It’s no exaggeration to say Botox is one of the most popular esthetic treatments available today. Injections of botulinum toxin A have been used for more than two decades to minimize frown lines and smooth wrinkles. Botox is by far the most frequently performed cosmetic procedure in the country. The American Society of Aesthetic Plastic Surgery estimates that in 2008 alone, nearly 2.5 people received Botox injections, nearly a quarter of all cosmetic procedures for that year. Botox has a safety record that surpasses that of nearly every other medication available.
Botox is the brand name given to a purified protein made using botulinum toxin, most frequently botulinum toxin A. There are thousands of articles in scientific and medical literature that support its use both in therapeutic and cosmetic applications. Within a few hours of Botox being injected into the muscles of the face it attaches to the endings of the nerves that control the muscles. Over the next two to ten days, the Botox begins to block transmission of nerve signals that cause the muscles to contract. Wrinkles are caused by contractions of the muscles under the skin, and then they cease to contract, the lines will begin to smooth out. Botox only affects the motor nerves, leaving the sensory nerves unaffected so there is no loss of sensation. Botox continues to block the nerve signals for about three to four months. This is affected by factors such as the amount of the product used, how quickly the patient metabolizes the toxin, and the patient’s lifestyle choices. As the effects wear off, wrinkles will begin to reappear, and the patient will need to be retreated.
The way in which Botox works is a big reason for its safety record. First, treatment with Botox is localized, so the effects, along with any side effects, are typically only seen in the treated area. Second, the product is, by its very nature, temporary. Once Botox has worn off, it and its effects are gone completely. This is unusual in the realm of dentistry, where most treatments are intended to last long term. The biggest exception to this is teeth whitening, which needs to be repeated periodically.
Botox is most often used to erase or minimize facial wrinkles found on the forehead and between and around the corners of the eyes. These areas are the ones most commonly treated by Botox, though it can also be used in other areas.
DENTAL USES FOR BOTOX
Currently about 7-8% of dentists in North America offer cosmetic treatments with Botox to their patients and this number is growing. As more dentists offer the procedures, more innovative uses are being developed. Many dentists are still unaware of just how many benefits Botox can offer as a complementary treatment in both dentistry and esthetics. Botox has been found to be benefits as an adjunct therapy for cases of TMJ, bruxism, and facial pain that do not respond to traditional treatments. Because it blocks nerve signals, Botox is effectively a muscle relaxer. In doses half of those used for esthetic applications, Botox can reduce the muscle contractions that cause TMJ and facial pain, offering substantial pain relief. Every dentist has seen at least a couple of TMJ patients who, despite appliances and even entire mouth reconstructions, continue to struggle with pain. Botox can significantly reduce, and even eliminate, facial pain for many of these patients.
Botox is frequently used alongside dermal fillers to resolve cases of high lip lines without surgery. Traditionally, these cases have been most often treated surgically. A dentist would raise the height of the gingiva by performing a periodontal flap surgery with both osseous reduction and crown lengthening. This would be followed by crowns and a bridge in order to improve dental esthetics. Even the newest and most inexperienced dentist knows just how aggressive this type of treatment would be. Very few dentists would choose treatment like this for themselves, yet it is what is most often offered to patients.
Using a little Botox to weaken the muscles around the mouth and a bit of dermal filler to augment the lip, one can achieve results just as good as with surgery without the expense, pain, or recovery time associated with surgery. Of course, it’s important to approach the procedure with caution so as to maintain normal lip function, including enunciating, smiling, and eating. When done well, the lips cannot be raised as high, but maintains the ability to function normally.
As with any treatable condition, it is important to provide the patient information, including risks and benefits, for all alternatives. Even the aggressive treatment has its advantages, primarily that the treatment is permanent. The disadvantages, of course, are initial cost, the number of appointments, potential complications, possible sensitivity, possible need for eventual endodontic therapy, and possible need for repeat surgery, should the gingiva begin to recede. The advantages of treatment with Botox and dermal filler are near-immediate results, no need to remove tooth structure, minimal discomfort, no recovery time, and minimal risk of complications. The disadvantages are the need for repeated injections every four to six months and the cost associated with regular retreatment. It makes little difference to the dentist which treatment option the patient chooses, but it certainly offers more options.
A BEAUTIFUL SMILE MEANS MORE THAN BEAUTIFUL TEETH
This is just one example illustrating the importance of Botox and dermal fillers, along with more traditional options such as veneers and resins, to esthetic dentistry. As important as straight, white teeth, the soft tissue around the mouth is vital to a beautiful smile. Dentists have developed a teeth-centric mindset that it is easy to forget that the area around the mouth is just as important for an esthetic smile. Have you ever noticed a dental case involving a patient with teeth that are perfectly straight and white in the middle of a face with thin, wrinkled lips and deep lines around the mouth? It would not be inaccurate to suggest that these patients have beautiful teeth, but not necessarily a beautiful smile.
A number of other dental applications have been developed for Botox, including complementing other therapies by retraining muscles. Moving the teeth orthodontically is easy, but if your patient has strong muscle movement, the teeth will eventually slip back. Botox can weaken these muscles so they can be retrained to more optimal movement. As an adjunct therapy, it is a good option for those patients that have experienced orthodontic relapse as a result of overactive muscles.
Botox is also helpful for patients who have just been fitted with new dentures, especially if they have been without teeth for a long time or have old dentures that are overclosed. Even dentures that fit perfectly can be difficult for a patient to get used to and keep in the mouth if the patient has strong muscle contractions.
As we age, the corners of the mouth start to droop. When Botox is injected into the muscles in this area, they will relax, allowing the corners of the mouth to lift. Botox can also help erase the wrinkles around the mouth caused by action of the orbicularis oris muscles. These lines are often referred to as smokers’ wrinkles, though nonsmokers are just as likely to be affected.
DENTISTS ARE SPECIALISTS IN THE ORAL AND MAXILLOFACIAL AREA
While the number of dentists who offer Botox and dental fillers is growing, the number is still quite small. This is due to the prevailing misconception that these therapies are outside the scope of dentistry practice. On the contrary, currently half of US states, as well as some Canadian provinces allow dentists to administer the injections for all oral and maxillofacial applications. In states where it is not currently allowed, dental associations are working to change legislation. Readers need to be familiar with the laws regarding scope of practice in their area.
Botox is frequently offered by many healthcare providers, including plastic surgeons, dermatologists, podiatrists, OB-Gyns, ophthalmologists, physicians’ assistants, nurses, and even medical estheticians, who are often not medically trained. It is time for the world of dentistry to acknowledge that dentists are far more knowledgeable and proficient in oral and maxillofacial areas than any of these professions. Dentists are also experts regarding the facial muscles that are most the targets of these treatments.
Opponents of Botox and dermal fillers in dentistry argue that are a medical treatment that should only be performed by physicians. While the premise has merit, the conclusion is based on an assumption that dentists are not real doctors, which is patently untrue. Dentists routinely inject local anesthetic into patients. These local anesthetics are no less medicinal than Botox, and have potential systemic complication. As a dentist, injecting local anesthetics is second nature and you are confident in your ability to manage any complications, which have the potential to be far more severe than any seen with Botox or dermal fillers. With a little training, you can be just as confident in your ability to administer Botox and dermal fillers as you currently are with local anesthetics. Having trained hundreds of healthcare professionals of all stripes, I can confidently say that dentists have the easiest time learning to perform these treatments, are realistic and conservative when administering the injections, and are well qualified to manage any complications when giving injections in the head and neck areas.
Another common misconception is that learning to administer Botox and dermal fillers is a skill that takes months to learn. Many dentists believe that plastic surgeons, dermatologists, and other healthcare professionals that offer the treatments only do so after extensive training as part of their medical residencies. This could not be further from the truth. Having spoken and worked with many healthcare providers, I have learned that, unless a residency has a cosmetic element, the topics are barely touched on at best. Most healthcare professionals who administer the injections attend courses that last as little as a day or two to learn the skill before adding it to their practices. Many nurses who perform the procedure do not even attend a course; they receive their training on the job. Some states allow nurses and physicians’ assistants to offer not just Botox and dermal fillers, but also sclerotherapy, laser and chemical peels, and mesotherapy without physician supervision. Should dentists, with their specialized medical training, be considered to be less qualified? I don’t believe I’m exaggerating to say we are far more qualified. It is important for dentists to rethink the profession and its place in the medical arena and stop letting politics dictate esthetic facial procedures.
TRAINING IS THE KEY
Hands on training is vital to learning not just how to perform these procedures, but how they can be used in conjunction with more traditional dentistry. Generally speaking, dentists finish training more proficient in performing these procedures on patients than any other healthcare profession. Having trained many healthcare providers, it has become apparent that dentists have such detailed knowledge of facial anatomy, and are already so skilled at administering injections, that they are the best qualified to provide the treatments, along with the dramatic effective they can provide, to their patients.
It’s time that we, as dentists, extend ourselves to be able to offer our patients all possible options. Botox and dermal fillers are conservative, minimally invasive, and versatile treatment option that can expand the benefits we can offer our patients. They should be seen as a potential extension of where the dental industry is headed. The procedures are not difficult to learn or to perform with proper training. Statistics show that patients are seeking out these therapies and would be thrilled to be able to have them done at the same time as their regular dental appointments. Botox and dermal filler therapies are an ideal addition to any dental practice. Sign up for our Botox Training & Dermal Fillers Training Programs.