Estimated read time: 5 mins
Short term orthodontics (STO) is becoming increasingly popular with adult patients, driven by factors such as social media and advertising. Where once adults were reluctant to embark on a course of orthodontic treatment, STO can offer a more aesthetic option than conventional fixed orthodontics with the promise that it can be completed in a relatively short period of time, and with the added convenience of treatment being provided by a general dental practitioner (GDP).
Dentists are of course keen to satisfy this demand from patients although there are a number of factors to take into account when contemplating offering a course of STO, and there are potential difficulties for a GDP in providing treatment for which they have no formal specialist orthodontic training.
These can include:
Poor case selection as a result of a lack of detailed knowledge on how the particular systems work and their limitations. Often training has been undertaken in only one STO system and that training may be limited, sometimes comprising only one day. The providers of the training will naturally want to extol the virtues of that particular system and may underestimate their limitations; in addition, there may be other systems that would be better suited to a particular clinical scenario but which the dentist will have no knowledge of.
The difficulty in undertaking a full orthodontic assessment and diagnosis. STO, despite the commercial aspects and promise of a swift outcome, is of course still orthodontic treatment and as such a full orthodontic assessment and diagnosis should be undertaken at the outset. Often in cases Dental Protection assists with there is very limited documentation of the orthodontic assessment, leading to difficulties in defending the actions taken.
Treatment planning and the ability to envisage the end result and any potential future problems, such as achieving a stable end point. There may be a limitation in the ability to utilise an alternative treatment should the selected aligner technique not succeed in achieving the desired outcome or a refinement be required using, for example, a fixed appliance.
The consent process, which should include offering alternative treatment options, for example, referral to an orthodontist specialist.
Failure to identify and then manage patient expectations. The type of patient who may be seeking a cosmetic form of treatment such as STO may have high expectations that are difficult to manage, and they are often a new patient drawn to your practice because you offer STO. This means that you have not had the opportunity to build up a professional relationship beforehand, as you have with your regular patients. This can lead to issues surrounding compliance as you have no prior knowledge of the patient’s motivation, attitude to treatment, and attendance pattern. Given that STO and subsequent retention require significant compliance this lack of prior knowledge can lead to problems.
Retention: in the rush to embark on STO treatment patients can underestimate the retention process, which the British Orthodontic Society (BOS) has emphasised must be considered to be lifelong, as part of their #HoldthatSmile campaign.
Many of the cases Dental Protection is asked to assist with are difficult to defend due to vulnerabilities relating to one or more of the factors outlined above, with the most common issues relating to consent and retention. By way of resolution patients will often seek financial recompense as STO involves a significant financial outlay, so that they can embark on a further corrective course of orthodontics. This can bring further issues such as the risk of root resorption from repeated tooth movement, and further financial and time commitment for the patient.
GDPs must be able to recognise when patients are not suitable for STO and when their treatment needs are beyond their clinical capability to avoid getting into difficulty. Whilst STO can be a great practice take care not to embark on treatment that may be beyond your knowledge and skills.