Dentist disciplined over Botox allegations

By Chelsea Conaboy
Globe Staff / August 30, 2011

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Helaine Smith thought patients at her dentistry practices in Needham and West Roxbury would benefit if she began offering Botox treatments to smooth wrinkles and adjust smiles.

Smith, a 45-year-old Needham resident, was disciplined by the state Board of Registration in Dentistry last month on accusations of using botulinum toxin on patients, as well as for numerous more serious violations. She was the first dentist punished under a board policy enacted in January 2008 prohibiting the use of Botox by general dentists. She closed on the sale of both offices last week.

The board allows certified oral and maxillofacial surgeons, who receive training in the use of Botox and dermal fillers, to use the injections in the course of treatment for “disease, disfigurement, or disfunction.’’ But some take issue with the distinction, saying that general dentists are most qualified to administer the injections and may take continuing education courses to learn how.

“As a licensed dentist, I can do dangerous, life-threatening surgery in the oral cavity,’’ Smith said in a recent interview. “Botox is not life-threatening in any way.’’

The state began investigating Smith soon after she told The Boston Globe in March that she had been offering the service for about a year and had seen high demand.

Smith agreed in July to surrender her license for at least six months, dating from the March investigation. The agreement said she had advertised Botox services and provided them in her office. Despite signing that document, Smith contends she had never administered Botox to patients, though she planned to.

The state agreement outlines a long list of other alleged violations, including the failure by Smith to conduct weekly tests of sterilization equipment, correctly store dental instruments, provide necessary emergency medical equipment, or maintain proper records. In addition, Smith improperly prescribed controlled substances, kept inadequate records of patients receiving them, and administered sedation without a permit, the document said.

Smith said she felt bulldozed by the board, which is overseen by the Department of Public Health. She said she tried to fix the violations within days of the investigation.

But Jean Pontikas, director of the Division of Health Professions Licensure, said Smith’s violations were serious. Smith’s use of Botox was “a minor issue’’ that may have prompted only a cease and desist notice if it weren’t for the other infractions, she said.

Pontikas said the Botox was not what prompted the board’s investigation, though she could not cite the specific cause.

According to the American Dental Association, dental boards in at least 20 states, including Massachusetts, have deliberated over the issue of Botox. The group did not have a breakdown of which had approved or prohibited its use by dentists.

A spokesman for the American Academy of Cosmetic Dentistry said the group defers to state regulators on the topic, though it teaches dentists how to apply Botox during training seminars and in its journal.

Warren Roberts teaches courses at academy events and is director of the Pacific Training Institute for Facial Aesthetics in Vancouver. He said the use of Botox on the face, particularly around the mouth, should be accepted in dentistry.

“When it comes to opening, closing, and smiling, that’s dentistry, isn’t it?’’ he said.

Roberts said the decision to permit oral surgeons to administer Botox but not general dentists amounts to “a political and turf war’’ over the Botox industry.

Pontikas disagreed, saying the board regulates all dentists, including general dentists and surgeons, and the policy was meant “to safeguard the public and ensure that the practitioners had the relevant experience in this.’’ But, she said, the board is set to reevaluate that policy soon.

Smith said she is pursuing training programs required by the board for her license to be reinstated. She does not plan to practice dentistry in Massachusetts again.

Chelsea Conaboy can be reached at