5 minute read
Worrying signs
With increased instances of oral health professionals exploring and developing new services, it is time to understand the boundaries
In recent times, DHAA members have expressed interest in a number of emerging procedures or treatments that are far outside the interventions typically performed by dental practitioners. The NSW Dental Council has issued the following advice which, in our opinion, is very useful for dental practitioners across the country:
IN RECENT YEARS, the (NSW Dental) Council has seen an increase in complaints being made against registered dental practitioners, particularly in relation to clinicians practising and/or teaching procedures that the Council considers unsafe. The nature of these treatments falls outside treatments or interventions which would typically be performed by a dental practitioner and the risks outweigh the benefits. The Council is concerned about the level of training and education that precedes these treatments because it raises doubts about the practitioner’s competency to perform these treatments.
These procedures/treatments include:
• Periocular cosmetic injections;
• Carboxy therapy (injections using carbon dioxide);
• Lipolosis (fat dissolving injections);
• Microneedling.
These procedures/treatments appear to be administered for facial aesthetic purposes such as the removal of dark under-eye circles and/or fine lines and the treatment of fat deposits.
In relation to periocular cosmetic injections, the Council reiterates that the risks of undertaking these procedures outweigh the benefits to patients because dental practitioners are not trained to recognise and manage sight-threatening complications that may result from injectables administered to the periocular region.
The Council has also seen complaints about extra-oral injection techniques such as acupuncture, dry needling and trigger point injection techniques, using Botulinum toxin and steroids, as part of treatment options for temporomandibular joint (TMJ) disorders. Some of these techniques were performed in areas such as the lumbar back region.
These complaints have also raised issues concerning the procurement and handling of medication in line with legislative requirements, concerns about the facilities where these treatments have been performed, including infection prevention and control, and other concerns relating to informed consent and record keeping.
While the overall number of complaints is small, the therapeutic risk to the health and safety of the public, when dental practitioners practice outside their expertise and skills and beyond the usual areas of the dental practice, are, in the Council’s view, not immaterial, and are, in fact, potentially significant.
The use of botulinum toxin and dermal fillers
The Council acknowledges that the Dental Board of Australia (The Board) has defined its expectations regarding dentists and the use of botulinum toxin and dermal fillers in their practice, and they have developed a fact sheet.
When using botulinum toxin and/or dermal fillers, dentists need to practice within the The Board’s definition of dentistry. Dentists must also adhere to relevant drugs and poisons legislation and regulations and comply with the requirements of the Therapeutics Goods Administration (TGA).
Botulinum toxin and dermal fillers should only be used if the treatment can be justified. Informed consent, including financial consent, must be obtained and the risks associated with the treatment explained to the patient and documented.
Dental practitioners need to be acutely aware of the patient’s expectations regarding the use of botulinum toxin and dermal fillers and must communicate effectively with the patient to ensure that they are understood and that the patient’s expectations are reasonable or managed accordingly.
Botulinum toxin and dermal fillers should be administered with documented consent
Expectations of dental practitioners
The Board provides a summary definition of dentistry as follows:
All dental practitioners are expected to practice within the definition of dentistry and their dental practitioner division. The Board also stipulates that dental practitioners must only perform dental treatment for which they have been educated and trained, and in which they are competent (their individual scope of practice).
Dental practitioners are responsible for assessing their individual practice and must be aware of their individual competence for each treatment/ procedure they perform. The Board has developed a reflective practice tool to assist practitioners to determine their individual scope of practice and supporting continuing professional development.
Good practice, as defined in the Board’s Code of Conduct, includes:
• Considering the balance of benefit and harm in all clinical management decisions.
• Practicing in accordance with the current and accepted evidence base of the health profession, including clinical outcomes.
• Facilitating the quality use of therapeutic products based on the best available evidence and the patient or client’s needs.
• Investigating and treating patients or clients on the basis of clinical need and the effectiveness of the proposed investigations or treatment, and not providing unnecessary services or encouraging the indiscriminate or unnecessary use of health services.
This article is an excerpt from the New South Wales Dental Council Newsletter (Aug 2021).
