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Remote orthodontics: We need regulation not warnings

Blog Author Eddie Crouch

Blog Date 20/05/2021

Why the new guidelines on remote orthodontics are no substitute for meaningful regulation when it comes to protecting patients.


Sky News segment highlighting safety concerns arising from people buying aligners online without seeing a dentist


It’s been a long time coming, but the General Dental Council has finally published patient guidelinesand information for professionals on remote orthodontics.


Unfortunately, the new guidelines still fall short of the protection we need to ensure patient safety.


Here’s what you need to know:


Protecting patients during a ‘Zoom Boom’

“Given these aligners can lead to fundamental changes to a patient’s mouth... we’ve not let up on the need to see proper protections in place.”

More than half of UK orthodontists are now reporting a larger than anticipated jump in demand for treatment. And a large portion of that demand is being met by remote orthodontic providers. It’s nigh on impossible to escape the ads on social media, promising perfection with a quick 3D scan or via an impression taken from an at-home impression kit.


Given these aligners can lead to fundamental changes to a patient’s mouth that may be irreversible we’ve not let up on the need to see proper protections in place. For years we have made the case to both the GDC and CQC.


At the very least the vital principles we’ve advocated for have finally been acknowledged in the new guidelines, including:


  1. orthodontic patients need to be fully assessed by a dentist
  2. direct dentist-to-patient interaction – the basis for informed consent - is essential
  3. patients must know the name and registration number of the dentist responsible for their care

It’s progress – but it’s not enough. It’s crucial that we have proper safeguards for patients.


Regulation not warnings

We all know that the target market for remote ortho are not likely to venture over to the GDC website after getting the hard sell on Instagram.


The reality is warning patients on the risks of direct-to-patient orthodontics is no substitute for meaningful regulation.


What this guidance lacks is any clarity on the sanctions the GDC might utilise. How will the regulator back up its assumption that such models of care are "safe for many people”?


I have seen for myself the online treatment plans created for patients with advanced gum disease who should never have been provided with these retainers, given the risk of tooth loss. Cases who clearly have had previous treatment with no radiographs to confirm if root shortening had occurred. Post treatment computer simulated outcomes demonstrate straight teeth - but it’s an occlusion that has no chance of being a long term stable result.


The risks are real, and so is the need for action.


The GDC has rightly defined these procedures as the ‘practice of dentistry’. At the bare minimum that means their premises need to be registered and inspected by the CQC (and its equivalents in the other UK countries). Equally all ads and websites also should be in line with GDC advertising guidance.


Picking up the pieces 

Last year an investigation into a leading provider by US network NBCrevealed a wide range of complaints on remote treatment outcomes, including migraines and nerve damage.


It’s a familiar picture: no face to face contact with a dentist, and unhappy customers forced into signing non-disclosure agreements.


Remote ortho isn’t going to go away, but neither is the need to ensure patient safety.


The GDC has recognised that with orthodontic treatment a sound diagnosis based on informed consent is key. The challenge now is to deliver a direct-to-patient model that is actually compatible with the basic principles underpinning decent care.


Proper safeguards remain essential. Until we see them in place dentists will be left picking up the pieces when patients have undergone wholly inappropriate treatment.


Eddie Crouch 

Eddie Crouch

BDA Chair


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