Hands OnWhose bailiwick?
Section snippets
Background
Historically an individual's ideal occlusion was based on “nature's intended ideal form,” but that has changed to pursue optimal esthetics while maintaining the fundamental aspects of a stable dental structure and functional occlusion. The face is now viewed as an esthetic unit rather than as separate entities that occur together. Perioral structures can benefit from advances in pharmacology and biocompatible augmentation materials, so that it is now possible to modify these structures safely
Training
The universal requisite for providing diagnostic and therapeutic health care is that the provider is able to satisfy the standard of care. The ability to do this requires sufficient education, training, and experience. Medical providers usually do not receive training in providing adjunctive esthetic services such as neurotoxic therapy (Botox, etc) and injectable fillers. Select residency programs offering this training to medical professionals are few and relatively new. It is not uncommon for
Risk-Benefit Considerations
The risks attending neurotoxin and injectable filler administration must be considered in the proper context. Inadvertently injecting lidocaine with epinephrine intramuscularly or air emphysema in the buccal tissues produces discomfort and an undesirable esthetic appearance. However, the condition resolves without intervention and few if any long-term sequelae. Undertreatment with neurotoxins may produce the painless, transient consequence of inadequate attenuation of muscle activity.
Scope of Practice
In the United States, the state regulatory board determines the scope of professional practice for health care professions. Dental boards that secure the statutory authority for their licensees to selectively administer neurotoxins and injectable fillers chart a progressive course. These generally also include a mandate for proven proficiency and diagnostic specificity in many cases. Virtually all states allow the dentist the privileges of using neurotoxins and injectable fillers when there is
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Costa LE II: The dentist, Botox, and injectable fillers. J Esthetic Restor Dent 26:1-4, 2014
Reprints available from LE Costa, 247 Calhoun St, Charleston, SC 29401; e-mail: [email protected]