Agencies | Governor
Virginia Regulatory Town Hall
Department of Health Professions
Board of Dentistry
Regulations Governing the Practice of Dentistry [18 VAC 60 ‑ 21]
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7/22/19  8:56 pm
Commenter: Nick Pappas, BBP Orthodontics

Looking out for our patients' best interests.

As a practicing orthodontist, I have seen first hand the negative impact that orthodontics completed with the use of unsupervised digital impressions can have on a patient. Patients that have previously had unsupervised orthodontic care have visited my office seeking re-treatment due to uncontrolled periodontal disease that had not been appropriately diagnosed at the initial impression, which was completed without professional oversight. Without having the disease under control prior to orthodontic care, the risk of bone and tooth loss is exponentially increased. In addition, patients visiting my office who have received digital impressions that have not been under a dentist/orthodontist's supervision and have received at-home orthodontic aligners have also expressed issues with improper jaw alignment related to undiagnosed malocclusions (the way the top and bottom jaw fit together). Impressions, whether completed through a digital scan or through the use of a physical alginate, are an integral part of the initial exam and treatment planning process that drive the course of a patient's care. Based on my knowledge of orthodontics and case studies presented to me by my own patients, consistent supervision of this initial step in treatment planning is necessary to ensure optimal treatment outcomes.  It is true that we have the technology to digitally scan a patient's mouth  and send that scan off to a company that will be able to move teeth.  Is this what is best for the patient? The person overseeing the movement of teeth has never seen the patient to ensure proper dental health, heard their rationale for wanting orthodontic treatment, and does not have any follow up with the patient after they receive their aligners.  Just because we have the ability, does it mean it is the right decision? Protecting patients and providing knowledge they may not have is a responsibility doctors have to the public. Removing the doctor from such an integral piece of treatment planning exposes patients to risks, thus counteracting the top priority of dentists and orthodontists everywhere-- providing optimal oral healthcare.