Non-surgical cosmetic treatments and the use of botulinum toxin
Frequently asked questions
26 April 2016
Further to the removal of the interim policy on the use of Botulinum toxin and dermal fillers in November 2014, on 11 December 2015, the Dental Board released a facsheet entitled The use of botulinum toxin and dermal fillers by dentists
to explain what they expect of dentists when using botulinum toxin and dermal fillers in their practice.
Does the new Dental Board factsheet: The use of botulinum toxin and dermal fillers by dentists, now give me a green light to provide a full range of cosmetic and therapeutic botulinum and dermal filler treatment to the head and neck?
The Dental Board's factsheet clarifies the Board’s expectations of dentists providing these treatments to be that they practice in accordance with the Board’s regulatory standards, codes and guidelines by:
- performing only those dental procedures for which they have been educated and trained and are competent;
- practice within the definition of dentistry contained in the Board’s Guidelines for scope of practice;
- ensure they have appropriate professional indemnity insurance arrangements in place for all aspects of their practice;
- meet the Board’s recency of practice requirements;
- act in accordance with the standards set out in the Code of conduct including expectations about informed and financial consent, and;
- complete ongoing continuing professional development that contributes to the development, maintenance and enhancement of knowledge, skills and performance;
- adhere to the relevant state and territory drugs and poisons legislation and regulations by using scheduled medicines only for the purpose that the authority is granted. This is usually described in terms such as ‘for dental therapeutic use’ and understand and comply with the requirements of theTherapeutic Goods Administration (TGA) in relation to:
- the advertising of therapeutic goods;
- approved uses of botulinum toxin and dermal fillers for use in Australia, and;
- 'off-label’ use of botulinum toxin and dermal fillers.
What does the Board consider to be the 'Practice of Dentistry'?
The 'Practice of Dentistry' is defined in the Guidelines for Scope of practice as covering 'the widest range of any procedures that a person educated in dentistry can carry out. Dentistry involves the assessment, prevention, diagnosis, advice, and treatment of any injuries, diseases, deficiencies, deformities or lesions on or of the human teeth, mouth or jaws or associated structures'.
Does this mean we can treat crow’s feet around the eyes, and frown lines in the forehead, face or glabella region?
The Board’s definition does not clarify what the 'associated structures' are with regard to dentistry and this is where the difficulty arises.
Advocates of these treatments will suggest that the forehead and perio-orbital regions or even the neck fall into this category, whereas others will suggest that in defining the practice of dentistry, the intended definition is far more limiting, with the teeth, mouth and jaws (mandible and maxilla) being the focus and the 'associated structures' logically being the lips, chin and cheek in the peri-oral area. Therefore the provision of isolated treatments to the forehead and around the eyes may be seen very differently by the Board to that carried out in the peri-oral region in conjunction with intra-oral treatment such a prosthetics. As things stand there is no certainty in this regard, one way or the other.
This is further complicated by the section ‘When does the Board expect dentists to refer a patient?’ which states:
The Board expects dentists to refer a patient to a suitably trained and qualified:
dental practitioner - when the treatment required by the patient is outside the personal scope of practice of the individual dentist, but still within the definition of dentistry, or
- medical practitioner - when the proposed use of botulinum toxin or dermal fillers is outside the definition of dentistry.
Implying perhaps that there will be some areas identified by a dentist as being appropriate for treatment with botulinum toxin and/or dermal fillers but not necessarily being within their scope of practice to provide.
What is DPL doing to clarify this position?
DPL acts in the interests of its members to protect their professional reputation and integrity, by giving advice upon which members can rely. Given the potential difficulties the current position presents, DPL has written to the Dental Board, highlighting our concerns and seeking clarification with regard to the term '…associated structures.'
Some parties, in order to serve their own ends, have suggested that DPL is ‘not supporting’ members who wish to carry out these procedures. On the contrary, we are acting responsibly to keep members safe and avoiding the risk that they might be drawn unwittingly into a Dental Board challenge.
DPL’s Position Statement makes it very clear that we already support members who are carrying out the prescribing and administering of Botox and/or dermal fillers in other parts of the world where the national or local regulator (Dental Board/Council) has made its position a lot clearer than is the case here in Australia.
The Dental Board of Australia has stated that it will not provide a specific policy for this area:
"We consider that a specific policy is not required because the existing regulatory framework, which includes the Board’s standards, codes and guidelines applies to all dental practitioners regardless of the care being delivered or the setting."
Will I be indemnified to carry out such treatments?
The policy provided for DPL members by MDA National Insurance Pty Ltd, subject to its terms and conditions would respond to claims and investigations arising from the provision of healthcare services as long as they are not outside the terms, limitations and requirements of your registration.
Therefore, policy holders would be covered for both a claim and an AHPRA investigation resulting from a practitioner’s involvement in the prescribing and administering of Botox and/or dermal fillers provided the practitioner:
is using the products for dental treatment that the Dental Board would consider to fall within the dentists scope of practice;
- has the appropriate training, skills, qualifications and licenses to prescribe and administer the product;
- is acting within the National Board’s registration standards requirements and;
- is not in breach of relevant state and commonwealth legislation (for example the Drugs and Poisons Act).
Why is DPL not simply giving the green light when my colleagues say that I can do all treatments I have trained for?
For the reasons above, we would advise members to proceed with caution until greater clarity is provided. We note that Federal ADA is giving its members precisely this same advice. Our aim is to keep members safe, not expose them to additional risk – especially if they would be unaware of that risk because of misinformation they have received from other sources. It would be irresponsible and inappropriate of DPL to give members any advice or encouragement that could potentially increase their risk of a regulatory or legal challenge.
DPL believes (and is on public record as stating) that dental healthcare professionals are better placed, in many respects, than many other potential providers to carry out non-surgical cosmetic treatments safely and successfully, not least because of their particular range of background knowledge and training, the standards of infection control and their ability to manage a medical emergency.
DPL members in other countries such the UK, Ireland, South Africa, New Zealand and Singapore are able to request assistance from us in relation to such treatments. However the advice they receive is appropriate to the specific regulatory requirements of each country at that time.