Non-surgical cosmetic interventions account for around 75% of a market worth an estimated £3.6bn so it's perhaps not surprising that many dental professionals provide or are considering providing a range of non-surgical cosmetic treatments such as dermal fillers.

There have been efforts to regulate the provision of botulinum toxin and dermal fillers in recent years, including the establishment of the Joint Council for Cosmetic Practitioners (JCCP). The JCCP self-regulates the non-surgical aesthetic industry and maintains a voluntary register of practitioners. The JCCP has a memorandum of understanding with the GDC to share certain information and also publishes a code of conduct, which includes guidance on ensuring practitioners are appropriately trained and experienced to practice safely.

This piece outlines the DDU's advice about the legal and ethical implications of providing botulinum toxin, dermal fillers and similar treatments.

Ethical requirements

The GDC expects dental professionals to be trained, competent and to meet its ethical standards in any treatment they carry out. This includes obtaining appropriate consent, explaining the cost and ensuring patients are able to make a complaint. Failure to do so could invite a fitness to practise investigation.

Training and qualifications

The GDC's Scope of Practice includes 'providing non-surgical cosmetic injectables' as an additional skill that a dentist can acquire post-qualification, and it would expect a dentist to be trained and competent before they start treating patients.

It's up to you to choose an appropriate training scheme so you can make sure you've had the necessary training to meet your individual needs. Reputable training providers will set out clear anticipated learning outcomes, use suitably qualified trainers and have established systems of quality control. The JCCP has a register of approved education and training providers.

Prescribing

In its guidance on prescribing medicines, the GDC states 'you must only prescribe medicines to meet the identified dental needs of your patients'.

Botulinum toxin is a prescription-only medicine (although dermal fillers are not) and is not considered suitable for prescription under a patient group direction. As a prescriber, the dentist would generally need to make a full assessment of the patient and accept responsibility for them.

The GDC states that dentists 'must not remote prescribe (for example via telephone, email, or a website) for non-surgical cosmetic procedures such as the prescription or administration of Botox or injectable cosmetic medicinal products.'

Indemnity

As far as the DDU is concerned, we offer access to indemnity for dentists undertaking injections of botulinum toxin and FDA approved dermal fillers in the face, but not in the neck or anywhere else in the body. The DDU can arrange access to indemnity free of charge or for a supplement, depending on the income you earn from providing these techniques. Contact our membership team (0800 085 0614) for full details.

We do not provide indemnity for work undertaken outside the setting of a dental surgery, except for bona fide domiciliary visits. Dental professionals would need an alternative indemnity provider for work carried out elsewhere. We also do not offer indemnity to dental hygienists and dental therapists carrying out botulinum toxin or dermal filler procedures.

Records

To process and retain personal data either you, or the clinic or practice you are working at, must be registered with the Information Commissioner as a data controller, and you must comply with the General Data Protection Regulation and the Data Protection Act 2018. Any clinical records you make are sensitive personal data.

Marketing

When advertising or promoting a non-surgical cosmetic treatment, the same principles apply as for any dental treatment. The GDC's Standards for the Dental Team 1.3.3 states: 'You must make sure that any advertising, promotional material or other information that you produce is accurate and not misleading, and complies with the GDC's guidance on ethical advertising.'

It's important to avoid any offer or claim which could be seen as misleading. Patients also need to give consent for the use of their confidential information in marketing material, which should be both contemporaneous and specific. This includes photographs and testimonials.

All marketing material must also conform to the code published by the Committee of Advertising Practice (CAP). The Advertising Standards Authority (ASA), which enforces the Code, can demand the withdrawal of adverts.

Under the Human Medicines Regulations (2012) you're not allowed to advertise or promote a prescription-only medicine, so you can't use the word 'Botox' or the words 'botulinum toxin' in an advert or on a practice website or information leaflet. You can instead refer to 'facial cosmetic treatment' or 'anti-wrinkle treatment'.

Joint ventures

Some dentists have asked about setting up joint ventures with other healthcare professionals to provide cosmetic treatments. In principle, the GDC would not disapprove of a dentist practising alongside another registered healthcare professional, such as a nurse practitioner. We advise seeking expert legal advice and drawing up a written contract with the healthcare professional, covering specific areas of responsibility such as maintaining appropriate registration, professional indemnity, infection control procedures and data protection.

Any professional association between a dentist and a person or business who is not a healthcare professional, such as a beautician or beauty salon, might be harder to justify. The GDC would certainly disapprove of an incentive or commission being paid to any third party for referring patients to you.

Dentists who want to offer these types of cosmetic treatments should contact the membership department for more information.