The scene
A newly qualified dentist was several months into their FT1 year when they saw a patient who was extremely unhappy with his ‘wonky’ front teeth.
The patient said he’d worn a brace at school but thrown it away after being teased. But then he’d read about aligners on the practice website and was eager to give them a try.
While the FT didn’t want to disappoint the patient, they didn’t feel they knew enough about limited treatment (LT) orthodontics to make an assessment or advise them on the most suitable option. They called the DDU for advice on how to approach this.
DDU advice
The FT was right to be concerned about going beyond their competence. Trying to please the patient would carry the risk of harming them and running into problems with the GDC, which expects dental professionals to “work within [their] professional knowledge and skills” (‘Standards for the dental team’, principle 7)
Although LT orthodontics is an increasingly popular service in dental practices, it isn’t appropriate for every patient with crooked teeth and can have poor outcomes when carried out incorrectly.
The British Orthodontic Society (BOS) recognises that it may be appropriate to use LT orthodontics to address an adult patient’s cosmetic concerns, provided “this option is presented in addition to all other viable restorative and comprehensive orthodontic options and all diagnostic criteria have been assessed.”
However, it would be difficult for a newly qualified dentist to have gained enough knowledge and experience to make this assessment or obtain informed consent for LT orthodontics – which would include talking with the patient about all their treatment options, explaining the potential risk of failure and other complications, and highlighting the need to wear a retainer.
It is important to use the opportunity given during foundation training to focus on developing core skills and prepare for independent practice or further training. The dental foundation training curriculum doesn’t include the provision of orthodontic treatment, although it does include the following relevant competencies:
- diagnose, assess and treat malocclusions and refer those that require specialised advice and/or management
- recognise and manage problems related to orthodontic treatment, relieve trauma and discomfort related to orthodontic appliances and arrange emergency repairs when required
- use orthodontic indices.
In addition, NHS England’s ‘Guide for commissioning dental specialties – orthodontics’ says, “Training in Orthodontics, at both undergraduate level and during FD, is focussed on diagnosis, assessment of treatment need and appropriate referral. Contemporary teaching in Orthodontics at this level rarely includes the delivery of treatment. Consequently, post FD, dentists will not have the required competencies to provide Orthodontic care without further training.”
Another factor is that adult LT orthodontics is not usually available under the NHS. As foundation dentists are directly employed by the NHS, they would be unlikely to get permission from their employer to undertake extensive private work.
In this situation, it would be best for the FD to explain they aren’t able to advise the patient about aligners in detail and arrange for them to see a suitably qualified dentist in the practice.
What happened next
The dentist spoke to their training programme director who confirmed that it wouldn’t be appropriate for them to advise the patient about their suitability for LT orthodontics.
However, if they were interested in orthodontics, they could consider getting further training and experience by applying for core training after they’d completed their FT1 year.
When they next saw the patient, the FD explained they were not able to advise him about orthodontic treatment as they didn’t yet have the necessary experience and training.
With his agreement, the FD referred the patient to a practice colleague who had a special interest in LT orthodontics.
If you want to explore more about a career in orthodontics, see our careers consultation with Professor Tony Ireland from February 2024.
Not a DDU member?
The DDU is here for you as a student and throughout your dental career. Visit the join DDU pages to explore the benefits of membership now and beyond graduation.
This page was correct at publication on 14/05/2025. 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.
by Leo Briggs BDS, MSc Deputy head of the DDU
Leo Briggs qualified from University College Hospital, London, in 1989. He has worked extensively in the community dental service, including a brief period overseas. He has also worked in general dental practice.
Leo gained a masters degree in periodontology from the Eastman in 1995 and is on the GDC specialist register for periodontics. Since 1995, he has provided specialist periodontal treatment in both the salaried dental services and private practice. He started working for the DDU in 2005.
Between 2007 and 2009 he worked part-time at the DDU and part-time as a clinical tutor at the School for Professionals Complementary to Dentistry in Portsmouth. In 2009, Leo went full time with the DDU and became deputy head in January 2016. He continues to work clinically as a specialist periodontist in a general practice on Saturdays.