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Dentistry’s regulator, the General Dental Council (GDC) made an announcement last week regarding Direct to Consumer Orthodontics.  It is a timely statement and one that is welcomed by the profession.

 

One of the problems that has arisen with Direct to Consumer Companies is that the person ordering the treatment does not have a physical assessment.  This means that hidden away pockets or holes or other seemingly acceptable problems (because the patient is unaware of their presence) are not diagnosed.  If there is a painless underlying gum problem (10% of the population are susceptible) rapidly and aggressively accelerated bone loss occurs with orthodontic treatment.  This has led to situations where patients have lost teeth.

 

There are many successes with direct to consumer treatments. If the cost of though, is avoidable irreversible problems for patients, the companies should face up to the problems.  They should do more to ensure that proper examinations are carried out. Full records should be taken with patients able to speak with someone at the start and at any point during the treatment.

 

The statement that treatments are 3 times faster than braces is very misleading.  Companies are using aligners which are a form of brace.  If one limits what is achieved, anyone can treat patients faster, so a statement of this kind misleads patients into thinking that the teeth move faster, when the reality is that the movements are more limited.  This in itself leads to a higher level of dissatisfaction.

 

Our other concern is what happens after treatment.  Patients will often believe that this is the end of the story.  Well our teeth can move throughout life. so what is put in place to ensure that the teeth are retained post treatment?  Sometimes, nothing is put in place and the teeth will, predictably relapse.  Sometimes into a different position that is less satisfactory than prior to the treatment.  Even where retainers are provided, there are different degrees of instability.  Sometimes more than just bonded retainers are necessary and anyone providing these needs to know in detail what treatment was carried out, what the start point was, to give reasonable advice.  So it is not a great idea to have some treatment carried out in one place and expect someone else to look after the retention part of the treatment elsewhere.

 

Complaining patients are often asked to sign non-disclosure statements to receive money back from some of the Direct to Consumer Companies.  This in itself does not smack of a company that has the patient’s best interests at heart.  The very act of asking someone to sign a non disclosure agreement, as a routine protocol, is to admit that you wish to hide something.  Is this an altruistic way to work?

 

I have seen comments on websites where patients have not been able to contact anyone, let alone a qualified dentist.  The problem is that some of these companies become so big that it becomes difficult for regulators to act.  Perhaps it is time for companies who do not follow guidance from the regulator to be fined large sums as a warning.  Just as utility companies are, when not delivering on their promises, this money could be used to fund good healthcare.

This is the GDC’s statement:

Direct-to-consumer orthodontics: information to support professional judgement

New forms of treatment can bring real benefits, especially when affordability and patient access are improved. But new approaches must not be allowed to compromise well-established measures, designed to ensure patient safety.

Our updated statement in relation to direct-to-consumer orthodontics includes important information for dental professionals. It is based on three main requirements.

  1. In line with current authoritative clinical guidance, and orthodontic training, clinical judgements about the suitability of a proposed course of orthodontic treatment must be based on a full assessment of the patient’s oral health. At present, there is no effective substitute for a physical, clinical examination as the foundation for that assessment. Should a dentist rely upon information from another source to inform their own clinical judgement, for example information from another dental professional about a clinical examination they have conducted, the responsibility for that judgement rests wholly with the prescribing dentist.
  2. Direct interaction between patient and practitioner – whether in person or remotely – is essential for providing patients the opportunity to ask questions, provide valid and informed consent, and be satisfied that the course of treatment proposed is likely to meet their needs and expectations.
  3. Patients must know the full name of the dental professional responsible for their treatment and be able to make direct contact with that person if they need to.

The overriding factor for dental professionals to remember however is that, as in any other setting, it is the treating dentist who is responsible for ensuring they have met all of the https://www.gdc-uk.org/information-standards-guidance/standards-and-guidance/standards-for-the-dental-teamStandards for the Dental Team. In remote models of treatment, this responsibility rests with the GDC registrant who prescribes the treatment.

 

As ever, all of the Standards are important. Here though, we highlight some which may be of particular importance in relation to some models of direct-to-consumer orthodontics. Please note that this is not an exhaustive list of the things you need to be aware of, and it remains your responsibility to ensure you adhere to all relevant standards and requirements.

 

While cost is an issue, it is rarely the issue.  Orthodontists are able to carry out limited objective treatments in a programmed way and these will often cost less than the limited objective treatments being carried out by Direct to Consumer companies.

Our National Society released this statement in response to the GDC statement:

British Orthodontic Society welcomes GDC statement on DIY Orthodontics

Today (13 May): The British Orthodontic Society (BOS) wholeheartedly welcomes the GDC statement (link) and accompanying guidance for both patients and professionals regarding direct-to-consumer orthodontic treatment.

 

BOS members have long warned of concerns about direct-to-consumer orthodontics. The most recent members’ survey from last month (April 2021) showed that 82% of members were concerned about more patients seeking DIY orthodontics during the pandemic, and 98.92% wanted to see the GDC take action.

 

In their statement today (13 May 2021) the GDC backs the long-held stance of BOS and has reiterated that:

“In line with current authoritative clinical guidance, and orthodontic training, clinical judgements about the suitability of a proposed course of orthodontic treatment must be based on a full assessment of the patient’s oral health. At present, there is no effective substitute for a physical, clinical examination as the foundation for that assessment.”

The statement went on to remind direct-to-consumer providers, dentists and others that:

“The GDC is aware of an increasing number of organisations offering services remotely, including ‘direct-to-consumer’ orthodontics using clear aligners. These services fall within the legal definition of dentistry so can only be performed by dentists and dental care professionals who are registered with the GDC. All dental professionals must adhere to the GDC’s Standards for the Dental Team. Anybody practising dentistry while not registered with the GDC could be subject to prosecution for illegal practice.”

Director of External Relations, Anjli Patel said,

“Today’s announcement is about the most fundamental element of healthcare – patient safety. We are delighted that our concerns have been heard by the GDC and acted upon. However, as the voice of orthodontics in the UK, we still have reservations about how any wrongdoing by DIY orthodontic companies could be picked up by authorities and we don’t want patients falling through regulatory cracks. Patients don’t know what they don’t know – we will endeavour to give them all the facts.”

The GDC also included information for registrants (link) to support their statement and ensure that they have met all the Standards of the Dental Team. Whether a consultation is in person or remote, responsibility rests with the GDC registrant who prescribes the treatment.

The guidance for patients (link) is particularly appreciated and we would recommend to our members and the wider dental community that these be shared widely on social media so as many patients/potential patients can consider what questions they should be asking.

The BOS first duty of care is to patients – the charity’s ultimate beneficiaries are patients, and benefits to patients are provided through the advancement of knowledge, practice and standards.

The Society advises that anyone seeking orthodontic treatment should speak to a dentist or orthodontist first.