Neuromodulators and injectable fillers have been a large part of my practice for decades.  I sit on multiple advisory boards for Botox, Allergan and Abbvie.  I have been a Diamond level Botox injector for over 12 years and in the top 5% of injectors in the USA.  I have taught Botox and filler techniques to every specialty including general dentists for decades, nationally and internationally for over 20 years.  I have published numerous scientific papers and textbook chapters on these techniques.

The situation concerning "who is trained to inject" should be based on the core training of the health care provider and bolstered by contemporary course work that outlines the diagnoses, treatment, and complications of available FDA approved products.  

In the Commonwealth of Virginia, Nurses are allowed to inject these products as is any person with a medical degree.  This would include professions with very little anatomic training and injection experience in the head and neck.  If a nurse can legally inject in this state (and I know many competent nurse injectors), then these services should be within the scope of general dentistry.  Very few specialties in medicine (and nursing) have the comprehensive head and neck anatomy training as do general dentists and virtually no other specialty provides the volume of injections in the facial area than do general dentists.  Many of these situations boil down to the politics of competing specialties and turf wars.   In fact, they should be based on education, experience, expanded education and safety.

Oral & Maxillofacial Surgeons in the commonwealth have these privileges and apply for a certificate from the Department of Health Professions to perform these procedures.  These procedures are part of the core training in OMS residency programs, are part of our boards and are covered under our malpractice insurance.  Cosmetic injectables are also taught in some dental schools as part of cosmetic dentistry and many states have allowed their administration by general dentists for years.

Every practitioner has the obligation to offer his or her patients the latest advances in their specialty and as long as they have the inherent training and experience that is equal to or surpasses those already credentialed, this should be viewed as progress, not competition.

Filler injection is not without possible complications, some which can be tragic, but in their day to day duties, general dentists use, handle, operate and inject with procedures that can have serious side effects.  They are well educated on safe treatment and avoiding complications.  As more and more aesthetic injectables enter the marketplace, ongoing continuing education is imperative for any an all specialties providing these services.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia