The British Orthodontic Society has issued a statement in response to the post from Kevin O’Brien and I’m including it here so you can read about the concerns being expressed by Orthodontists on behalf of patients. You should read Kevin’s blog post first. 

British Orthodontic Societies Response (BOS) to Kevin O’Briens blog, by Peter J McCallum, Director of External Relations.

BOS welcome the invitation from Kevin to comment on his blog. The Society are very concerned about this new development ‘direct-to-consumer’ or “DIY” orthodontics. The Mission Statement of BOS is:

The Society strives to promote the study and practice of orthodontics, to maintain and improve professional standards in orthodontics and to encourage research and education in orthodontics. In doing so, BOS seeks to improve the quality of medical care for the benefit of patients. The charity’s ultimate beneficiaries are therefore patients, and benefits to patients are provided through the advancement of knowledge, practice and standards in the specialty.

We do not have any legislative powers to prevent the illegal practice of dentistry or orthodontics.

As Kevin has indicated, there is a difference between the two models he has commented upon. BOS have also made detailed enquiries about both of these models.

Invisalign Connect appear to be ‘pop ups’ which provide information to the general public about the Invisalign product. Our understanding is that they do not engage in any clinical activity or examine the patient’s mouth. They do have representatives who discuss the method and provision of treatment and provide details of a few local Invisalign providers who are registered with the GDC. The orthodontist, or dentist, to whom the patient attends is then responsible for their clinical assessment to determine their suitability for orthodontic treatment. This, of course, includes dental fitness, appropriateness for treatment, their understanding of treatment options together with the potential outcome and informed consent. Ultimately, the provider of treatment has contact with the prospective patient and is responsible for their care.

This model is based on direct contact with patients and engages in a similar way to Invisalign’s website. The website has a “doctor locator” which is a map of Invisalign trained orthodontists in the UK. It is a form of marketing which may sit uncomfortably with some, but as far as we understand is not the illegal practice of dentistry.

The second model involves care being provided remotely. The main players in this area organisations such as Smile Direct Club, Franksmile, Straight Teeth Direct, Straight My Teeth, Your Smile Direct, Smile Kit, Happy Brace have a different modus operandi. Our understanding is similar to the way Kevin describes. We understand that here a dentist will be making decisions and prescribing treatment for each patient remotely. No assessment of dental health appears to have been undertaken and therefore in our view, is impossible for that remote dentist, to know whether the patient has any underlying health issues including periodontal disease, caries or other oral health problems. BOS are not aware of how informed consent can properly be obtained or how the prescribing dentist is able to determine whether treatment is appropriate. Based on the information we hold about how these businesses work, our concern is that patients’ health may be put at risk.

Two models exist to obtain patient records with this type of direct-to-consumer orthodontics. The first is where patients take their own impressions. This would appear to circumvent the rules on impression taking which govern the illegal practice of dentistry. The second is where the patient attends a store to have a scan undertaken. Our view is that unless a qualified dentist is present and prescribes that scan, the person carrying out the scan is undertaking the illegal practice of dentistry.

Experience from the USA

According to recent media reports, “The American Dental Association and American Association of Orthodontists have asked the Food and Drug Administration, which regulates aligners, to sanction SmileDirect for treating prescription medical devices like an over-the-counter product. The FDA hasn’t taken action.” Bloomberg Aug 22, 2019. Several States are taking action to prevent scanning without a dentist present

BOS are very concerned about the development and increase in the provision of direct-to-consumer orthodontics. We cannot legislate against this practice. The fundamental issue is the protection of the public. BOS’s view is that unless a registered dentist examines the patient and discusses all the issues involved with the provision of orthodontic treatment, the safety of the public is at risk. We are currently preparing and will be embarking on an educational campaign with the Oral Health Foundation to inform the public about the risks of direct-to-consumer orthodontics.

BOS cannot bring legislation against this practice as we are a charity and not the regulator of the dental profession. We implore the dental regulator, the General Dental Council, whose “primary purpose is to protect patient safety and maintain public confidence in dental services”, to investigate the practice of direct-to-consumer orthodontics as a matter of great urgency.