Integrating Aesthetic Medicine into Dentistry

By Aesthetics journal / 25 Oct 2022

Dr Martin Nimmo provides his advice for dentists looking to make the move into aesthetics

As a dentist now working solely in aesthetic medicine, if someone had told me this would have been my calling 10 years ago, I simply wouldn’t have believed them. When I embarked upon my initial botulinum toxin and dermal filler training back in 2011, I thought injectables would be a minor add-on to complement my general dental treatments.

Fast forward over a decade, and the evolution of aesthetic medicine has occurred at a tremendous rate. The increased understanding of the facial ageing process has coincided with improvements in both device-based treatments and the quality of injectable products and our utilisation of them. These developments have helped us optimise treatment plans to create global facial improvements.

The advancements have also been met by a surge in patient demand, and dentists are optimally positioned to capitalise on this by utilising their existing skills and expertise, working environments and patient bases. However, I’ve found that many dentists are anxious about making a move into aesthetics because they are apprehensive about treating extra-orally, opening up conversations about aesthetic concerns that are perceived to be awkward, or that they simply do not know where to start when it comes to finding reputable training courses and mentorship. Here, I will identify how dentists can experience a successful transition into aesthetic medicine.

How dentists can utilise existing skills

Even in the early stages of a dentist’s career, due to the structure of the undergraduate curriculum, they exhibit a high degree of manual dexterity, excellent knowledge of head and neck anatomy and aesthetic proportionality, while simultaneously understanding pharmacology and materials science. These qualities lend themselves especially well to dermal filler and toxin treatments. Dentists can quickly acquire the assessment skills in order to adequately evaluate an individual’s concerns and treatment suitability to ultimately deliver safe treatments with good aesthetic outcomes, while respecting the functional anatomy.

It’s easy to see why dentists are suitable to undertake this. The most obvious one is the fact that as a dentist, one of our main tasks is to assess patients, openly discuss their concerns and the treatment options suitable for them and then develop an integrated treatment plan addressing the ‘issues’ that have been discussed.

Asking open questions and responding in an empathetic and caring manner is something all successful dentists will be skilled at. These basic communication skills are entirely transferrable to aesthetic medicine and paramount to gathering information about patients' facial concerns, treatment aspirations and discussing potential options.

That being said, many patients are apprehensive about embracing injectable treatments so answering questions clearly and concisely about patients’ perceived barriers to treatment goes a long way to converting them and retaining them in the longer term. At the end of the day, it comes down to trust. Apart from being highly skilled, the Care Quality Commission requirements call for dental surgeries to follow strict

cross-infection control measures and provide good lighting, while also have provision to deal with medical emergencies.1 As such, these strict clinical conditions make them not only a desirable environment for safe practice, but also for fulfilling the potential future premises requirements recommended by the Joint Council for Cosmetic Practitioners (JCCP)2 which could come into force with a new licensing regime following an amendment in the Health and Social Care Act.3

Using an existing patient base

Unlike many other healthcare professionals starting their careers in aesthetic medicine, dentists have a distinct advantage – an existing patient base. Many healthcare professionals who struggle to get their aesthetic medicine career off the ground do so as a result of the time and money taken to grow a sustainable list of patients.

The likelihood is that most dental clinics will have a good number of patients who can be informed of aesthetic medicine procedures through the clinic’s existing direct marketing channels, as long as the relevant advertising guidance from the General Dental Council4 and the Committee of Advertising Practice5 is adhered to.

Although discussion of the contents of these documents would exceed the remit of this article, it is worth noting that as botulinum toxin is a prescription-only medicine, it therefore cannot be advertised to the public by name. Any intervention using toxin should be referred to in non-specific terms, such as ‘a consultation for the treatment of lines and wrinkles’. Other notable points are that aesthetic procedures should not be marketed to those under 18 years of age, and that dentists should not refer to themselves as ‘specialists’ or ‘specialist in’ aesthetic medicine.4,5

In light of these regulations, marketing ‘solutions’ to common concerns rather than the specific treatments themselves can often be a more engaging way to attract new and existing patients. Marketing emails or social media posts which, for example, discuss improvements in skin quality or reduction of lines can include references to broad treatment categories such as, ‘our latest injectable treatment’. Not only does this comply with marketing standards, it stimulates curiosity with the reader to find out which specific treatment can achieve these results. Having a call to action such as, ‘Would you like to see how we can help you? Book your consultation today’ can prompt the patient to make further enquires, hopefully resulting in a conversion to treatment.

Another way of raising awareness and starting conversations with patients is through an interests questionnaire, which includes both dental and facial aesthetic aspirations. As the questionnaire is completed prior to a patient’s appointment, it will indicate those who have a genuine interest in seeking interventions and allow the practitioner to discuss the subject without fear of potentially causing offence. 

Useful tools for the facial aesthetics component may be as simple as having a diagram of a face with tick boxes pointing to specific facial areas with common corresponding concerns, such as forehead lines or marionette lines. This is often easier for patients to understand and likely to achieve more engagement than an open question such as, ‘do you have any facial aesthetic concerns’, especially if the primary reason for attendance in the clinic is for dentistry. Asking about a patient’s previous aesthetic treatment history can also identify those who are already undertaking aesthetic interventions, allowing a conversation to start about treatments you may offer to complement their current regime.

Training and requirements

There is a plethora of training courses in facial aesthetics on the market, ranging significantly in duration, price and unfortunately, quality. It is important to research the providers thoroughly and ensure they are registered healthcare providers (HCPs) with extensive experience in aesthetic medicine. Ultimately, there is currently no set requirement for the minimum level of training, however this may change given the potential amendments to the Health and Social Care Act as previously discussed. 

It is important that any training you undertake meets your own individual learning needs, while also understanding that a foundation course is the very beginning of a journey, which can take years to master. It is pertinent to consider a training provider that can provide some form of mentorship and follow-up, especially if you are undertaking procedures in a clinic where you are the sole provider.

Incorporating your team

It is also wise to educate your wider dental team in the various aesthetic interventions you plan to undertake following training. Many patients’ initial inquiries will likely be with the reception team who may not have a significant degree of understanding of aesthetic procedures if they are from a purely dental background. It is essential that they are competent in their basic communication of procedures so patients have sufficient confidence in the clinic to proceed with booking a consultation.

Dental nurses can also be utilised to assist in facial aesthetic procedures. Having a second pair of hands is invaluable at improving the flow of treatment, assisting with aseptic technique and helping to stem any bleeding.

Indemnity

In order to undertake aesthetic treatments, it is a legal requirement to hold the appropriate level of indemnity for the procedures you wish to undertake.6 Some dental indemnity providers, such as the Dental Defence Union, will provide cover but require an additional supplement if you are a recently qualified dentist or if your gross earnings for this work exceed £8,000 per year.7 Other indemnity providers, such as Cosmetic Insure, Enhance Insurance or Hamilton Fraser Cosmetic Insurance, can provide separate indemnity cover. It is important to undertake personal research with the various providers to establish which cover will be most suitable for your individual needs.

Where to start with treatments

Upon completion of initial training, like any other new clinical service, it is essential to build upon the basic fundamentals before embarking upon more complex treatments. Patient selection at this stage is key. It is important to choose patients who present with relatively easy-to-treat concerns away from higher risk areas such as the tear trough and nose. 

During the initial phases of administering injectables, it is important to focus on injection technique and hone skills such as hand stability, particularly when aspirating dermal filler with a needle, and aseptic technique. Dentists are ideally placed to offer treatments directly related to common functional issues and dental aesthetic concerns. Toxin can achieve very good results in reducing masseteric tenderness as a result of parafunction and, in many cases, can offer a relatively straightforward solution to addressing ‘gummy smiles’ as opposed to surgical crown lengthening.

Consider treatments outside injectables

Although most dentists will commence their aesthetic medicine practice with injectable procedures such as botulinum toxin and dermal fillers, there is a growing demand for adjunctive treatments to improve skin quality and other aesthetic concerns. One of the benefits of modern aesthetic practice is that there are now a number of adjunctive devices on the market, such as radiofrequency and microneedling machines, which can be easily integrated into an aesthetic treatment plan in a dental practice. Most devices now do not take up a significant degree of physical clinical space, and can potentially attract more patients who are apprehensive about undertaking injectable treatments.

Get started in aesthetic medicine

The field of aesthetic medicine is a rapidly growing and exciting area to be a part of. Although many dentists can be apprehensive about working outside of the intra-oral comfort zone, the transferable skills outlined in this article demonstrate the ease of integrating these treatments into a dental clinic, providing a high degree of patient and provider satisfaction.

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