Can an RN in Wisconsin administer Botox and fillers under the medical direction of a dentist who is also certified to do so?

I always recommend that patients see a provider that specializes in the area that they want treated. As such, if you have problems with your teeth, don't see a facial plastic surgeon, see a dentist. If you have a problem with lines and wrinkles, you don't see your dentist, you see a facial plastic surgeon. Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa

Dear Muffyjean, I do not know the answer to your question, but I agree with my colleagues that this a grey area at best and a practice out of scope at the worst. I DO know that board certified plastic surgeons can perform and supervise the performance of Botox and other filler injections. My advice...see a physician or an RN/PA who is supervised by an MD for your cosmetic needs. Let the dentist fix your teeth. Good luck. Dr. Gervais.

Normally dental boards and medical boards have different sets of criteria.  Dentists cannot practice medicine and physicians cannot practice dentistry.  I notice that more dentists are injecting botox and I believe this is a gray area from traditional dental practice.  In general, RNs must be under the direction of a physician especially in the case of botox and fillers which has been considered for many years as a medical intervention.  Dentists can supervise dental assistants, and registered dental hygienists, but it would be a stretch to supervise an RN.  This is definitely at the very least, a gray area, and at the very most, an unlicensed practice pattern for both the RN and the DDS.

Most states let physicians supervise registered nurses for botox injections provided the physician is on the premises and performs a good faith examination and makes an order for treatment. A dentist is not a physician. This is most likely the unlicensed practice of medicine. You can report them to the state medical board and the dental board. Also find an ethical injector. 

Thank you for your question muffyjean. 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 best way to answer this specific question is to consult the dental board in the state of question, in this case Wisconsin.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!

Thanks for writing,In Tennessee and other states the dental license says they can work on ‘teeth and surrounding structure’. This is a stretch of their license and their training. I don’ t do dental work, because I am not trained it that area. Find a Board Certified Plastic Surgeon who understands the anatomy and is comfortable with injections. You can call the Wisconsin Medical Board for a definitive answer. Good luck.Stephen M. Davis, MD, FACS
Certified: American Board of Plastic Surgery
Member: American Society for Aesthetics Plastic Surgery
Member: American Society of Plastic Surgeons
Member:RealSelf Hall of Fame 

Generally RN's can inject Botox and fillers under the supervision of an MD or OD but not sure about a dentist, but if it is legal for a dentist in WI to do this then the RN should be able to do this. However,l  suggest you see a board certified dermatologist for your cosmetic issues and let the dentist fix your teeth

May need to check with the Dental Board. But the real question is, would you trust someone who is not trained in this (a dentist) to do the supervision?