The Wrinkles that Botox Causes for Dentists by Kristen Guarente and Al Anthony Mercado, Esq. In the ever-increasingly competitive profession of dentistry, dentists search for the competitive edge. In some practices, this competitive edge is spelled B-O-TO-X. Botox is marketed as a way to increase patient traffic to the dental office by providing them with additional aesthetic and therapeutic treatment options. However, the use of Botox in dentistry carries additional unique risks that are unknown to many dentists. This article will discuss the use of Botox in dentistry, identify risks in its use and provide guidance for minimizing those risks. A History of Botox The Food and Drug Administration (FDA) first approved Botox in 1989 and, since its initial approval, its uses have expanded to encompass various medical conditions. The FDA-approved uses of Botox include treating:1 • The appearance of glabellar lines (wrinkles) • Overactive bladder • Urinary incontinence associated with a neurological condition • Chronic migraine in adult patients • Upper limb spasticity in adult patients • Cervical dystonia in adult patients (severe neck muscle spasm) • Severe axillary hyperhidrosis (excessive underarm sweating) • Blepharospasm (spasm of the eyelids) • Strabismus (squint) In 2013, Botox was approved for temporary improvement of “crow’s feet” in adults and has since been proven to be an effective, nonsurgical tool in cosmetic treatment. Since the effects of Botox last only four to six months, it can generate increased patient traffic to a medical or dental office. Contrary to popular belief, the FDA has not approved Botox for a specific use in dentistry. In dental treatment, its use is technically “off label.” Some of the accepted uses of Botox as part of a therapeutic and/or cosmetic dental treatment plan are for addressing:2,3 • Bruxism • Temporomandibular joint disorders • Orofacial myofunctional disorders • Sialorrhea (excessive salivation/ drooling) • Facial pain and trigeminal neuralgia • Oral and maxillofacial trauma • Denture wearers struggling with getting used to a new set of dentures due to irregular and uncoordinated muscle activity • Dentofacial aesthetics and gummy smile • Drooping of corners of mouth • Perioral lines, or wrinkles around the lips, commonly called the “smokers wrinkles” Dermal fillers can also be used to treat • High lip line cases as an alternative to gingivectomy, crown lengthening and veneers • Angular cheilitis •“Clack triangles” between teeth after periodontal and implant treatment that did not preserve the papilla • Lip volume for proper phonetics (in addition to or in place of teeth lengthening with fixed or removable prosthodontics) • Lip and perioral volume aro- und the mouth for retention of removable prosthodontics There is no exclusive list of accepted therapeutic or cosmetic uses for Botox in dentistry. This, combined with the lack of FDA approval specifically for dental applications, makes its use subject to regulatory compliance issues as well as the increased risk of professional misconduct charges and malpractice allegations. Case Study: Dazed & Confused A 52-year-old female plaintiff with a history of bruxism underwent placement of a fiveunit bridge in the upper-right portion of her mouth, as well as the placement of two upper anterior implants, six lower anterior veneers, and crownwork. The plaintiff, who was an admitted Botox user, received Botox injections to her jaw muscles and around her eyes during her dental work. The plaintiff alleged that the dental work was negligently performed and she needed to have all the restorations removed, root 8 SDDS BULLETIN SEPTEMBER/OCTOBER 2023 — VOLUME 40 ◊ NUMBER 5
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