The Dental Council has received several queries from health practitioners concerned about an emerging area of DIY dentistry – remote orthodontic treatment – that is now available in New Zealand.
Global commercial enterprises such as WonderSmile and SmileDirectClub have entered the New Zealand market, offering remote or direct-to-consumer customised teeth aligners.
Our key responsibility under the Health Practitioners Competence Assurance Act 2003 (the Act) is to regulate practitioners registered with us to practise in the oral health professions in New Zealand, in the interests of protecting the health and safety of the New Zealand public.
We recognise the oral health industry is constantly evolving with the opportunities provided by technology. And we agree that new technology enabling oral health treatment with little or no direct contact between a registered practitioner and their patient increases the potential for risk of harm.
However, the Act does not give us any jurisdiction over non-registered practitioners, nor commercial enterprises offering dental equipment or services.
To protect public safety, the Act allows for specified activities to be restricted, meaning they can only be provided by registered health practitioners. In this new and emerging area of remote services, a question arises whether taking an oral scan with the intent of providing orthodontic treatment would fall under the practice of dentistry as a restricted activity.
In our view from the available information about the processes advertised by these direct-to-consumer companies, there does not appear to be “…insertion…” of a removable orthodontic device as it is the customer or patient who does that.
Further, arguing that the use of the scanner is a “clinical procedure involved in the insertion … of a removable orthodontic appliance” might be too remote from the obvious intent of the definition of a restricted activity to apply.
However, there is potential to argue otherwise—and there is growing disquiet among the dental profession about the safety of the remote service being offered.
If restricted activities are being performed in New Zealand by non-registered persons then that would become a matter for the Ministry of Health, not the Dental Council to investigate and prosecute. Anyone found guilty of illegally performing a restricted activity faces a fine of up to $30,000.
The Council has drawn this matter to the attention of the Director-General of Health to highlight a potential public safety issue.
The Ministry of Health could declare an activity, such as providing remote DIY orthodontic services, to be “restricted” to registered practitioners only. The Ministry would be required to consult widely on any proposal should a change to the list of restricted activities be proposed.
We have also added information for patients on our website about orthodontic treatment.
As with any area of innovation, registered practitioners must ensure that ethical and regulatory standards are maintained—irrespective of how the services are delivered.
This means that any registered practitioner practising dentistry remotely would be held to the same standard of care as the practitioner providing in-practice patient care. The absence of personal patient contact does not eliminate a practitioner’s responsibility to comply with the mandatory standards set out in the Dental Council Standards framework for oral health practitioners.
Your patients may ask you for your opinion on the merits of seeking treatment remotely. While patients have the right to make their own decisions about their oral health, as an oral health practitioner, you have an obligation to ensure your patients are fully informed of their oral condition.
It is an opportunity to explain the advantages of seeking care from a practitioner registered in New Zealand and the assurance of competence this brings. The Dental Council professional standards require New Zealand practitioners to take an all-inclusive holistic approach to care. This requires you to consider the patient’s overall health, their psychological and social situation, their oral health needs (immediate and long term) and their desired outcomes. A physical clinical examination gives an opportunity to evaluate a patient in areas not possible at a distance. TMJ, muscles of mastication, occlusal function and adequate radiography are best assessed clinically.
However, in the end, patient autonomy and the patient’s right to make their own oral health care choices, is the overarching principle.