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Patient Management

A patient's willingness and knowledgeable agreement to have dental procedures performed on him/her is necessary if you are to avoid being charged with malpractice or misconduct. Your ability to effectively explain procedures, answer questions, and offer alternatives will be vital to avoiding costly litigation.

DIY Dentistry

From magazines to online ads, consumers today are being inundated with promises of how they can achieve whiter, cleaner, and straighter teeth—all from the comforts of home without seeing a dentist. These promises come in the form of dental fads like “oil pulling” to improve oral health, charcoal for tooth whitening, and over-the-counter bleaching products. Consumers are also seeing countless ads for do-it-yourself (DIY) teeth straightening, meaning they can undergo orthodontic therapy using clear aligners they receive by mail from online companies, without visiting their dentist.

The Massachusetts Dental Society (MDS) and the American Dental Association discourage the use of direct-to-consumer dental products, including aligners, veneers, mouthguards, snoring appliances, teeth whitening trays, and bleaching products. Self-administered, unsupervised dental treatments have the potential to cause damage and irreversible complications for patients.

The MDS has communicated its concerns regarding DIY or remote orthodontics in letters to the Massachusetts Board of Registration in Dentistry and the Massachusetts Attorney General.

SmileDirectClub Seeks to Muzzle the MDS

In a recent letter to Massachusetts Dental Society (MDS) President Dr. Janis Moriarty, legal counsel for SmileDirectClub (SDC) alleged that communications by the MDS to the Massachusetts Board of Registration in Dentistry and the Massachusetts Attorney General, as well as its publication of a video expressing concerns over “do-it-yourself” (DIY) or remote orthodontic treatment, constitute false and defamatory statements directed at SDC. SDC demanded that the MDS correct the record, withdraw its letters to the Massachusetts dental board and Attorney General, and cease and desist from making “further defamatory statements.”

The MDS, through legal counsel, has issued a thorough response rejecting SDC’s claims. The MDS response states, “MDS will not be intimidated into silence or inaction when confronted with matters of public health. It will vigorously defend any lawsuit commenced by SDC.” In defending such a lawsuit, the letter states that MDS would “seek full-fledged discovery into SDC’s business practices” and that a “defamation lawsuit would put front and center the intensity and frequency of the real-life involvement of licensed dentists in all aspects of a patient’s treatment under SDC’s low-cost, high-volume model as well as the real-life results experienced by patients.”

The response concludes, “While MDS does not invite litigation, it will not shy away from its mandate to promote oral health. It certainly will not bend to any effort to chill its petitioning and free speech rights. There is a rising chorus of concern around SDC’s treatment model and business. Picking a fight with MDS will not abate this chorus, will not deliver SDC any meaningful relief, and will not set the table for any type of constructive relationship with a non-profit that represents 80% of dentists in Massachusetts.”

Read the full content of both letters below:

How to Talk to Patients About DIY Orthodontics

The MDS encourages you to educate your patients about the benefits of an office visit and the potential risks of these remote DIY options, including bone loss and receding gums, loose teeth, a misaligned bite, and other issues.

Q: If my patient tells me they are considering DIY orthodontics and remote treatment through an online company, what should I tell them?

A: While many patients believe that direct-to-consumer orthodontics sounds simple, the American Association of Orthodontists has published a flier listing questions patients may first want to consider. You can download and print the flier to share with your patients or direct them to the list of questions posted at You can also share with patients the Summer/Fall 2019 edition of Word of Mouth, which features the cover story, "Online Orthodontics: Too Good To Be True?"

Q: What if my patients have already undergone DIY treatment and encountered problems?

A: If you have seen patients who have experienced injury or adverse results from using mail-order orthodontic devices or other DIY dental treatments, the MDS Dental Practice and Benefits Committee encourages you to direct them to the MDS website at, where they can locate contact information for reporting the issue to state and federal regulators.

Clinical Practice Guidelines

Dismissing a Patient

Preventing Opioid Misuse

Record Keeping

X-ray Frequency Recommendation

Terminating Network Participation

Deciding to terminate a relationship with an insurance company is a difficult decision. If you decide to move forward with terminating network participation, it is important that you inform your patients of your reasons for this decision. Most insurance providers will send letters to your patients suggesting the patient changes to a "network dentist" so don't let them have the last word. 

Send a letter to your corresponding patient base informing them that you are terminating participation, and explain your decision, what the change will mean, and the high value you place on the dentist-patient relationship. You may use the sample template provided here.

What to include in your letter:

  1. Thank you for being my patient. The relationship between a dentist and patient is a vitally important one based on trust, comfort, and communication.  
  2. My patient philosophy is [...]
  3. After long and careful consideration, I want to share with you that starting [insert date], I have decided to end my practice’s relationship with [company]. Most importantly, this decision does not change our relationship. Your insurance will still be accepted here. I will still continue to offer you all the advantages my practice has to offer. We will continue to work with you to process your benefit claims. 
  4. I decided to end my practice's relationship with [company] because [...] 
  5. Here’s what the change will mean for you. Because I am no longer an in-network provider, there could be an increase in treatment costs. Also, because [company] does not allow its members to assign benefits directly to their dental care providers, your insurance company may pay your benefits directly to you, which means that we may invoice you for payment. We can discuss these changes now or the next time we meet. But please know that we will continue to have your best interests in mind and value the relationship we have built.