CATEGORY 60 AUSTRALASIAN DENTIST CLINICAL record with reasoning regarding why an offlabel treatment was chosen. Review what has changed since the previous visit: the patient’s goals, health and medicine history, response to treatment, adverse effects and whether treatment is still justified. Record the reason for proceeding and the consent discussion relevant to that visit. This does not mean copying a lengthy literature review into the file every time. It means that another practitioner reading the record can understand why this patient received this off-label treatment on this occasion. A pre-filled template may prompt you to collect information, but it cannot replace patient-specific findings and judgement. Ahpra’s National Prescribing Competencies Framework calls for the reasons for off-label use, potential benefits and risks, and informed consent to be evaluated and documented. Reconstitution: the off-label step dentists may overlook Many dentists prepare the brand Dysport botulinum toxin using the dilution taught during their initial training. They may have followed that method carefully for years without realising that the current Australian Product Information for the brand and vial they use specifies a different preparation. Training undertaken in good faith does not make a method an approved use of every product. Each brand has its own reconstitution directions, units, storage requirements and conditions for use after preparation. A dilution taught for one brand should never be carried across to another without checking its Product Information. Even within a brand, the instructions need to be checked against the particular vial presentation and proposed treatment. If the method used falls outside the applicable Product Information, it is a departure from the approved directions and must be considered as part of the off-label decision. That does not mean every dilution different from a commonly taught example is off-label: first check whether the Product Information permits a range of preparations. Where the intended method is outside its directions, the dentist needs to understand why it is being used, assess the evidence and risks, explain what is relevant to the patient’s consent, and document the patient-specific decision alongside the concentration actually prepared and administered. This is an important reason to revisit earlier training. The question is no longer simply, “Can I reconstitute this toxin?” It is, “Can I show that the way I prepared this particular product was consistent with its current Australian directions – or explain and justify why I departed from them?” A reason to revisit your training Ahpra’s guidance provides a useful moment to test established habits. Can you locate the current Australian Product Information for every toxin brand in your clinic? Can you identify an off-label indication, explain the patient-specific rationale and discuss reasonable alternatives? Do your records show the product, preparation, consent and reasoning clearly enough for another practitioner to follow? Dermal Distinction Academy has updated its e-learning and practical session information to provide guidance on these prescribing considerations. We want to support dentists who value current knowledge, thoughtful treatment decisions and careful documentation. Training can help practitioners recognise the questions they need to ask; each dentist remains responsible for checking the applicable requirements and making the decision for their individual patient. u Want to enrol in training, visit www.dermaldistinction.com for more information.
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