April 5, 2017
by Dr. Les Rykiss, DMD
Boy time flies! A year ago I was given the privilege of becoming the editor of the April Aesthetic issue of Oral Health. Taking over for Dr. Elliot Mechanic is not an easy task and one that I have not taken lightly. Every April, Dr. Mechanic had successfully assembled articles from some of the best Aesthetic/Cosmetic dentists worldwide, in order to teach all of us techniques and procedures to help us in our everyday practices. A job extremely well done! Thank you Dr. Mechanic. My hope is that I will be able to continue along the same path and provide all of you worthwhile articles from many different sources over my time at Oral Health.
Having said that, who is Les Rykiss? I have two wonderful children that keep me on my toes and support me in my endeavors daily. I graduated my formal dental education from University of Manitoba in 1990 and have continued to practice in Winnipeg from graduation until now. While I was happy with my private practice, which I built in 1995, I decided that I wanted to gain further knowledge and expand my scope of practice. So, in 2007, I started with hard tissue lasers and graduated with an associate fellowship in laser dentistry from the WCLI. In 2008, I started my formal cosmetic training with Dr. Ross Nash at the Nash Institute in Charlotte, North Carolina. After graduation with a certificate in cosmetic dentistry, I went on to be a mentor/educator at the institute. I also have a fellowship in the International Academy for Dento-Facial Aesthetics.
I continue to practice full-time doing cosmetic and restorative dentistry. I can credit my knowledge of aesthetic dentistry to my many mentors, Dr. Ross Nash, Dr. Elliot Mechanic, Dr. Irwin Smigel, Dr. George Freedman, and on. Being an accredited member of the American Society for Dental Aesthetics, I have had the privilege of broadening my knowledge from, in my humble opinion, the world leaders in aesthetic dentistry. One of my passions was being chairman of the annual Alpha Omega Memorial Lecture in Winnipeg for almost a decade, researching and sharing some of the best educators in dentistry with our members. I have lectured and written on topics of cosmetics and laser dentistry. I am encouraging all Oral Health readers who may wish to contribute an aesthetic article for future issues to contact me at firstname.lastname@example.org. I will be very happy to help you get published.
Enough about me. So, “who owns the face?” This is a quote often heard from the father of aesthetic dentistry, Dr. Irwin Smigel. Unfortunately, Dr. Smigel passed away in late 2016, but not before passing on his incredible knowledge and wisdom to so many! Dr. Smigel preached that we as dentists can make changes to the way the face appears to others by making cosmetic changes intraorally via restorative means. I think that this quote is quite fitting with regards to a controversial topic in dentistry today, Botulinum Toxin (Botox) and dermal fillers.
It is quite interesting that upon researching the use of Botox in Canada, there is a wide disparity from provincial dental governing bodies across Canada on the allowance of its use. This ranges from Botox and dermal fillers can be administered by trained professionals for any purpose in dentistry, to Botox only for treatment of pain, to Botox cannot be used in a dental setting by any practitioners whether certified or not for any reason. Table 1 shows a breakdown of which provinces allow Botox and or dermal fillers to be administered and for what purposes.
I have spent much time thinking about this topic. It would seem reasonable to think that since dentists spend an appreciable amount of time studying in depth the nerves, vasculature, and muscles of the face that we would be quite qualified to use our judgement and be able to administer Botox and fillers to our patients as long as the practitioner has had certified training. Who administers these in a Medical dermatology clinic? It is usually a technician or nurse that the Doctors train themselves. In other words, injected by individuals with no formal training. How about the odd shopping mall Kiosk? I am actually scared to find out.
We as aesthetic/cosmetic dentists should utilize Botox and fillers in our practice to handle our patient’s requests and needs from a cosmetic standpoint. I am specifically referring to trained and certified dentists who have completed the necessary programs that are readily available. It is my feeling that the governing bodies need to revisit the legislations for Botox and dermal fillers. There are many offices that administer both Botox and fillers already (just from a random sampling of offices across Canada), without the knowledge or permission of their governing body. This practice is only harmful to our profession. The only way that this can be stopped or at least lessened is by legislating its training and application in the dental office. We as dentists are trusted with injecting anesthesia intraorally where there are a multitude of nerves and vasculature that can be affected, yet giving us dentists the responsibility of injecting Botox or fillers extra orally is taboo. So, do the governing bodies give the responsibility of this to our profession, or continue to allow unqualified technicians in a medical office or shopping mall kiosk the responsibility of this? Again I ask you, “Who Owns The Face?” We do! OH
About the Editor
Dr. Les Rykiss, DMD maintains his private practice in Winnipeg, MB. He is a graduate of the University of Manitoba as well as a graduate and Mentor at the Nash Institute for Dental Learning in Charlotte, N.C. He has his Fellowship with the International Academy for Dental Facial Esthetics, an associate Fellowship from the World Clinical Laser Institute, and is a member of the ASDA and CAED. He teaches, lectures, and writes articles on restorative, cosmetic dentistry, and hard and soft tissue laser use.