Neurotoxins and dermal fillers

The use of neurotoxins and dermal fillers by dental practitioners has long been a contentious issue within the Australian dental profession.

Central to the debate is whether the use of these materials, which have both clinical and cosmetic applications, falls within the scope of practice of a dentist as defined by the Dental Board of Australia (the Board). A key element of the practice of dentistry in Australia, scope of practice is defined as the “full range of activities and responsibilities which individuals within the profession are educated, trained and competent to perform”.

Up until October 2014, the Board’s policy stated that the use of neurotoxins, such as Botulinum toxin, the best known brand of which is Botox, should be used specifically for treating a range of temporomandibular joint disorders and that any other use fell outside of the practice of the dentistry. It’s worth noting at this point that any use outside of a drug’s officially approved use is classified as “off label”, which would apply to the majority of treatments using these items undertaken by doctors and dentists.

An argument in favour of the use of neurotoxins and dermal fillers by dentists is that they have a comprehensive knowledge of facial anatomy. Conversely, others argue that this is not a sufficient reason to allow dentists to administer these materials since, anatomical knowledge aside, they wouldn’t provide sufficient numbers of treatments to become proficient enough in their use.

Current policy

In December 2015, the Board issued a factsheet, The Use of Botulinum Toxin and Dermal Fillers by Dentists, which replaced the previous interim policy, and sought to explain regulatory expectations for practitioners using botulinum toxin and dermal fillers in their practice.

Primarily this new policy is not intended to be specific since the Board contends that the existing regulatory framework, which includes its standards, codes and guidelines, is applicable regardless of the type of care being delivered or the setting in which it takes place.

The Board made it clear that dentists and specialists can use these medicines, including botulinum toxin, as long as they adhere to these requirements and any issued by other regulatory bodies such as the Therapeutic Goods Administration.  Dentists are also expected to ensure their professional indemnity insurance appropriately include the use of these medicines as well.

Dentists and specialists are expected to observe both Scope of Practice Registration Standard and the Guidelines for the Scope of Practice, and the Code of Conduct, which stipulates that a practitioner’s must make the welfare of patients their first concern, and only administer these procedures with informed consent from the recipient. 

In contrast, use of these procedures by prosthetists, hygienists, dental therapists or oral health therapists is not allowed, being deemed to fall outside of their scope of practice, irrespective of any training they might have received.

For the full range of expectations that the Board has for dentists and specialists in regards to the use of neurotoxins and dermal fillers, please go to The Use of Botulinum Toxin and Dermal Fillers by Dentists.