The British Dental Association has warned that newly published guidance for patients on the risks of direct-to-patient orthodontics is no substitute for meaningful regulation.
Remote provision – offering patients plastic aligners based on a 3D scan of their mouths or via an impression taken from at-home moulding kits – are growing in popularity, but 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.
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 patients with advanced gum disease that have been linked to wearing 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.
The BDA says now that these remote procedures have been rightly defined as the ‘practice of dentistry’ by the GDC, at the bare minimum their premises need to be registered and inspected by the CQC in the same manner as other healthcare providers, simply to ensure patient safety.
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.”
