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.

[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.

[Beauty and esthetics: juridical approach]. / Beauté et esthétique : approche juridique.

Although beauty is increasingly becoming a right mostly as it relates to objects, people are now beginning to make a new demand - the right to personal beauty: the right to live in and surrounded by beauty and the right to be beautiful.

Canting of the occlusal plane: Perceptions of dental professionals and laypersons

Objectives: To determine if canting of the occlusal plane influences esthetic evaluation of the smile among orthodontists, dentists and laypersons. Study Design: A frontal photo of a smile with 0º occlusal plane canting in relation to the bipupillary plane was modified using Adobe Photoshop C3 (Adobe Systems Inc, San José, California) to generate two images with occlusal plane inclinations of 2º and 4º. The three images were evaluated esthetically by orthodontists (n=40) general dentists (n=40) and laypersons (n=40). Each image was awarded a score as follows: 1=esthetically acceptable;2=moderately acceptable; 3=esthetically unacceptable. Evaluators also placed the three images in order in preference. Data were analyzed using the Kruskal-Wallis (p<0.05) and the Mann-Whitney tests, applying the Bonferroni Correction (p<0.016).Results: No significant differences (p> 0.05) were found between the three groups for 0º and 2º cants (median for orthodontists=1; general dentists=1; laypersons=1). Orthodontists (median score=3) made evaluations of the image with 4º occlusal plane that were significantly different from general dentists (median=2) and laypersons(median=2). All three groups put the 0º image in first place in order of esthetic acceptability, the 2º image in second place and the 4º image in third place. Orthodontists placed the 0º image in first place with significantly greater frequency (p<0.016) than laypersons. Conclusions: Occlusal plane canting of 0º and 2º were evaluated as esthetically acceptable by the three groups. The 4º occlusal plane cant was evaluated more negatively by orthodontists than by general dentists and laypersons. All three groups placed the 0º image in first place of esthetic acceptability, 2º in second place and 4º in third. Orthodontists put the 0º image in first place with significantly greater frequency than laypersons (AU)

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.

Risk management in clinical practice. Part 7. Dento-legal aspects of orthodontic practice.

Orthodontic treatment, like any aspect of general dentistry, exposes the clinician to the risk of malpractice and litigation. While for orthodontists this issue has not been a major concern over the last century, risk management has, over the last decade, become a significant issue in orthodontic practice. The patient-orthodontist contact may be classified into pre-treatment, active treatment and post-treatment periods. Risk management issues pertinent to each time period are discussed in this article with the intention of increasing the clinician's awareness of potential problems. Armed with this knowledge the overriding message for the clinician is to practise orthodontics with the philosophy of prevention and avoidance. To the best of your ability, avoid giving patients a reason to institute legal proceedings.