Oral health effects of botulinum toxin treatment for drooling: a systematic review / Efectos sobre la salud bucal del tratamiento con toxina botulínica para el babeo: una revisión sistemática

ABSTRACT

Background: Drooling is a major morbidity in several neurological diseases. Intraglandular botulinum neurotoxin(BoNT) injections have been used to manage this condition. However, by decreasing salivary flow, BoNT injectionsmay result in an increased risk of caries and other oral adverse effects. In this study, we aimed to assess whether,in patients with drooling, intraglandular BoNT injections are associated with increased dental caries development,modifications on salivary composition (oral pH, buffering capacity and osmolality) and cariogenic bacterial load.Material and Methods: We performed a systematic review, searching PubMed, CENTRAL, Web of Science, andScopus for all experimental and observational studies reporting on adverse effects of intraglandular BoNT injectionsin patients with drooling. Primary study selection, quality assessment, and data extraction were independently per-formed by two researchers. No studies were excluded based on their language, publication status or date of publica-tion. Studies’ quality was based on revised Cochrane Risk of Bias tools. Meta-analysis was not performed.Results: We retrieved 1025 studies, of which 5 were included. Two studies were two randomized controlled trialsand three quasi-experimental studies. None of the included studies found BoNT injections to be associated withdental caries development or with significant reductions in oral pH. One of the included primary studies evenobserved an increase in salivary buffer capacity. One study found an increase in Lactobacilli counts. As for therisk of bias, two studies were classified as having a critical risk, two as high risk and one as having some concerns.Conclusions: Currently, there is no evidence that, in patients with drooling, BoNT injections associate with in-creased risk of dental caries or disturbances in oral pH or salivary buffering capacity. However, the includedprimary studies had important limitations and differences in their...(AU)