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The increasing popularity of orthodontic treatments

​Like many areas of practice, orthodontic treatments are a popular specialism requiring knowledge and time to perfect clinical skills.

Clare Lawrence smiles at the camera
Clare Lawrence Dento-Legal Advisor

Many GDPs provide orthodontic treatment, which is an increasingly popular option for adults. Patients using social media are aware of available options and prefer unnoticeable treatment such as lingual appliances, clear aligners, and ceramic brackets. However, this can be more challenging to treat.

Greater patient awareness often gained from online reading, results in higher expectations so when approached by a patient about the possibility of undertaking orthodontic treatment, practitioners must always carry out a detailed case assessment to consider whether this is a reasonable option.

Crucial competence for invasive orthodontic treatments

Extractions or interproximal stripping (IPR) may be required to create space; however, invasive, or irreversible treatment requires knowledge and skill. It is important that you are capable, have the necessary training and are competent. In aligner cases where IPR is required, GDPs are heavily reliant on the laboratory in respect of design and outcome and may not have the expertise necessary to consider or provide alternatives.

You must always work within your competencies and capabilities, using your knowledge, skills and clinical judgement when providing treatment.

To undertake treatment, you must perform an in-depth analysis of the patient’s history, especially when previous orthodontics have been undertaken and have a full understanding of what the patient is hoping to achieve. Clinical judgement is required to formulate a treatment plan, based on reasonable options. Minimal knowledge or experience in alternative options or techniques can result in clinical bias or over recommendation of a specific aligner system. During the assessment process you must be able to recognise whether you have complete knowledge of all the options available and, in case you do not, must point patients towards a specialist that can provide further information.

By not being able to explain the full range of risks, consequences, and limitations of each option, you run the risk of challenging the consent process. Dentists will be held liable in cases where something does not go according to plan. You must always work within your competencies and capabilities, using your knowledge, skills and clinical judgement when providing treatment. Otherwise, you may find yourself answerable to claimant solicitors and the GDC and, legally, overly relying on the aligner provider’s prescription or recommendation will hold limited weight.

All dentists must be able to recognise when a treatment is not performing as expected, sometimes because of lack of compliance, change in circumstance, or high patient expectations. It is vital for practitioners to know when to stop and reassess the treatment.

Explaining orthodontic treatments

It is essential to go through the consent process in full and clearly record the options available, and the risks and benefits of each for the specific patient. Without being fully informed, full and valid consent cannot be obtained from a patient for a procedure. Each option should include costs, timescales, and a final treatment plan. You might find it helpful to consider the possible risks associated with each treatment option and explain them to the patient as potential risks which can occur before treatment, during treatment, and post-treatment.

Before treatment, you must obtain valid consent by considering the suitability of the treatment, the option and value of a specialist referral to achieve better outcomes, and by explaining all reasonable options alongside their costs and timeline. Many issues can be avoided by providing clear information to patients at the outset. Consent is an ongoing process, and it is vital to identify the patients’ expectations, how to achieve them without setting unrealistic expectations on timelines and what additional costs there might be. For example, patients often say they were unaware of the need for retention post treatment and how long it will be necessary for.

During treatment, you must check that any procedures have been performed properly, if the costs are what they set out to be and if you are working toward the results as agreed and expected. Lastly, during the post treatment stage, you need to record the outcome and provide appropriate retention based on what was discussed at the outset. The risks associated with each stage must be thoroughly explained which will allow patients to make a fully informed decision.

Clear aligner techniques and short-term orthodontics are increasingly being used by clinicians with all levels of experience and non-specialists. Minimal training is required and, due to the potential limitations, there is a significant risk that the outcome will not meet expectations. If you have any questions our advice team is available to support members on an extensive range of issues. Extra and Expert members can access tailored one-to-one advice by calling our advice team on 020 7563 4572 or emailing [email protected].