Dentists Look to Use Botox for Cosmetic Purposes As Board Pulls Interim Policy to Review It

As you lie in the dental chair to get your teeth whitened, how would you feel about getting your laughter lines erased at the same time?The use of Botox and dermal fillers to get rid of wrinkles or crow's feet or to fill deep lines around the mouth is usually done at a cosmetic clinic by a doctor or a nurse working under a doctor's supervision.But a few dentists also offer the service in Perth and others are looking to.As Dr David Hallett points out, dentists spend each day, every day working on the inside of clients' mouths and know facial anatomy better than most."Their education and training [is] in anatomy, specifically in the muscles, the nerves, the vascular system and the physiology of the face," he said."But also too of course, dentists inject in the face all day, every day as part of their practising life, it's just that they inject from inside the mouth rather than outside the mouth."Dr Hallett is the CEO of the state's dental association and said there is widespread interest among its members in being able to use Botox cosmetically."A number of dentists have contacted us wanting to know why, in the past anyway, we haven't supported some deregulation of the use of Botox in dentistry," he said. "Up until now, dentists have been able to use Botox but purely for therapeutic purposes where they've been able to treat jaw joint pain and facial pain but they've not been authorised to use it for what we would call cosmetic purposes."The Dental Board of Australia says under the laws of most states and territories, "prescribing [of Botox] must be for dental treatment only".In WA, the situation is a little different because dentists are authorised to prescribe Botox "for the practice of dentistry" but the Health Department leaves it up to the dental board to decide what the "scope of that practice is".This provides the grey area over its cosmetic use.Paul Meara, who is an oral and maxillofacial surgeon and has trained as both a doctor and a dentist, is concerned about the push by dentists to offer Botox for cosmetic purposes."In its best practice you have a doctor supervising that practice so say, for example, they might have a cosmetic business and the nurse provides the injections but the doctor is supervising the treatment protocol," he said."They decide what dosage they're going to give the patient, where the injections are going to be, and how regular the repeat injections are because it is a temporary drug."He thinks the practice should stay within the remit of a doctor, not a dentist. "Even though they have a good understanding of the anatomy of the face because they're working on the jaws which support the tooth structures, they have less in-depth understanding of a person's general health, the associated effects of Botox being repeatedly used," Dr Meara said."There are some risks with Botox if you inject it in the wrong place; the person can have loss of muscles to the eyelid so they can't see out of an eye, they can have asymmetry in their face, they might over-paralyse one muscle compared to another so they look like a stroke victim."If you have somebody like a dentist doing it just occasionally after doing the course, then their level of experience and their ability to get good results for the patient is a lot less, and it's likely to always be a lot less unless they specifically restrict their practice to cosmetics."Dr Hallett said dentists would back a move into the field."I think it's a sensible move as long as it's in conjunction with their dental treatment so being used to enhance their dental procedures," he said."It would generally mean if you're doing work on people's front teeth that you would probably use Botox or dermal filler in those areas surrounding the [mouth] to enhance their smile or help them adjust to their new dentures or build out their lip or reshape their lip."Dr Meara said pharmaceutical companies were also behind the push."If you're going to the dentist to have teeth whitening, you have to keep going back because your teeth get stained and you have to go back and whiten them," he said."It's the same with Botox; you go, you get your wrinkles fixed and then it wears off, you have to keep going back so obviously from the pharmaceutical company's point of view, pushing the resell of something that's only got a temporary effect is good for business."It's in the pharmaceutical companies' best interest to encourage widespread use of it because they make money out of it, not necessarily because it's being supervised by really experienced practitioners."There are 2,422 dentists registered to practice in WA but no figures as to who offers cosmetic Botox procedures as it is not available on Medicare or private health insurance so is purely a private transaction.Within the industry, it is known that there is at least one clinic in Kelmscott, a practice in Fremantle and one in South Perth offering the service, and others looking to get involved in what is estimated to be a multi-billion-dollar industry.Then there is the question of whether it would become a 'turf war' between dentists and doctors. "I imagine there would be some discussion," Dr Hallett said."I think originally it was the dermatologists and the plastic surgeons to offer the procedures and then it's spread out into more mainstream medical practice and now we've got to a situation where nurse practitioners, under the guidance of a medical practitioner, can also use Botox and dermal fillers."He said the ADA would support the use of Botox for cosmetic purposes and believes there is a mood for change.The Dental Board has removed its interim policy on the use of Botox from its website while it undertakes a review but was unable to say when that would be completed.Topics:dental,doctors-and-medical-professionals,drug-use,perth-6000,broome-6725,karratha-6714,geraldton-6530,kalgoorlie-6430,bunbury-6230,albany-6330 First posted December 06, 2014 10:04:23