Australasian Dentist Magazine Nov Dec 2021

Category 96 AustrAlAsiAn Dentist liniCal with any other dental procedure that we undertake. How often should you get dermal fillers? to ensure an optimal and long lasting result, a top-up treatment is sometimes recommended 6-12 months after the initial treatment. However there is no real time line or guideline, as it varies so widely from area to area, and person to person. the dental injector will be able to give some kind of guideline as to the expected lifespan. As a general rule of thumb, lip filler lasts around 4-6 months, and cheek filler lasts around 12-18 months. But often the trigger for retreatment will be when the patients sees the volume created, starting to fade. i would recommend reassessment with each schedule dental appointment, to maintain the results beautifully. What questions do patients generally ask about dermal filler? some great questions that i get asked include: u What is involved in treatment? u Will lip filler hurt? Do you use numbing cream or do you use more than that? u How much filler will i need? is the filler listed/approved with tGA? u How long will the filler last? u What are the risks? u is there any downtime? For example, if there is bruising or swelling, how long might this last? u What are the costs? u Who will do my treatment? i do not consider any of these questions too simple or silly, but rather shows that the patient is engaging in a frank and honest consultation with me. What risks or complications can occur with dermal filler? the most common risks are discomfort or pain, bruising and swelling. these risks are often minimal, transient but also sometimes unavoidable. sometimes some fillers create lumps and bumps under the skin or in the lips. if dealt with early – usually within a week of filler placement – they can be manipulated by the dental injector and they will easily dissipate. A much more serious risk, but also much less common, is vascular occlusion. Vascular occlusion is the medical term for a blocked blood vessel. if you are a dentist injecting dermal filler, you should understand the anatomy of the face intimately and also the best techniques to avoid this complication, but also how to deal with this serious complication should it occur. this also includes not placing too much filler in any one area in one sitting. Finally the most serious of risks is blindness. this has occurred once in Australia a couple of years ago. there are some high risk zones on the face and some risky techniques. Dentists should only ever practice in their scope, and know when to refer a patient. this includes treatment is high risk zones, as well as patients that have a history of previous surgery. What are your options if the patient doesn’t like how they look? this is something that needs to be considered, as aesthetics can be a difficult concept to convey to the patient. Again like any dental procedure, we need to be able to give the patient an idea of the overall result we are trying to achieve. i would never guarantee a particular result, but it is important that both the patient and dentist are on the same page. in my experience, travelling slow is a good option, so that you can slowly build a result. this helps the patient slowly see the emergence of a result, rather than being shocked by a sudden change. in some ways, teeth are easier, in that we are dealing with predictable hard tissues. soft tissues are an entirely different thing. We need to ensure that the patient understands that there is a settling in period, where the filler can look uneven as it begins to attract water. there is also a period of time where the dental injector can modify the result through manipulation of the filler. scheduling a review appointment after treatment definitely helps to ensure a great result is achieved. However if this still is not quite right for the patient, you can also discuss the option of using a dissolving agent or enzyme, where the HA filler can be ‘melted’ away. the enzyme is called Hyaluronidase, and must be on hand in the practice for any dentist using dermal filler. it is 100% mandatory so that you may deal with a vascular event should one occur. But Hyaluronidase may also be used to dissolve filler (partially or fully) where the filler has not resulted in a good outcome. Keep in mind that permanent types of fillers cannot be dissolved, so i do not recommend dentists venture into using those filler products. What areas of the face can dermal fillers be used? Almost any area of the face can be treated. this includes the lips, nasolabial folds, cheeks, temples, jawline and chin. However, for dentists, it is important that we remain within our scope of practice. so the most commonly performed and requested treatments are the lips and perioral region. Along with the general and cosmetic tooth-based dentistry we do, dermal filler can really add to the results we achieve, and finish off the lip, jawline and chin position where other options are not viable or suitable for the patient. Is getting dermal fillers painful? Most fillers have anaesthetic included, which helps to eliminate discomfort. An option that works really well for my patients is the use of a cannula which helps to reduce bruising and discomfort markedly. A cannula is able to weave its way around the face, under the skin, reducing the needle for multiple needles. Medical grade numbing creams can help reduce discomfort around the face, along with the use of ice to reduce sensations. However, i find that when using a cannula, the treatment is very comfortable, and i say this as both an injector and someone who has herself received treatment too. lip enhancement, on the other hand, is an entirely different story. i highly recommend and always use complete dental anaesthesia to numb my patients prior to lip enhancement. this area is incredibly sensitive, and creams or distracting vibrating tools just do not cut it. With dental anaesthesia, my patients do not feel anything at all. i believe that this gives them a comfortable experience, but also enables me to do a better job as my patient is at ease. i find that this also reduces the risk of bruising as my patient is not wincing or moving around in pain. Once you try it this way, you will never go back to a cream! What does an average procedure involve? step 1: Face to face consult, a dental examination and treatment planning discussion. We will then discuss risks and run through the treatment process, options and so on. step 2: A complete photo survey of the patient is undertaken, and measurements of the face to record proportion (or lack of). step 3: the areas to be treated are