Your Legal Guide to Adding Medical Aesthetics to a Dental Practice

With exponential growth in the medical spa industry, many dentists are looking into offering medical aesthetic services in their dental practices. This makes sense. Dentists are experts in facial anatomy and have an established base of trusting patients. Not only can aesthetic services drive revenue, but many treatments feel like a natural extension of a dental practice. 

All it takes is a quick Google search and you’ll find a multitude of training programs to help train dentists to become injectors for dental facial aesthetics. Business consultants and financial advisors share that medical aesthetics are a good way to boost revenue in a dental practice.

While the internet makes this process seem simple, the law involved is less straightforward.

Dentists hoping to roll out aesthetic procedures, either through injecting or other medical aesthetic procedures, may find themselves contending with the complex gray areas of medical aesthetic law. This is particularly true when it comes to scope of practice and ownership. These laws vary widely from state to state and licensure type, making it difficult for dentists to navigate a few central questions, which we answer in this article, including:

• Can a dentist inject neurotoxins and fillers?

• What medical aesthetic procedures can a dentist supervise or delegate? 

• Can a dentist own a medical spa? And if so, how?

  
  

Of course, the answer to these questions is one all-too-commonly used by lawyers: it depends. Below are the legal considerations to help you navigate the wild world of medical aesthetics in your dental practice. 

Can a dentist inject neurotoxins and fillers? 

Before we answer the question, an important note: While this article discusses adding “medical aesthetics” to a dental practice, some dental regulations may refer to injectable procedures as “facial aesthetic services” because dentists cannot practice medicine.

Now, back to the question at hand. As a general rule (and remember - this is not legal advice), yes, a dentist can usually inject neurotoxins (like Botox) and fillers, to an extent. Many dentists already do so as a part of dental treatment plans. However, the scope, training requirements, conditions, and limitations can vary from state to state. 

Most state dental boards and dental practice acts allow dentists to inject neurotoxins and fillers if it’s for dental-related or facial therapeutic and cosmetic purposes, especially in the head and neck region, which is considered within their scope of training. However, some states require specific training or certifications for dentists to inject for “cosmetic” purposes (like forehead lines). 

Training

Because it can be argued that many toxins and fillers have both aesthetic and therapeutic use, it is typically possible for dentists to offer these treatments with the proper training. Even the American Dental Association (ADA) offers training courses for dentists like this one: Botulinum Toxin (Botox) Injectable Therapy for Every Dental Practice. American Academy of Facial Esthetics (AAFE) offers many courses and resources for dentists wanting to perform aesthetic treatments. 

State-by-State Differences

Because state regulators vary in how they approach injecting for dentists, it’s extremely important to understand the laws where you live. In Texas, for example, dentists can administer Botox and fillers for dental and facial therapeutic or aesthetic purposes, as long as they’re properly trained. But in California it is permitted only when used in conjunction with a dental treatment plan (e.g. - bruxism, TMJ, or gummy smile).

If you’re a dentist hoping to add these services, check your state regulations, attain proper training, and reach out to legal counsel if you have questions about compliance. 

What aesthetic procedures can a dentist supervise or delegate? 

Now, if a dentist wants to move beyond injectable services, what other services might they add to their practice? This is where we have to consider a dentist’s scope of practice and what is considered a medical procedure. 

We’ve heard of numerous instances of dentists purchasing cosmetic lasers and training dental team members (e.g. - hygienists and dental assistants) to use them within the dental practice. Unfortunately, this is not legally compliant in most states. That’s because “shooting” these types of aesthetic devices are not typically within a dentist’s scope of practice, either to perform or to supervise, as they are considered the practice of medicine. 

Again, this can vary from state to state, but in nearly all cases, a dentist will need to hire a third-party Medical Director to oversee the clinical aspects and medical providers. The credentials of the Medical Director vary, but generally the individual will have to be a physician, nurse practitioner with independent practice authority, or in some instances, a physician assistant.

Medical services would need to be offered not through the dental practice, but in a medical practice or medspa. That takes us into the question of ownership and the MSO (Management Services Organization) model. 

Can a dentist own a medical spa? 

The answer, as usual, is that it depends. Mostly, it depends on the dentists' state CPOM laws.

States will fall into one of two buckets. In a non-Corporate Practice of Medicine (CPOM) state, virtually anyone can own a medical aesthetics practice. There is no requirement that an individual be a licensed clinician of any kind to own the entity. The owner, of course, must employ the proper clinicians to perform procedures, but they are free to own the business itself. As such, a dentist could certainly own a medical spa in these jurisdictions.

In states that subscribe to the CPOM doctrine, medical spa ownership is mostly limited to a select few licensure types; namely physicians, nurse practitioners (in the 28 independent practice states), and occasionally, a physician assistant. In these states, the best pathway to medspa ownership for a dentist is through an MSO. 

What is a Management Services Organization?

In the world of medical aesthetics, the emergence of the Management Service Organization (MSO) model as a means of compliance with CPOM is the bridge some groups use to legally function, much the same way DSOs first arrived on the scene in dentistry. While an unlicensed (or under-licensed) individual may not be able to own a clinical entity (think: the medical facility that is injecting or shooting lasers), they can own a management company that supports the operation and receives a fee in exchange. 

Under the MSO model, a dentist would need to partner with a physician, NP, or PA so that the latter clinician can own the clinical entity. In a select few states - such as California - dentists may take a minority ownership stake in the medspa, as long as a physician maintains at least 51% control.

What pathway is right for you? 

Despite the legal complexity, there are many reasons dentists are interested in adding medical aesthetic services to their practices. Medspa services are catapulting in popularity, driving revenue and volume into dental practices.  As you can deduce from this article, though, how you bring them into your practice will be dependent upon where you live. It will be paramount to have clarity on how your state’s dental board regulates medical aesthetic procedures, as well as your state’s application of the CPOM doctrine.

Add Medical Aesthetic Services to Your Dental Practice with Marti Law Group

Our team can help you navigate regulations in your state; whether you need to establish an MSO, hire a Medical Director, or navigate rules for administering aesthetic treatment. Reach out to us to get started.