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FAQs – Treatments

Can you advertise Botox to the Public?

No.

Botox is a prescription-only medicine (POM) and as such, cannot be advertised to the public (rule 12.12) (Venus Beauty Lounge, 5 August 2015 and MyCityDeal Ltd, 14 March 2012).

In traditional non-broadcast media, such as leaflets, press ads, brochures, posters and even on sponsored ads, the ASA considers almost every reference to Botox and other Botulinum toxin products as promoting a POM and therefore a clear breach of rule 12.12.

The BACDP are referring to “Botox” instead of “muscle relaxing treatments” on this website when quoting from the GDC.

Can a Dentist use their dental insurance to cover non surgical treatments?

Yes.

The DDU offers access to indemnity for it’s Dentist members, upon application, for cosmetic procedures (botulinum toxin and FDA approved dermal fillers in the face but not the neck or other parts of the body) at no additional subscription when earnings from this work do not exceed £7999 per annum.

If earnings from this work is £8,000 or more a subscription supplement is chargeable.

Can a Dentist Prescribe Remotely for another Dental Professional?

No.

Remote prescribing (for example via telephone, email, skype, website etc) for treatments such as muscle relaxing injections and other prescription non-surgical cosmetic procedures is NOT permitted.

A face to face consultation with the patient must be conducted in order to assess a patient’s suitability and medical fitness for facial aesthetic procedures and a prescription made.

Does a Dentist have to be trained in the administration of Botulinum Toxin to prescribe or carry out Botox?

Yes

As a Dental Hygienist/Therapist can I adminster muscle relaxing injections through direct access?

The administration of muscle relaxing injections is not the practice of dentistry and so it does not appear in a Dental Hygienist/Therapists scope of practice.  As muscle relaxing injections involve prescription only medicines, patients must be seen by either a registered doctor or dentist for an initial face to face consultation to assess their suitability and treatment and medical status.  However, once this prescription has been obtained a Dental Hygienist/Therapist may then administer the muscle relaxing injection provided they are fully trained, indemnified and competent to do so.

The Doctor or Dentist is responsible for the prescription and the Dental Hygienist/Therapist is responsible for the treatment.  Both prescriber and practitioner need to work together in the patient’s best interest.

As a Dental Hygienist/Therapist can I administer dermal fillers through direct access?

Yes.

Injectable dermal fillers are classed as medical devices and so do not require a prescription.  Dental Hygienists/Therapists who wish to provide injectable dermal fillers to a patient must be fully trained, competent and indemnified to do so.

Do I need to work in a specialist clinic or can I provide facial aesthetics at home?

In order to practice safely and in line with current guidelines, the BACDP would advise dental professionals working in non-surgical aesthetics to work in premises registered with either the CQC, Save Face or your Local health authority where possible.

Do I need specialist indemnity insurance to offer non-surgical facial aesthetics?

Yes.

It is highly unlikely that your dental indemnity will cover any non-surgical aesthetic procedures.  Cosmetic Insure is an insurance company we as an association highly recommend for their professionalism and support and their understanding of the training undertaken by dental professionals.

I live in Scotland. Do the same regulations and legislation apply?

To regulate and improve the healthcare in Scotland in independent healthcare clinics, from the 1st April 2017 only premises registered with the Healthcare Improvement Scotland (HIS) can offer treatments such as toxin and dermal fillers. From April 2017 it will be an offence to offer these treatments in an unregulated environment and practitioners can be prosecuted.  HIS will inspect independent clinics including those providing non-surgical cosmetic treatments to ensure the industry performs to a high standard that continually improves.  If you are currently operating a service and intend to operate it past 31st March 2017, then you need to be registered by 31st March 2017.

For more information visit www.healthcareimprovementscotland.org

In the event of an emergency can a Dental Hygienist/Therapist administer emergency drugs?

Whatever the treatment you are providing it is important to follow your training in the event of a medical emergency.  In Dentistry dental professionals must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council (UK).  The guidance by the Resuscitation Council is that clinical settings staffed by Dentists, Dental Hygienists and Therapists are to have an emergency drugs kit.

​Some drugs in an emergency kit are prescription-only medicines (POM), controlled drugs or pharmacy medicines and are therefore subject to restrictions imposed by medicines legislation.  A Dentist may purchase any of these emergency medicines whereas a DCP may not. A dental hygeinist or therapist may administer a controlled drug if there is a presciption by a Dentist or a patient group directive.

Medical legislation exempts certain parenteral (intravenous or intramuscular) POMs from the requirements if used in an emergency to save a life.  These medicines do not require a prescription and may be administered by anyone.

Following the medicines on the dental emergency drugs list:

* Glyceryl trinitrate (GTN) spray (400mcg/dose) – pharmacy medicine

* Salbutamol inhaler (100mcg/actuation) non-parenteral – POM

* Adrenaline injection(1:1000, 1mg/ml) parenteral – POM allowed for use in an emergency

* Aspirin dispersible (300mg) – pharmacy medicine

* Glucagon injection 1mg parenteral – POM allowed for use in an emergency

* Oral glucose solution/tablets/gel/powder – not classed as a medicine

* Midazolam 10mg (buccal) – controlled drug

* Oxygen – not a POM

Midazolam is the only drug above requiring a PGD.

​However the GDC believes when it comes to a medical emergency you should act in the best interest of your patient, therefore if they needed a drug to save their life you would be acting in their best interest to administer it.

​For more information on the guidelines for medical emergencies go to www.resus.org.uk

Can a Dental Hygienist/Therapist administer Local Anaesthesia for Non-surgical treatments?

Local anaesthetic is a prescription-only medicine (POM) which means under the Medicines ct 1968 it can only be prescribed by a suitably qualified prescriber i.e. usually a doctor or dentist.  However, it can be administered by both dental hygienists and dental therapists either under a written patient-specific prescription or under a Patient Group Directive (PGD).

How much will my indemnity insurance cost?

Indemnity insurance may vary considerably depending on the provider and the type of treatments you will be offering.  It is important you are very clear on what your insurance will and won’t cover you within your policy before deciding who to go with.  Any reputable insurance company will ask to see your qualifications and training certificates prior to issuing you with a policy and should be easily contactable for any queries you may have.

Where can I purchase products for non-surgical facial aesthetics?

There are many pharmacies that sell a wide range of products and the pharmaceutical industry can be very confusing.  A suggested starting point is to talk to your training company with regards to products and suppliers they recommend.   Whilst suppliers can be competitive it is important to not make cost your primary consideration.  Product suitability to each individual patient and procedure are essentials considerations when choosing products.

Wigmore Pharmace-London, Church Pharmacy, and Dental Directory are all reputable suppliers and work with dental professionals.

Can you advertise Botox to the Public?

No.

Botox is a prescription-only medicine (POM) and as such, cannot be advertised to the public (rule 12.12) (Venus Beauty Lounge, 5 August 2015 and MyCityDeal Ltd, 14 March 2012).

In traditional non-broadcast media, such as leaflets, press ads, brochures, posters and even on sponsored ads, the ASA considers almost every reference to Botox and other Botulinum toxin products as promoting a POM and therefore a clear breach of rule 12.12.

The BACDP are referring to “Botox” instead of “muscle relaxing treatments” on this website when quoting from the GDC.

Can a Dentist use their dental insurance to cover non surgical treatments?

Yes.

The DDU offers access to indemnity for it’s Dentist members, upon application, for cosmetic procedures (botulinum toxin and FDA approved dermal fillers in the face but not the neck or other parts of the body) at no additional subscription when earnings from this work do not exceed £7999 per annum.

If earnings from this work is £8,000 or more a subscription supplement is chargeable.

Can a Dentist Prescribe Remotely for another Dental Professional?

No.

Remote prescribing (for example via telephone, email, skype, website etc) for treatments such as muscle relaxing injections and other prescription non-surgical cosmetic procedures is NOT permitted.

A face to face consultation with the patient must be conducted in order to assess a patient’s suitability and medical fitness for facial aesthetic procedures and a prescription made.

Does a Dentist have to be trained in the administration of Botulinum Toxin to prescribe or carry out Botox?

Yes

As a Dental Hygienist/Therapist can I administer muscle relaxing injections through direct access?

The administration of muscle relaxing injections is not the practice of dentistry and so it does not appear in a Dental Hygienist/Therapists scope of practice.  As muscle relaxing injections involve prescription only medicines, patients must be seen by either a registered doctor or dentist for an initial face to face consultation to assess their suitability and treatment and medical status.  However, once this prescription has been obtained a Dental Hygienist/Therapist may then administer the muscle relaxing injection provided they are fully trained, indemnified and competent to do so.

The Doctor or Dentist is responsible for the prescription and the Dental Hygienist/Therapist is responsible for the treatment.  Both prescriber and practitioner need to work together in the patient’s best interest.

As a Dental Hygienist/Therapist can I administer dermal fillers through direct access?

Yes.

Injectable dermal fillers are classed as medical devices and so do not require a prescription.  Dental Hygienists/Therapists who wish to provide injectable dermal fillers to a patient must be fully trained, competent and indemnified to do so.

Do I need to work in a specialist clinic or can I provide facial aesthetics at home?

In order to practice safely and in line with current guidelines, dental professionals working in non-surgical aesthetics must work at premises registered with either the CQC, Save Face or your Local health authority.

Do I need specialist indemnity insurance to offer non-surgical facial aesthetics?

Yes.

It is highly unlikely that your dental indemnity will cover any non-surgical aesthetic procedures.  Cosmetic Insure is an insurance company we as an association highly recommend for their professionalism and support and their understanding of the training undertaken by dental professionals.

I live in Scotland. Do the same regulations and legislation apply?

To regulate and improve the healthcare in Scotland in independent healthcare clinics, from the 1st April 2017 only premises registered with the Healthcare Improvement Scotland (HIS) can offer treatments such as toxin and dermal fillers. From April 2017 it will be an offence to offer these treatments in an unregulated environment and practitioners can be prosecuted.  HIS will inspect independent clinics including those providing non-surgical cosmetic treatments to ensure the industry performs to a high standard that continually improves.  If you are currently operating a service and intend to operate it past 31st March 2017, then you need to be registered by 31st March 2017.

For more information visit www.healthcareimprovementscotland.org

In the event of an emergency can a Dental Hygienist/Therapist administer emergency drugs?

Whatever the treatment you are providing it is important to follow your training in the event of a medical emergency.  In Dentistry dental professionals must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council (UK).  The guidance by the Resuscitation Council is that clinical settings staffed by Dentists, Dental Hygienists and Therapists are to have an emergency drugs kit.

​Some drugs in an emergency kit are prescription-only medicines (POM), controlled drugs or pharmacy medicines and are therefore subject to restrictions imposed by medicines legislation.  A Dentist may purchase any of these emergency medicines whereas a DCP may not. A dental hygeinist or therapist may administer a controlled drug if there is a presciption by a Dentist or a patient group directive.

Medical legislation exempts certain parenteral (intravenous or intramuscular) POMs from the requirements if used in an emergency to save a life.  These medicines do not require a prescription and may be administered by anyone.

Following the medicines on the dental emergency drugs list:

* Glyceryl trinitrate (GTN) spray (400mcg/dose) – pharmacy medicine

* Salbutamol inhaler (100mcg/actuation) non-parenteral – POM

* Adrenaline injection(1:1000, 1mg/ml) parenteral – POM allowed for use in an emergency

* Aspirin dispersible (300mg) – pharmacy medicine

* Glucagon injection 1mg parenteral – POM allowed for use in an emergency

* Oral glucose solution/tablets/gel/powder – not classed as a medicine

* Midazolam 10mg (buccal) – controlled drug

* Oxygen – not a POM

Midazolam is the only drug above requiring a PGD.

​However the GDC believes when it comes to a medical emergency you should act in the best interest of your patient, therefore if they needed a drug to save their life you would be acting in their best interest to administer it.

​For more information on the guidelines for medical emergencies go to www.resus.org.uk

Can a Dental Hygienist/Therapist administer Local Anaesthesia for Non-surgical treatments?

Local anaesthetic is a prescription-only medicine (POM) which means under the Medicines ct 1968 it can only be prescribed by a suitably qualified prescriber i.e. usually a doctor or dentist.  However, it can be administered by both dental hygienists and dental therapists either under a written patient-specific prescription or under a Patient Group Directive (PGD).

How much will my indemnity insurance cost?

Indemnity insurance may vary considerably depending on the provider and the type of treatments you will be offering.  It is important you are very clear on what your insurance will and won’t cover you within your policy before deciding who to go with.  Any reputable insurance company will ask to see your qualifications and training certificates prior to issuing you with a policy and should be easily contactable for any queries you may have.

Where can I purchase products for non-surgical facial aesthetics?

There are many pharmacies that sell a wide range of products and the pharmaceutical industry can be very confusing.  A suggested starting point is to talk to your training company with regards to products and suppliers they recommend.   Whilst suppliers can be competitive it is important to not make cost your primary consideration.  Product suitability to each individual patient and procedure are essentials considerations when choosing products.

Wigmore Pharmace-London, Church Pharmacy, and Dental Directory are all reputable suppliers and work with dental professionals.

FAQs – Training

What qualifications do I need to apply for the MATA postgraduate qualification level in Injectable Therapies?

Safe and competent injectable practice requires a certain level of prior medical and anatomical knowledge, so you need to show you have studied to at least undergraduate degree level (level 6) in medicine, dentistry, nursing or pharmacy.

I qualified as a dental hygienist/therapist (DHT) with a Higher Diploma, can I still attend the MATA postgraduate level qualification in injectable therapies?

We will be happy to look at your existing qualification and map it to our entry requirements and recommendations of the Joint Council of Cosmetic Practitioners (JCCP) to identify any ‘bridging’ studies you might need to enter our postgraduate programme.

I am new to aesthetic practice. What is the best way to get started in injectable therapies?

MATA would never pressure you into signing up for a qualification that might not suit you. We recommend you join us for two days of hands-on clinical practice to see if you have the right aptitude and skills for aesthetic interventions. You can assess patients and learn how to administer safe appropriate facial rejuvenation treatments – all under the guidance of our expert clinical tutors.

I can’t take much time away from work. Can I fit the MATA postgraduate level qualification around my work and home life?

Absolutely you can.  The educational experts at MATA know that people have different learning styles and preferences. That is why our ‘blended learning’ approach works so well – you can access the knowledge modules via our University standard learning platform and then attend the clinical skills sessions at a time and place to fit your working life!

How long will it take to complete the MATA postgraduate level qualification?

The time from enrolment to certification depends upon your own circumstances. MATA’s fantastic blended learning programme lets you study at your pace – some learners like to take small chunks of knowledge at a time, others complete it in one go. Typically most learners are taking around 4 – 6 months to complete the knowledge, practical and assessment elements. But remember, it isn’t the speed of the qualification that matters; it’s the content, quality and learning experience that counts! The qualification is a postgraduate certificate, meaning it has a total qualification time of between 120 and 369 hours.

What will I study and practice in the MATA postgraduate level qualification?

The content of the MATA postgraduate programme has been mapped to the recommendations of the JCCP so you will cover: skin A&P, anatomy for injectable therapies, patient consultation and assessment, pharmacology & toxicology of toxins and dermal fillers, safe injectable practice and preventing and managing complications. The content is delivered through blended learning, a mix of self directed study and time with expert tutors where you will be assessing and treating our volunteer patients.

To gain the qualification you need to pass the written exams, OSCEs, observed procedures and complete a Clinical Log Book. MATA give you all the guidance and support you need when preparing for the exams and assessments.

Is it true that I won’t be able to offer injectable therapies unless I have a postgraduate level qualification?

No, this isn’t true. The Joint Council of Cosmetic Practitioners (JCCP) are developing the competencies and clinical practice standards they would like all cosmetic practitioners to adopt, which includes foundation, undergraduate and postgraduate level qualifications.  But it’s not a legal requirement. It is important to speak with your insurance underwriters if you want to deliver cosmetic interventions as they may have particular requirements you need to meet.

What if I am already delivering injectables, do I have to take the MATA foundation or advanced courses before I apply for the postgraduate level qualification?

No, you can apply directly for the qualification but MATA will talk to you about your current practice to check you’re ready for the qualification and if you can use your previous training and experience as recognised or accredited prior learning/experience. You’d then be invited to complete an application form for APL/APEL.

What’s the difference between an MSc. in aesthetic therapies and a level 7 postgraduate qualification?

An MSc. degree is a Master of Science degree, and can only be awarded by a University. There are many different Master’s degree programmes as Universities have the authority to set the title and content of their curriculum, as long as it meets the standards set by the Quality Assurance Agency for Higher Education (QAA). MSc. programmes tend to be more ‘academic’, giving a very in-depth and comprehensive knowledge base and can be taken as full-time, part-time or online programmes.  The MATA qualifications in injectable therapies and cosmetic interventions offer learners a more flexible and blended mix of academic and clinical skills whilst still adhering to high academic standards of learning and assessment.

What does ‘level 7’ mean?

In academic terms, the ‘level’ of a qualification indicates its ‘difficulty’ and complexity of the knowledge and skills associated with the learning – it is a marker of intellectual demand, depth of learning and learner autonomy. In England there are 8 levels – the higher the level, the more difficult the qualification is. For example; ‘A’ levels are level 3, a higher national certificate is level 4, a DipHE is level 5, a degree is level 6, a postgraduate qualification is level 7 and a doctorate (PhD) is level 8.

The Health Education England framework, now owned by the JCCP. used ‘levels’ to describe the element of risk associated with cosmetic procedures rather than true academic, educational levels. However, it is now widely accepted that practitioners are expected to evidence study at the educational levels set by JCCP, e.g. injectable therapies, level 6 and level 7.

What’s the difference between an award, certificate and diploma?

The regulated qualifications framework (RQF) provides a simple system for cataloguing regulated qualifications. It’s like a bookcase in a library, with qualifications indexed by their ‘level’ and ‘size’. Qualifications can be written at different ‘levels’, but require similar amounts of study and assessment time. Equally, qualifications at the same level can take different amounts of study and assessment time. Small qualifications are not necessarily less valuable, they’re just smaller.

There are 3 common sizes of qualification on the RQF, Award, Certificate and Diploma, as described by the total qualification time (TQT) which is the average time (hours) a learner might typically take to achieve and demonstrate the competence required for the qualification.

Award = 10 – 120 TQT

Certificate = 121 – 369 TQT

Diploma = >370 TQT

So you can see that you would learn more about a subject in a Certificate than you would in an Award, and that a course of just a few days duration is not going to equate to a diploma!

I’ve heard there’s only one real level 7 qualification. Is this true?

The JCCP has not yet endorsed or approved any Awarding Body or education or training provider, even though you might have seen claims to the contrary. The JCCP have advised that education and training providers should aspire to deliver courses and qualifications that meet the JCCP and CPSA standards and MATA are confident they meet these standards. Its programmes are recognised as qualifications, but will additionally be added to the Ofqual register, meaning they can be referred to as ‘regulated’ qualifications.

I’ve done a weekend course but don’t feel confident to work independently yet. Can you help with mentoring or clinical support?

It’s not usual for MATA to hear this as many other weekend or foundation courses just don’t give the time and practice you need to become confident and competent. We have experts that can support and guide you – either with the knowledge or clinical skills. Plus MATA has a whole range of other learning events that will help you establish your clinic – everything from developing your brand through to clinical photography.  Most importantly you need to be confident you can prevent and manage complications that can arise from injectable therapies, which is why MATA training includes guidance, links and consensus documents on its learning platform.

If I am not a prescriber, what should I do about having hyaluronidase available in the event of a filler adverse event?

It is not sufficient to ask your dentist or prescriber to keep hyaluronidase in clinic if you don’t how to administer it correctly in an emergency. So you need to contact your insurance underwriter as to what they expect of you with regard to training in the administration of hyaluronidase.  There is a consensus document written by the Aesthetic Complication Expert (ACE) Group that you can access via: http://acegroup.online/wp-content/uploads/2016/01/ACE-Group-Hyaluronidase-v1.2.pdf.  It is likely that the work of the JCCP and Clinical Practice Standards Authority (CPSA) might impact on this situation, so keep yourself up-to-date.

What the are ‘JCCP registers’ that everyone is talking about, and do I have to join it?

The remit of the JCCP is to develop and implement credible training frameworks and competencies for all practitioners that deliver non-surgical cosmetic interventions. This would be achieved by creating two registers, one for practitioners and another for ‘JCCP approved’ training providers. The registers will be open to public scrutiny and are intended to be in place by 2018 but the detail of what experience/training/qualifications you need to join the practitioner register and the clinical standards you need to meet are still being discussed. However, the JCCP recognises that the registers will be voluntary and therefore not a legal requirement, but they expect the insurance underwriters to support them, which might mean practitioners who don’t join the register finding it harder to get insurance to practice.

There are so many training companies out there – how do I know which ones are good?

When choosing a training provider it’s important to look carefully at the programme to ensure it meets the standards that are expected of training providers, for example:

• does the programme of study have a published specification that sets out the entry requirements, learning content, including aims, objectives, teaching and assessment strategies, learning hours, total qualification time (TQT)?

• does it state the size of the programme? (size of a qualification is indicated by the terms; award, certificate and diploma)?

• does it actually meet the RQF definition of academic level? (level of a programme is outcome-focused and indicates the difficulty and complexity of the knowledge and skills associated with the learning – it is a marker of intellectual demand, depth of learning and learner autonomy), and does it assess you against that level

• is the programme a qualification, accredited courses or endorsed programme of learning? The JCCP have not

• is it theory only or competence based training?

• what is the delivery format, face to face teaching, e-learning or blended learning (a combination of the two)?

• does the programme allow learners to treat patients, if so, what is the learner:tutor ratio, how many patients will you treat? what products and techniques will you use?

• who are the tutors or clinicians, educators delivering or assessing the programme and are they appropriately skilled or qualified to do so?

MATA will be happy to answer all of these questions will full and open answers – plus any other questions you might have. We are not about quick-fix training but want our learners to become ‘agents of change’, putting your professional and personal development at the heart of your practice to ensure you deliver safe and appropriate patient-centered care.

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