Dental Board on botox

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botoxThe Dental Board of Australia has released its latest communiqué, and has taken the opportunity to remind dentists and other practitioners of its interim policy on use of botox or botulinum toxin. The communiqué says the Board continues to work on the review of the Interim policy – use of botulinum toxin and associated fact sheet on Obligations of dentists for using Botulinum toxin (BTX) and dermal fillers, and while this work continues the Board has removed the documents from its website.

“The Board has removed the documents understanding that the public remains protected by the Board’s existing regulatory polices particularly the Scope of practice registration standard and associated guidelines, and the Code of Conduct and various Commonwealth and State legislation,” the communiqué says.

Dentists using agents such as botulinum toxin and dermal fillers in their practice are expected to do so in consideration of the requirements of the Board and other regulatory authorities. Prescribing under legislation in most jurisdictions must be for dental treatment only. Specifically dentists and specialists must ensure that they have undertaken education and training in the use of these agents; that they are competent in the use of the agents; and that there is documented informed and financial consent.

For dentists, including dental specialists, the Board considers the approved program of study that qualifies a dentist for registration as providing the foundation knowledge. Further training and study in the use of facial injectables can maintain competency and knowledge in the prescription and administration of Scheduled Medicines. This can be done through continuing professional development (CPD).

There is no approved training for dental prosthetists, dental hygienists, dental therapists or oral health therapists in the use of botulinum toxin or dermal fillers. Jurisdictions’ drugs and poisons legislation do not authorise the use of these agents by these dental practitioners. Any use of botulinum toxin or dermal fillers by these practitioners would be considered as practising outside of the practitioner’s scope of practice.

Part of the review of these documents has involved liaison with the Therapeutic Goods Administration (TGA). The TGA is part of the Australian Government Department of Health and Ageing, and is responsible for regulating therapeutic goods including medicines, medical devices, biological, blood and blood products.

TGA approved indications for scheduled medicines are published in the Australian Register of Therapeutic Goods. The practice of healthcare practitioners prescribing scheduled medicines outside of their approved indications (i.e. the indications entered in the Australian Register of Therapeutic Goods) is a matter for healthcare practitioners, who are not regulated or controlled by the TGA.

The use of a medicine outside the approved indication/s for supply is often referred to as ‘off label’ use. The TGA does not assess ‘off-label’ uses and they are therefore regarded as experimental.

A dentist using botulinum toxin in their practice should be familiar with the approved indications of this scheduled medicine. For example, the use of botulinum toxin for the treatment of Temporomandibular joint disorder/dysfunction is considered to be ‘off-label’.

If a dentist does decide to use a scheduled medicine ‘off-label’ then this is a clinical judgement that should be made in consultation with their patient.

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