Botox is exploding in popularity as a quick, efficient and painless aesthetic treatment. Botulinum toxin injections have been used for decades to eliminate wrinkles and reduce frown lines. Estimates by the American Society of Aesthetic Plastic Surgery (ASAPS) say that in 2008 alone, approximately 2.5 million people had Botox injections. Some of the procedure’s popularity comes, no doubt, from the safety of the procedure; it’s as close to risk free as any modern medical procedure.
The name Botox comes from the scientific name for the botulinum toxin, from which the branded purified protein is derived. The various uses (cosmetic and therapeutic) for botulinum toxin are detailed in thousands of scientific medical articles.
When injected into the muscles just beneath the skin, Botox attaches to nerve endings which control the muscles. By blocking the nerve signals that cause muscles to contract (which is what makes wrinkles), Botox acts over 2 to 10 days to reduce wrinkles. Skin is left smoother with fewer lines and remains so for about 3 to 4 months. Because Botox only affects motor nerves, and not sensory nerves, patients do not lose any sensation in the treated area. Different factors, like the patient’s lifestyle or metabolism, causes the exact duration of the effect to vary from person to person.
Botox is extremely safe because any effects or side-effects are only experienced in the exact location of the treatment, and the effects are temporary. It wears off.
Though Botox can be used in other parts of the body, it is primarily used to smooth out wrinkles on the forehead and around the eyes.
Botox in Dentistry
Just under 10% of Dentists in Canada and the U.S. offer cosmetic procedures such as Botox, and that number is growing. This growth is linked to the innovations that continue to happen in the field of facial aesthetics as professionals branch out to learn more about it. Even now, when one out of every ten dentists offer Botox, many remain unaware of the various complementary uses there are for Botox in dentistry.
Botox has been effectively employed to enhance therapies to treat TMJ, facial pain, and bruxism. As a muscle tranquilizer, Botox acts to reduce the painful symptoms associated with TMJ. The treatment’s origins can be found in the frustrations of dentists’ struggling to help TMJ patients for whom traditional treatments have done little to halt their agony.
Botox is also often used along with dermal fillers to fix high lip lines without the need for surgery. As you may know, such cases would involve raising the height of the gingiva through a periodontal flap surgery with osseous reduction and crown lengthening. Crowns and bridges came next for aesthetic purposes. With Botox, a more simple and immediate (and just as effective) course of treatment can be set.
A full exploration of the pros and cons of each procedure is, of course, advisable; but, patients have a real choice, and their dentist can offer it to them.
A radiant smile is about more than your teeth
It’s common for dentists to consider straight, white teeth as the only component involved in a beautiful smile. However, just as important is the soft tissue of the lips and face. Botox can be a valuable complementary treatment to the traditional array of aesthetic dental procedures offered at most offices in the country.
Did you know that there are a few dental applications of Botox? Injecting Botox after orthodontic procedures can reduce remission by weakening muscles, thus diminishing excessive movements that cause teeth to fall back into places we don’t want them. This is an excellent auxiliary treatment when the patient’s clinical record indicates orthodontic relapse.
Imagine a different patient, one who has just been assessed as a candidate for new dentures. Botox is recommended in this situation, as well. Some denture patients have been compensating for a lack of teeth, or have been using old, overclosed dentures. These patients can experience strong muscle contractions that complicate the process of adapting to the new dentures, and whether or not they can keep them in the mouth. As our patients (and indeed, as we ourselves) age, the corners of the mouth naturally droop. However, Botox injection can lift those muscles again by relaxing the area. When you think of other types of lines that naturally occur with aging, such as the so called “smokers’ wrinkles” around the mouth – well, these affect both smokers and non-smokers alike – and almost everyone can have these fine lines erased with the application of Botox.
Specializing in the oral and maxillofacial area: your dentist
The scope of dentistry practice in roughly half of the United States, as well as some Canadian provinces, currently allows for the administration of oral and maxillofacial applications of Botox, via injection. The number of dentists who see the benefits of offering this service is growing steadily, but remains small, relative to the potential for treatment across North America. Notably, in those areas where the scope of practice excludes such treatments, dental associations are working to update the legislation. Please note that it is each DMD and/or DDS’s responsibility to familiarize herself with the applicable laws in her area.
The patient who seeks or can benefit from Botox injection has many options among healthcare providers, including: plastic surgeons, podiatrists, ophthalmologists, dermatologists, OB-Gyns, nurses, physician assistants, and medical estheticians (the latter of whom may lack medical training despite their title). And yet we know that the medical professionals who are expert in the oral and maxillofacial areas are none of these! It is past time for the dentistry profession to recognize that dentists are the most proficient practitioners available to treat these areas, especially those facial muscles that are most often the area of the injection site and the target of treatment.
Those who detract from the benefits of Botox and dermal fillers in dentistry posit that such treatments are the purview of medical physicians, and as such, do not have a place in dentistry. This absurd argument is based on an assumption that dentists are not technically doctors. How can this be true? Dentists, in fact, regularly inject local anesthetic to facilitate treatment. Most dentists would likely wave this aside as a routine part of their practice. But consider: local anesthetics are no less therapeutic than Botox – these anesthetics carry the risk of potential systemic complications that dentists by and large feel quite competent in their ability to manage. Conversely, Botox and dermal fillers have fewer and less severe complications associated with their therapeutic use. With training in how and when to administer Botox effectively, dentists can be just as adept and confident in its use as they are in their administration of local anesthetics.
Now, I have trained several hundred healthcare professionals from almost every discipline. With this experience, I can tell you that dentists seem to have the easiest go of it when they are apprehending the process. Dentists are, in general, realistic and conservative when it comes to injection administration, as well as confident and well-qualified to assess and address any complications that may arise during an injection into parts of the head or neck. It’s that simple.
There is yet another misconception afloat in the medical professions, including dentistry that learning to administer dermal filler and Botox injections is a highly specialized skill that requires several months to master. I have heard dentists object to their own training in this area, on the grounds that plastic surgeons, dermatologists and the like (those who have more traditionally administered dermal filler treatments) have incorporated Botox into their practice only after months of training integrated into medical residencies! I cannot emphasize enough that this is a drastic exaggeration of the truth! In discussing this with the many and varied medical and healthcare professionals whom I have trained, these topics are barely considered in most medical residencies, unless that residency has a specifically cosmetic component! I am happy to report that most healthcare professionals who currently administer dermal filler injections have participated in training seminars as brief as a day or two. In other words, a weekend of training and these professionals are ready and prepared to integrate the treatment into their practice.
I want to highlight that I believe most dentists are selling themselves short when they omit themselves as potential Botox and dermal filler providers. In some states, nurses and medical assistants are able to offer injections of this kind, in addition to laser and chemical peels, sclerotherapy and mesotherapy… without physician oversight. It is baffling that some dentists, with highly specialized medical training and years of essential practice under their belts, should somehow be considered less qualified. This is simply not the case. In fact, dentists are considerably more qualified. Let us stop and reconsider what constitutes the profession of dentistry. We need to adapt our shared paradigm of how dentistry fits into the larger web of medical practices and procedures. And certainly, we must resist the politics that dictate who is qualified to assess and treat when it comes to esthetic facial procedures.
Training is essential
How can these procedures be used in conjunction with more traditional dentistry? This is part of the very hands-on training that is so crucial when learning to perform Botox and dermal filler injections. On the whole, dentists complete their training with a proficiency in administering the injections that is impressive, even among the other health care professionals who consider themselves qualified to do the same. I want to repeat that I have worked with, and indeed, trained, many healthcare providers. In my not inconsiderable experience, dentists have a very detailed and specialized knowledge of facial anatomy, and are usually already adept in administering injections. It follows that dentists are the best qualified medical professionals to offer such treatments, along with the substantial and often dramatic benefits they provide, to their patients.
It is past due! We, as dentists, are in a position to offer our patients every possible option for treatment – we need only adapt to change, move forward, and extend ourselves a little in the interests of our patients. Botox and dermal fillers have versatile applications that can be highly useful and effective in dentistry practice. These options are also conservative, and minimally invasive. This natural potential expansion of practice and treatment can be integrated with brief, but diligent, training. The market is also ready – statistics show that patients are indeed seeking out such therapies, and would be pleased to find them available to them during otherwise routine exams and appointments with their dentist. In short? Botox and dermal filler therapies hit all the high notes as the ideal next step, in any dental practice.
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