Can a Dentist Perform Botox Injections?

Question

Paul Vitenas, Jr., MD · Answer

A better question would be should a dentist perform Botox injections. The regulations on who can inject medications vary from state to state. Some dentists are adept at injections and some are not. Is it in the scope of their practice? Probably not. Would you go to a Plastic Surgeon for a root canal or dental extractions? I do not think so. Plastic Surgeons are trained and have a great deal of experience with Botox injections and dermal fillers and I believe they are the correct medical professionals for these injections.

David Shafer, MD, FACS · Answer

Drug companies will sell medications to any doctor - no matter what speciality. Also, there are no clear regulations on who can inject Botox or inject dermal fillers. You really need to make sure that you are injected by a board-certified plastic surgeon or dermatologist to ensure that you are having the highest trained person inject your face. You would not go to the car wash to get your engine repaired. Likewise, you should not go to your dentist to have plastic surgery.

Harold J. Kaplan, MD · Answer

Regulations regarding which practitioners are allowed to inject Botox vary from state to state and we do not have an answer to this question for the state of Georgia. California dentists are allowed to inject Botox.
If a dentist wanted to dedicate the time and effort into proper injection and facial anatomy training, they might become proficient in the procedures. But just like any other specialty, it takes time and effort. We question why a dentist that could spend his/her time and effort specializing and getting better at traditional or cosmetic dentistry procedures would think it would be a good use of their time to stray into the domain of facial cosmetic procedures.  We're not sure why that would be a good idea for the dentist or the consumer. Whatever practitioner you choose, make sure that they specialize in the procedure you are looking for.

Shahram Salemy, MD, FACS · Answer

More and more commonly, practioners without cosmetic surgery training, without surgical training, and even without a medical license are performing a whole host of cosmetic procedures, from Botox to Lasers, Lipo to breast augmentation.  Whether or not an individual "can" perform a procedure legally or adequately is certainly a good question, but the more important one is whether or not they should perform it on you?  In the end, it is your body and your investment, and I would highly recommend going to someone with the proper credentials and qualifications to perform the procedure properly.  Ask yourself a couple of questions:
First, why is the dentist, who has no formal training in this field, offering this procedure?
Second, would you go to a plastic surgeon to clean your teeth or perform a root canal? 
Use your best judgement and pick the individual who can give you the best chance at an excellent result.
Dr. S

Michael A. Persky, MD · Answer

In the United States, the laws vary from state to state.  Ethics are a different matter.  They are the same in every state.
Botox is a medical procedure with risks and complications.  Anyone can (and does) inject Botox, I think my dry cleaner is now offering Botox injections, but patients must decide whom they trust the appearance of their face with for a 4 to 6 month period.
Personally, I like to have my teeth taken care of by my dentist, have my gastroenterologist take care of my colonoscopy, and when the time comes, have a trained and experienced cosmetic surgeon treat my wrinkles with Botox.  
Anyone want a root canal?
Dr. P

Ira D. Papel, MD · Answer

Each state has laws and regulations which govern the scope of practice of dental professionals (DDS and DMD degrees). Patients interested in injectable treatments such as Botox or dermal fillers should check with the medical and dental boards where they live to determine if dentists are authorized to provide these treatments. 
In any situation patients should seek qualified injectors who have appropriate specialty training, experience in the procedures sought, and a safe medical environment where proper procedures are followed.
Further information about injectables can be found by consulting injectablesafety.org.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Lora. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
Botox is a prescription strength medication that is injected into the skin or other areas. Therefore, it is important that the treatment is performed by a trained medical professional. This can be a physician, physician’s assistant, nurse practitioner, or nurse. Laws vary from jurisdiction to jurisdiction on who is allowed to provide the treatment. In California, for example, any of these aforementioned medical professional is permitted to provide a treatment. With the recent explosion of cosmetic medicine, there are more and more people offering such services. This includes core physicians such as plastic surgeons and dermatologists as well as other physicians who are trained in cosmetic treatments such as general physicians, gynecologists, or other specialists. It is important to understand that just because a doctor is a plastic surgeon or dermatologist does not necessarily make them an expert on Botox. General doctors who routinely perform Botox treatments multiple times per day likely have more experience and expertise than a plastic surgeon who spends most of his time performing surgeries and performs perhaps only a single Botox treatment per month. Similarly, there are many outstanding nurse injectors who spend their entire days performing cosmetic treatments, as they are often delegated to nurses. Their experience can at times be great than that of many doctors. This understandably makes it difficult to find a good provider. I recommend looking for experience (specifically in Botox and other minimally invasive cosmetic treatments such as fillers and lasers), before and after photographs, and testimonials. Looking for an office who offers the most competitive price is often a recipe for disaster. We have had many patients come to our office to correct various issues they have had when they selected an injector based on price alone.The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
  
While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Mary E. Hurley, MD · Answer

While technically a dentist or any other licensed practitioner can perform Botox, I would be very wary of visiting any practitioner who does not have extensive training and knowledge of facial anatomy for Botox injections. While it may seem like Botox is just a simple injection that anyone can perform, the truth is that it is both an art and a science that requires skill and finesse. In order to get the best results, your injector needs to know exactly where to place the injections, how many units to give for a natural result and how to avoid potential complications. Eyebrow and eyelid droop, asymmetry, as well as frozen, unnatural expressions can occur as a result of misplaced injections. Instead of going to your dentist, I recommend visiting a board-certified dermatologist who regularly performs Botox injections and can give you a customized treatment plan for your individual concerns.  For whatever the ailment or concern, I recommend finding a provider that practices within their area of expertise.

Robert L. Kraft, MD, FACS · Answer

As an officer of the county medical society, I can tell you that the dental societies have attempted to modify scope of practice laws in New York and have been unsuccessful because the legislature has recognized that this is a medical, not dental, treatment.  Would you go to your plastic surgeon for a root canal or tooth extraction? Hopefully not!  A dentist who injects Botox or filler could face disciplinary proceedings including suspension or loss of license.

Jessica J. Krant, MD, MPH · Answer

There is a big difference between the questions "Can _____ inject Botox?" and "Should _____ inject Botox?" Legally, many different types of people can inject it, varying from state to state, including nurses, dentists, and other people without an M.D. degree. Some M.D's who do not have board-certification in a relevant field often inject it.

	The safest way to pursue Botox treatment, is to see a physician (MD) board-certified in dermatology or plastic surgery, or the specific body area directly relevant to their specific training (around the eyes for an oculoplastic surgeon). Make sure to ask the "board-certified physician" what FIELD he or she is board-certified in. You may get a very big surprise. Many medispas run by a "board-certified doctor" are run by doctors who have no training in an appropriate core aesthetic specialty (dermatology, plastic surgery, oculoplastics, or ENT).