California Law Requires X-Ray Reviews Before Orthodontic Treatment

Dentistry Today


California Governor Gavin Newsom has signed legislation that requires dentists who provide orthodontics to review each patient’s recent x-rays prior to the movement of teeth. While the California Dental Association (CDA) applauds the law, which will take effect on January 1, 2020, Smile Direct Club has expressed reservations. 

The CDA says that the law protects patients from do-it-yourself orthodontic companies that put profits before patients by taking potentially unsafe shortcuts to the accepted standards of care. Also, the CDA says, the law establishes greater transparency and fundamental consumer protections for patients who receive dental treatment via telehealth.

Further, the CDA calls the law a first-in-the-nation protection measure that can serve as a model for dental boards across the United States to consider. It also creates explicit parity in the standard of care, the CDA says, whether a dentist is treating a patient through telehealth or in a dental office.

The law also will require telehealth companies and dentists who use telehealth to provide patients with basic information about their treating dentist, such as the dentist’s full name and state license number. Brick and mortar dental practices already provide that same information to patients, the CDA says.

Finally, the bill preserves the consumer’s ability to submit complaints about licensees to the Dental Board of California even if they have signed an arbitration clause or nondisclosure agreement.

The CDA cautions that providing dental care, especially moving teeth, without sufficient diagnostic information can potentially lead to serious patient harm, including loose or cracked teeth, gum recession, and tooth loss.

With emerging business models offering various dental services outside of a dental office’s four walls, the CDA says, including companies that provide direct-to-consumer orthodontic services, it is imperative that dental treatment continues to meet the standards of care.

The law ensures that telehealth advances continue to develop in a thoughtful way that puts patient safety first and is as effective as in-person treatment, the CDA says.

Though Newsom signed the legislation, which granted the state’s Dental Board continual authority to oversee and regulate dental services through January 1, 2024, he noted that it also includes significant policy changes involving self-applied orthodontic treatments administered via telehealth and other technologies.

“While I am signing this legislation, sunset bills are not the appropriate vehicle for policy changes that lack broad stakeholder input,” Newsom said. “Such proposals should be considered in separate legislation and evaluated accordingly. I will not look favorably upon any future regulatory sunset bills that include those provisions.”

SmileDirectClub, which provides telehealth orthodontic services, said that it was pleased with Newsom’s concerns about the legislation. The company also noted that while the law does not preclude its continued operations in California, it will create unnecessary hurdles and costs to Californians who need care but struggle to afford it.

Additionally, SmileDirectClub said that the legislation’s “ill-advised” policy changes have created arbitrary barriers to innovation, with no clinical studies or guidelines affirming the mandatory radiography or other equivalent bone imaging requirement. The law, the company said, represents the dental lobby’s attempt to protect traditional dentistry at the expense of state residents.

Nothing regarding teledentistry in the legislation can take effect until the Dental Board has given all stakeholders the opportunity to submit public comment and debate the merits of any proposed rules with clinically based data, as Newsom requested in his signing statement, SmileDirectClub said. 

The company added that it will reach out to its partners to coordinate efforts to achieve a positive outcome for the industry and for California consumers. It also plans on being an active participant in administration-directed public debates surrounding teledentistry while continuing to provide affordable orthodontic care to state residents, it said.

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