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Remote Orthodontics

Dear colleague, There is some disquiet in the profession regarding the provision of 'Remote Orthodontics', with some patients opting for at-home clear aligner treatment because they do not know that their own dentist may provide this with more supervision and better outcomes. The CQC has provided the following guidance: In recent years, several providers have started to offer orthodontic treatment remotely. This usually involves providing dental aligners, which patients can apply themselves. Over time, the aligners will move teeth to the desired new position. Dentists and orthodontists have been providing these treatments for many years, with good clinical results. However, the development of direct-to-consumer orthodontic care has been a challenge to many professional groups and regulators. The General Dental Council (GDC) has produced some guidance on direct-to-consumer orthodontics to support professional judgement. Registration requirements We consider the treatment, planning and diagnosis associated with orthodontic aligners following an intraoral scan or when a patient has taken impressions themselves to be regulated activity, regardless of how the treatment is initiated. If you are a provider of direct-to-consumer aligner treatment, you are likely to need to register for the regulated activities of: Treatment of disease, disorder or injury Diagnostic and screening procedures. This is a legal requirement under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It is an offence to carry on a regulated activity without being registered. To register with us, providers must assure us that they are able to provide safe and effective care in line with relevant legislation and guidance. When we inspect We recognise that direct-to-consumer orthodontic aligners are part of an innovative process that is happening across healthcare. The use of technology is advancing rapidly. Our role as a regulator is not to inhibit progress but to ensure that the care offered is safe and of a high quality. We expect to see the following in a service that is operating in accordance with the regulations. Providers must ensure:

  • they have an appropriate CQC registration

  • a GDC registered dentist is responsible for assessing, diagnosing, prescribing and supervising the aligner treatment

  • the responsible clinician has details of the patient’s general dental practitioner to facilitate any necessary contact

  • the premises used to initiate care are fit for purpose

  • staff are appropriately trained and qualified and only provide care in accordance with the relevant GDC scope of practice

  • patients receive full information about their treatment, including risks, benefits and alternative treatment options, with all costs explained before treatment is provided

  • any treatment that may be necessary to retain the teeth in their final position is explained before starting treatment

  • there is a record of the tooth position at the start and completion of treatment

  • treatment outcomes are audited regularly. The prescribing dentist must:

  • have adequate and sufficient information to form a treatment plan, which may include:

    • a face-to-face clinical examination

    • an accurate assessment of the patient’s current oral health to ensure that treatment will not endanger future oral health

    • an up-to-date medical and dental history

    • suitable intra oral scans

    • appropriate radiographs and photographs

  • understand that they are responsible and accountable for the orthodontic care in the absence of a physical examination of the patient and ensure they obtain informed consent

  • monitor the progress of treatment and be available to the patient if they need advice or have problems. Home impression kits

  • Home impression kits may not be accurate enough for diagnosis or for fabricating the aligners. See all issues: Dental mythbusters: listed by key question Dental mythbusters: full list

For dentists who want to offer clear aligners but who don't feel they have had adequate support or training there are other options. Some companies offer a free 4 week clear aligner training course and mentorship from UK-based specialists orthodontists on cases, as standard. Their aim is to achieve better clinical outcomes, and increase patient access to professional clear aligner treatment with their own dentist. Artificial Intelligence in Clear Aligner Treatment - read the article HERE Kind regards, Clint Foreman (Asst. Sec. Essex LDC)

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