Home The Washington Diplomat July 2011

Cavities and Crow’s Feet: Botox at the Dentist’s Office

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The next time you visit your dentist to get a filling replaced or have your teeth cleaned, he might ask if you've considered doing something about those pesky frown lines between your brows or crow's feet wrinkles around your eyes.

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Photo: Dennis Guyitt / iStock

That's because more and more dentists — especially general dentists — are taking the plunge into the lucrative field of "facial esthetics." According to a survey done by "The Wealthy Dentist" (www.thewealthydentist.com), 16 percent of dentists are already offering Botox to their patients, 27 percent would like to if regulations permitted, and 37 percent might consider it someday. Only 20 percent said "No way!"

Botox, or botulinum toxin, was recently approved by the U.S. Food and Drug Administration to treat migraines, and it's also used by some dentists to treat temporomandibular joint (TMJ) disorders that cause pain around the jaw area and face (Botox relieves jaw tension by making muscles unable to engage in the grinding movement of the jaw that can produce headaches and pain).

From there, it wasn't much of a leap for some dentists to start considering the treatment — a neurotoxin that's injected into a muscle, blocking nerve signals or paralyzing certain muscles — for other conditions. That's because the real money in Botox is in bestowing a Nicole Kidman-esque smooth forehead. At $300 to $400 per treatment (or more), with a lot of repeat business — all paid out of pocket with no insurance company discounts — the profits can add up fast. That kind of cosmetic treatment has usually been the province of the plastic surgeon, but the times they may be a-changing, as dentists discover the dollar signs behind Botox.

In some states, like Minnesota, dentists are already permitted to offer their patients cosmetic Botox, as long as they adhere to the requirements that other specialists must meet. "As a dentist, I'm very well trained in the musculature and anatomy of the face, and I feel no other doctor can give an injection better than a qualified and experienced dentist," Michael Skadron, D.D.S., told the Minneapolis Star Tribune in March, two months after he began offering Botox at his West River Dental Care in Minneapolis. "It's a marvelous fit."

Other states, like California and Nevada, have labeled cosmetic Botox as outside the scope of general dentistry. The website of the Dental Board of California is pretty clear on the matter: "Botox or any related agents can only be used for the diagnosis and treatment of TMD/myofascial conditions as part of a comprehensive treatment plan. Use for isolated cosmetic purposes is illegal, unless privileged under the Facial Cosmetic Surgery Permit."

In New Jersey, new regulations that will take effect in December may limit the ability of dentists to provide Botox injections. They mandate that dentists are only allowed to administer Botox and filler injections to the "perio-oral area and associated tissue," which might prevent them from injecting the drug into the forehead area, where most people want to wipe out wrinkles. But the general counsel of the New Jersey Dental Association argued that the term "associated tissue" cannot be clearly defined.

Konstantine Trichas, a general dentist in Montclair, N.J., is just fine with the restrictions. He receives at least one solicitation every month from companies wooing him to attend weekend Botox continuing education courses — which he promptly throws away.

"They believe that we have enough head and neck training through our schooling and accreditation process that it's just the matter of getting a certificate," he said. "But my thought process is, a plastic surgeon takes 15 years to learn to do what he does. I can learn it in a couple of weekends? I don't think so. What makes a doctor great is his ability to handle things when something goes wrong, and I don't think a few weekend classes give me the ability to handle a crisis with Botox. Could I sleep at night if I had a case of facial paralysis?"

An Illinois dentist who responded to the Wealthy Dentist's survey feels the same way: "It isn't dentistry," he wrote. "Just because we're qualified to give injections, and these cosmetic injections are within inches of the mouth, does not mean that the procedure should be done by dentists."

But others are enthusiastic. "With proper certification, I would support this. Oral surgeons are doing it, and we certainly have the training and intelligence to include this procedure with additional training in this product and its indications, techniques and contraindications," wrote a Florida dentist surveyed by the Wealthy Dentist.

So, if you're considering getting Botox, should you let your dentist do it or not? First, make sure he or she is permitted to do so. In Virginia, for example, the state dental board permits only oral and maxillofacial surgeons who have additionally received a cosmetic certification to provide Botox. General dentists aren't allowed to jump into the field. Maryland also does not allow general dentists to provide cosmetic Botox, although the subject is still under discussion in the wake of a public hearing held last October. (The D.C. Board of Dentistry did not respond to a call seeking information.)

Once you've established that your dentist is actually permitted by his licensure to provide Botox, ask these questions: How long have you been providing Botox? What training did you receive? Are there reasons I shouldn't get Botox? (For example, your provider should know that people with neuromuscular disorders have a higher risk of side effects.) What are the possible side effects? How often have you encountered them, and how do you manage them?

While getting Botox from a licensed dentist is probably at least safer than getting it at a "Botox party" in someone's home, that doesn't necessarily mean it's your best bet. So consider all your options carefully before going "under the needle."


About the Author

Gina Shaw is the medical writer for The Washington Diplomat.

Last Edited on June 19, 2014