Why Dentists Should Learn to Do Botox


James Tharp, DDS

What do you say to your patient when he comes in with a recently placed crown that has a broken cusp. It is packing food between the upper molars and is missing brand-new porcelain?  He just paid over a grand for that crown. Not to mention having to waste his time at your office when he could have been out playing golf with his buddies. By the way, it was his crown till it broke. Then it became “that damn dentist’s crown.”

 Or even worse how about the patient that now has a two piece implant.  Half of it still in the bone. He hands you the other half in a napkin from McDonalds.  He just paid five grand for that implant and wants his money back. You know that money that your wife just spent on her new Louis Vuitton purse.  It took you months and multiple appointments to get the beautiful results that you now hold in your hand. 

 Or how about the patient that comes in and you look in his mouth and see that he has many chipped and broken teeth.  There are lots of flat wear spots everywhere. He says “I have dental insurance that pays 100% for everything and I want them fixed right.”  You do your full diagnostic work up. Mounted study models, diagnostic wax-up, full mouth radiographs, diagnostic intraoral photographs and even a cone beam CT. You practice your case presentation. You are sure he is going to spend the cost of a luxury car on his smile.  When you tell him the cost of a full mouth rehabilitation, (which you know he really needs, and besides that you don’t have enough money to make payroll this week.) He looks at you “like a deer in the headlights” or like you have a third eye in the middle of your forehead.  He says, “Can’t you just patch me up.” Or “Let me think about it.” What he’s really thinking about is how fast he can get out of your office.

 Or how about the TMJ patient that is having significant pain. Even though she swears that she is wearing her night guard.  You know that she has been because it is covered with flat wear marks and you can see light through the holes in it. She paid a lot of money for that nightguard.  She may have had her bite perfectly equilibrated and is still having headaches and jaw joint pain. She is definitely grinding and clenching. However, like Dr. Peter Dawson says it may be because “she hates her mother.”

 Or how about the patient that has been coming to you faithfully for years, with good cleanings and checkups, not a hint of plaque on her teeth. You know she flosses three times a day, because you can see the cut marks in the gingiva where the floss has been.  But now she has developed deep pocketing on teeth that are subject to lateral forces from grinding. After you told her she may lose some teeth she is now thinking about calling her lawyer. He will call it “failure to diagnose” and plan his next Mexican vacation to Cabo San Lucas.  Paid for by your malpractice insurance. Plan on paying double the premium next year.

 All of these problems are caused by clenching or grinding. 

 In the Bible, there are multiple references to “gnashing of teeth.” This problem has been around for a while.

 What can you do to solve this problem?  Plastic night guards either wear out or are not worn or are taken out in the middle of the night.  Equilibration helps but often does not stop the grinding. Jaw joint surgery is expensive, invasive and often doesn’t solve the pain.   Muscle relaxants like 2 mg of Valium help, but not always. You can try TENS, light therapy, psychotherapy and a few other things. None of these are 100% effective. 

 Guess what, we now have a treatment that works!

 You squirt 20 to 25 units of Botox into each masseter every three months for a year and your patients will have weaker masseter muscles. 

 But wait, isn’t Botox expensive and hard to sell?  Yes and no. Your cost for 50 units and supplies is about $350. (January 2017) Multiplying that by four times a year is $1400. 

 After three or four times the muscles have gotten smaller and may not need more.  If your sales skills are good you can just sell it for a reasonable profit.

 What’s your cost to do an implant over?  What’s the cost to your reputation when she tells her story to all her friends on Facebook?  Negative or positive. ( Positive, if you did the right thing.)

 Build the cost into your big cases.  Sell it for small cases. Your headache patients sell themselves because it works. 

 Bottom line, find a good course online.  Get well trained. Do Botox for your relatives and friends at cost, till you feel confident.  

 Your patients will love you. You will sleep better. You might even make more money.

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