Australasian Dentist Issue 93

CATEGORY AUSTRALASIAN DENTIST 63 result because you “feel bad” in addressing the patient about their appearance. Numerous findings on a patient’s physical exam may pose limitations to the expected outcome irrespective of the skill of the practitioner. Despite the artistry with which the supportive tissues are manipulated, the ultimate aesthetic outcome of the face is based on how the overlying skin drapes over the supporting framework. Thick and thin skin can both predispose todifferent outcomes.Thick skin draped over even the most well-structured skeletal and dental structure, will hide the detail in these supporting structures. In contrast, thin skin is unforgiving in that all imperfections can be visible. Filler boluses, as well as minor irregularities, can become alarmingly apparent requiring revision. Are dentists cosmetic injectors, or they cosmetic injectors dentists? And is it in our scope as dentists? For some reason, this seems to be a point of contention, but I have never really understood this. For me, you will always be your primary vocation by title. I went to dental school and will always be a dentist. That does not mean that you cannot develop skills that further assist your patients. So I consider myself both a dentist and cosmetic injector, and these are not exclusive of one another. But let’s look at some key opinion leaders for some insight. Mauricio De Maio is a plastic surgeon and KOL for Allergan, the company that produces Botox. He has authored a textbook titled “Injectable fillers in Aesthetic medicine” [Springer, 2014]. In this book, Dr Maio writes the following statement: “The physical examination is of utmost importance in lip reshaping. Both the upper and lower dental arcade promote an important role in lip augmentation. If the teeth (central and lateral incisors) are inclined backwards, lip projection is extremely difficult and sometimes impossible.” So as dentists we are in the prime position to undertake lip augmentation, as we consider the position of the incisors on a daily basis. I believe that this highlights that cosmetic injecting and dentistry are intimately connected, and always should be. We need to be dentists first, whilst paying reference to the lip structure and architecture, as this helps our cosmetic injecting whilst we work as dentists. Here is another example. I am sure many of you know of Dr Ronald Goldstein, the father of cosmetic dentistry. I had the pleasure of hearing Dr Goldstein speak in New York in 2016 about integrating facial aeshetics and dentistry for outcomes that include all the facets of the patient. Dr Goldstein has authored the textbook “Esthetics in Dentistry” [Wiley, 3rd Ed, 2018]. He has dedicated chapters to consideration and treatment of the facial tissues alongside more traditional restorative approaches. In this textbook, Dr Goldstein writes, “Our approach to diagnosis and treatment planning includes three major areas: the face (macroesthetics), smile (miniesthetics), and teeth (microesthetic). These serve as a framework for systematic evaluation of the aesthetic needs of each particular patient.” It is a disservice to our dental patients if we do not consider the face. Comprehensive treatment planning should include the treatment options for teeth, smile and the face overall. Choosing only one component in our treatment planning, is akin to ignoring orthodontic assessment and only focussing on decay. And it is in our scope as dentists to consider facial injectable treatments. It is included in the guidelines for scope of practice for AHPRA. As with any dental treatment, we must be trained, insured, have recency of practice and remain competent before proceeding with treatment. This also means offering all treatment options, including no treatment and referral where necessary in our treatment plan. How to develop the plan: what steps do we take? The best treatment plan comes from the goal of achieving an improvement in the facial aesthetic of our patient that looks natural and untouched. Our responsibility and goals are to help them be realistic in what they can accomplish so that they can look their best. It is not about getting rid of every line and wrinkle. It is about helping women and men look their best at any age. To develop an aesthetic plan, we have to shift from a two-dimensional focus of picking out a particular problem, but rather we should shift toa three-dimensional focus (recontouring and volume restoration). It LINICAL