By Dan Schulte, J.D.
MDA Legal Counsel
From the April 2008 issue of the Journal
Question: I frequently receive advertisements urging me to purchase texts and other training materials on the "art and science of lip and perioral augmentation." These procedures are advertised as profitable opportunities to increase my practice income. How can it be legal for a dentist to practice lip augmentation? Is this procedure within the scope of dental practice?
Answer: No, it is not. It is been explained in this column many times that in Michigan dentists enjoy a broad scope of practice. This scope of practice is defined in Section 16601 of Michigan’s Public Health Code as "The diagnosis, treatment, prescription, or operation for a disease, pain, deformity, deficiency, injury, or physical condition of the human tooth, teeth, alveolar process, gums or jaws, or their dependent tissues, or any offer, undertaking, attempt to do, or holding oneself out as being able to do any of these acts."
The Public Health Code allows the Michigan Board of Dentistry to issue specialty certifications in prosthodontics, endodontics, oral and maxillofacial surgery, orthodontics, pediatric dentistry, periodontics, or oral pathology. However, whether possessing a specialty certification or not, all Michigan-licensed dentists are authorized to provide any of these specialty or general dentistry services.
The dental scope of practice, while broad, does have limits. The disease, pain, deformity, etc., being treated must affect one or more teeth, the alveolar process, the gums, jaws or a dependent tissue of the teeth, alveolar process, gums or jaws. The lips are not teeth, the alveolar process, gums or jaws. This much is clear. Could the lips be considered a "dependent tissue" of the teeth, alveolar process, gums or jaws? Unfortunately, dependent tissue does not appear to be a medically defined term. Relying on an ordinary dictionary definition of "dependent," the lips cannot be said to be dependent tissue of the teeth, alveolar process, gums or jaws. This definition of dependent would require the teeth, alveolar process, gums or jaws to be hanging from the lips, influenced, controlled in some way by the lips or otherwise relying on the lips for support. This simply is not the case. Therefore, lip augmentation through the use of Botox injections or in other ways cannot be within the permitted scope of the practice of dentistry in Michigan.
In addition to being guilty of practicing outside the scope of dental practice, engaging in the practice of administering Botox injections would violate the combined Michigan Dental Association and American Dental Association codes of ethics. Section 2 generally requires member dentists to know their own limitations, and when appropriate to make referrals to specialists or health care professionals. It should go without saying that this rule requires member dentists to refrain from performing procedures on patients that are not within the legal scope of dental practice, especially when such procedures would arguably be considered within the scope of practice of another health profession — for instance, medicine).
Section 5.E. prevents member dentists from misrepresenting their training and competence in away that would be false or misleading in any material respect. Section 5.F. prohibits member dentists from otherwise advertising or soliciting patients in any form of communication that is false or misleading in any material respect. Certainly, making an announcement or otherwise advertising that you provide a service that you cannot legally provide (e.g., administering Botox injections for lip augmentation) would violate these ethical rules. Therefore, announcing, advertising and/or performing such procedures could put in jeopardy your membership in good standing with the Michigan Dental Association and American Dental Association.