Sir, a 56-year-old gentleman presented with an upper left central incisor that was slightly tender but he had noticed that when he pressed on this tooth the twitch over his left eye that he had suffered from for over five years went away. He had consulted his general practitioner and a hospital specialist on a number of occasions for this twitchy muscle and had had some temporary relief with Botox injections into the muscles above and under the eye which had been repeated on more than five occasions. Over this period there were no dental symptoms, this tooth was not heavily restored and he had attended regularly for routine examinations.

A panoral radiograph from 1998 revealed no pathology surrounding this tooth. On initial examination the tooth showed no vital signs and a periapical radiograph showed apical pathology associated with the tooth. Once the non-vital pulp was removed his twitching eye muscle symptoms cleared up. He has had no further symptoms in four weeks and now the endodontics have been completed we are both waiting to see if his tic returns.

I am interested to know if other readers have come across similar cases; perhaps dental examinations should be carried out before Botox is considered.