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BOTOX® in Dentistry: Innovations and Insights with Dr. Lisa Germain

Published on: Nov 5, 2023
By: Brought to you by Dr. Reza Ardalan
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by Dr. Reza Ardalan, Dental Slang Podcast

In this episode, I sit down with the esteemed Dr. Lisa Germain, a renowned board-certified endodontist from New Orleans. Together, we explore Dr. Germain's pioneering work in integrating BOTOX® into dental practice, revolutionizing both therapeutic and cosmetic treatments. Join us as we discover the multifaceted applications of BOTOX® beyond traditional medical realms. Dr. Germain unveils insights from her new book, which promises to be the go-to guide for dentists seeking to incorporate BOTOX® into their repertoire. From enhancing smiles to alleviating pain, we delve into a comprehensive exploration of how cosmetic injectables can elevate the standard of dental care.

Listen to the full podcast on DentalSlang.com, or read the recap below.

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Dr. Ardalan: Welcome to the Dental Slang Podcast. I'm your host, Dr. Reza Ardalan. Our guest today is Dr. Lisa Germain, a board-certified endodontist practicing in New Orleans, Louisiana. Dr. Germain obtained her DDS degree from the University of Maryland and completed her special degree in endodontics, along with a Master of Science, from Boston University's School of Graduate Dentistry. She is a fellow of both the Misch Implant Institute and the American Academy of Oral Implantologists, lecturing internationally on BOTOX® use for dental practitioners and endodontics. Dr. Germain serves as the clinical director for DC Dental Company, where she developed a webinar series focused on continuing education in dentistry. She is also the author of several journal articles and has been recognized as a top educator by Dentistry Today. Welcome, Dr. Lisa Germain. How are you today?

Dr. Germain: I'm doing great, Reza, absolutely wonderful.

Dr. Ardalan: I've got so many questions for you. Let's dive right in. You're a repeat guest on the Dental Slang Podcast, and your expertise spans a wide range of topics. Let's start with your work with BOTOX® and aesthetic dentistry. How did your interest in this field develop?

Dr. Germain: Well, it's not so much about aesthetic dentistry as it is about enhancing cosmetic dentistry by learning how to selectively relax muscles, which is what BOTOX® does. But even more than that, it has amazing therapeutic value in dentistry, which is truly my passion, to be perfectly honest with you. I mean, you know, as an endodontist, relieving pain is one of our primary responsibilities, number one, and actually for me, it's one of my greatest joys to relieve someone's pain. So, yeah, the book is now out, and it was a labor of love, and it took forever to write it, but my focus really was to give dentists the opportunity to understand the advantages of using BOTOX® in the dental office because, you know, it's really been kind of absconded, I want to say, by the medical profession, the dermatologists, and they say no dentists shouldn't be doing it. The book is an amazing tool for so many things like I said if you choose just the aesthetic value of it, you know, you create these beautiful teeth and the patient has all the wrinkles around their mouth, you can create a beautiful frame for them and soothe that.

The other thing is that as dentists, we have such a great relationship with our patients. They trust us. So, we have this captive audience, and it's a great way to increase your income because you are adding an extra procedure, which really is not all that complicated to be honest with you, into your practice, and it's an income stream. It's really, it's just a natural segue. And again for me, as an endodontist, it was really more about the therapeutic value, but you can't teach the therapeutic value without understanding the cosmetic implications of it.

Dr. Ardalan: Fascinating. What do you find most challenging about teaching BOTOX® and cosmetic procedures?

Dr. Germain: I believe there are several important aspects to consider. Firstly, it's crucial to effectively manage a patient's expectations. This is paramount in dentistry, as well as in any service-oriented profession. Understanding what the patient expects and then aligning those expectations with realistic outcomes is key.

For example, it's essential to convey that while I can't make someone who's 50 look 20, I can certainly help someone who's 60 look 50. Secondly, understanding your own limitations regarding dosage, dilution, and knowing when to stop is critical. The textbook not only covers dosage and dilution procedures but also includes safety zones and danger zones for each procedure discussed. These visual aids illustrate where to inject specific muscles, how much to administer, and areas to avoid to prevent adverse effects. Therefore, grasping the boundaries of botulinum neurotoxin application is the most challenging aspect.

Dr. Ardalan: Do you believe dentists can learn this type of treatment solely from books, or do hands-on courses play a crucial role?

Dr. Germain: Certainly, that's a great question. I believe that when it comes to dermal fillers, a hands-on component is absolutely essential. However, with BOTOX®, I think it's more about building comfort with facial injections, as we already administer many injections in that area. While you can learn a great deal from the book, having a mentor is invaluable. You need someone who has experienced every mistake, like myself, as detailed in the book, to guide you and troubleshoot your cases.

Moreover, as an endodontist, I find BOTOX® to be an exceptional diagnostic tool. Without access to various resources and mentors, you'll only scratch the surface of its potential. Having someone to share their experiences and offer advice on complex cases is crucial. While the book provides information, it doesn't offer the mentorship or personalized guidance that a mentor can provide.

Dr. Ardalan: Your journey from endodontics to cosmetic injectables is quite unique. How did your background in endodontics contribute to your expertise in BOTOX® and fillers?

Dr. Germain: It was really what I didn't know that drove me to it because once I ruled out toothache pathology, once it wasn't odontogenic anymore, in other words, the teeth all tested fine and the patient still had pain in their tooth, according to them, right, as the source, I thought, this is not right. And then, not only did they leave still in pain, I had no way of helping them by directing them somewhere else.

And so many patients that have TMD pain, which is one of the main focuses of Therapeutic BOTOX®, just get lost in that black hole and have pain for years. So, I began exploring it and then thought, this is not hocus pocus. I grind like I am a blue ribbon bruxer, okay? I grind like crazy. So as soon as I learned how to do it, I injected my own TMJ and I got better. I was like, oh, there's something to this.

Then I took a huge deep dive down the rabbit hole and started reading everything I could get my hands on in medical journals and just in the dental literature alone there now is a lot more, but in dental literature at the time there wasn't a whole lot. I wrote a couple of articles about how to deal with non-odontogenic pain and it just led me on a pathway that ended here. Not that it's ended, but that this was really something. I have helped so many people.

It gives me more joy than anything. This tool has been remarkable for people. I had a patient the other day that came in, said she felt like somebody was twisting a screwdriver in her ear. So, I treated her and two weeks later she said, “I haven't been this pain-free for 10 years.”

Dr. Ardalan: That's truly remarkable, and I believe that speaks to your endodontic background. It's inherent in us as dentists to alleviate pain, and this offers yet another means to achieve that goal. What's truly fantastic is having this book now, providing a data-driven roadmap for those interested.

That's truly fascinating. Speaking of books, I have to inquire about this. Now, as a pediatric dentist, my understanding is that you've also authored, and I believe illustrated, a children's book on a completely different aspect of dentistry. I would be remiss if I didn't ask about that. Could you share some insights into this book and the endeavor to create a dental-themed book tailored for kids? I find that aspect particularly intriguing.

Dr. Germain: You haven’t seen this book? I will send you a copy. The idea sprang from a Christmas poem I wrote, imagining Santa Claus with a toothache. It's been a fulfilling creative endeavor. So, I attempted to hire an illustrator, but initially, it was exorbitantly costly, and when I finally found someone affordable, their depiction of Santa Claus resembled more of a burglar than the jolly gift-giver we all know. That's when I decided to take matters into my own hands. During the COVID period, when there was a bit more flexibility, I delved into learning Photoshop and took on the task of illustrating the book myself. And you know what? I couldn't be prouder. Despite being a board-certified endodontist and all that jazz, this children's book, available on Amazon, stands out as one of my most significant achievements. It's been an incredibly enjoyable experience. It truly is a labor of love. While I'm eager to explore other book ideas, I've found myself increasingly immersed in writing, especially with the completion of the textbook. So, while I've been sidetracked from starting another book, I'm confident it will happen in the future. 

Dr. Ardalan: I've heard through the rumor mill that you're an artist. Do you have a preferred medium or style of art? And is there a reason you gravitate toward one over the other?

Dr. Germain: I love steampunk. Do you know what steampunk is? 

Dr. Ardalan: I do. I only discovered steampunk because my wife and I had to attend a steampunk party, and I had no clue what it was. Even after Googling it and consulting my younger brother for information, I was still puzzled. It seemed to blend futuristic elements with historical aesthetics, and while I managed to put together an outfit, I was more focused on it being a fun Halloween costume. 

Dr. Germain: Okay, so if I told you it's something called assemblage, assembling little pieces of things, I guess. I don't know whether it's my dentistry or my artistry that puts my brain into, "Oh, wow, that looks like an eyeball," and I'll pick up a washer or something from the ground. My kids are used to me doing this. They're looking around at the trees and the beauty or whatever, and I'm looking at the floor trying to pick up junk, right? So, I make little robots and found object sculptures basically with a steampunk edge to them. It sounds bizarre, but first of all, I love doing it. For me, it's the ability to take something old and recyclable and make something else out of it. It's the antithesis of dentistry because in dentistry, everything has to be so exact and precise. My art is my alter ego. It's the part of me that can dream and imagine and just be free to do whatever I want. People say I should sell it, but I think that might suck the fun out of it. It's a nice escape for me.

Dr. Ardalan: That's fantastic. I'm going to ask you to put on one of your other hats, one of the many hats you wear. You happen to be the clinical director for DC Dental. You’ve hosted a webinar series for a long time, nearly a decade. Can you tell us a little bit about the webinar series for our listeners who may not know about it.

Dr. Germain: Yes, we're in our 10th year now. Everything is archived on the DCDentalClinical.com, which is my spiel that I repeat every other week. I schedule them probably twice a month so that we don't overwhelm people, and it's agenda-free. That's the rule. In other words, you can talk about a product if you want to, but only if you use that product in your office and it makes a difference. Often, I'll even run a special on the product. But for me, it's more about teaching dentistry.

The audience usually ranges between 300 and 600 people in every webinar. The information is always fresh and new; we don't have the same people giving the talks. I select speakers who I believe can offer something new to the program. The main goal is to ensure the audience learns something valuable. If you can teach them at least one thing, I want you on the webinar.

I also make an effort to include speakers every year who can address team members and hygienists. For example, we have a great periodontist on the faculty, Dr. Pamela Ray, who loves teaching hygienists. We try to make the program varied and exciting, with speakers who are on the cutting edge of their fields. It's been wonderful. I've learned so much from people that, you know, I can't even tell you. As an endodontist, you kind of get stuck in your own little tunnel, and this experience has been amazing.

Dr. Ardalan: It's incredible to offer such resources for free. How can interested individuals access these webinars?

Dr. Germain: Anyone can access the archived webinars on DCDentalClinical.com. The series covers a wide range of topics and offers CE credits, making it a convenient and valuable resource for dental professionals.

Dr. Ardalan: Thank you, Dr. Germain, for sharing your expertise and insights with us today. It's been a pleasure having you on the podcast.

Dr. Germain: Thank you, Reza. It's been my pleasure. And to all the listeners, thank you for tuning in. Your support is greatly appreciated.

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To listen to the full podcast, visit DentalSlang.com

Cosmetic Injectables & Therapeutics

The ultimate guide! If you are a smile designer, you need to give the patient not just what they need, but what they want as well. This groundbreaking work by Dr. Lisa Germain and Dr. Benji Dhillon offers an in-depth exploration of minimally invasive cosmetic and therapeutic procedures tailored for dental professionals.

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