2 February 2010

Q. The dentist I work for is considering adding facial aesthetics to the list of services our practice offers to patients and wants me to train to use Botox and fillers. I am not sure that this is where I wanted to take my career. Where do I stand legally and ethically if I want to follow this up?

Unfortunately, the answer to this question is not at all simple and depends on a number of factors.

Botox is a prescription only medicine (POM) and therefore has to be prescribed by a dentist or a doctor for an individual patient and administered by a suitably trained and qualified clinician. Dermal fillers, however, are quite different and do not require a prescription. Theoretically dermal fillers can be provided by any unqualified member of the public (beauty therapists, etc). This fact and the seemingly unregulated control of this new healthcare industry were highlighted in the recent ITV ‘face-to-face' documentary (September 2008) on non-therapeutic cosmetic treatments.

It is generally considered that the current situation is unsatisfactory. As a consequence, the government has asked the Independent Healthcare Advisory Services (IHAS) to consider the feasibility of self-regulation in this area and have indicated that in their opinion the provision of such treatment should only be undertaken by doctors and dentists. At the time of writing the IHAS has still to report on their findings.

Many dental practices, often as a result of patient enquires, have started to consider the possibility of providing this type of ‘treatment' and feel that this may be something a suitably qualified hygienist or therapist could undertake, especially given the relaxation of the earlier restrictive DCP duties. The current GDC guidance, as set out in section 2 of Principles of Dental Team Working makes it very clear that a DCP may only provide treatment after the patient has been seen by a dentist, a full mouth assessment undertaken and a suitable treatment plan formulated. In short, the DCP can only be involved in the administration of non-therapeutic cosmetic treatments under the prescription of a dentist.

There is a further difficulty in that it is debatable whether the provision of such non-therapeutic cosmetic treatments is actually the practise of dentistry. Opinions are mixed and unfortunately the GDC does not appear to have made the answer any easier when one looks their latest statement issued at the beginning of March 2009. The statement indicates that suitably qualified and indemnified registrants should think carefully before offering these procedures to patients. Indeed this statement seems to contradict the earlier statement made by the GDC (now withdrawn) where they indicated that such treatment was not the practise of dentistry.

From a hygienist's and therapist's point of view, it is necessary to be able to demonstrate that s/he has had the appropriate training and is competent in the provision of such treatment. At present it would appear that most of the current training courses in non-therapeutic cosmetic treatments are designed for doctors and dentists, rather than hygienists and therapists, and therefore most DCPs may well find it difficult to identify a training programme that the GDC would feel was appropriate. Given the GDC's recent statement, it is expected that this will now change and that suitable courses for DCPs will become available. The provision of ‘in-house' training is fraught with difficulties since its educational and practical content may not necessarily be verifiable and, as a result, it is an approach that is best avoided.

The DCP and the prescribing dentist also need to ensure that they have appropriate indemnity before providing elective treatment to improve facial aesthetics. At present Dental Protection offers a top-up indemnity over and above the normal level of indemnity for those registrants who are providing this type of treatment. Similar indemnity may be available elsewhere; often through individual insurers. There is a word of warning here, however. The DCP does need to be careful, because some indemnity providers restrict their indemnity to clinical negligence claims alone and they may not assist the DCP if there is some form of disciplinary action or a GDC complaint arises.

In short, it might be prudent not to become involved in this type of treatment until the ‘powers that be' have answered some of the outstanding questions.

Find out more about IHAS here www.independenthealthcare.org.uk

Dental Protection Limited is registered in England (No. 2374160) and is a wholly owned subsidiary of The Medical Protection Society Limited (MPS) which is registered in England (No.36142). Both companies use Dental Protection as a trading name and have their registered office at 33 Cavendish Square, London W1G 0PS.

Dental Protection Limited serves and supports the dental members of MPS with access to the full range of benefits of membership, which are all discretionary, and set out in MPS’s Memorandum and Articles of Association. MPS is not an insurance company. Dental Protection® is a registered trademark of MPS.

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