Does Botox Have a Role in Dentistry? Yes!

By Dr. James Catt

Does Botox have a role in dentistry?  This was what I was determined to discover when I registered for my first introductory Botox course.  The course was instructed by Dr. Warren Roberts from the Pacific Training Institute for Facial Esthetics (PTIFA) in Vancouver B. C. .  I was drawn here because of its recognition by both ADG PACE and ADA CERP as well as this being the most thoroughprogram that I could find. I was in search of answers, not a diluted course that spoon fed material and handedout a flowchart of “how to’s”.  I needed both a didactic and clinical perspective in order to arrive at a sound judgment on the practicality and safety of the possible utilization of Botox in my practice if Oregon were to allow dental professionals access to this therapy.  PTIFA fulfilled this requirement for me.

Admittedly, prior to attending the training I had some pre-existing bias on two levels.  Apprehension of the drug’s effects and unwanted clinical outcomes made up the bulk of my bias.  In addition, understanding the psyche of the patients who seek this type of therapy also added to my unease.  The latter was less of an issue since I learned multipleclose acquaintances evidently received Botox therapyregularly provided by individuals who at first glance appeared to have fewer head and neck anatomy credentials then I.Also, all of these acquaintances seemed like normal people and their outcomes were as expected.  In reality, it was only due to my close relationship with them and their voluntary divulging of this informationthat I had any idea they had received treatment at all.  So the question lingers; how does Botox apply to dentistry?

In short, the education that I received allayed my misgivings concerning Botox.  Let me repeat that.  The educationallayed my misgivings concerning the safety and utilization of Botox.  I’ve since taken an additional 16 hours of continuing education from PTIFA (totaling  32 hours) which focused on specific dental applications and hands on exercises.  There is absolutely no question in my mind that this treatment can provide dental advantages.  The next question would pertain to who specifically should be providing the therapy for dental applications.

In making my assessment and attempting to answer this question, I began to systematically review what my particular “job” as a dentist currently entails.  My “job”, as I would describe it, may be quite different then my dental colleague’s “job” who practices next door if he were to describe his own duties.  We are both D.M.D.’s, obtained our degrees from the same dental school and we are both required to meet the same standard of care.  However, he may state that his “job”entails extensive endodontic and pediatric treatment.  Theoretically, in these cases, I may state that my “job” is to schedule these patients with a great specialist.  My colleague has taken additional training and provides a high level of care in these cases that I don’t necessarily feel comfortable becoming involved in.  The converse may also be true.  After dental school I chose to pursue a greater level of understanding of occlusion.  I began a four year post graduate path that ultimately provided a competence in treating complex occlusion cases.  Coincidently, often times, this therapy helps with head and neck pain.  My colleague may not report this as one of his “job” objectives.  We are both working within our scope but our focuses differ.  I believe that it is well established that while working within our scope the discretion of what services we provide is based on our education.  Likewise, one practioner’s voluntary dispassion for a type of dental procedure does not, nor should it ever, preclude other practioners from focusing on this said procedure as long as it’s within the scope of dentistry.   Which dental professionals should be allowed to administer Botox for dental purposes?  The answer is the dental professionals who have taken advanced Botox training for dental purposes.   Dental purposes include, but are not limited to, muscle/frenum pulls leading to gingival recession and other periodontal concerns, bruxism and hypertrophic facial muscles, excessive gingival display, and muscle related TMD symptoms.

Some may say that the general dentist should stick with treating teeth and gums.  Some may say that facial musculature isn’t something that the general dentist should involve themselves with.   At this point I am going to use my own training as an example of how the general dentists in our state, who have had the proper advanced training, currently involve themselves with facial musculature every day.   The application of Botox by the general dentist is not an expansion of scope.  On the contrary, Botox is simply a potentially powerful new tool in our armamentarium of treatment options.    The question at hand is,which dental professionals can use Botox in a comprehensive manor and safely maximize the benefits of this therapy?By no means is this example to imply a specialty on my part.  Like many of my dental colleagues, this is simply one aspect of my “job” as I’ve defined it through advanced education and is what I’ve chosen to study and implement in my practice.

 All of us dentits have seen severely worn dentitions.  We as dental professionals know that severe dental attrition is only one sign of a systemic problem.

After ruling out other biological etiologies such as medications, eating disorders and gastric problems, it is inherent that we address the facial musculature system which attaches to and controls the grossly worn hard tissues.  It is impossible to predictably treat the teeth alone since the hard tissues and the soft tissues are reliant on one another.  Without superfluous explanation since the methods vary, the facial muscles need to be relaxed, the jaw joint needs to be passively stabilized, a diagnosis made and treatment options proposed.Botox therapy could often times be useful atmany of these junctures.After consent is given, irreversible procedures are performed on the hard tissues.  The treatment objective is to provide therapy which will lead to permanent stabilization of the occlusion and therefore provide a state of musculature stability which coincides with this new stable occlusion.    As I mentioned earlier, the consequence of this treatment is often times a reduction in myofacial pain.  Below are several photos of one of my own cases.  These photos document the muscular changes that occur when advance occlusal therapy is performed.   There is no refuting that there are permanent changes to this individual’s facial musculature.  This is an irreversible and, might I say, quite an invasive procedure.  However, the results are predictable and successful due to advanced education.  This treatment falls within today’s scope of practice for our state’s general dentists.  Not all dentists perform this type of invasive, advanced, irreversible procedures whichaffect the hard AND soft muscular tissues.  This is a voluntary choice made through the practitioner’s involvement in advanced education.  Botox therapy, even though reversible, should have similar educational requirements.

 Before and After Occlusal Therapy and Muscle Stabilization

So, should a general dental professional be allowed to provide Botox Therapy?  The answer is a resounding, YES!  The caveat being, the general dental professional should be required to meet a standard of competency based on educational requirements.  It is obvious that there are well trained general dentist who treat facial musculature every day and we do this with irreversible procedures.  Botox therapy can be used as an adjunct to such treatment as well as others. Not only is Botox proven safe to use in the right circumstances, it is completely reversible.  The real question is, who better to provide dental Botox to our patients?  Logic requires that the treating doctor has the knowledge of the masticatory system, complex occlusion, head and neck anatomy, as well as possesses the dexterity for specific injection techniques.  Certainly this treatment option isn’t for every dental practitioner, but let’s not withhold this from those general dentists who have the ability, desire, and education to serve their deserving patients.

 

Dr. Jim Catt  practices health centered comprehensive cosmetic restorative dentistry in Medford, Oregon. He received his Bachelor of  Science from  Oregon State University and was Magna Cum Laude from Oregon Health and Sciences University with his Doctorate in Dental Medicine.  Dr. Catt is  a past president of the ODA and has served as an  Trustee for 13 years, participating on many Boards and Committees. He is a member of the International College of Dentists, American College of Dentists, and Pierre Fauchard Academy. In addition, he facilitates dental health in children through dental health awareness in Medford schools, volunteering at Jackson County Children’s Dental Clinic, and acting as the Project Lead for the Southern Oregon Mission of Mercy.

 

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