European Backing For Fight Against DIY Orthodontics
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- Published: Wednesday, 03 November 2021 07:41
- Written by Chris Tapper
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The fight against unsafe remote orthodontic treatment has had a massive boost, with Europe-wide support from dental organisations joining together to declare ‘DIY Orthodontics is hazardous for patients.’
The British Orthodontic Society (BOS) has joined professional dental and orthodontic societies, associations, and institutions from 25 countries to endorse and fully support a Joint Declaration regarding the unacceptable and potentially unsafe remote treatment of malocclusions.
The British Orthodontic Society has been at the forefront in bringing the dangers of ‘direct-to-consumer’ orthodontics (DTC) to the attention of the public and dental profession in the UK.
In September, BOS and the Oral Health Foundation (OHF) announced a new joint campaign Safe Smiles, to highlight the benefits of safe dentistry and treatment when carried out in dental practices by trained and registered professionals.
The campaign was a response to mounting concerns about the rapid growth of direct-to-consumer (DTC) orthodontics in the UK.
One of the major concerns of dentists and orthodontists is that companies offering direct braces don’t carry out full clinical examinations of patients in order to check that the teeth and periodontium can withstand orthodontic treatment.
BOS has long been involved in bringing the issue of the dangers of DTC orthodontics to the attention of the General Dental Council.
It was only in May of this year that the GDC issued a statement on its position with regard to DTC orthodontic services.
The GDC said “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.”
The GDC statement went on to say, “At present, there is no effective substitute for a physical, clinical examination as the foundation for that assessment.”
The GDC’s statement ended “Those who do not comply with the Standards for the Dental Team, indemnity requirements and authoritative clinical guidance put patient safety, and their registration, at risk.”
The GDC’s stated position fell well short of hopes, according to the British Dental Association and dental commentators.
The BDA said “Newly published guidance for patients on the risks of direct-to-patient orthodontics is no substitute for meaningful regulation.”
DTC orthodontics “Can lead to fundamental changes to a patient’s mouth that may be irreversible,” the BDA said.
But in July, the Care Quality Commission published on its website, the CQC’s "Registration requirements for providers of ‘direct-to-consumer’ orthodontic treatment"
The CQC said “We consider orthodontic treatments provided to patients following an intra oral scan or when a patient has taken impressions themselves to be regulated activity."
“This is in the same way that treatment planning and diagnosis associated with aligners is also regulated activity.”
The CQC said ‘Where a service is carrying on what the law describes as a regulated activity, that provider has to register with the CQC.”
“Providers cannot legally carry out regulated activities without registering with us. It is an offence under Section 10 of the Health and Social Care Act to provide regulated activities without being registered with CQC. We can use our regulatory powers to prosecute such offences.”
This new Declaration by the European Federation of Orthodontic Specialists Associations (EFOSA) clearly states the basic requirements that must be met for any orthodontic treatment.
A spokesperson for BOS said “Dentists and Orthodontists all over Europe are witnessing the increasing activities of start-up companies promoting and selling orthodontic treatment using aligners by post with great concern.”
“This type of remote treatment is provided without either proper initial diagnosis or any form of regular clinical monitoring. These companies often present their services as affordable, fast, and safe, although they clearly do not meet required professional dental standards.”
“Orthodontic treatment without proper initial diagnosis and regular clinical monitoring can cause severe risks to patients’ health.”
Professor Christian Scherer, who coordinated the project for EFOSA said “The unanimity shown by European orthodontists on this subject makes it clear that orthodontics is more than just aligning the front teeth. It is about a holistic approach to care where the patient’s best interests are at the heart of our treatments.”
“Every patient should make sure that the basic requirements formulated in the Joint Declaration are also observed in his or her treatment so that their treatment is practised safely.”
Dr Anjli Patel, Director of External Relations for the British Orthodontic Society added, “Orthodontic treatment without thorough clinical face-to-face examination of the patient, x-ray imaging and regular clinical monitoring, is potentially hazardous to the patient’s health.”
“Any self-administered and remote treatment cannot be justified from a professional medical perspective and thus represents a serious violation of ethical, medical and dental standards.”
The EFOSA declaration read “On the remote treatment of malocclusions Various companies offer self- and remote treatment of malocclusions without direct contact between patient and a regular dentist by means of tele-media by transmitting image or video files.”
“Treatment planning is based on impressions taken by the patient themselves, followed by consecutive manufacturing and deployment of treatment devices - particularly aligners- to the patient via mail. Treatment progress monitoring happens entirely without patient contact.”
“In this respect we declare:
1. Any treatment of malocclusions represents a medical intervention in the stomatognathic system and should therefore be exclusively performed by a fully qualified dentist.”
2. Any treatment of a malocclusion must be preceded by a thorough clinical examination of the patient. Moreover, imaging findings must be evaluated for adequate treatment planning in order to identify contraindications or special risks.
3. Any treatment of malocclusion requires regular clinical monitoring. It is essential to assess the treatment progress, but also to detect possible complications such as undesirable tooth movement or other intraoral pathologies at an early stage.
4. Patient self-treatment and exclusive patient remote treatment must therefore be rejected as potentially hazardous to the patient’s health. Exclusive self- and remote treatment cannot be justified from a professional dental perspective. Exclusive self- and remote treatment represents a serious violation of the dental standard.”
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