The British Orthodontic Society is delighted to join a Europe wide consensus that sees 31 professional dental and orthodontic societies, associations, and institutions from 25 countries come together to endorse and fully support a Joint Declaration regarding the unacceptable and potentially unsafe remote treatment of malocclusions. This Declaration by EFOSA (European Federation of Orthodontic Specialists Associations) clearly states the basic requirements that must be met for any orthodontic treatment.

Dentists and Orthodontists all over Europe are witnessing the increasing activities of start-up companies promoting and selling orthodontic treatment using aligners by post with great concern. This type of remote treatment is provided without either proper initial diagnosis or any form of regular clinical monitoring. These companies often present their services as affordable, fast, and safe, although they clearly do not meet required professional dental standards. Orthodontic treatment without proper initial diagnosis and regular clinical monitoring can cause severe risks to patients’ health.

“The unanimity shown by European orthodontists on this subject makes it clear that orthodontics is more than just aligning the front teeth. It is about a holistic approach to care where the patient’s best interests are at the heart of our treatments,” says Prof. Dr. Christian Scherer, who coordinated the project for EFOSA. Every patient should make sure that the basic requirements formulated in the Joint Declaration are also observed in his or her treatment so that their treatment is practised safely.”

Anjli Patel, Director of External Relations for the British Orthodontic Society added, “Orthodontic treatment without thorough clinical face-to-face examination of the patient, x-ray imaging and regular clinical monitoring, is potentially hazardous to the patient’s health. Any self-administered and remote treatment cannot be justified from a professional medical perspective and thus represents a serious violation of ethical, medical and dental standards.”

The Joint Declaration on the remote treatment of malocclusions is available in twelve languages. It reads:

On the remote treatment of malocclusions
Various companies offer self- and remote treatment of malocclusions without direct contact between patient and a regular dentist by means of tele-media by transmitting image or video files. Treatment planning is based on impressions taken by the patient themselves, followed by consecutive manufacturing and deployment of treatment devices – particularly aligners – to the patient via mail. Treatment progress monitoring happens entirely without patient contact.

In this respect we declare:

1. Any treatment of malocclusions represents a medical intervention in the stomatognathic system and should therefore be exclusively performed by a fully qualified dentist.
2. Any treatment of a malocclusion must be preceded by a thorough clinical examination of the patient. Moreover, imaging findings must be evaluated for adequate treatment planning in order to identify contraindications or special risks.
3. Any treatment of malocclusion requires regular clinical monitoring. It is essential to assess the treatment progress, but also to detect possible complications such as undesirable tooth movement or other intraoral pathologies at an early stage.
4. Patient self-treatment and exclusive patient remote treatment must therefore be rejected as potentially hazardous to the patient’s health. Exclusive self- and remote treatment cannot be justified from a professional dental perspective. Exclusive self- and remote treatment represents a serious violation of the dental standard.

We have endorsed this joint declaration

The Consultant Orthodontist Group (COG) of the British Orthodontic Society are delighted to support the publication of the GIRFT report into Hospital Dentistry.  Recommendations in this new report aim to improve access and standards of care for patients, and knowledge of activity to the secondary care trusts and wider NHS.

Liz Jones, National Lead for the report, engaged with specialties as data collection revealed variations, coding of activity being a standout issue especially in Orthodontics.

The COG working group, chaired by Helen Travess, developed two booklets to clarify the guidance on coding for hospital dentistry, published by BOS, RCS and GIRFT.  Developed for clinicians, clinical coders and other health professionals within secondary care trusts, it aims to improve the quality of data and reduce unwarranted variation. It has been widely published through the society, with open access to clinicians. Orthodontics has been an exemplar to the field, with other specialties also now developing guidance to coding.

Jonathan Sandler, President of BOS, said: “We welcome this new report into hospital dentistry.  It couldn’t be more timely in this post pandemic phase of healthcare delivery.  Interdisciplinary working is key to hospital dentistry.  This report supports these aims with recommendations on workforce and access to such care. It also highlights the role of oral heath advice and multi government agency action.” 

The British Orthodontic Society (BOS) is delighted that the CQC have provided further clarity on the position of Direct to Consumer Orthodontic providers and the fact that they must be CQC registered.

In their statement, the CQC are very clear:

“We consider orthodontic treatments provided to patients following an intra oral scan or when a patient has taken impressions themselves to be regulated activity. This is in the same way that treatment planning and diagnosis associated with aligners is also regulated activity. Regulated activities are listed in Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In this case, they come under the regulated activities of Treatment of disease, disorder or injury and Diagnostic and screening procedures.”

The statement goes on to say: “We can use our regulatory powers to prosecute such offences.”

In a recent BOS members’ survey (April 2021), 82% of members were ‘concerned about more patients seeking DIY orthodontics during and following the pandemic’. In fact, it has been a concern for BOS members for a number of years.

BOS Director of External Relations, Anjli Patel said, “This news from the CQC is very welcome. This is something that BOS have been calling for, for a long time. As we have highlighted before, this is a patient safety issue and we hope that this action will provide more certainty for those seeking orthodontic treatment. One of our primary concerns about DIY orthodontics is that many patients were said to be unaware of the identity of their supervising dentists. Today’s announcement will mean this is rectified.”

The BOS first duty of care is to patients – the charity’s ultimate beneficiaries are patients, and benefits to patients are provided through the advancement of knowledge, practice and standards. The Society advises that anyone seeking orthodontic treatment should speak to a dentist or orthodontist first.

The British Orthodontic Society are delighted to announce that this year’s British Orthodontic Conference, to be held in the iconic Midland Hotel in Manchester on the 16th-18th September 2021, will be the event’s first ever hybrid offering.

Following such an unusual year, the BOS would like to invite everyone with an interest in orthodontics – consultants, specialists, training grades, GDPs, therapists and nurses – to come along, listen to a fantastic programme live, visit Manchester, socialise and meet friends and colleagues again.

The hybrid element event will allow those delegates who, for whatever reason, can’t travel, or overseas delegates, to be able to register and access the BOC lecture programme virtually, as well as attend a virtual trade exhibition and network with colleagues online.

The conference features a tremendous programme that includes Phil Hammond (Private Eye’s M.D., physician, broadcaster, comedian and commentator on health issues), and the prestigious Northcroft Lecture will be presented by BOS President, Professor Jonathan Sandler. There will also be parallel sessions: ‘Driving Private Practice’, ‘So you want to know about Orthodontics’ for aspiring Orthodontists, and a 2-day DCP programme.

David Waring, Chair of the British Orthodontic Conference Committee added, “We were so disappointed not to have a conference in 2020 and we have worked extremely hard to deliver a conference in 2021 that is doubly good! Everyone can book with confidence – if we have to make any changes or hold a purely virtual event, you will always be able to transfer to the online event and get the appropriate refund. We recognise the importance of flexibility when it comes to plans and hope this provides the reassurance colleagues need.

We feel that we have something for all the team at this year’s conference and look forward to welcoming everyone.”

Registration will open at the start of May for the 2021 British Orthodontic Conference – please follow us on Facebook (@BritishOrthodonticSociety) or Instagram (@bosbraces) for updates or visit www.bos.org.uk/News-and-Events/Events-Meetings to find out more and to book.

An early bird discount will be available for all bookings made before 23rd July and a combined team rate is on offer too so that the whole team can come along, learn, and have fun.

Your Jaw Surgery – a valuable information resource for patients (and clinicians) from the British Orthodontic Society has celebrated its 5th birthday. Created to help patients better understand jaw surgery, it includes videos detailing what patients can expect at every stage of the jaw surgery journey, animated films, downloadable advice sheets as well as patients sharing their experiences and stories.

The most recent statistics show that since upload of the videos in 2016, there have been more than 1 million impressions and over 200,000 video views. These views have been across the whole of the UK and indeed further afield. The lack of reliable, high quality information not just in the UK but worldwide is further illustrated by more than 10% of total views being from overseas.

Caroline McCarthy, Consultant Orthodontist and Chair of the organising committee of Your Jaw Surgery commented, “Your Jaw Surgery was inspired by the success of the BOS Jaw Surgery DVD but with a desire to update the information and to enable online access for patients considering surgical options. It has now been going for 5 years and the statistics speak for themselves.

“We are all really proud of this piece of work and are glad that it is staying current and relevant to more than 3000 people who undergo orthognathic treatment in the UK every year. It also helps those people with a dentofacial condition to accept this and decide that treatment is not for them. We know, as hospital consultants, that hospital departments are recommending the website to the patients who are seeking orthognathic treatment.

“We would also like to encourage our general and specialist colleagues to access the information too so that their patients can be directed to it and benefit from all the information available. It will help GDPs gain greater insight into this complex multi-disciplinary treatment and would also help specialist orthodontists with the many adult patients seeking orthodontic treatment. Many of these wish to accept the skeletal aspect of their problem and the information on this website can really help patient understanding for the informed consent process.” This valuable resource can be found at: https://www.bos.org.uk/Your-Jaw-Surgery

The British Orthodontic Society has published an open letter to the Secretary of State for Health, Matt Hancock, Chief Dental Officer for England, Sara Hurley and Ms. Gabi Darby, Interim Director of Primary Care Commissioning Transformation.

The letter can be found below and was accompanied with a covering text:

“The letter shares our concerns about the implications of the recent 7th Letter of Preparedness and associated guidance. In particular, we have reservations concerning the move to increase the volume of parents and patients attending practice settings to start what is considered essential but in the vast majority of cases non-urgent orthodontic care during this very acute phase of the pandemic.

This sits very uncomfortably alongside the national stance of discouraging non -essential travel and interaction and potentially puts patients, dental teams and the public at an increased risk.”

The letter reads:

Dear Secretary of State, Dr Hurley and Ms. Darby,
Thank you for your recent communications with the profession in the form of the 7th
letter of preparedness and supporting documentation. We are writing this open letter on behalf
of the British Orthodontic Society and orthodontic providers to express our concerns
surrounding the implication of these documents particularly given the context of the very acute
phase of the pandemic that we now find ourselves in and thus the risk that these guidelines may
pose to patients, orthodontic teams and the wider public.
Throughout the recovery phase of the pandemic so far, we have had the opportunity to
attend engagement meetings with representatives from NHS England and NHS Improvement
and these meetings have been very welcome. Whilst there was continued improvement both in
capacity but also the health threat posed by the pandemic, the desire on behalf of commissioners
to return to system of service delivery more closely aligned to a formal activity target was
understandable. However, the timing of the announcement on December 22nd came as
something of a surprise and the notice period regarding a change in contractual expectations
was particularly disappointing given that most orthodontic providers book their appointments
8 weeks in advance and so any change to service delivery presents huge logistical challenges.
There are also concerns surrounding the viability of the targets set, the methodology and data
used to set these targets as well as the proposed year end reconciliation process and lack of
increased flexibility to carry forward activity. This is a particularly important point given that
many providers will face increased challenges to delivering targets such as increased levels of
staff absence due to isolation and shielding, increased patient cancellations and challenges in
getting adjunctive work carried out such as dental extractions which are often necessary prior
to starting treatment. It is disappointing that much of the discussion and associated work carried
out by the teams involved in the engagement meetings and subsequent negotiations was not
reflected in the guidance when it was published.
However, these concerns aside for now, perhaps our biggest concern of all surrounds
the appropriateness of the guidance and how it sits alongside the national measures in place at
present to encourage the nation to stay indoors and avoid unnecessary travel or social
interaction. We appreciate that attendance for medical and dental appointments is permissible
and this is welcome with respect to emergency, urgent and other high priority care. From an
orthodontic perspective, this allows providers to continue to provide emergency care and also
importantly to continue ongoing care on patients with active appliances. Without appropriate
supervision, such appliances can lead to harm and treatment outcomes could be compromised.
This active supervision is considered high priority and constitutes the majority of clinical time
within an orthodontic setting. As a proportion of clinical time this has increased further as a
result of working safely within the scope of the standard operating procedure. However, despite
there being a demonstrable health need for orthodontic treatment in NHS funded cases, it is
hard to argue that in the vast majority of cases it is urgent for treatment to start during what is
widely regarded as the most dangerous phase of the pandemic to date, especially with
transmission of the new Covid variant.
Introducing these targets with a view to increasing the number of cases being started
will increase the number of patients and parents attending a practice and increase the overall
caseload in treatment for almost all practices. Despite a proven track record of high standards
of cross infection over many years, this increase in travel, social interaction, footfall and
congestion within practice settings will inevitably contribute to increased transmission
ultimately increasing risk to the general public and put increased pressure on the NHS.
With these concerns in mind, we would ask for urgent consideration as to whether
increasing targets for new orthodontic case starts for non-urgent care during Q4 is a responsible
course of action for NHS England and NHS Improvement to pursue given the inevitable risk it
brings to patients, dental teams and the public?
Yours sincerely,
Dr Anshu Sood, Director of Clinical Practice, British Orthodontic Society
Dr Richard Jones, Chair, Orthodontic Specialists Group, British Orthodontic Society