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Dentists want to provide orthodontic care, orthodontists opposed

Braces on models of teeth.
Braces on models of teeth. Source: Della Reikop/ERR

Orthodontists and dentists in Estonia have found themselves at odds – dentists believe they, too, could also perform simpler orthodontic procedures, but despite being booked out for years, orthodontists disagree.

Most impacted by the lengthy waiting lists for orthodontic care are kids, for whom it would be unreasonable to wait months or even years to begin correcting the positioning of their teeth.

By law, only orthodontists are permitted to provide orthodontic care, however no explicit boundaries have been set regarding specific procedures – which is why dentists believe that they should also be able to do simpler orthodontic procedures, provided they have completed the relevant training.

"That is our offer – that dentists could also do simpler orthodontic work, meaning teeth straightening, alignment and without changing classifications," said Estonian Dental Association president Katrin Metstak.

Nonetheless, Triin Jagomägi, associate professor of orthodontics at the University of Tartu (TÜ), says that all dental anomaly-related work should be left to orthodontists.

"This is always a matter of liability," Jagomägi explained. "All fields have certain competences that can be achieved following studies and which an individual has acquired. If someone has acquired the relevant competencies, then they can operate within the limits of their competence and skills. Medical specialist training – this isn't three years; it's full-time studies. It's not like they're just sitting around."

The Ministry of Social Affairs likewise considers the waiting times for orthodontic treatment a problem, however they don't want to specifically regulate the field either.

"I don't think the solution here lies in amending the law right now," said Heli Paluste, healthcare network manager at the Ministry of Social Affairs.

"Rather, I'd like to encourage constructive discussion between parties," she continued. "It's possible that it's necessary to reach an agreement regarding coursework, such as what further training a dentist is required to have completed."

Dentists claim that orthodontists, who earn an average of more than €10,000 a month, aren't interested in sitting down to talk.

The Health Board has taken the latter's side as well. To date, the authority has issued precepts to three dental care providers where dentists have started aligner treatment.

According to attorney Ants Nõmper, there may be more precepts to come, and in order for anything to change, dentists should take legal action.

"This will have to be argued in court, if that's what they want," Nõmper said, adding that he is unaware of any current such lawsuit. "I believe the law is sufficiently clear regarding where the profession's boundary lies and what they are authorized to do."

What may be possible to do in the future is to update the curriculum for dentistry to include some degree of orthodontic procedures, the attorney acknowledged.

"But until this training is changed, it can't be interpreted any other way in the meantime," he added.

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Editor: Aili Vahtla

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