Medicine is constantly evolving, and with the increased desire to meet beauty standards or seek alternative pain treatments, botulinum toxin type A (Botox) and dermal fillers are becoming a highly demanded product. It is estimated that 20% of dentists in America have been trained in on Botox procedures. Historically, the injections have been utilized as part of a treatment plan for various dental conditions, and not as a standalone product. However, since the Arizona Senate Bill SB 1074 was passed on March 18, 2022, the practice of dentistry has expanded to include the administration of Botox and dermal fillers to the oral maxillofacial complex for therapeutic or cosmetic purposes. Dentists can now use Botox to treat dental disorders or help patients accomplish their desired facial appearance. Although this is an exciting opportunity for dental offices to add these services, it is important to understand the parameters around what Botox can be used for, and who can safely administer the drug.
Botox was first introduced to the medical industry to treat hemifacial spasms in 1989, and its popularity and accessibility have increased significantly in recent years, expanding its applications beyond its initial medical use. Commonly used for therapeutic purposes, Dentists can administer Botox to treat conditions such as TMJ disorders, pathological clenching, bruxism causing trauma, masseteric hypertrophy, and myofascial pain. The use of Botox by Dentists can help alleviate pain and discomfort for patients, contributing positively to the dental industry. Cosmetic Botox works by relaxing targeted facial muscles, effectively reducing the appearance of wrinkles such as crow’s feet, frown lines between the brows, and even certain lip deformities. Including Botox in cosmetic dentistry enables dentists to provide aesthetic solutions, addressing both dental and facial aspects to enhance appearance and overall dental health.
The inclusion of Botox and dermal filler administration by dentists in Arizona can indeed stir up discussion, especially regarding the expanded scope of practice and the involvement of dental hygienists in these procedures. Expanding the scope of practice to include treatments like Botox demands a deep understanding of the associated liabilities. According to R4-11-601, dental hygienists are allowed to perform procedures not listed in A.R.S. 32-1281 under certain conditions as follows:
- The procedure is recommended or prescribed by the supervising dentist.
- The dental hygienist has received instruction, training, or education to perform the procedure in a safe manner; and
- The procedure is performed under the general supervision of a licensed dentist.
Additionally, it is stated that a dental hygienist shall not perform an irreversible procedure. The Attorney General does not offer a definitive answer on whether the administration of Botox is an irreversible procedure, this determination is left to other authorities such as the State Board of Dental Examiners (BODEX) or regulatory agencies, to define and address within the context of dental practice regulations. It is crucial for dentists to be aware of the conditions under which they may be held liable for their hygienists’ actions. Clarifying roles and responsibilities while adhering to state regulations and ensuring patient safety would be focal points in such discussions. BODEX is not likely to determine whether dental hygienists can administer Botox prior to the 2025 legislation. Until this decision is made, it is prudent to assume that dental hygienists may not have the authority to perform Botox injections in Arizona.
As the use of Botox for nontraditional procedures continues to grow in the dental field, it is vital to stay up to date with what the BODEX has confirmed is included under the course and scope of your license as a dentist. Since the FDA has not yet approved the administration of Botox for dental therapeutic and cosmetic uses, Botox in dentistry is off label, which proposes its risks if chosen to be implemented in your practice. To minimize the exposure of a malpractice claim in regards to Botox, you can receive essential training that is approved through BODEX, supervise any individuals who are licensed to provide these services, and obtain informed consent from your patients before performing the injections. The use of Botox may fall outside the scope of practice as defined in your professional liability insurance policy for you and applicable employees. To ensure that your practice has proper coverage if utilizing Botox in your services, please review your policy definitions and exclusions, or you can ask your insurance agent for guidance. Botox will continue to be an area that will advance in the dental field. Continuing to stay up to date with legislative laws and state board updates will allow you to be in the know and better cater to your patients’ needs.
Article Sources :SB1074, A.R.S. §32-1281 (B, www.azag.gov/opinions/i23-003-r23-001, AzDA, https://www.facialesthetics.org/dentists-botox-time/, https://www.rdhmag.com/patient-care/article/14296010/the-buzz-about-botox-what-dental-hygienists-need-to-know
Katelyn Haniotes
