Botox® in the Dental Office - Is It Worth the Risk?
By Robyn Thomason, Risk Management Analyst, TDIC
The Food and Drug Administration (FDA) approved the use of Botox® in 1989 for eye muscle disorders, but physicians used it “off-label" to reduce the appearance of wrinkles. In April 2002, the FDA officially approved its use for the temporary improvement in the appearance of moderate to severe brow furrows. According to the American Society of Plastic Surgeons, “Botox® injections were the top requested, nonsurgical cosmetic procedure in 2005 with a 16 percent increase from 2004. Over $1 billion was spent by Americans on Botox® alone in 2005.”
With such a high demand for cosmetic treatment and no existing regulations on who can administer Botox®, many dentists have begun offering this treatment to their patients. Even though dentists are educated to treat conditions of the head and neck, they must remember to follow the regulations that govern the practice of dentistry in their states. In August 2005, the Minnesota Board of Dentistry’s Facial Cosmesis and Pain Management reported:
“In 2002, the Colorado Board of Dental Examiners concluded that the use of Botox® or Restylane® injections may be within the scope of the practice of a Colorado dentist but there may be exceptions. The Board determined it would look at such a question on a case-by-case basis. In November 2000, the Florida State Board of Dentistry stated: ‘The use of botulinum toxin injections for management of facial pain shall be restricted to dentists in the practice of Oral and Maxillofacial Surgery (OMS) and/or other dentists who can demonstrate specific training in the use of this modality. In March 2003, Dr. Michael Murphy of the Ohio State Board (of Dentistry) stated, ‘Our policy has always been that whatever the OMS has been trained to do in his or her accredited residency training program is within their scope of care.’ The dental boards of Oklahoma, California and North Carolina have determined that treating patients specifically for wrinkles is not within the scope of dental practice.”
There are continuing education (CE) providers promoting the use of Botox® for treatment within the dental office. That a CE provider states performing this treatment may be within the scope of a dental license and suggests professional liability carriers cover this procedure, does not necessarily mean it is true. When dentists who are not oral and maxillofacial surgeons use Botox® to improve patients’ smiles or to reduce their brow furrows, they are practicing outside the scope of dentistry.
Some practitioners believe that Botox® has few, if any, serious side affects, including droopy eyelids, which can last for a few weeks; flu like symptoms; headache and upset stomach. Though rare, there have been serious reactions, including death. Some of these patients had pre-existing conditions such as cardiovascular disease. Additionally, many of the patients who request the use of Botox® for cosmetic treatment are women of childbearing age, and if pregnant, there is a risk of fetal malformation.
Dentists have used Botox® to alleviate pain related to temporomandibular disorders. However, this is rarely the first choice of treatment for TMD as there are little data available to support long-term effects. Attempt treatments such as a soft diet, physical therapy, splint therapy and medications before resorting to Botox® to treat TMD. Dentists who wish to use Botox® to manage pain associated with TMD should first contact their state dental boards.
Practicing outside the scope of one’s dental license is a violation of dental practice statutes. Violation of a statute that results in an injury to a patient is a presumption of negligent care. When dentists practice outside the scope of their license, they may be voiding their professional liability coverage should an allegation of an untoward result be made.
So, keep in mind that when dentists practice outside the scope of their licenses, they may also be incurring a risk that my not be covered by their professional liability coverage. Prior to including Botox® within a dental practice, ensure it is within the scope of dentistry. Until the dental board states that Botox® or any other procedure is within the scope of dentistry, continue to use traditional methods to treat dental conditions.
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