Arun K Garg - Dermal Fillers for Dental Professionals

Most dentists learn early in their career that a personal recommendation made by a satisfied patient can do more for their bottom line than any marketing campaign. Dental appointments top the list of the average person’s least-favorite activities, so having a patient refer a friend is an exceptional honor. Indeed, the dentist-patient relationship is a unique and special one, with few if any analogues.

Our patients trust our professional skills in diagnosing their problems and delivering their treatment safely and effectively. They also trust our advice on matters that are purely esthetic, such as matching a shade or choosing the shape of a crown. We know our patients’ faces better than anyone else (except perhaps their spouses). Who better, then, to matter-of-factly suggest a minimally invasive procedure to smooth the lines around their mouth (ie, nasolabial folds) that add years to their appearance? Especially considering many of these patients may otherwise never seek such treatment.

This strategy will obviously take time and patience, but you can use that time to improve your skills through practice on staff, family, and friends. In the beginning, you will want to focus on patients who are more likely to feel comfortable if the procedure takes longer than expected or requires a follow-up to add more filler. The same discretion was required when you first opened your dental practice. The advantage today is that you have a whole practice of patients who already respect and trust you.

Conclusion

If you ultimately decide to incorporate cosmetic dermal filler procedures into your dental practice, you cannot hope to be successful unless you continue to deliver the same high quality of care, and that requires training and knowledge. This unique book was written by dentists for dentists; it recognizes and builds on the practicing dentist’s knowledge in areas of overlap, such as head and neck anatomy, facial musculature, anesthesia, and managing patient expectations. In areas that fall outside the scope of dentistry, it takes a more comprehensive approach. Thus, in addition to providing step-by-step instructions for performing dermal filler procedures to address simple, moderate, and advanced conditions, the book includes chapters on the physicochemical properties of commercial fillers, standard injection protocols, facial esthetic analysis, adverse effects and potential complications, locating specific dermal planes, and other critical concepts.

Expanding your practice to include facial esthetic treatment can be a catalyst for positive change and bring many rewards, such as the unfamiliar pleasure of witnessing your patients’ enthusiasm and excitement on the day they pre-sent for their new treatment.

References

1.American Society of Plastic Surgeons. 2018 Plastic Surgery Statistics Report. https://www.plasticsurgery.org/documents/News/Statistics/2018/cosmetic-procedure-trends-2018.pdf. Accessed 21 April 2020.

2.Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Dermatology. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/080_Dermatology_2019.pdf?ver=2019-06-13-071913-123. Accessed 21 April 2020.

3.American Academy of Facial Esthetics. Dentists doing Botox? It’s about time! https://www.facialesthetics.org/blog/dentists-botox-time/. Accessed 21 April 2020.

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Anesthesia for Dermal Filler Injections

In facial esthetics, as in dentistry, patients often assess the quality and success of treatment based not on the outcome, but on the process. Dentists know, perhaps better than most medical professionals, that pain control is an integral part of the process: The more attention given to pain management, the more likely the patient will feel happy and satisfied with the outcome. Pain control and the methods used to achieve it play a central role in the practice of facial cosmetic rejuvenation. 1

Aside from reducing patient discomfort, proper anesthesia administration minimizes tissue alteration of the treatment site, increases injection/application accuracy, and optimizes esthetic outcomes. The choice of anesthetic method depends on a number of factors, including patient pain tolerance, treatment site sensitivity, type of filler used, tissue plane of the dermal injection, and amount of product injected. In general, the more sensitive the site, the more likelihood there is that injectable anesthesia should be used. Understanding the available armamentarium is critical in determining which method or methods are best for the patient and practitioner. This chapter offers a detailed review of pain control methods, from least to most invasive.

Noninvasive Anesthesia Techniques

Cooling therapy and vibration

As most dentists know, a calm demeanor and gentle touch can go far in reducing the fear and anxiety that many patients experience before an injection. This approach is even more effective when combined with other noninvasive modalities of pain control.

There are many different forms of cooling therapy that offer safe, simple, and effective pain control at the site of the injection. Ice packs, vapocoolants, and contact cooling devices can be used alone or in conjunction with topical anesthetics as a pretreatment for pain. Covered ice can be applied to the skin for about 1 to 2 minutes to numb injection sites. 2,3While this method will only blunt the pain at best, it is safe, inexpensive, and easy. Spraying the injection site with a vapocoolant, such as topical ethyl chloride (Fig 2-1) or dichlorotetrafluoroethane skin refrigerant, desensitizes topical nerves immediately upon application. A randomized split-face study found a statistically significant reduction in pain of 64% when patients were treated with vapocoolant spray prior to dermal filler injections. 4 This method is less cumbersome than ice packs, fast-acting, and cost-effective. However, the spray should only be used in the cheek and nasolabial folds area, and caution should be exercised for those at risk for reactive hyperpigmentation. 2 Alternatively, contact cooling devices (Fig 2-2), again applied to the injection site for only 1 to 3 minutes until the skin is erythematous, not only anesthetize the treatment area, but can also reduce posttreatment ecchymosis and swelling at the site due to the vasoconstrictive effects of the cold. Patients who participated in a split-face trial experienced a 61% decrease in immediate pain and a 66% reduction in ecchymosis as measured 1 day after receiving dermal filler injections. 5 However, prolonged contact at one site can result in injury to the epidermis.

FIG 2-1Topical ethyl chloride (Gebauer) can be used to numb the injection site prior to injection of dermal fillers.

FIG 2-2A contact dermal cooling device (ArTek Spot, ThermoTek) not only numbs the skin but reduces posttreatment bruising and swelling as well.

Vibration (Fig 2-3) has also been shown to be an effective method to minimize the pain of dermal filler injections. 2 The application of a vibration device to an area adjacent to the injection site is thought to reduce pain through stimulation-induced analgesia—a concept associated with the gate control theory of pain—and by relaxing facial muscles. 3,6The vibration is applied concurrently with the injection (Fig 2-4) or just before it is administered, depending on the model used, and it is completely safe.