A LEADING DENTIST has warned of an increase in corrective work being required due to complications arising from botox treatments carried out by non-medically trained persons.
Dr Mairead Browne has close to 20 years of experience as a general dentist and has also been doing facial aesthetics for over 15 years.
Common facial aesthetic options include botox injections to the upper face to reduce wrinkles, lip fillers to give volume to lips, and dermal fillers to reduce wrinkles to the lower face.
Browne has completed a Master’s in facial aesthetics and splits her working week between dentistry and facial aesthetics in a separate practice.
Only a doctor, dentist or registered nurse under direction of a medical doctor can administer botox under Irish law.
However, a recent RTÉ Prime Time investigation found that illegal botox is being administered by unqualified people, and that prescription medicines were being transported into the country from the North.
Browne told The Journal that dentists often work in facial aesthetics and that their background makes them well suited to this.
“At undergraduate level, we do anatomy and pharmacology injection techniques so it’s a natural progression for us,” said Browne.
“It’s a very popular treatment and there’s a lot of dental applications for botox.”
Browne explained that botox is often used for people with TMJ and ‘gummy smiles’.
TMJ causes pain and tenderness in jaw joints and the surrounding muscles and ligaments and botox can help relax tense jaw muscles and alleviate pain.
Meanwhile a gummy smile, known medically as excessive gingival display, is when you smile and too much gum tissue shows above the top teeth.
Botox can be used to temporarily freeze the muscles that contract or elevate when you smile, allowing people to smile without showing their gums.
Browne urged anyone who is interested in facial aesthetics to attend to someone who is sufficiently qualified.
“These are medical products and controlled substances, they have risks and can have adverse effects,” said Browne.
She noted that botox can only be prescribed and administered by medically licensed professionals and said the RTÉ Prime Time investigation was “deeply concerning and quite shocking.”
“From a patient perspective, ask someone what their qualifications are, and what is the product they’re using,” said Browne, who added that the products have to be stored and transported in a certain way to maintain its efficacy.
Browne said that if someone were to have a complication or an adverse effect when attending to a licensed profession, they would be able to contact the pharmaceutical company directly and have a complete traceability of that product.
Meanwhile, Browne also issued a warning about the increase in dermal fillers being carried out by people who have taken a “one day course”.
While botox injections minimise muscle movement to soften wrinkles in the upper face, dermal fillers aim to pump up the face in order to fill in lines and wrinkles around the lips and cheeks.
Dermal fillers contain hyaluronic acid and can be legally administered in Ireland without a professional qualification.
Browne told The Journal that she has seen “a lot of complications coming on my door due to dermal fillers”.
“There is an exponential rise in this area of dermal fillers where people are attending one day courses, and then setting up as aesthetic medical practitioners offering high risk medical procedures at bargain prices and completely unregulated.
“A day course is not sufficient to allow someone to understand how the face works,” said Browne.
She added: “There is a prescription medicine we use to reverse dermal filler if there is a complication but that’s by a prescriber and cannot be obtained by a non-healthcare professional.”
Browne called for a “legitimate body” to oversee dermal fillers.
Browne also remarked that younger people are often requiring corrective work due to complications from these types of facial treatments.
“I have so many patients coming to me who went to a clinic essentially, particularly younger people, and they don’t know what treatment they had done or what filler they had injected,” said Browne.
“They’re coming to me having filler dissolve but there’s no accountability and their calls aren’t being answered.”
Browne warned that medical organisations and government agencies “need to be proactive and not reactive”.
“Aesthetic medicine is a unique and new discipline, we need to develop best practice guidelines and that will require collaboration from all of the medical organisations and government agencies.
“We need to be proactive, not reactive, when it comes to this and there needs to be guidelines and a legitimate body overseeing it.”
Browne said her main advice for anyone considering botox treatment is to attend to somebody who has medical qualifications.
“It’s an evolving discipline and you constantly need to be doing courses,” said Browne.
“I do complications management courses at least once a year and attend conferences internationally.
“This is a licensed, controlled substance, so make sure the person administering it has the appropriate medical qualifications.
“Ask how many years of experience they have doing this, and if they are using high quality and traceable products that are sourced correctly.”
And for those who are “price driven”, Browne explained that “botox is costly because you’re paying for a premium product and premium delivery and traceability”.
“You want to have the best possible stable medication and it should be treated with that respect,” she added.
Browne is a member of the Irish Dental Association, which has warned about a recruitment crisis within the profession.
The Association has said patients are having difficulty in accessing essential care as a result.
“We’re at crisis point,” said Browne, “and I know of practitioners who have had to sell their practices because they couldn’t get the staff.
“A lack of resources put into us ultimately results in our patients paying the price.”
However, Browe said the recruitment crisis has nothing to do with dentists opting to pursue the often lucrative field of facial aesthetics.
“When it comes to the staffing crisis, we have a dental school issue and we have a work permit issue,” said Browne.
“We had a survey recently internally, where 65% of dentists were unable to recruit candidates for dental positions and this has a knock-on effect on our patients and impacts our capacity to treat emergency appointments.”
She called for the Dental Act to be reformed and for an increase in places at the country’s dental schools, within University College Cork and Trinity College Dublin.
“We have two dental schools and there’s been no significant expansion or investment in them,” said Browne.
“We’re not producing dentists and the dental auxiliary staff to meet patient demand.”
Browne noted a recent decision to scrap plans to develop a new and bigger dental school in UCC, despite the Dean of Cork University Dental School, Professor Paul Brady, warning that the current building is “frail”.
“Pressure needs to be put on the Department of Further and Higher Education so that we can increase capacity here,” said Browne.
She added that dental nurses and technicians need to be added to the critical skills list so that staff can be sourced from outside the EU.
Browne also noted that dentists have been “hammering home the need to reform the Dental Act” and that this will be the “big message” from the upcoming annual conference of the Irish Dental Association, which will take place from 25-27 April in Killarney.
The Dental Act dates back to 1985 and as it stands, the Dental Council does not have the relevant powers to conduct investigations, carry out inspections or issue sanctions.
“We engaged in a consultation process with the Department of Health on legislation back in 2013,” said Browne.
“We need urgency in legislating for this new Dental Act, its needs to be modernised to allow the relevant powers to do the inspections.”
The Irish Dental Association conference, starting this Thursday, will bring together members to explore the latest developments and challenges in the oral health sector.
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