The rise of dental spas, offering both dental care and injections of Botox, Juvéderm, and Restylane, for purely aesthetic, cosmetic purposes unrelated to any dental treatment or care, presents a complex legal landscape that varies significantly from state to state. This article explores examples of this diversity from a number of states across the country and suggests how dentists may participate in dental spas even in the most restrictive states.
On The One – Hand (Most Restrictive States)
California and Maine are the most restrictive and the most demonstrative about their restrictions. The California Dental Board has definitively stated that the use of Botox and other similar injectables is only permitted for the diagnosis and treatment of TMD/myofascial conditions as part of a comprehensive dental treatment plan. Their use for cosmetic purposes is “illegal.” The State of Maine Board of Dental Examiners has similarly stated that such injectables can only be used for dental-related procedures such as bruxism, TMJ or other maxillofacial pain as part of a dental treatment plan and any other use is “considered professional misconduct and is subject to disciplinary action.”
On The Other – Hand (Most Permissive States)
Florida appears to be the most permissive state, particularly because of its somewhat vague definition of the practice of “dentistry.” Florida does not specifically regulate the use of Botox and other injectables except to state that their use must be safe and within the accepted standards of care. However, dentists are required to have the proper training to administer these injectables for purely cosmetic purposes and they must be used within their manufacturers prescribed parameters. In addition, under the statutory definition of “dentistry” these injectables can be administered only in the “human oral cavity and its adjacent tissues and structures.” However, this fairly vague statutory language leaves much to interpretation as to how far afield from the “human oral cavity” a dentist can go in Florida. At least arguably this definition permits a Florida dentist to inject Botox in a patient’s forehead to eliminate wrinkles.
Ohio similarly permits dentists to administer such injectables for cosmetic purposes; but only within the oral and maxillofacial areas. In addition, dentists are required to complete extensive residency training in ADA accredited programs before they can provide these services.
No Guidance
Quite a number of states, for example Vermont, Wyoming, and Delaware have not provided any regulatory guidance on this subject. In these states dentists must look to the definition of practicing dentistry in their state laws and regulations to determine the permissible scope of practice, and whether it includes administering injectables for purely aesthetic/cosmetic purposes unrelated to the providing of preventive or restorative dental care or treatment.
Other Restrictions
In addition to scope of practice restrictions, some states impose limitations on the types of permissible business arrangements for dentists which may further restrict their ability to operate dental spas. These limitations may include the permissible business entities for the practice of dentistry; those other healthcare professionals who dentists can employ; the ability of dentists to own spas with other healthcare professionals and limitations on the percentage of the dentist’s ownership.
National Implications & Need for Specialized Legal Consultation
Even with these additional limitations, and even in the states with the most restrictive scope of practice on dentists administering injectables, there may be creative business arrangements which will still permit dentists to have ownership interests, or at least participate, in dental spas. However, because the laws and regulations differ so significantly from state to state, it is essential that dentists consult with attorneys specializing in dental law to avoid the potential for legal issues and possible disciplinary action in opening a dental spa.