Look How Far We’ve Come

When the American Academy of Facial Esthetics (AAFE) was founded over eight years ago and expanded into dentistry, people thought we were crazy. Teaching botulinum toxin (Botox/Xeomin) and dermal fillers for use by dental professionals seemed crazy at the time, even though Botox already had a long yet limited history in dentistry for the treatment of TMJ and orofacial pain.

I am very appreciative to those first dental state board members who saw the future and had the foresight to affirm the use of these pharmaceutical agents within the scope of dental practice. When you take a look at the legal language of nearly every dental practice act, botulinum toxin and dermal fillers are no different than lidocaine or antibiotics when used in the oral and maxillofacial areas; they are within the scope. The AAFE has trained dozens of dental state board members over the years.

These dental board members understood the benefits these agents could provide to patients in the areas of orofacial pain, TMJ therapy, bruxism, and esthetic dentistry. When looking at the 20-plus-year safety record that botulinum toxin and dermal fillers have, it’s easy to see that these pharmaceuticals are safer than just about anything used in dentistry, especially local anesthetics, which are much more toxic to patients than botulinum toxin.

It goes without saying that dermatologists and plastic surgeons were unhappy with the increased use of Botox and fillers by dental professionals as part of a classic turf war based purely on economics. For some strange reason, even some oral surgeons joined this turf war. Dentists are highly trained professionals, and unfortunately we’ve kept this a secret and haven’t garnered the respect we should have from fellow professionals. Now that so many dentists are providing Botox and dermal fillers, these are facts that other professionals cannot ignore. Through the AAFE’s efforts, it is now well accepted that dental clinicians can provide equal and often better patient treatment because of our familiarity with head and neck anatomy and dento-facial esthetics.

Botulinum toxin and dermal filler training now takes place at many national, regional, state, and local dental societies and dental universities. Over the last eight years, the AAFE and I have presented continuing education, including live patient training courses, at over 60 dental societies and universities, including the ADA Annual Meeting, AGD annual session, the Hinman, the Chicago Midwinter Meeting, Greater New York, and many others.

Look how far we have come. Thanks to the efforts and forward thinking of Dean Joel Berg of the University of Washington School of Dentistry, botulinum toxin and dermal fillers are now part of the undergraduate dental curriculum, and dental students perform hands-on therapeutic and esthetic training. If I had told you this eight years ago when the AAFE started that dental students would be using Botox in dental school as part of their curriculum, I would have been (and was) laughed out of the room. This is real progress for dentistry and better dental treatment.

The AAFE has now pioneered and integrated the use of botulinum toxin and dermal fillers with many other dental therapies, including dental esthetics, orofacial pain, TMJ trigger point therapy, bruxism monitoring and therapy, dental implants, and dental sleep medicine. This evidence-based research and education has now made its way through all levels of dental education, from undergraduate to high-level postgraduate continuing education. Is it safe to say that Botox and fillers are now considered part of dentistry? Of course it is. It’s time for you to become trained so your patients can get better treatment outcomes than ever before, and you can significantly grow your practice.

Louis Malcmacher, DDS, MAGD

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