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'Remote orthodontics': BDA welcomes call for evidence on risk to patients  

24 February 2020


The BDA has welcomed the General Dental Council's call for evidence on the risk presented by remote orthodontic providers, such as SmileDirectClub, and urged the regulator to engage with the growing weight of evidence emerging overseas.


Dentist leaders have raised concerns over the status of remote provision – that offer patients plastic aligners based on a 3D scan of their mouths or via an impression taken from at-home moulding kits - with health watchdogs the Care Quality Commission and GDC in summer 2019.


In a statement published today the GDC has now accepted that remote orthodontic work falls within the practice of dentistry and noted reports of remote providers offering services without face-to-face patient contact with a dental registrant, a legal requirement under the Dentists Act 1984. The regulator emphasised that for all dental interventions "this important interaction between clinician and patient should take place at the beginning of the patient consultation." It indicated its willingness to gather evidence on potential harm.


Dentists stress the risk of misdiagnosis and lack of informed consent in the absence of face to face consultations throughout the course of treatment.

A recent investigation into SmileDirectClub by leading U.S. network NBC revealed a wide range of complaints on treatment outcomes, including treatment that resulted in migraines and nerve damage. Patients were able to avoid any in person assessment with a dentist, and unhappy customers were made to sign non-disclosure agreements. Nine members of Congress have asked the U.S. Food and Drug Administration and Federal Trade Commission (FTC) to investigate whether the business is misleading customers or causing patient harm.  


Jeffrey A. Sulitzer, SmileDirectClub's chief clinical officer, now faces a formal complaint filed by the office of California's Attorney General and prepared by the state dental boards executive officer; accusing him of violating state law, defrauding state dental regulators, and acting with gross negligence toward patients, while helping SmileDirectClub grow its business. Sulitzer faces losing his license following a two-year investigation.


BDA Chair Mick Armstrong said


"The GDC's willingness to acknowledge deeply felt concerns from across this profession is welcome progress but there are still many questions left unanswered.


"We want to see patients receive high quality care, after a sound diagnosis, based on informed consent. Direct-to-consumer orthodontics appears to fly in the face of these principles.


"We understand the GDC's need to gather evidence but it should be willing to reflect on the wealth of evidence building overseas. We shouldn't have to wait until UK patients are left with irreparably damaged mouths and undiagnosed oral disease, resulting in lost teeth or worse."