Orthodontics - Navigating the challenges of taking over care

The recent demise of Smile Direct Club has left a reported 65,000 UK patients ^[1] without access to the provider of their orthodontic treatment. Although the quoted volume of patients affected is unprecedented, it isn’t the first time that Dental Protection has addressed the dentolegal challenges arising from patients transferring care midway through treatment. 

Many in the profession have stepped forward and offered to take over patient care and support patients. We know from experience, that managing the transfer of care can introduce new complexities and challenges and Dental Protection is happy to provide members advice. One of the questions we are often is about the position of the dentist accepting treatment in the event there is a subsequent a complaint or claim.

As a general guide, a clinician would become responsible for the ongoing care of the patient from the point they take over the care. It is therefore important to ensure that time is spent at the point of transfer in gathering all relevant information to ensure any future treatment plan is appropriate for that patient and they fully understand the risks and limitations of any ongoing care. Dentists need to ensure they are not pressured into continuing with a course of treatment if this goes against their professional judgment.

The following may help in reducing the risk of future challenge and help in ensuring patient expectations are met.

Records

Every effort should be made to obtain any previous dental records that may help to provide information about the pre-treatment occlusion and health of the dentition. The patient may have some records shared by a previous orthodontic provider but equally there may be other records held by other dental practices that may help in the assessment process.

If the previous records are not available at the time of the initial appointment consider whether the treatment can be deferred until records have been obtained, allowing a full assessment to be undertaken when all information has been collated.

Assessment and Treatment

Ensure comprehensive baseline records are taken to establish the patient’s current dental health and that they are suitable to continue with any orthodontic care. Patients may have commenced treatment in the absence of any comprehensive oral health check and it is imperative not to be pressured by a patient to just focus on the orthodontic treatment without ensuring this is in the patient’s best interests. 

It may be relatively easy to understand the orthodontic treatment goals, however lack of pre-treatment records may compromise the ability to ensure treatment is appropriate and that those goals are realistic and achievable. 

Where records are available, there is still the potential that a different treatment plan might be more appropriate e.g. the need for dual arch treatment. For some patients the risk of ongoing treatment may outweigh the benefits. A previous Dental Protection article looking at root resorption cases in child patients highlighted that inadequate assessment and lack of consent were common themes in the cases captured by the study. These issues are equally of relevance for adult patients.

Working with Competency and Training

Regulatory standards require us to work within our knowledge, skills and professional competence ^[2]. Given the potential complexities arising from transfer of care, the lack of records and risks of compromised oral health, it is advisable to have a low threshold before seeking more experienced support. This may be through specialist referral or via supported specialist treatment planning e.g. the DUO service from 32Co*.

Above all, it is necessary to ensure patients' best interests are put first and whilst the transfer of patient care mid-treatment may not be ideal, having a clear plan in place and ensuring patients understand the options available, their expectations are managed and consent is valid will help smooth the journey for both the treating dentist and the patients. 

*Dental Protection members get priority access to 32Co's clear aligner training.

Payment

Patients may be facing financial loss and, as the continuation of orthodontic treatment will inevitably result in the patient having to pay additional fees, this financial burden may impact on whether a patient wishes to continue with treatment.

A patient seeking advice may elect to stop treatment however it is important that they fully understand the implications of discontinuing treatment and any potential short- or longer-term risks this might cause. Documenting the advice given to the patient and following this up in writing will help demonstrate a patient’s decision to end treatment is fully informed.

Support and protection for dentists 

Members who have questions about managing the transfer of patient care can contact us in the usual way to request advice and assistance. For expert dentolegal advice from our in-house team, call 0800 561 1010.

If you are undertaking orthodontics, your membership documents should reflect your orthodontic practice. If you are taking on additional patient care or increasing your hours, you will need to check your membership reflects your new hours of working or additional hours of orthodontic procedures. Dental Protection members can review and update their membership details online here. 

Further guidance developed by Dental Protection in partnership with 32Co to help address and mitigate concerns about transfer of care and risks is available here.