Should General Dentists provide orthodontic treatment?
Should general dentists provide orthodontic treatment?
In this post I’m going to discuss the rather controversial area of whether general dentists should provide orthodontic treatment. I will also risk discussing Short-Term Orthodontics (STO), Six Month Smiles, Anterior Alignment Orthodontics and Fast Braces.
This issue is often raised by specialists and specialist societies. The British orthodontic Society even took out an advertisement to state its position and inform the public.
I have approached this discussion by considering the overall premise that a general dental practitioner can provide any treatment in which they are competent. This is also true of specialist, who also have varying competencies. Importantly, the decision on whether they are competent is taken by the individual practitioner.
This is also complicated by the varying aims of undergraduate programmes. There is no doubt that these vary throughout the world. In the UK ,the current guidelines suggest that the newly qualified dentist should be competent in diagnosis and assessment in order to refer their patients to a specialist. The Dental Schools do not train student dentists to be competent in providing active orthodontic treatment.
This raises a problem. If a practitioner wants to provide simple orthodontic treatment and does not want to train to become a specialist; opportunities are limited. In the UK there were training schemes, for these practitioners, but these have now discontinued, leaving a void. The “training void” can also be filled by practitioners gaining experience by attending courses to obtain competences and some of these are delivered over a length of time. But practitioners should be wary of the short course that is held over a weekend.
The counter argument, is that in order for someone to recognise that a treatment is “simple” they need to be fully competent in all aspects of orthodontics. In some ways I agree with this, however, it should also be possible for specialists to identify simple cases and provide a treatment plan for the practitioner. Again, in many countries this is standard practice.
Anterior Aesthetic Orthodontics or Short Term Orthodontics
Over the past few years I wonder if there has been an expansion of short 1-2 day courses of instruction and “accreditation” in orthodontic techniques. Some are marketed heavily as new techniques that speed up treatment and this is a selling point to the practitioners and patients.
This introduces an additional “dynamic” to the situation. As we all know, treatment is faster if the aims are simply to line the front six teeth. Indeed, this is a treatment that can be carried out for adults by correcting the “social six”, sometimes in combination with other cosmetic procedures. Examples of these treatments are posted on this Facebook site. Most of these cases are well treated, however, in my opinion, some could have been treated with extractions and more complex mechanics .
I have given this concept some thought and I feel that if this type of treatment is carried out within the practitioners competence for an informed adult then risk is minimised. Indeed, some providers review case records for practitioners and prescribe a treatment plan for them to follow. If this treatment is confined to adults there is less chance of harm.
Interestingly this provision has been expanded by other companies,for example, Fast Braces practitioners who state that this method may be used to to treat adults and children. This concerns me because the risks may be increased, particularly, if the inexperienced practitioner is completely sold on the new non-extraction treatment philosophy (which is not new at all). Importantly, in the UK this treatment is mostly provided on a private basis, but it is marketed as a “faster” alternative to conventional treatment, which is provided at no cost on the National Health Service to children. It is also provided according to the prescription and instruction of a remote practitioner or specialist. It is also heavily marketed by advocates. See this video.
This type of provision also raises the issues of who is responsible if a treatment for a child does not go well? It is clear that this is the providing dentist and not the remote instructor.
I would also point out that not all care provided by specialists is exemplary. I have made many errors in my career and not all of my treatment has worked well. However, I cannot help feeling that there is less chance of me making a mistake than an inexperienced dentist working to the prescription of a remote prescriber.
We also need to bear in mind that specialists make unsubstantiated claims on the speed and comfort of treatment, particularly with respect to self ligating systems.
Where does this leave us?
This is clearly a difficult situation and I shall attempt to summarize a few important points
- Practitioners and specialists need to work within their competencies.
- There is likely to be minimal risk from simple alignment of the anterior teeth in adults by a practitioner who is competent.
- Most importantly, practitioners (and specialists) should inform patients of their competencies, their training and experience and be honest about the various systems of delivery.
- We all need to avoid making unsubstantiated claims about the speed and comfort of our treatment.
Emeritus Professor of Orthodontics, University of Manchester, UK.