Australasian Dentist Issue 93

CATEGORY AUSTRALASIAN DENTIST 79 and neck cancer, which has been shown to carry a much higher risk of aggressive metastasis than cancer appearing on other parts of the skin and Australia leads the world in our rate of lip cancer. Few dental practitioners stop to think that our oral health instruction must naturally then, extend to advice about the best, scientifically proven products and methods for protecting and maintaining the health of patients’ lips. Without professional guidance, our patients are at the mercy of confusing, distracting and misleading noise from a plethora of dubious marketing slogans; shelves of shiny products; and influence from social media false prophets. As we see with other oral care and teeth whitening products, this lack of professional guidance and the use of inappropriate products at home, can have serious health implications. Specialist dermatologists and skin cancer specialists from Harvard University have raised warnings relating to the use of poor lip care products, especially the increasingly popular luxury branded, non-SPF based high-sheen gloss or oil products. These have been shown to actually enhance the optical passage of ultraviolet rays (like a magnifying glass), increasing theirpenetrationinto thealreadyvulnerable lips and increasing the risk of lip cancer. To achieve the best clinical outcomes for lip enhancement, dental practitioners should start by actively asking patients how they care for their lips daily and recommending professionally formulated lip care products, like Lip-Tx (www.lip-tx.com ), at the same time as providing other oral hygiene instruction and recommendations for intra-oral care. In addition to ensuring patients use the right products at home practitioners should be helping patients to actively maintain the health and vitality of their lips, in the chair, at every regular dental maintenance appointment. Lip tissue responds favourably to proactive regular maintenance therapy, just like a scale and clean for the teeth, to reduce the need for more invasive and costly procedures in the future. A regular gentle lip exfoliation and deephydrationmask, applied at every recall hygiene visit, ensures lip barrier function is optimized by continuing to stimulate the renewal of supportive collagen, elastin and extracellular matrix components. These active rejuvenation treatments should end with an SPF lip balm being applied to the lips prior to the patient leaving the clinic to ensure they are protected from the sun. While damage from the sun, neglect, smoking and other environmental aggressors play the most significant role in lip tissuedeterioration, afinal consideration for prevention of lip damage relates to the action of the underlying Orbicularis Oris and other peri-oral muscles. Excessive activity of the musculature surrounding the mouth can not only be unsightly in itself (e.g., a gummy smile, downturned corners), but can contribute to the breakdown of the delicate lip tissue. In these cases, the selective use of micro-doses of Botox can help to reduce these destructive forces, making subsequent therapies more effective. Step 2: Ensure there is a foundation of structural integrity Just as the success of a dental implant relies heavily on there being a solid foundation of support sotoodoesagreat lipenhancement. While it is difficult to forget the need for solid anchorage when placing an implant, it is often these considerations which are lacking when practitioners perform a lip enhancement, leading to unsightly results and a lack of longevity at best. It is our ability to consider and improve the underlying dental support structure of the lips, that positions dentists at the forefront of delivering quality lip enhancement and it is why AADFA is often called upon to teach plastic surgeons, nurses, GP doctors and dermatologists how to assess these parameters and refer to a dentist when needed. Too many practitioners fail to identify and inform patients that a lack of lip support from the underlying dentition may be a primary issue effecting lip aesthetics. Moving ahead with other inappropriate interventions like dermal filler, in these cases, will invariably result in a poor result as natural lip anatomy and proportion must be blown out to compensate for absent structural support. While non-surgical procedures have become increasingly popular in dento- facial rejuvenation, we can also never forget that surgery still has its place, especially in more advanced cases of deterioration. Many older patients typical have a long upper white lip, together with the reduced vermillion display that is usually the focus of their desire for a lip enhancement. In these cases, providing a vermillion lip enhancement alone, particularly with dermal filler, will only serve to worsen the appearance when the correct treatment recommendation would be a surgical lip lift in the first instance. LINICAL Fig.2: Before & immediately after Lip-Tx Pro treatment in the dental chair. Patients are then given Lip-Tx Home to use daily. The majority of improvement in lip health & aesthetics comes from the use of proper, scientifically proven at home lip care products & regular in-clinic maintenance. Assuming the patient’s dentition is providing adequate underlying support to the lip and the white lip is not excessive in length, there is still a final structural consideration that most practitioners fail to consider with a lip enhancement – the use of PDO threads. PDO threads are essentially injectable, dissolvable surgical sutures that act like the steel rods used to reinforce concrete in building construction. The threads ensure that the lips maintain their structure, resilience and shape long into the future. PDO threads can often be used to enhance lips on their own, completely avoiding the need for dermal filler and the more substantial complications it can bring, or they can be used in conjunction with filler to provide increased longevity to treatment and to limit some of the problems that can be seen with dermal filler use alone, such as product migration. Step 3: The pretty bit on top, with imaging to ensure success It is unfortunate that the notion of a lip enhancement can stir such negative connotations in the minds of patients and practitioners alike. This has largely Fig.3: The placement of PDO threads into the lip, will ensure they maintain structural integrity over the long-term and can either completely eliminate the need for more dangerous dermal filler, or at least help to reduce the chance of complications.