There are some dentists across North America who can now do more than keep your pearly whites their brightest and your gums in the pink.

Some dentists have now added another service to both their CV's and their repertoire: the ability to inject Botox, Restylane, Juvederm and other fillers anywhere in a patient's face.

It used to be that only a medical doctor (like a board-certified dermatologist) could take care of your crow's feet or laugh lines with a shot of Botox, but within the last five years, dentists in British Columbia and Alberta (and in several states south of the border) have been given the OK to administer the popular treatments for both therapeutic and cosmetic uses. (In provinces that don't yet allow dentists to inject Botox or fillers for cosmetic purposes, dentists can have doctors or nurses in their clinics to do the administering.)

Dentists administer Botox for health and cosmetic reasons

"Dentists have been using Botox for quite a few years but not for cosmetic reasons," says Dr. Sol Weiss, DDS, a cosmetic dentist in Toronto. "We use it to reduce muscle soreness, fatigue and headaches that are caused by grinding." Cosmetic dentists also use Botox to help treat temporo-mandibular joint disorder (TMJ) and migraines associated with jaw pain.

"Patients like coming to me for Botox because I'm a familiar face," says Richmond, B.C.-based dentist Dr. Michele Nielsen, DDS, who is trained and certified in Botox by The Pacific Training Institute for Facial Aesthetics in Vancouver. On top of her regular duties as a dentist, Dr. Nielsen softens and treats frown lines, crow's feet, forehead and smoker's wrinkles, and eyebrow lifts. The benefits of Botox are "a decrease in wrinkles and a younger, smoother, more relaxed look. Botox at an earlier age before deep static wrinkles set in can help prevent these lines from occurring. It also improves facial symmetry," she says.

"Patients know dentists are highly trained and educated in the muscles, nerves and anatomy of the head and neck. We also give injections every day and focus on being gentle and as pain-free as we are with all of our other work."

Botox for your smile

Dentists say Botox can also fix smiles — one of their major areas of expertise. "Another more recent use of Botox in the dental office is for gummy smiles," says Dr. Weiss. "Injecting Botox below and at the corner of the nostrils, we can prevent the hyperactive movement of the upper lip," he says, which causes gummy smiles. "Since cosmetic dentists are very aware of how muscles, lips, teeth and wrinkles affect smiles, we should know how to make changes to improve any aspect of it." Adds Dr. Nielsen, "Fillers can be used to improve lip shape and create a beautiful smile since your lips are what frame your smile."

Who do you choose?

Though a trendy option for patients (and one that's gaining in popularity as more and more dentists are petitioning their provincial governing boards for permission to start using fillers cosmetically), the issue is definitely a contentious one among the many dermatologists who aren't on board with dentists honing in on their territory. "Dentists use it to make money. It's a pity if patients don't get a good result with Botox because they didn't have someone properly trained administering it," says Dr. Alastair Carruthers, MA, BM, BCh, FRCPC, FRCP(Lon), a Vancouver-based cosmetic dermatologist and professor of dermatology who, with his wife Dr. Jean Carruthers, pioneered the cosmetic use for Botox in the 1980s.

"There's no reason why dentists should not inject around the mouth; that's where there expertise is. They should establish themselves as experts in Botox for TMJ and bruxism. But these shouldn't be the same people who use it cosmetically," he says. "The joy of Botox is that it's an easy procedure that doesn't have any long-term consequences. The same can't be said for fillers; permanent fillers can cause permanent damage when people who are less competent are administering."

As more and more provinces follow British Columbia and Alberta's leads, people who are considering a little lip-plumping or line-filling will have a decision to make as to whether or not they have procedures done by their trusted dentist who they see on a regular basis or a dermatologist who deals in Botox.