Remote orthodontic treatment

Aesthetic dental treatments have seen enormous growth in recent years, and orthodontic treatment is commonly included in treatment plans or provided as a stand-alone treatment. A large variety of systems have been developed to cater for patients' needs in terms of the treatment itself, as well as the time and cost involved.

With increased demand in a competitive market, patients are able to shop around for the treatment they would like within their budget. There has also been a recent rise in direct-to-consumer orthodontic treatment being offered by companies, to cater for patients wanting orthodontic treatment at a reduced cost and without having to attend regular appointments.

Dental professionals are increasingly being asked for their opinion by patients thinking of using such services. Colleagues are being asked to confirm patients' teeth are suitable for the treatment plan being offered, often by completing forms provided by the company due to provide treatment. This raises dento-legal issues for the dental professionals concerned.

Legal and ethical requirements

The General Dental Council (GDC) issued specific advice on this issue in early 2020. Its update on providing dental care remotely explains that orthodontic work falls within the practice of dentistry (as defined by the Dentists Act 1984). The requirements of the Act include that dental professionals:

• should be registered with the GDC - anyone practising dentistry while not registered with the GDC could be subject to prosecution
• should provide only treatment falling within their Scope of Practice
• should adhere to the GDC's Standards for the Dental Team.

After gathering evidence on this issue and discovering that some direct-to-consumer orthodontic treatment may not include face to face patient contact with a dental professional, the GDC updated its statement on direct-to-consumer orthodontic treatment.

The GDC's view is that, "the suitability of a proposed course of orthodontic treatment must be based on a full assessment of the patient's oral health. At present, there is no effective substitute for a physical, clinical examination as the foundation for that assessment."

Information for patients

The British Orthodontic Society strongly advises the public not to undertake such treatments. It advises in a statement: "If you are considering braces please seek the advice of your dentist first..."

Safe Smiles is a joint initiative between the British Orthodontic Society (BOS) and the Oral Health Foundation. The BOS president, Jonathan Sandler, says, "For me, one of the issues with 'DIY braces' is that it offers just one narrow solution when there may be a more appropriate one for the patient. The value of informed choice cannot be over-estimated."

The GDC has also published advice for patients on the things to consider with aligners or braces sent direct to their home.

Advising patients

If you're approached for advice by a patient considering orthodontic treatment with one of the direct-to-consumer providers, it's important to be aware that you are responsible for any opinion provided.

If the patient wants you to confirm their suitability for the treatment being offered by the provider, it may be advisable not to comment on the specific treatment offered. You can, however, discuss with them the general options for orthodontic treatment with a qualified clinician.

It would also be sensible to explain the benefit of making sure any proposed orthodontic treatment the patient embarks on is suitable for their individual circumstances, and that any underlying oral health problems are considered in detail. Be sure to make a note of the advice provided in the records.

Contact our dento-legal experts for specific advice if you face a dilemma like this.

This page was correct at publication on 20/01/2023. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.