We all can do a magnificent job of making teeth look great and giving people a healthy and beautiful smile. Esthetic dentistry has been an absolute boom over the last 30 years especially when it comes to such innovative techniques as teeth whitening and minimally invasive veneers like Cristal Veneers by Aurum Ceramics. Now that the teeth look good, what about the perioral areas around the mouth? If the teeth look good but we ignore the rest of the face, then we have really limited what we have done in esthetic dentistry. It is time to seriously give serious consideration to extending the oral-systemic connection to the esthetic realms and facial pain areas of the face which dentists are more familiar than any other healthcare practitioner. Get certified! See the Botox Certification & Training Level 1 Course Outline.
Botox® is a trade name for botulinum toxin, which comes in the form of a purified protein. The mechanism of action for Botox® is really quite simple. Botox® is injected into the facial muscles but really doesn’t affect the muscle at all. Botulinum toxin affects and blocks the transmitters between the motor nerves that innervate the muscle. There is no loss of sensory feeling in the muscles. Once the motor nerve endings are interrupted, the muscle cannot contract. When that muscle does not contract, the dynamic motion that causes wrinkles in the skin will stop. The skin then starts to smooth out, and in approximately three to ten days after treatment, the skin above those muscles becomes nice and smooth. The effects of Botox® last for approximately three to four months, at which time the patient needs retreatment.
The areas that Botox® is commonly used for smoothing of facial wrinkles are the forehead, between the eyes (glabellar region), and around the corners of the eyes (crow’s feet) (Figures 1&2) and around the lips. Botox® has important clinical uses as an adjunct in TMJ and bruxism cases, and for patients with chronic TMJ and facial pain. Botox® is also used to complement esthetic dentistry cases, as a minimally invasive alternative to surgically treating high lip line cases, denture patients who have trouble adjusting to new dentures, lip augmentation, and has uses in orthodontic cases where retraining of the facial muscles is necessary. No other healthcare provider has the capability to help patients in so many areas as do dentists.
Dermal fillers, such as hyaluronic acid (Juvederm®, Restylane) and calcium hydroxylapatite fillers (Radiesse®), are commonly used to add volume to the face in the nasolabial folds, oral commissures, lips, and marionette lines (Figures 3 & 4). As we age, collagen is lost in these facial areas and these lines start to deepen. These dermal fillers are injected right under the skin into to plump up these areas so that these lines are much less noticeable. Dermal fillers are also used for lip augmentation and are used by dentists for high lip line cases, uneven lips, and to make the peri-oral area more esthetic. The face looks more youthful and is the perfect complement to any esthetic dentistry case that you do.
I have been trained and have had experience with these Botox® and dermal fillers for a while and these are very easy procedures to accomplish. We as dentists give injections all the time – this is just learning how to give another kind of injection that is outside the mouth but is in the same area of the face that we inject all the time. We also have a distinct advantage over dermatologists, plastic surgeons, medical estheticians, and nurses who commonly provide these procedures in that we can deliver profound anesthesia in these areas before accomplishing these filler procedures. I will never forget that during my training, my patients were completely comfortable during dermal filler and lip augmentation therapy because of my ability to deliver proper anesthesia to these areas. The patients treated by other health practitioners were quite uncomfortable and indeed this is one of the biggest patient complaints about dermal fillers.
Many dentists are surprised to find that in nearly half the United States, state dental boards allow dentists to provide Botox® and dermal fillers to patients. Why wouldn’t you provide these services, you already offer whitening and esthetic dentistry to your patients? I would make the strong argument that dentists are the true specialists of the face, much more so than most other healthcare professionals, including dermatologists and plastic surgeons. It is time to stand up for what we know and what we can accomplish.
Is there a market for these services? In 2008, close to 3 billion dollars were spent on botulinum toxin and dermal filler therapy in the US. Think about this – that was money spent on non-surgical elective esthetic procedures that could have been spent on esthetic dentistry but the patient made a choice. Interestingly, these procedures become more popular in an uncertain economy because patients want to do something to look better that is more affordable than surgical esthetic options.
Like anything else you do, this requires training. The learning curve is short because you already know how to give comfortable injections. I often give training sessions in Botox® and dermal fillers and dentists are amazed how easy these procedures are to learn and accomplish compared to everything else we do. Finding practice models is easy – start asking family and friends who will fight to have you practice on them. If you want further proof, ask women in your practice if they have had or would like Botox® or dermal filler therapy. You will be overwhelmed at the positive response and shocked at the number of people you know already receiving these treatments.
The next big thing in dentistry? It may come as we start expanding outside of the teeth and gums into the peri-oral tissues, which is within every dentist’s skill set. All you need is knowledge and practice. Then, you will be able to deliver these new services to your patients and truly complement the rest of your dental practice.
Dr. Louis Malcmacher is a practicing general dentist in Bay Village, Ohio and an internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for Clinicians Reports (formerly Clinical Research Associates), Dr. Malcmacher has served as a spokesman for the AGD and is a consultant to the Council on Dental Practice of the American Dental Association. He works closely with dental manufacturers as a clinical researcher in developing new products and techniques. For close to three decades, Dr. Malcmacher has inspired his audiences and consulting clients to truly enjoy doing dentistry by providing the knowledge necessary for excellent clinical and practice management. His group dental practice has maintained a 45% overhead since 1988. You can contact him at 440 892-1810 or email firstname.lastname@example.org . You can also see his lecture schedule at www.commonsensedentistry.com where you can find information about his Botox® and dermal filler training, building the best dental team ever, big case acceptance success! and sign up for his affordable monthly consulting programs, teleconferences, audio cd’s and free monthly e-newsletter.