The Dental Council of New Zealand has amended its statement on the administration of botulinum toxin by dentists as it considers the previous statement to be confusing.  In particular there was concern about the precise meaning of the scope of general practise by dentists that is restricted to the nasolabial folds and/or perioral area.  The Council states that the use of prescriptive words without any additional explanation has caused significant uncertainty to the point that they are regarded as unhelpful and potentially unsafe.

The Council also recognises that there have been significant advances in science and healthcare delivery methods since the statement was issued in 2005 and they are to undertake a full review of the current statement of the administration of botulinum toxin by dentists in combination with review on the Council’s policy on advanced areas of practise planned to occur later in 2016.

Furthermore, Council has agreed to amend the statement by removing the references to nasolabial folds and perioral areas as an interim measure until it can carry out a proper review of its position.

The Council’s position is that dentists wishing to administer botulinum toxin in their practice must comply with the requirements of:

• Standards framework for all oral health practitioners.
• The policy on advanced and new areas of practise.
• Statement on the administration of botulinum toxin by dentists as amended July 2016 which states that dentists must be able to demonstrate that they maintain records to demonstrate they have the appropriate knowledge and training to undertake this procedure including knowledge of the relevant scientific literature.  This means dentists will need to document the  evidence of their training including formal qualifications, courses attended, continued professional development involving either unsupervised or self-director training, and evidence of a logged record of their  experience in the use of of botulinum toxin.
• Must ensure that patients obtain the patient’s informed consent for the procedure.  The patient should be aware of the methods that the practitioner has been trained in and the other options available to them, such as treatment by a specialist or another practitioner.    
• Patients must understand the nature of the service/procedure and the possible risks and side effects and should have a realistic expectation of the results that can be achieved.  There must be a clear and comprehensive record of the consent process.  Dentists should also be aware of their indemnity arrangements in relation to the new techniques and procedures.
• Dentists must comply with the requirements of the general dental scope of practise defined as “the maintenance of health through the assessment, diagnosis, management treatment and prevention of any disease, disorder or condition of the orofacial complex, and associated structures within the scope of the practitioners approved education, training and competence”.

The Council further states that the intention behind the interim measure to amend their existing statement is not to provide approval for the  wider use of botulinum toxin by dentists, but rather to be a reasonable provisional intervention in view of the concerns raised.

Dental Protection believes, and is on public record as stating, that dental healthcare professionals are better placed in many respects than many other potential providers to carry out such treatment safely and successfully, not least because of their particular range of background knowledge and training, the standards of infection control and their ability to manage a medical emergency.

Dental Protection members in other countries such as UK, Ireland, South Africa, Australia and Singapore are able to request assistance from us in relation to such treatments. The advice provided by Dental Protection is tailored to reflect the specific regulatory requirements of each country in which a member is treating patients at that time.

Dental Protection acts in the interests of dental members, to protect their professional reputation and integrity by giving advice upon which members can rely.  Given that the Dental Council states that the interim measure to amend the statement is not intended to give approval to the wider use of botulinum toxin but rather to be a reasonable provisional intervention in view of concerns raised, we can confirm that  Dental Protection will continue to indemnify members in this regard. Dental Protection also echoes the Council’s view that the current position does not support or approve the wider use of botulinum toxin to that previously intended by restricting its use to the perioral area and the nasolabial folds.

Dental Protection will continue to reflect the regulator’s position in each jurisdiction and will await the outcome of the review, following which further comment will be made.  For the time being the provision of indemnity for Dental Protection members in New Zealand has not changed in relation to the provision of treatment with botulinum toxin.

Please contact us if you require further information.