Online Orthodontics - BDA Says Guidance For Patients Is “No Substitute For Meaningful Regulation”
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- Published: Friday, 14 May 2021 06:06
- Written by Chris Tapper
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The General Dental Council’s long-awaited statement on the much-criticised direct-to-consumer orthodontics industry, has had a mixed reception from two leading professional organisations.
The GDC said on its website that because these direct-to-consumer (DTC) orthodontic services fall within the legal definition of dentistry, they can only be performed by dentists and dental care professionals who are registered with the GDC.
Most of the ‘online’ clear-aligner companies offer customers either ‘do-it-yourself’ impression kits or offer in-store digital scans, rather than full and comprehensive clinical examinations by dentists or orthodontists.
While video conferencing is offered by many companies during treatment, there is no physical face-to-face initial examination by appropriate GDC registrants. Many companies operate from overseas, chiefly in the United States.
The GDC acknowledged the growth in the numbers of organisations providing DTC clear aligners.
The regulator’s statement said “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 GDC warned that “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.”
“The Standards for the Dental Team apply to all dental professionals in all treatment settings, including interactions provided on a remote platform.”
GDPUK recently saw one firm publish a review from a satisfied customer which referred to a ‘dental nurse.’
One of the main criticisms of the DTC orthodontic industry in the UK is that patients may not know who their supervising dentist is, or their registration status.
Since most of the DTC orthodontic companies don’t carry out full clinical examinations, the GDC said that any prescribing dentist who relies on information supplied by another dentist regarding a clinical examination, bears full responsibility for their clinical judgement in using that information.
The GDC said the treating dentist must make and keep a full patient record, including the reasons for any decision to deviate from established practice and guidance.
It said “As in any other setting, it is the responsibility of the treating dentist to ensure that they communicate directly and effectively with their patients, explain the treatment options available, and obtain valid consent both at the outset and throughout any course of treatment.”
“Patients must know the full name of the dental professional responsible for their treatment and be able to make direct contact with that person.’
The regulator said that dental professionals who don’t comply with the Standards for the Dental Team guidance and indemnity requirements put their registration at risk.
While the British Orthodontic Society broadly welcomed the GDC’s statement, which addressed patient safety, Director of External Relations Anjli Patel said, “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 most recent BOS members’ survey from April 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.
The British Dental Association was more critical of the GDC’s statement saying on the BDA News website that “Newly published guidance for patients on the risks of direct-to-patient orthodontics is no substitute for meaningful regulation.”
The BDA said DTC orthodontics “Can lead to fundamental changes to a patient’s mouth that may be irreversible. The BDA has raised concerns directly with regulators – the Care Quality Commission and General Dental Council – about this practice since 2019.”
“The new patient guidelines from the GDC acknowledge vital principles long advocated by the BDA that orthodontic patients need to be fully assessed by a dentist, that direct dentist-to-patient interaction – the basis for informed consent - is essential, and that patients must know the name and registration number of the dentist responsible for their care.”
“However, the guidance does not offer any clarity on what sanctions the GDC might utilise and how the regulator backs up its assumption that such models of care are "safe for many people.”
“Dentists have stressed the risk of misdiagnosis and lack of informed consent in the absence of face-to-face consultations throughout the course of treatment.”
“The BDA has seen cases of patients with advanced gum disease that have been provided with these retainers, potentially leading to tooth loss.”
“Last year an investigation into a leading provider by U.S. network NBC revealed a wide range of complaints on treatment outcomes, including migraines and nerve damage. Patients were not required to have any in-person assessment with a dentist, and unhappy customers were made to sign non-disclosure agreements.”
BDA Chair Eddie Crouch said "Guidelines are one thing, but what’s really needed are rules and regulation to protect patients.
"Regulators have recognised that with braces a sound diagnosis based on informed consent is key. They can offer warnings, but they cannot escape the fact the direct-to-patient model is incompatible with many of the basic principles underpinning decent care.
"Until we see proper safeguards dentists will be left picking up the pieces when patients have undergone wholly inappropriate treatment.”
The Oral Health Foundation also welcomed the GDC’s statement. A press release from the OHF said the “Charity believes that this announcement solidifies the critical role a trained dental professional plays in orthodontic treatment and underscores the importance of a physical face-to-face examination.”
Dr Nigel Carter OBE, Chief Executive of the Oral Health Foundation, hopes this clear stance from the GDC will send a warning sign to anyone thinking of trying DIY orthodontics.
Dr Carter said “When it comes to orthodontic treatment the input of a trained dental professional is key if both the patients’ expectations are to be met and also to ensure safety.
“Innovation in orthodontic treatments is always welcome however it must not come at the expense of patient safety or effectiveness. What this statement from the GDC emphasises is the role professional orthodontists play in providing safe and effective treatment. It also underscores the need for a physical examination in order to be able to effectively assess a patient.”
The Oral Health Foundation has long been aware of the need for patients to be able to make informed and safe decisions when it comes to orthodontic treatment. That is why the charity set up SafeBrace in partnership with the British Orthodontic Society. The campaign aims to offer the public independent and impartial information and advice about all things orthodontics. This includes the processes involved and how to get orthodontic treatment in a safe and effective manner.
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