Dentists’ use of Botox requires appropriate dental treatment plan documentation

August 5, 2019

At the direction of the 2018 CDA House of Delegates, CDA has been working with the Dental Board of California to better understand the scope of practice for general dentists as it relates to the use of cosmetic agents such as Botox and dermal fillers. The house directed CDA to take this action to clear up confusion that arose from the creation of the Elective Facial Cosmetic Surgery permit as it relates to the scope of cosmetic services general dentists may provide.

In the response to CDA’s request, the dental board in a letter advised in part: “ … the Board’s message, since 2011, has been consistent: cosmetic procedures, and the use of appropriate products for those procedures, that are performed for one of the purposes laid out in Section 1625, and are part of a dental treatment plan fall into the definition of the practice of dentistry. As with any dental procedure, the licensee must possess the knowledge, skill, and ability as to when and how to perform a procedure.”

The letter explains that a dentist who does not hold an Elective Facial Cosmetic Surgery permit may only provide Botox and dermal fillers for cosmetic purposes when administered as part of a comprehensive dental treatment plan. Furthermore, an oral surgeon with the EFCS permit is the only dentist who may provide these services for cosmetic purposes on a standalone basis.
If you are not an EFCS-permitted dentist, CDA advises:

  • You are prohibited from using Botox and dermal fillers solely for cosmetic enhancement purposes and from advertising their use, which misleads the consumer to think that cosmetic enhancement alone is permitted.
  • To use Botox, dermal fillers or other products that have an extraoral, perioral esthetic impact, you must be providing dental services to the patient whereby the use of such products is directly related to those dental services and the treatment outcome.
  • If you have an established patient with healthy teeth who expresses a desire to improve their facial appearance, even if that improvement involves just the lips, you are advised to proceed with caution, as you may be providing care that has no dental-related purpose and is therefore outside of your scope of practice. In these instances, a referral may be advised.

Dentists should be aware that the board’s enforcement staff has made it clear that explicit, detailed documentation, including photographs, is essential for a complete dental record — not only for procedures performed to improve dental treatment esthetics, but for all dental treatment procedures. Enforcement actions have been pursued against general dentists who perform cosmetic procedures for the sole purpose of cosmetic improvements of facial tissues rather than for cosmetic improvements related to dental treatment. Because of this, CDA advocates that dentists use caution when administering these procedures and document extensively with regard to treatment rationale.

Furthermore, dentists should be wary of continuing education courses on the use of these products because they may teach procedures beyond California’s scope of dentistry.

TDIC policyholders are reminded that procedures that are not permitted under the Dental Practice Act are not covered and incur liability for the dentist.

Read the letter from the dental board.


Was this resource helpful?