To say that Botox has really taken off in the 21 years or since since it was introduced would be a vast understatement. Botox is currently the most popular cosmetic procedure in North America with well over 2 million procedures performed in 2008, according to estimates from the American Society of Aesthetic Plastic Surgery. That equates to 24% of all cosmetic procedures done that year, and 92% of them were done on women. Botox has a safety record that beats nearly every other medication available.
Botox is the brand name of botulinum toxin. After it is injected into facial muscles, it attaches to the nerve endings, blocking nerve signals to the muscles, paralyzing them but not blocking sensation. It is the movement of these muscles that causes wrinkles in the first place, so when they cannot move, they cannot cause wrinkles. These effects last 3-4 months, depending on a variety of factors. The temporary nature of Botox is the reason it has such a great safety record.
The most common esthetic uses of Botox are smoothing the fine lines in the forehead and between and around the corners of the eyes. As more and more dentists begin offering Botox, other, more therapeutic uses are being found. Many dentists are unaware that Botox can be used to treat TMJ, bruxism, and other types of facial pain caused by muscle spasm.
Botox is frequently used alongside dermal fillers as a nonsurgical method of treating high lip line cases. Traditional treatment involves periodontal flap surgery that includes substantial osseous reduction. This procedure would be followed by procedures to establish dental esthetics to complement the surgery. It doesn’t take a dentist to realize that is far more invasive and aggressive treatment than most people want to undergo. Alternatively, a bit of Botox to weaken the muscles around the lip and dermal fillers to augment the lips can achieve much the same result with far less expense and recovery time. Of course, this should be done carefully so as to maintain normal function of the lips.
That’s not to say that the more aggressive option doesn’t have its advantages. After the treatment is complete, the results are permanent, while Botox and dermal fillers must be repeated a couple of times a year. However, the results are immediate and recovery time is minimal. As a dentist, it doesn’t make a whole lot of difference which route the patient chooses, but it does provide more treatment options.
This is just one scenario that shows the role Botox and dermal fillers can play in esthetic dentistry. Color and position of teeth are no more important to a beautiful smile than the soft tissue around the mouth. As a dentist it is easy to become so focused on the teeth that one can forget that other areas are just as important.
Botox can also play an important role in orthodontics. In some patients, a strong mentalis muscle can cause teeth to slip back to their pre-therapy positions. Botox can weaken these muscles so they can be retrained to follow more normal movement.
Botox can also be helpful for patients getting used to dentures. Even perfectly fitting dentures can be difficult for patients with strong muscle contractions.
There is some confusion regarding whether Botox fits in the scope of dental practice and it’s important to realize that dentists, because they work almost exclusively in the oral and maxillofacial areas, are at least as skilled as any other healthcare professional that doesn’t spend near as much time working on this area. Currently, every state allows dentists to offer Botox for therapeutic purposes, and about half of states allow dentists to use it for cosmetic purposes.
Some dentists have concerns that these products should only be used by doctors. However, I would point out that dentists inject local anesthetic frequently. Local anesthetics have much greater potential for complications and reactions than Botox or dermal fillers. After training, you can be just as comfortable injecting Botox as you are injecting local anesthetic.
Another common misconception is that learning to administer Botox takes months of training. Quite the contrary, most professionals learn to administer Botox and dermal fillers in a one or two day course. These courses include a hands on component that is absolutely critical to becoming proficient in these procedures and learning to combine them with dental treatment plans.
Isn’t it time to expand your practice to use all of the tools available? Botox and dermal fillers are minimally invasive tools that can provide additional options to your patients. The procedures can be performed in just a few minutes while your patient is already in the office for their regular checkups. Patients love being able to get the procedures done by someone they trust and with whom they have developed a relationship. It just makes sense.
Dr. Katz is the President and founder of Dentox, a premier teaching facility for dental Botox and dermal fillers and has co-invented most indications for dental uses of Botox. Dr. Katz has injected and supervised injections on more patients than any other educator in this field. It is with this extensive experience that he has created protocols for dental esthetics of dermal fillers for many US cosmeceutical companies.
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