Journal of Oral and Maxillofacial Surgery is published by the American Association of Oral and Maxillofacial Surgeons to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.

American Association of Oral and Maxillofacial Surgeons

	Botox therapy can provide significant relief with only a mild risk for negative effects to patients with stubborn pain in the muscles involved in chewing, according to a new retrospective study.

	Chemically known as botulinum toxin A, Botox is a protein made from bacteria that, when injected, stops nerve signals that command muscles to contract, resulting in a months-long decrease in muscle activity. It has been used to treat conditions such as muscle spasms, facial wrinkles, migraines and excessive sweating.

	According to the study published in the November issue of the 

Journal of Oral and Maxillofacial Surgery

 – the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS) – botulinum toxin A injections also may have pain-relieving properties.

	To determine the therapy’s safety and effectiveness in treating stubborn jaw muscle pain, researchers conducted a retrospective review of 116 patients. The patients underwent at least two Botox injection cycles for refractory masticatory myalgia – pain in the muscles used for chewing – that had not responded to other therapies. The patients at the Department of Oral and Maxillofacial Surgery at Massachusetts General Hospital also had coexisting chronic pain disorders and were receiving other therapies and/or taking medications.

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	Nearly one-third of participants (30.6 percent) reported significant pain relief – defined as 75 percent or greater – for an average of 10.1 weeks.

	“This is an important outcome for this particular cohort of participants, considering that 72.9 percent of the participants had been in pain for at least five years, with 60 percent or more receiving two or more concurrent therapies,” researchers wrote.

	In addition, 39.8 percent of participants had moderate relief for 8.7 weeks on average, and 29.6 percent had no or minimal relief for 1.3 weeks on average.

	Among the participants, 16.4 percent reported at least one negative effect during the two injection cycles. Those who had significant pain relief had the largest number of adverse effects at 30.3 percent.

	The most common side effect was a decrease in the size of the masticatory muscle, possibly due to blocked release of a chemical that activates muscles, the study states. However, all of the negative effects were minor and brief, and full recovery occurred within 16 weeks.

	Simultaneous use of opioid pain relievers was a predictor of no or minimal relief. Of the participants, 36 percent were using a long-term opioid therapy. Long-term opioid use can result in opioid-induced hyperalgesia – a painful response to the medications – and having chronic pain disorders can lead to diminished effect of pain relievers, researchers wrote. “Together, these factors may result in poor outcome and response to therapy,” they say.

Effectiveness, Safety, and Predictors of Response to Botulinum Toxin Type A in Refractory Masticatory Myalgia: A Retrospective Study

” are all from the Department of Oral and Maxillofacial Surgery at Massachusetts General Hospital: David A. Keith, DMD, BDS, Professor at Harvard School of Dental Medicine; Steven J. Scrivani, DDS, DMedSc, Chief, Division of Oral and Maxillofacial Pain; Nicole Holland, DDS, MS; and Shehryar N. Khawaja, BDS, MS, Post-Graduate Fellow at Harvard School of Dental Medicine.

Articles

According to new research, Botox therapy can provide significant relief with only a mild risk for negative effects.

Study finds Botox can relieve jaw muscle pain

	More than 20 oral and maxillofacial surgeons were honored by the American Association of Oral and Maxillofacial Surgeons (AAOMS) for contributing to the specialty through their exceptional research, education and advocacy. 

	Awards were presented October 11 during the Opening Ceremony of the 99th AAOMS Annual Meeting – the largest gathering of oral and maxillofacial surgeons in the country.

	The Annual Meeting was dedicated to William H. Bell, DDS, of Stowe, Vermont, posthumously, for his vital research on the Le Fort I osteotomy – one of the most commonly used procedures to correct midface deformities. He also is credited for contributing to the specialty’s movement from oral surgery to oral and maxillofacial surgery. 

	AAOMS presented its top award – the Robert V. Walker Distinguished Service Award – to Thomas Dodson, DMD, MPH, FACS, of Seattle, Wash., for his clinical research that has benefited patients and cultivated innovations in the practice of oral and maxillofacial surgery. Dr. Dodson has authored more than 100 peer-reviewed articles, covering topics from office-based anesthesia and wisdom teeth extraction outcomes to identifying victims of domestic abuse with clinical markers. 

More from AAOMS: Limiting dental benefits increases hospital visits

	• Board of Trustees Special Citation Awards – Alejandro Roisentul, DDS, of Safed, Israel; and Mark Wong, DDS, of Houston, Texas

	• Clinical Research Award – Leonard Kaban, DMD, MD, FACS, of Boston, Mass.

	• Committee Person of the Year Award – James Mercer, DDS, of West Columbia, S.C.

	• Daniel M. Laskin Award for an Outstanding Predoctoral Educator – Ruben Figueroa, DMD, MS, of Mount Dora, Fla.

	• Donald B. Osbon Award for an Outstanding Educator – Steven Roser, DMD, MD, FACS, of Atlanta, Ga.

	• Faculty Educator Development Awards – Carolyn Brookes, DMD, MD, of Shorewood, Wis.; Michael Markiewicz, DDS, MD, MPH, of Chicago, Ill.; Ryan Mirchel, DDS, MD, of Cincinnati, Ohio; Mohammed Qaisi, DMD, MD, FACS, of Chicago, Ill.

	• Honorary Fellowship – Karin Wittich, AAOMS Associate Executive Director of Practice Management and Government Affairs, of Rosemont, Ill.

	• Humanitarian Awards for Fellows and Members – Shahid Aziz, DMD, MD, FACS, of Newark, N.J.; and Robert Bruce MacIntosh, DDS, of Northville, Mich. 

	• John F. Freihaut Political Activist Award – Eugene D’Amico III, DDS, of Newark, Del. 

	• Legislator of the Year Award – Congresswoman Jackie Walorski (R-Ind.) was honored for advocating for the prevention of over-prescribing opioids.

	• Presidential Achievement Award – Daniel Gesek Jr., DMD, of Jacksonville, Fla.; and James Boyle III, DDS, MS, of York, Pa., were honored for committing to the specialty and AAOMS’s mission.

	• Resident Scientific Awards – Ashish Sharma, BDS, MSD, of Loma Linda, Calif.; and James Phero, DDS, MD, of Cincinnati, Ohio

	• Special Honorary Fellowships – Stephen Dover, BDS, MBChB, FDSRCS, FRCS, president of the British Association of Oral and Maxillofacial Surgeons; and Tara Renton, PhD, MDSc, BDS, FDSRCS, FRACDS (OMS), FHEA, president of the British Association of Oral Surgeons, both of London, England

	• William J. Gies Foundation Award – Joseph Van Sickels, DDS, of Lexington, Ky., was recognized for his distinguished achievements as an educator.

The American Association of Oral and Maxillofacial Surgeons recognized more than 20 professionals for excellence in the field.

AAOMS honors oral and maxillofacial surgeons during Annual Meeting

	Limiting dental insurance coverage to emergency-only treatments caused an increased volume and severity of tooth-related infections and led to higher hospital health care costs, according to a new comprehensive study of the effects of Medicaid spending reforms in Illinois.

	The study analyzed hospital data over an 18-month period both before and after the 2012 passage of the Save Medicaid Access and Resources Together (SMART) Act, a package of laws intended to financially rescue Illinois’ Medicaid system. The findings appear in the March issue of the Journal of Oral and Maxillofacial Surgery – the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS).
	
	A key spending reduction provision in the SMART Act eliminated all but emergency adult dental services for low-income residents that the researchers say resulted in increases in emergency department visits, surgeries and hospital admission days. The average patient cost rose by 20 percent and the total cost-of-care increased by 77 percent – or $1.6 million – at the University of Illinois Hospital in Chicago during the study period.
	
	“The negative public health effects and increased economic impact of eliminating basic dental care show the importance of affordable and accessible preventative oral health care,” the authors say. “The substantial increase in cost of just one urban hospital’s population could be extrapolated to the state level to illustrate a large financial burden.”

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	The researchers said earlier studies have established that preventive dental treatments in outpatient settings are more effective and cost-efficient and Medicaid spends more on emergency department treatments when compared with routine preventive care. “However, there have been very few studies that have accurately analyzed the hospital costs associated with these dental infections” using cross-referencing of patient record diagnosis codes as study inclusion criteria, they said.
	
	After passage of the SMART Act, the patient data analysis showed emergency department visits increased 48 percent, surgical interventions increased 100 percent and hospital admission days increased 128 percent. Patients also were more likely to have an oral and maxillofacial surgery (OMS) consult, an incision and drainage procedure, and a longer hospital stay.
	
	“The negative public health effects and increased economic impact of eliminating basic dental care give special importance to affordable, accessible oral health care and valuable social interventions,” the authors concluded.
	
	“Does Restriction of Public Health Care Dental Benefits Affect the Volume, Severity, or Cost of Dental-Related Hospital Visits?” is authored by David Salomon, DDS, R. Eric Heidel, Ph.D., Antonia Kolokythas, DDS, MSc, Michael Miloro, DMD, M.D., and Thomas Schlieve, DDS, M.D.
	
	Read the complete study findings at 

http://www.joms.org/article/S0278-2391(16)31028-X/fulltext

An increased severity of tooth-related infections and higher hospital costs were also reported.