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Herrero Babylon A, Kapos FP et al. Oral Surg Oral Med Oral Pathol Oral Radiol 2016;121: e148–e153

Patients with refractory orofacial pain of non-dental origin often receive treatment with several different medications such as the sodium channel blocker, carbamazepine. Such patients may also benefit from add-on drugs, such as gabapentin and valproate. Evidence for the efficacy of these adjuncts is weak, and in addition all such medication is associated with side-effects. Acetylcholine is blocked by botulinum toxin that in turn may inhibit the release of local nociceptive neuropeptides. This paper describes the care of two patients, but only the treatment of that patient with persistent dento-alveolar pain disorder (PDAP), will be described. Of note, the patient had received multiple root-canal therapies with no effect. Both conventional systemic medication and topical application delivered by an intraoral appliance did not control symptoms. Yet a combination of both extraoral and intraoral injections with onabotulinum (Botox®) achieved a satisfactory outcome with only minor side-effects. These comprised some intraoral dryness resulting in food retention in the sulcus, and mild muscle asymmetry.