Ahead of the British Orthodontic Society's annual conference, taking place from 16-18 October in Birmingham, BDJ In Practice caught up with BOS President Nikki Atack to discuss the society's 30th birthday and the changing landscape seen within orthodontics.

As the society's 30th anniversary approaches, how would you reflect on its development and role in the discussion surrounding orthodontics?

The orthodontics landscape has changed dramatically over the last 30 years with the development of new techniques, ways of working (including the introduction of a new group of dental care professionals, orthodontic therapists), and the introduction of the 2006 dental contract as well as the changes in patients' awareness and expectations. Having a Society presenting clear orthodontic information and evidence-based advice for practitioners and the public is essential in, what can be, a confusing landscape. We would like to think that both our members and the public can contact the British Orthodontic Society (BOS) for evidence-based advice and guidance. Secondly, that public bodies and the Government would seek our views as orthodontic professionals before decisions regarding orthodontic matters are made. We do not claim to speak for all practitioners that undertake orthodontic practice, however we would like to think that the BOS presents one voice with clear messaging within this field of dentistry.

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Patient safety is foremost - what major changes have you seen in this area?

Patient safety should be at the heart of how we all practice orthodontics. Over the last decade, with the increased awareness of orthodontics, we started to see the explosion of DIY orthodontic treatment. This was often undertaken with no involvement from a dental professional. The BOS united with other organisations across the whole field of dentistry including the BDA, to lobby successfully for safeguards to be put in place for patients choosing to undertake this type of treatment.

In 2022 the BOS produced the guidance on teledentistry and remote interaction in orthodontic care. This guidance suggested a code of practice of how to integrate these new innovative technologies into routine practice whilst maintaining patient safety. Whilst we not a regulator, as a charity one of our charitable aims is to maintain and improve professional standards in orthodontics. With this in mind, the BOS produced our guide to professional standards in orthodontic practice in 2014 the aim of which was to underpin safe and ethical practice and, where possible, avoid the pitfalls of inappropriate or ill-advised treatment advice or teaching. Over the past 30 years we have worked with our members, dental organisations and external bodies to promote the study and practice of evidence-based high quality orthodontic care.

Is there one particular area or development you're most proud of?

Yes, the support for research within orthodontics through the British Orthodontic Society Foundation (BOSF). The foundation has provided over £1.5 million of funding since its foundation in 1999. In an era where research funding is increasingly challenging to obtain, we have funded research that has a direct impact on patient care. There has been a diverse range of funded projects from investigating the effects of treatment quality of life and health benefits to the effectiveness of different types of treatments regimes. The impact of this funded research can change the way we deliver care and through this initiative our members invest in the advancement of high-quality evidence-based orthodontic practice. It is disappointing, however, that in the recent revision of the orthodontic specialty curriculum approved by the GDC in December 2023 the need to complete a research element was changed. Historically, the UK has always been looked to as a global leader with our orthodontic training pathways. At a time when other European countries are striving for recognition of orthodontics as a specialty, it is vital that we encourage our future specialists to maintain the UK's strong tradition of high quality research through higher degree programmes with significant research components.

How would you describe the orthodontic landscape as we find it today?

In a nutshell? Challenging but with huge potential for the future. The demand for treatment has never been higher but, similar to the situation for general dental practice, some areas of the country are under-provided for access to NHS orthodontic services. In secondary care, my own area of work, this problem is becoming acute with units being unable to fill vacate consultant posts. Recruitment in some areas remains difficult which can result in long waiting times for patients to access advice and treatment.

You are the orthodontic lead for the dental undergraduate programme in Bristol. Is the future of orthodontics in good hands?

The simple answer to this is ‘Yes'. We have some amazingly talented students and new graduates coming through. In Bristol there has always been strong support for the integration of practical ‘hands-on' orthodontics as well as the theoretical teaching of the subject in the undergraduate teaching programme and this continues. Teaching dental students what is possible, what to watch out for and how to refer for advice/treatment is essential for their comprehensive dental education. Speaking as a Bristol graduate myself, Bristol Dental School has a strong tradition of encouraging the next generation of orthodontic specialists. Part of our role as educators is to inspire and enthuse new graduates to consider orthodontics as a career, this will maintain the strength of our specialty.

What is the biggest change you would like to see in the sector?

Like most of the profession, we would like to see a reform of the NHS Dental contract in England, currently this is not working to enable the provision of quality dental service for the UK population. In orthodontics some patients are struggling to access regular care during complex treatments as well as not being able to be referred in the first place. These difficulties may well be contributing to patients seeking to find their own solutions via suggestions on social media, taking dentists out of the equation altogether but this can lead to less than ideal outcomes.

The BOS would like to see policy makers seeking the profession's input when developing the model for the future and valuing our views on decisions over provision of care.

What do you think the next 30 years may have in store?

If only I had a crystal ball, advancements in clinical techniques, patient management systems and digital adjuncts to practice seems to be exploding exponentially. I think there are huge opportunities as we look at how we integrate these new digital technologies into our working orthodontic practices.

This has the potential to transform both how we deliver patient care and treatment modalities. Many practices are already well down the track of implementing digital workflows and it will be interesting to see how these new practises impact on the quality and efficiency of patient care. Worryingly I see the risk of some areas of practices/departments being left behind as this digital shift happens. The challenge will be taking the whole specialty along with these changes so all patients can benefit. ◆

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