A mother was shocked to discover concerns had already been raised about dentists practising orthodontics. Natalie Akoorie looks at advertising and injuries in part two of a two-part series.
Cath Darroch is not the first person to complain about a dentist providing orthodontic treatment.
Dentists are allowed to offer orthodontic services but the New Zealand Association of Orthodontists (NZAO) - who complete an extra three years of training to become specialists - says the issue of 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 complaints have been lodged over the same issue.
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 of the complaints raised concerns about practitioners' ability to advertise non-prescribed qualifications that could potentially mislead the public.
A significant and repeated issue raised was the concern that individual practitioners were deliberately causing public misinformation about orthodontic treatment options and specialist practice through their advertising.
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And there were multiple complaints about the same practitioner using different advertising mediums.
NZAO president Dr Kieran O'Neill said there was universal concern about dentists being allowed to do comprehensive, complex orthodontic cases when they had no experience.
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 and therefore reversible, 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 care provided by a small but significant number of dentists doing orthodontic work.
At Eden Orthodontics she sees patients who have had unnecessary or poorly executed treatment and at worst damaged teeth, gums or bite where they 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 with up to six classified as serious. The serious cases 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.
Of those, 12 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 practicing 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.
Part 1: Dentists doing orthodontics
Part 2: Investigation, advertising and injury