Bruxism and lips: botulinum toxin and hyaluronic acid have their place in dentistry – but only there. This page shows what dentists in Germany are permitted to do, where case law draws the line, and which courses lay the necessary foundation.
| Treatment | Context | Basis |
|---|---|---|
| Botulinum toxin for bruxism | Can be part of dental therapy. Use outside the marketing authorisation (off-label); not settled by the higher courts. | German Dental Association (Bundeszahnärztekammer), commentary on the model professional code of conduct 2024 |
| Lip augmentation with hyaluronic acid | In the view of the German Dental Association (Bundeszahnärztekammer), covered by dentistry. Not decided by the court in 2013. | German Dental Association (Bundeszahnärztekammer) 2024 |
| Wrinkle treatment in the face (forehead, glabella, nasolabial fold, perioral wrinkles) | Not permitted – neither with botulinum toxin nor with fillers. | Higher Administrative Court of North Rhine-Westphalia (Oberverwaltungsgericht Nordrhein-Westfalen) 2013 and 2017; Federal Administrative Court (Bundesverwaltungsgericht) 2014 |
| With an additional Heilpraktiker (non-medical practitioner) licence | Fillers possible outside the oral region, botulinum toxin not; the activities must be recognisably separate for patients. | Higher Administrative Court of North Rhine-Westphalia (Oberverwaltungsgericht Nordrhein-Westfalen); model professional code of conduct, section 9(4) |
| With a licence to practise medicine (e.g. oral and maxillofacial surgery) | No restriction to the oral region – the professional law governing physicians applies. | Higher Administrative Court of North Rhine-Westphalia (Oberverwaltungsgericht Nordrhein-Westfalen) |
As of: 10 October 2026. Overview with no claim to completeness, not legal advice. Your Chamber of Dentists (Zahnärztekammer) will provide binding information.
Under section 1(3) of the German Dentistry Act (Zahnheilkundegesetz), dentistry comprises the diagnosis and treatment of diseases of the teeth, mouth and jaw. From this, the Higher Administrative Court of North Rhine-Westphalia (Oberverwaltungsgericht Nordrhein-Westfalen) concluded in 2013 that dentists may not inject wrinkles outside the region of the teeth, the mouth including the lips, and the jaw. Botulinum toxin in the facial area and the treatment of perioral wrinkles and of the nasolabial folds were expressly rejected. In 2017, the court upheld the revocation of a dentist's licence to practise following repeated convictions.
Within this limit there are recognised areas of use. The German Dental Association (Bundeszahnärztekammer) names the injection of botulinum toxin for the treatment of bruxism as a possible part of dental therapy and considers lip augmentation to be covered by dentistry. Because botulinum toxin is not authorised for bruxism, the rules on off-label use apply – with correspondingly careful patient information and documentation.
You can find the complete overview for physicians, dentists and Heilpraktiker (non-medical practitioners), with all file numbers, in our guide Who may inject Botox and hyaluronic acid?.
Botulinum toxin (Botox) basic course – active substance, preparations, dosage, risks
Go to course →Online courseFacial anatomy – basic course: muscles, vessels and nerves
Go to course →Online courseLips & perioral indications – hyaluronic acid fillers
Go to course →Online courseComplication management in aesthetic medicine
To the course →GuideWho may inject Botox and hyaluronic acid? The legal situation with all file numbers
Read →OverviewBotox course for doctors: all building blocks
View →The online courses teach the mechanism of action, preparations, anatomy and the handling of complications – knowledge that applies irrespective of the area of use. MEDEMIE's hands-on workshops predominantly cover aesthetic indications in the face; we will gladly clarify with you in advance whether a date is suitable for your work as a dentist.
Only within the scope of dentistry, that is, in the region of the teeth, mouth and jaw. According to the German Dental Association (Bundeszahnärztekammer), the treatment of bruxism can be part of dental therapy. Under the case law of the Higher Administrative Court of North Rhine-Westphalia (Oberverwaltungsgericht Nordrhein-Westfalen), dentists are not permitted to perform wrinkle treatments in the face.
No. This is use outside the marketing authorisation (off-label). It requires particularly careful patient information and documentation and has not yet been decided by the higher courts.
The German Dental Association (Bundeszahnärztekammer) considers lip augmentation to be covered by dentistry. The Higher Administrative Court of North Rhine-Westphalia (Oberverwaltungsgericht Nordrhein-Westfalen) did not decide on this in 2013; it expressly excluded perioral wrinkles and nasolabial folds.
It can make filler treatments outside the oral region possible, but not the use of botulinum toxin. The two activities must be separated in substance, space and organisation, and this must be recognisable to patients.
The online courses teach fundamentals that also apply to dental use. The hands-on workshops centre on aesthetic indications in the face; please contact us before registering so that we can clarify whether the date fits your field of work.
Would you like a course specifically for dental use, for example on botulinum toxin for bruxism? Put your name down – if there is sufficient interest, we will inform you about a suitable offer. Without obligation and without a newsletter.
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