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Dental hygienists and Botox: It's complicated

Feb. 27, 2023
Can dental hygienists do Botox and dermal fillers? It depends on where you live. This author breaks down the reasons she thinks it's good for dental offices, hygienists, and patients to allow this practice everywhere.

In recent years, more dentists have been allowed to administer dermal fillers and Botox injections to patients. But why is it that dentists, nurses, and many others in health care can administer such a treatment, but dental hygienists in many areas of the country can’t? (Note: I work in California, where dental hygienists currently are not permitted to offer Botox or dermal filler injections. Some states do allow the practice; contact your state’s dental board to learn about Botox regulations for hygienists where you work.)

Allowing hygienists across the country to administer dermal fillers and Botox could help offices and patients in many ways, including by bringing in extra revenue and saving patients time in traveling to multiple offices for treatment of particular jaw disorders. 

It also makes sense from a competency standpoint. Dental hygienists are classified as head and neck experts; our entire practice revolves around our extensive knowledge of those areas. Every hygienist has taken courses in full-body anatomy along with specialized head and neck anatomy, and has demonstrated competency in order to get a license. Hygienists work with needles and syringes on a day-to-day basis administering local anesthetic into the head and neck, even giving injections around the TMJ.

Giving these injections requires not only extensive anatomical knowledge of the muscles, but also full knowledge of the vascular system. If hygienists can be trusted to competently administer local anesthetic, why shouldn’t they have the opportunity to administer Botox and dermal fillers? 

What’s the actual issue?

Registered nurses are allowed to administer these, yet they are not required to take specific head and neck anatomy courses nor are they working with needles in the head and neck region on a daily basis. The classes required to enter a nursing program are the same ones required to enter a dental hygiene program. Hygienists actually undergo a much more extensive head and neck anatomy class; they’re taught from the beginning of their program how to assess the jaw joint, looking for popping, clicking, or deviation along with palpating the muscles for signs of overuse.

So, is it really an issue of competency, or is the medical field trying to separate oral health from physical health?

Why hygienists are suited to give these injections

TMJ issues

Dental hygienists are taught all the signs and symptoms for TMJ issues. As anyone working in the field knows, patients often come to the dental office first for jaw pain. While nightguards can help in some cases, often that’s not enough for adequate pain relief.

I’ve had many patients report that getting Botox injections has provided a ton of relief for their TMJ issues. If hygienists were able to treat patients in-office and give this sort of treatment, it would save patients time and money. What’s more, Botox wears off in three to six months, which would often coordinate well with a patient’s cleaning schedule.

Doctors’ schedules

Allowing hygienists the ability to administer Botox during a cleaning appointment would also free up the doctor’s schedule, giving them more time for diagnosis and treatment. Hygienists know waiting on a dentist for an exam can take time; it also means making the doctor stop what they’re doing and switch gears, which can mentally take a toll as well as eat up appointment time.

Help for the “gummy smile”

For years, cosmetic changes to the head and neck have been achievable using dentistry. Many people can change their overall facial structure with orthodontics or veneers. However, using veneers or crowns to change a smile is often a permanent solution that can harm the enamel of the natural tooth.

Without proper home care, over time this can lead to bigger problems with hygiene and gingival infection, periodontitis, and much larger issues. Patients with an excess of attached gingival tissue look into surgeries to fix their “gummy smile,” but this can also be fixed with Botox, a much less invasive and much less permanent solution. A core part of hygienists’ work is to give patients more confidence in their appearance, so it seems like a no-brainer to allow them to do so with something as simple as an injection. 

A path to career growth

Allowing hygienists to perform these injections can also open up a broader scope of practice to care for those in areas underserved—and it can help prevent burnout in a career that is plagued with it. The repetition with no significant change is something a lot of hygienists find frustrating. This skill area would give hygienists something new to learn and practice and allow for something often lacking in their career field: growth. 

Hygienists are incredibly skilled, intelligent practitioners. As society continues to advance toward one-stop shopping, giving hygienists the ability to administer injections would bring in more opportunity for themselves and patients.

As well, allowing hygienists this opportunity would help bridge the gap between oral and systemic health and show patients that oral health and its practitioners are valued just as much as those in traditional health care. 

About the Author

Jessica Myers, BA, RDH

Jessica Myers is a practicing dental hygienist in San Diego, California. Before hygiene, Jessica pursued a career in journalism and media studies at San Diego State University. Jessica has a passion for helping other hygienists grow in their knowledge and careers.