By Iman Sadri, DDS
Coming soon to a dentist near you...Botox. That's right, dentists in many states are now legally able to administer Botox to their patients. Whether, it would be for therapeutic purposes, or cosmetic rejuvenation, dentists are becoming trained to offer both treatment modalities. Botox in a dental setting, for therapeutic purposes, is used to treat TMJ disorders, bruxism and sialorrhea (excessive salivation). Cosmetically, plastic surgeons and dermatologists administer Botox most commonly between eyebrows to decrease frown lines. Cosmetic cases that dentists focus on with Botox are to reverse the aging process of the muscles surrounding the mouth and the lip lines.
Botox, manufactured by Allergan, was approved in 1989 by the FDA to be used for therapeutic and cosmetic use. The composition of Botox, is actually a derivative of a botulin toxin that causes botulism. In severe cases, botulism can be life threatening as it leads to systemic muscle paralysis, including respiratory failure. Extremely small amounts of the botulin toxin are actually in each Botox prescription injection. The bacteria is heavily diluted to minimize potential systemic risks. Each injection administration lasts about four months.
The level of training necessary for dentists to administer Botox varies greatly by state, as does the liability insurance coverage. Dentists in favor of administering Botox for cosmetic purposes argue that it is an important supplement to facial analysis and smile design. Dentists can place fillers also, including Juverderm to soften deep folds, add to lip support, and to reduce wrinkles near the mouth. I would tend to agree that some veneer cases would be complimented by a stronger lip line. Also, a full mouth Lumineer case would have a more youthful appearance with minimal wrinkles along the angles of the lip. The Da Vinci Facial Analysis, a tool to attain the perfect curvature of the smile line, in my opinion, is incomplete without the proper muscle esthetics. But, dentists opposing Botox treatment argue that only heavily trained oral surgeons, plastic surgeons, and dermatologists should administer these injections. They argue that these medical professionals are more knowledgeable about facial esthetics and muscles response, than dental professionals.
For me, as a cosmetic dentist, it is quite rewarding to see the dramatic results from veneer cases. Having an added clinical arsenal, such as Botox, that I can actually do chair-side to achieve optimum facial analysis and smile design is imperative. It could be the added ingredient to achieve a more balanced result. In fact, I am taking a course this month on how to administer Botox taught by renowned cosmetic dentist, Dr Louis Malmacher. I could also moonlight with my brother, Ehsan, a Newport Beach based Ophthalmologist who does Botox like dentists do sealants. I also would argue that dentists perform challenging oral surgery and routinely administer anesthetic injections. So the actual administration of Botox is the easy part. The challenge is having the dental provider and the patient understand all risks and benefits and to actually achieve the desired planned results. Extensive training and risk control is imperative. If you find a cosmetic dentist confident enough to perform veneer and anterior porcelain crown cases, would you still go to them for Botox? Mark Twain once said: " Wrinkles only go where the smiles have been." Now because of your Botox-trained, cosmetic dentist: "Smiles will go where your wrinkles have been."
Dr Iman Sadri is a cosmetic dentist and writer based in Irvine, California. He is a graduate of NYU. He covered the Sacramento Kings for The Current at American River College.