Why Should Dental Hygienists Not Be Allowed to Perform Therapeutic Botox?

I am a registered dental hygienist in CA. Hygienists are trained and fully licensed in local anesthesia in the mouth, have extensive knowledge and training in head and neck anatomy and have taken the exact same science pre-requisites as RN's.

We already have the skill of giving injections regularly and performing many non surgical treatments such as soft tissue laser etc.With proper training and supervision by a licensed dentist why should hygienists be restricted? What exactly do the laws say?


Doctor Answers 9

Laws governing who can inject Botox

Laws are created state by state as to who can inject medicines. One state may allow non licensed individuals and others may only allow MDs PAs and NP / RNs.  Same with the operation of lasers. It is important to check with each state as to the laws and have them explain their rules.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Why a dental hygienist is not allowed to inject Botox

The standards set up by the Medical Board of California are made to ensure patient safety and the law states that medical doctors, nurses and physician assistants are allowed to inject Botox. While I have several very well qualified registered nurses who work for me I prefer to do each and every Botox injection myself. As a surgeon and artist I feel personally responsible for the happiness of all of my patients and I am able to ensure that through my many years of experience and expertise. I would not try and clean someones teeth even though some may think I would be qualified to do so if I was properly trained. It is best to stick with what you know and the standards and care required by the boards who mandate each speciality.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 210 reviews

The issue is patient safety and you are qualified to work as a hygienist

The medical board's duty is to protect the patients. At this time the Botox injection can be done by trained physicians or under their supervision. If your dentist decides to go back to medical school and do extra training,and you go back to school to become a nurse, then you can start injecting under your doctors supervision.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Why can't a dental hygienist inject botox

Okay,  I do laser procedures and local anesthetic injections and I do not think that unless I went to dental hygiene school, I would be qualified to do the things you do.  Botox injections should not be done by technicians but by fully trained medical professionals.  In my practice, I do all of my own facial Botox injections.  I don't even delegate it to an RN.  It's not as easy as it looks.   Same goes for filler. 

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 73 reviews

Why Can't Dental Hygenists Perform Botox Injections?

Hi RDH.  The laws in the state of California are set up so that only certain medical licensees are allowed to provide Botox.  The reason for this is patient safety.  Botox is a very safe drug, but just like any drug, can be dangerous in the wrong hands.  Only RNs, NPs, PAs and MDs are allowed to inject the drug and if an NP, PA and RN is not directly supervised, they can only inject when a standardized procedure is in place.  

We hear from estheticians almost every day that want to offer laser procedures and cannot.  The reason again is patient safety.  The livelihood of the persons that hold the MD, PA, NP and RN degree is dependent on maintaining those licenses.  And they are generally harder to acquire than an esthetician's license or a dental hygienists license.  Because these professionals value their licenses very highly, they are generally expected to have more training and to continually update that training, which ultimately lowers the risk that a consumer will have an adverse event.  

You must also realize that Botox is a prescription product and that dental hygienists are not allowed to write prescriptions.  So, while many patients trivialize Botox as a medication, it still is.  Bottom line is that states have to draw the line in the sand somewhere and it has been drawn in California at the RN level.

If you feel that your specialty should be able to provide Botox, then you should speak with your state licensing agency about that fact. 

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Only MD's or their designees can inject Botox in California

In California, only MD's or their designees like RN's, PA's, who operate under an established protocol for the given physician who's licence they are practicing under, are allowed to perform Botox Injections.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

The Law In California: Only Physicians May Perform or Supervise Botox Injections

In California, the practice of medicine is governed by the Medical Board of California.

The Medical Board states unequivocally that "physicians may inject Botox, or they may direct registered nurse, licensed vocational nurses, or physician assistants to perform the injection under their supervision. No unlicensed persons, such as medical assistants, may inject Botox."

The Medical Board also states that "Physicians may use lasers or intense pulsed light devices. In additional, physician assistants and registered nurses (not licensed vocational nurses) may perform these treatments under a physician's supervision. Unlicensed medical assistants, licensed vocational nurses, cosmetologists, electrologists, or estheticians may not legally perform these treatments under any circumstance, nor may registered nurses or physician assistants perform them independenly, without supervision."

Thus, the bottom line is that it is illegal for dental hygienists to perform Botox injections or to administer laser or intense pulsed light treatments in California. The laws vary from state to state.

Why do these rules exist? For the sake of patient safety. Botox injections may seem simple, but Botox is actually a very powerful medicine that can cause complications if not administered properly. I would personally choose an MD with expertise in facial anatomy (such as a plastic surgeon or dermatologist) to perform Botox injections.

Larry Fan, MD
San Francisco Plastic Surgeon
4.3 out of 5 stars 14 reviews

Hard to Believe This Question is Being Asked

With this type of logic why not allow barbers to inject Botox or better yet why not allow barbers clean teeth after they finish your hair cut.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 reviews

You clinical and anatomic knowledge is not as broad as you think.

I think the issue here is professional envy and arrogance.  Sure, as a dental hygienist you are highly trained for the tasks you perform.  You might be a very capable individual and perhaps in other circumstances perhaps you might have gone to medical or nursing school.  However, you choose a career in dentistry as a dental hygienist.  In California, only a handful of general dentists are qualified to inject BOTOX cosmetically.  So why do you think that you should be injecting the public with a service that dentists are not permitted to practice?

Please remember that being qualified to inject local anesthetic under the supervision of a dentist in no way qualifies you to safely inject BOTOX for the public.  I personally believe that the public is best served when highly qualified individuals offer services.  I strongly encourage the public to find highly qualified physicians and surgeons who personally perform these services rather than delegating the service to a nurse who may be permitted by law to perform the injection under the direct supervision of the physician.  The key is that this service is best when performed by someone with a surgical understanding of facial anatomy.  This is not like injecting the flu vaccine into the deltoid muscle.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.