Can Orthodontics Ever Be The Remit Of The GDP?
In these days of celebrity obsession and the ‘Hollywood’ ideal, more and more adults in the UK are opting for orthodontic appliances and as such, an increasing number of GDPs are looking into offering orthodontic treatment in their own surgeries. With Britain having a relatively small ratio of specialist to general practitioners (in comparison to the USA), what are the benefits and limitations for GDPs wishing to undertake adult orthodontic treatment?
The consumer market in the UK today is an increasingly knowledgeable and discerning one and patients are concerned with three things: speed of treatment, value for money and ‘aesthetic discretion’. Adult patients are unwilling to comply with treatments involving unsightly metal braces, which may interfere with their personal or professional lives, and they require the shortest possible treatment time in order to allow them to ‘get back to normal’. In addition to this, the desire to save money during the recession means that many customers will willingly go to a GDP rather than a specialist. Indeed research suggests that most customers can’t even tell the difference between GDP and specialist treatment.[1]
Because of the focus on aesthetics over functionality, there is a trend among patients towards treatment that only tackles the ‘social six’ and advances in orthodontic technology mean that this, as well as more complex treatment, is far easier for GDPs to carry out with machines that all but eliminate the possibility of human error. Systems such as digital 3D interactive software can assist practitioners in the construction of bespoke orthodontic treatment and, some suggest, may mark the end of the need for specialist orthodontists.
However, it’s not yet time for specialists to consider retirement! Without the intensive specialist training of orthodontists, GDPs can struggle to make complex diagnoses and treatment plans, and it has been shown that, in severe cases of malocclusion, GDPs may have trouble with the perception of treatment needs.[2] However, according to experts such as Mitchell:
There is a wealth of evidence to show that orthodontic treatment is more likely to achieve a pleasing and successful result if the operator has had some postgraduate training in orthodontics.[3]
The suggestion therefore, is that more thorough training for GDPs would result in a better understanding of orthodontics, and a greater empathy for specialist practitioners.[4] Ergo in the world of orthodontics it appears that training is the key to success for any practitioner, be they general or specialist, but the quality of that training is also of the utmost importance. Many companies offer courses on orthodontics to GDPs but the standard of education can vary considerably from operator to operator and many practitioners who think they are getting a cost effective training course, may be selling themselves short when it comes to the quality of the education they are receiving.
Although there are many reputable courses that GDPs wishing to practice orthodontics can, and should take, the happy medium in this case may be to have well trained GDPs working under the supervision of specialist practitioners. Such treatment can be considered a ‘viable’ alternative to treatment carried out by an orthodontist, especially in light of the lack of registered specialists and the increasing demand for the service.[5]
For GDPs wishing to practice orthodontics however, there are several salient points to consider. When recommending orthodontic treatment it is important to learn how to say no: adult patients in particular can have a very fixed idea of the result they expect and the type of treatment they want, regardless of its suitability to their case, and so GDPs must be prepared to fully explain the consequences and probable outcome of any treatment plan and be ready to offer alternatives. Orthodontics is a very specialised area of dentistry and, whilst it can be an excellent source of extra revenue for a general practice, GDPs need to be extremely careful and ethical, not just about their choice of training course, but also about the equipment and suppliers they use. Not all suppliers, or indeed appliances, are made equal. The increasingly popular plastic aligners for example, are well suited to simple alignment cases but are not appropriate for root uprighting, space closure and extrusion. In these, more complex cases, other appliances such as fixed traditional mechanics, or a combination of both, may be a wiser choice. The Clearstep system for example, represents a unique combination of these two techniques for a comfortable and effective fit. Again, however, situations in which the treatment options are unclear may benefit from the advice of a specialist orthodontist.
Whether or not orthodontics will make the move fully into the general practice remains to be seen but for now it appears that a balance between general and specialist treatment may be the best way forward for today’s adult orthodontics patients.
[1] Abei, Y., Nelson, S., Amberman, D. et al. Comparing orthodontic treatment outcome between orthodontists and general dentists with the ABO index. Am J Orthod Dentofac Orthop 2004; 126:544-8
[2] Kuroda, S., Fuji, A., Sugie, M. et al. Relationship between orthodontic expertise and perception of treatment needs for maxillary protrusion: Comparison of dental students, residents and orthodontists. Am J Orthod Dentofac Orthop 2010; 137:340-5
[4] Galbreath, R.N., Hilgers, K.K., Silveirs, A.M. et al. Orthodontic Treatment provided by general dentists who have achieved master’s level in the Academy of General dentistry. Am J Orthod Dentofacial Orthop 2006; 129:678-86. See also Gottleib. E.L. (ed.) JCO Roundtable: Current Issues in Orthodontics. JCO 1992;26:9:569-584
[5] Berndt, J., Leone. P., King, G. Using teledentistry to provide interceptive orthodontic services to disadvantaged children. Am J Orthod Dentofacial Orthop 2008; 134:700-6)
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