In some areas of dentistry, professional diﬀerences of opinion tend to be accommodated with relative ease and it is accepted that there are alternative interpretations and application of the evidence base.
However, sometimes the divergence of opinion leads to significant conﬂict. Orthodontics is one area that has provoked substantial dispute within the dental profession and this is recognised internationally.
One area of conﬂict relates to the actual types of orthodontic systems and approaches oﬀered that diﬀer from traditional, comprehensive treatment. For example treatment with orthopaedic appliances, exclusively non-extraction treatment and short-term aesthetically focused systems. In this article,these systems are referred to as ‘alternative’ orthodontic treatments.
Specialists have the benefit of significant formal, structured training (usually a minimum
of five years) and this is enriched by regular contact with specialist orthodontic colleagues throughout their career.
By contrast, many dentolegal cases involving non-specialist practitioners have highlighted the limited hours of orthodontic training undertaken by some practitioners before they embark on providing treatment. This vulnerability is also often compounded by the focus of any training being limited to the use of one particular system rather than developing a full understanding of orthodontic principles.
Whilst minor problems with alignment of the teeth and malocclusion may lend themselves to simple orthodontic treatment, some alternative systems are used to try and treat more complex problems. It is important that any practitioner should be able to assess the complexity of all the presenting orthodontic problems and not embark on treatment falling outside their competency or limitations of a particular orthodontic system.
Whilst the central message of some courses is that you do not require specialist training to carry out orthodontic treatment, dental professionals place themselves and their patients at risk if they are providing treatment for which they lack sufficient training or experience.
At the heart of the concerns that ‘mainstream’ orthodontists have with some alternative
orthodontic techniques, is the sometimes weak evidence base for their use either at all, or in the certain clinical situations for which they are being advocated.
When complaints and claims in negligence (or breach of contract) arise, the treatment
provided will not only be assessed on the clinical outcome but also the whole approach
to the treatment provided including the case assessment, diagnosis and treatment plan.
In addition to the assessment and treatment planning, it is inevitable that the consent process will also come under scrutiny. Patients are entitled to receive accurate and
balanced information about available treatment options, including the option of not proceeding with treatment at all.
It is common for questions to be asked about whether a patient fully understood and accepted the limitations and risks of a particular treatment approach and if they had been in a position to consider these risks alongside those for other treatment options.
When oﬀering treatment that may be viewed by others as being ‘alternative’, it is important the patient understands this is the case and how this diﬀers from conventional treatment methods. It is therefore best practice to record details of the available options, risks and limitations in writing to the patient, with a summary of the patient consultation being carefully recorded in the dated entry within the clinical notes.
Good records are essential to enable challenges about care to be defended. It is all the more important to ensure records are comprehensive when providing alternative orthodontic treatment, bearing in mind the increased risk of a challenge from the ‘mainstream’ establishment.
Allegations relating to consent are only one part of the story. It is also necessary to be to be able to justify the treatment approach itself, and that an appropriate examination and assessment was undertaken. In addition records should demonstrate appropriate monitoring of the treatment progress and overall that treatment was provided with the necessary skill and care.
‘Alternative’ orthodontic practitioners face particular challenges, in dentolegal terms, but
there is much that they can do to strengthen their ability to withstand the kind of challenge and criticism that they might encounter during a professional career.
Engaging constructively with others in the specialty, contributing to the scientifc/evidence base, and paying particular attention to issues of consent and record keeping, is a sensible starting point.
For more on the topic of Alternative Orthodontics, please login to PRISM, our online learning platform, where you can register for the Safer Practice Series of CPD modules.