Straight Teeth and Misaligned Interests: Courtrooms Are Crowded with SmileDirectClub Litigation.

SmileDirectClub markets, manufactures, and delivers clear plastic dental aligners directly to the consumer: no dental office necessary. This well-known business strategy-cut costs by cutting out the middleman-has in several instances caught the attention of state dental regulators. While the dental boards consider some of SmileDirectClub's practices to be violative of state dental practice law, the corporation has fought back in federal court, charging dental regulators with antitrust violations and with denying SmileDirectClub its constitutional rights.The Supreme Court, as noted by SmileDirectClub, has insisted that a self-regulating state professional board is not itself the state, so a board's actions might be subject to federal antitrust law. In the SmileDirectClub cases, however, state regulators have acted as required by state legislatures and as expressed in state dental practice acts. The boards' activities here are therefore cloaked in the states' immunity to antitrust litigation and should be treated deferentially by federal courts. Furthermore, judicial review of the substance of every regulation to which SmileDirectClub objects is inappropriate under principles of constitutional law. In the interest of public safety, courts should permit state dental regulators to fulfill their mandates and ensure that all dental providers comply with state health regulations.

Primer on State Statutory Mandates of Third-Party Orthodontic Coverage for Cleft Palate and Craniofacial Care in the United States.

Provision and timing of orthodontic treatment is a crucial part of comprehensive cleft palate and craniofacial care. Some states statutorily mandate orthodontic coverage for the medically necessary care of cleft palate and craniofacial anomalies. However, application of the medically necessary standard varies broadly. Disputes over medical necessity lead to orthodontic coverage denials and surgical intervention delays. Provider-friendly statutory definitions of medical necessity enable patients and providers to avoid such hurdles. The objective of this study is to evaluate state mandates and highlight language favorable to patients and providers.

Temporomandibular disorders assessment: medicolegal considerations in the evidence-based era.

Summary Temporomandibular disorders (TMD) are a frequent finding in cases of facial trauma or dental malpractice, and legal claims for TMD damage have been increased over the years. Temporomandibular disorders assessment in the medical legal setting is complicated by the peculiarities of these disorders, whose symptoms are heterogeneous, fluctuant, and recognise a multifactorial origin. A systematic Medline search in the National Library of Medicine's PubMed database pointed out that, despite the medical legal aspects of the dental profession are gaining a growing attention, there is a paucity of literature dealing with patients with TMD assessment. For these reasons, evidence-based knowledge in the field of TMD diagnosis and treatment was summarised in this article with the aim of providing useful suggestions for a medical legal approach to TMD.

Medicolegal perspective: interpretation of pretreatment orthodontic radiographs.

AIM: To detect the prevalence of anatomic anomalies and pathologic findings that could be screened from pretreatment orthodontic radiographs. METHODS: A thorough screening was conducted of the pretreatment orthodontic radiographs of a sample of 1,354 patients, collected by the author during the last 15 years from 4 locations, 3 in the Kingdom of Saudi Arabia and 1 in Egypt. RESULTS: A total of 154 significant anomalies and pathologic findings were recorded among the total sample group of 1,354 orthodontic patients (11.4%). Among these, 22 could have a serious effect on the general health of the patient. The findings included fractured odontoid process of the axis vertebra, os odontoideum, spondylolisthesis, fractured surgical needle in the oropharynx, fractured transpalatal archwire swallowed and stuck in patient's throat, unrecognized carotid artery stenosis, cystic lesions, and calcified stylohyoid ligaments. CONCLUSION: Medicolegal litigation is a main priority for the clinician, requiring cautiousness through screening of the pretreatment orthodontic radiographs beyond orthodontic purposes to exclude patients with significant anomalies and pathological findings. If not done from the medicolegal prospective, such screening should at least take place from an ethical perspective. The orthodontic clinician needs to know when to consult other medical specialties.

IOTN (DHC): is it supported by evidence?

UNLABELLED: The strength of the evidence linking some common malocclusion traits (which are used as the basis for IOTN classification) with dental disease is reviewed. It is concluded that IOTN is not a reliable predictor of the potential impact of malocclusion on future dental health, and that alternative indices, which place greater emphasis on the aesthetic impairment and take account of patient perceptions, are more appropriate for assessing an individual's orthodontic treatment need. CLINICAL RELEVANCE: IOTN is likely to assume greater significance with the advent of the new GDS/PDS regulations pertaining to orthodontics. However, all practitioners, including those who commission specialist services, should be aware of its limitations, especially in relation to the Dental Health Component.

Comparison between two orthodontic skeletal anchorage devices: osseointegrated implants and miniscrews - Medical-Legal Considerations.

The object of this article is to describe potential medical-legal problems concerning the use of miniscrews as orthodontic skeletal anchorage. The miniscrews, which are already used in rigid fixation, do not need either a healing period before loading, or complete osseo-integration as do implants. Their particular shape allows high primary stability and they can be placed in the sub-periosteal region. The dimensions of these miniscrews are minute, with dimensions of only 4-5 mm in length. They penetrate only slightly deeper than the cortical layer and therefore notably reduce the risk of lesions to roots, nerves, or maxillary sinus, when compared to other skeletal anchorage systems such as implants. The use of the miniscrew in oral surgery or periodontology does not need specific insurance coverage in contrast to the insertion of implants. Accordingly, orthodontic therapy completed by the dentist with orthopaedic microscrews as anchorage could also be included in a general civil insurance policy for orthodontics.

[Orthodontic treatment failure: the advice of a forensic expert]. / Échec d'un traitement orthodontique : les conseils de l'expert judiciaire∗.

If patients consider that their orthodontic treatment is a failure, they can claim compensation from their practitioner. Most often, discontented patients call on their third-party liability insurance when they are covered for "legal expenses protection". The patient's insurance company will then get in touch with the practitioner's insurance firm. Three-quarters of all claims are dealt with by the insurance companies. However, if an agreement cannot be reached or if the practitioner's insurance company manages to establish that he/she is not at fault, the patient can apply to the Tribunal de Grande Instance, the French Regional Court. The judge appoints a forensic expert who will examine the patient and follow a very precise procedure involving a dozen different questions. The advice of the forensic expert is therefore very valuable to orthodontists, in particular regarding their duty to inform patients and the importance of the medical file in order to avoid being held accountable following a course of treatment.

Belle Maudsley Lecture 2001. Risk management in orthodontics--making clinical practice safer.

Facing a civil claim for negligence or prosecution for breach of Health and Safety law is something that any sensible clinician wishes to avoid. This review discusses the main areas of risk in clinical practice and how such risks can be minimized when acting as a clinician and as an employer. Although orthodontic examples are used to highlight particular points, this paper is also relevant to general dental practice.