PHOTO BY GRANT SEGAL

“GGive me that angry face,” Dr. Rob Klaich told his patient, Christine Vandervort, in his Cranberry dental studio.

Vandervort tries to turn his smile into a scowl. A few fine wrinkles crease her 36-year-old face. The dentist bends over her chair and draws amber dots on it.

Then he said, “Give me a surprised look.” New wrinkles appear, and he draws dots.

Wielding a fine needle, Klaich injects all 15 points with Botox. One bleeds for a moment. They all puff up a bit. But Vandervort never winces.

A few days later, she says the beatings didn’t hurt her, the spots faded by the time she got home and her skin already looked smoother – a good thing for ‘sweet season’. squinting, when Pittsburgh has sunshine,” she said.

Such cosmetic treatments are increasingly common where patients typically go to fill cavities or clean their teeth. In fact, more than 30,000 dentists in the United States have been trained to administer Botox treatments for everything from smoothing wrinkles to treating dental problems, says Dr. Louis Malcmacher, a general dentist based outside of Cleveland. and president of the American Academy of Facial Aesthetics. He believes that dentists provide far more of these treatments than dermatologists and plastic surgeons in the United States.

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HUCK BEARD PHOTO

Dr Andy Shieh of the PGH Smile shop in Warrendale says these minimally invasive treatments make sense in dental practices. Dental schools teach head and neck anatomy, he says. “I look at the picture as a whole.” Additionally, dentists say patients tend to see them more often than other specialists and build more relationships with them.

Patient Rania Sakmar switched to Dr. Shieh from a plastic surgeon. She says the surgeon’s treatments took longer and hurt more, even with numbing cream. With Dr. Shieh, she skips anesthesia and gets treatment in 20 minutes. Other dental patients say they also ignore it and are treated so quickly.

In 1989, the FDA began approving Botox and other brands of drugs containing botulinum toxin to treat conditions such as crossed eyes, excessive sweating, chronic migraines, wrinkles on the forehead, wrinkles between eyebrows and some other affections. Derived from bacteria, it is the same toxin responsible for botulism, a type of food poisoning. The toxin blocks nerve signals to the muscles. But practitioners give much smaller, more localized amounts.

“We don’t freeze the muscles,” says Dr. Alexandra Masek of the downtown Pittsburgh-based Atlas Dental Specialists, who has been giving such treatments for two years. “We just relax them.”

There are several specific dental conditions in which dentists say Botox can also help, such as facilitating teeth grinding or clenching (known as bruxism) – which can lead to jaw pain – and calming the onset of “gummy smiles”, in which a high lip exposes the top of the gums. The FDA has not specifically approved Botox for these uses, but they are prescribed “off label,” a common and legal use for FDA-approved drugs.

Plum’s Alan Karelitz is one of thousands who cringe. He used to grind so hard that he destroyed his teeth and implants. But he calmed down thanks to Botox in the jaw of Dr. Brian Klaich, Rob’s brother and dental partner at Cranberry.

“It’s cheap if it keeps me from breaking something,” he says.

Patients and local dentists say each Botox treatment ranges from $300 to over $2,000, depending on the state. Insurance rarely covers it.

The pandemic has slowed treatments in recent years – but may boost them now. Rob Klaich says the added stress of battling the pandemic appears to make teeth clenching, grinding and damage worse in some patients. UPMC plastic surgeon Dr. Jeffrey Gusenoff says heavy use of Zoom and other video conferencing platforms has them turning to cosmetic treatments to enhance their close-ups.

Gusenoff, however, is wary of skin treatments administered by dentists. “I go to the dentist for my teeth,” he says.

A 2020 report by Polish researchers in the journal Advances in Dermatology and Allergology states, “Botulinum toxin treatment is widely considered safe, effective, and largely devoid of serious side effects.” With millions of injections administered each year, it is the most common cosmetic procedure in the world.

In 2020, practitioners purchased $3.2 billion worth of botulinum toxin worldwide, according to Fortune Business Insights. This amount is expected to reach $5.68 billion by 2028.

Still, practitioners say consumers should proceed with caution and ask questions. For one, the treatments are expensive, and the FDA says the benefits tend to only last three months.

Experts advise consumers to inquire about a practitioner’s training and experience with botulinum toxin. Also, a patient should ask the same questions as with any other treatment – ​​benefits, risks, aftercare, duration, cost and more. Disclose other medications and conditions. For example, botulinum toxin has not been proven safe for pregnant women or those who are breastfeeding.

Side effects of the drug can range from droopy eyelids and stiff expressions to swelling, pain, shock, and in rare cases, death. The Polish study indicates that therapeutic doses tend to be four times greater than cosmetic doses and that serious complications are 33 times more likely.

Botox is considered better for treating wrinkles caused by expression rather than sun or gravity, and better for preventing wrinkles or treating relatively new wrinkles than older, deeper wrinkles. Other wrinkles may respond better to fillers.

Botulinum toxin can also be overdone. Singer Brian McFadden said it made him sound like “a melted candle”. For jaw problems, a 2019 study in the British Dental Journal states that the drug “should definitely be considered, but due to cost implications and possible side effects, it seems appropriate that conservative options, such as self-management with explanation and physical therapies, should be exhausted first.

Some dentists say botulinum toxin may be too quick a fix for sore jaws. “You’re just treating the symptoms by masking the pain,” explains the website of Dr Alexandra George of Wexford, a neuromuscular dentist. “Adjusting the jaw and healing the pain is a better option.”

But Rob Klaich says relaxed muscles often need fewer, smaller doses over time. And Dr. Alison King of Bittner King Dental in O’Hara says she stopped treatment for a patient who no longer needed it.

Gusenoff, Pitt’s plastic surgeon, also says, “Your provider should specify [use of Botox for jaw problems or gummy smiles] is off-label. But some dentists say they don’t with botulinum toxin because studies support those uses. They just make the usual disclosures as with any on-label treatment.

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PHOTO: SHUTTERSTOCK

“If you have concerns, start small,” Rob Klaich says of using Botox. Treat one area first and, if you like the results, try the others.

Dental and medical students do not study botulinum toxin. Practitioners train later and consider it crucial; they attribute most side effects to poor technique.

Training comes from organizations such as the Malcmacher Academy or Empire Medical Training, based in Fort Lauderdale, Florida. Empire’s basic course is eight hours long and includes practice with living patients. Malcmacher takes 30 hours and also covers several other types of injections, such as dermal fillers, again with live practice.

Different states have different rules regarding Botox, and some do not: The Pennsylvania State Board of Dentistry, for example, does not have specific rules governing the use of botulinum toxin in dental offices. For now, the council’s Dr Brice Arndt says the drug should only be given by dentists, not their assistants, and to the parts of the head they normally treat.

A spokeswoman for the board said she was not aware of any disciplinary action regarding Botox.

Overall, Arndt says, “It’s not going to be a panacea. If you have structural problems, you cannot fix them using Botox. There are limits and there must be expectations.


Grant Segall is a nationally award-winning journalist who has written for The Washington Post, Cleveland Plain Dealer, Philadelphia Magazine, Time, Reuters, Science, Oxford University Press and other outlets.

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