One jaw broken every two months by dental work
Natalie Akoorie looks at advertising, injuries in the second of a 2-part series on dentists practising orthodontics
Dentists are allowed to offer orthodontic services but the New Zealand Association of Orthodontists — who complete an extra three years of training to become specialists — says competence has become a serious problem.
In 2015 the Dental Council of New Zealand set up an investigation into orthodontic treatment by dentists after seven complaints were made.
Since 2016 a further four similar complaints have been lodged. Of those, one practitioner was required to complete a competence programme and the most recent case is still being investigated.
There were also 54 complaints made between January 2014 and October 2016 on advertising related to orthodontic treatment.
Eighty-five per cent of the complaints came from the NZAO and individual orthodontists on the advertising of orthodontic services by dentists.
One complaint raised concerns about practitioners’ ability to advertise non-prescribed qualifications that might mislead the public.
A significant and repeated issue was the concern that some practitioners were deliberately misinforming about orthodontic treatment options and specialist practice through their advertising.
And there were multiple complaints about a practitioner using different advertising mediums.
NZAO president Dr Kieran O’Neill said there was universal concern about dentists with no experience being allowed to do comprehensive, complex orthodontic cases.
While some dentists practised orthodontics competently, mainly by limiting their work, O’Neill said problems often arose for complex treatment that took several years.
“There are patients and parents who are unaware their dentist isn’t an orthodontist and, by omission, they think they are. These people are not trained to do complex work.”
Dentists receive about 80 hours of orthodontic training whereas orthodontists receive 5000 hours including treating complex patients.
“Legally they’re able to do orthodontics but whether they’re competent is another story.”
He said the Dental Council needed to also consider emotional and financial harm instead of just legal harm when dealing with complaints.
While some inadequate treatments could be rectified that should not be an excuse or acceptable, because patients often suffered dental “burnout”, O’Neill said.
So when faced with several more years of expensive braces to correct treatment, patients often declined.
Auckland orthodontist Dr Rachel Smith said orthodontists were concerned about the quality of orthodontic care provided by a small but significant number of dentists.
At Eden Orthodontics she sees patients who have had unnecessary or poorly executed treatment and at worst damaged teeth, gums or bite and would have been better off before the treatment.
Smith said people often thought they had seen an orthodontist because of misleading advertising.
“Parents and patients often blame themselves for a poor outcome saying they ‘should have known better’.
“They do not complain as the process is complicated and they just want to move on. Treatment required to correct the problem is sometimes complex and is at the expense of the individual.”
University of Otago Professor of Orthodontics Dr Mauro Farella said the system needed improving with more opportunity for dentists to do extra training once qualified.
Orthodontists were now referring patients whose treatment had gone wrong with a dentist to ACC for injury cover.
In the 10 years to April 2016 ACC received 61 treatment injury claims for orthodontic-related injury.
It accepted 36 of the claims. Up to six classified as serious were all orthodontic treatment provided by dentists.
From April 2016 to June this year, there were a further 58 orthodontic treatment injury claims made to ACC, 30 of which were accepted. Twelve were recorded as major or serious.
ACC said over the seven years to December last year, 42 claims were accepted for facial fractures resulting from dental treatment injury, that’s one every two months on average.
Most of these, 37, were broken jaws. At least five of these patients needed surgery to repair their jaw.
Despite this, the working group commissioned by the Dental Council, including four dentists, a dental academic and one orthodontist, found no evidence of widespread harm or risk to patients and didn’t consider it necessary to make changes to limit the scope of a dentist’s practice.
However, Darroch said she was “gobsmacked” when she read the report to find out there were other complaints and concerns about dentists practising orthodontics four years ago and it felt like nothing had changed.
The Dental Council said it accepted all the recommendations of the working group and prioritised developing resources to guide patients considering orthodontic treatment.
Those resources were sent to practitioners, their professional associations and made available on the council website.