Remote orthodontic treatment

Advising patients about direct-to-consumer orthodontics

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, the time involved, and cost.

With increased demand in a competitive market, patients are able to shop around for the treatment they would like within their budget. Recently there has been a 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.

Increasingly dental professionals are 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

Fortunately, there are some useful sources of information for patients considering this sort of treatment. Safe Smiles is a joint initiative between the British Orthodontic Society (BOS) and the Oral Health Foundation. The BOS president, Jonathan Sandler stated, "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 are approached for advice by a patient who is considering orthodontic treatment with one of the direct-to-consumer providers, it is important to be aware that you are responsible for any opinion provided.

If the patient wishes 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 that any proposed orthodontic treatment they embark on is suitable for their individual circumstances and that any underlying oral health problems are considered in detail. Ensure you 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 11/01/2022. 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.

Eric Easson

by Eric Easson

Eric qualified in 2001 at Manchester University, gained the dip.MFGDP in 2006 and a Masters in Medical Law (LLM) with merit in 2015. He worked as a clinical teaching fellow at Manchester University from 2004-2020, and has worked in general practice since qualification.

He started to work for the DDU as a part-time dento-legal adviser in 2014, and is a current member of the Faculty of Forensic and Legal medicine [MFFLM], Faculty of Dental Surgery [MFDS] and College of General Dentistry [MCGDent].