California Passes Dental Law Regarding Self-Applied Orthodontic Treatments

ST. LOUIS, Oct. 17, 2019 /PRNewswire/ -- On October 13, 2019, California Governor Gavin Newsom signed Assembly Bill 1519 into law, granting the California Dental Board continued authority to oversee and regulate dental services in the state.^[1] The bill passed the California legislature with zero no votes.^[2] As Governor Newsom noted in his signing statement, "The bill includes significant policy changes related to the regulation of self-applied orthodontic treatments administered via telehealth and other technological platforms."^[3] Some of these changes include:

• Requiring an electronic notice for patients receiving dental services through telehealth including a provision that the California Dental Board is the entity that regulates dentists and dental assistants and provides the telephone number and internet website of the California Dental Board. See Section 1611.3.
• Defining "[u]nprofessional conduct" to include a treating dentist's failure, prior to the initial use of orthodontic appliances, to review the patient's most recent radiographs (e.g. x-rays) or equivalent bone imaging. See Section 1680 (ah).
• Requiring individuals and entities providing dental services through telehealth to make available the name, telephone number, practice address, and California state license number of any dentist who will be involved in providing services to a patient prior to the rendering of services and when requested by a patient. See Section 1683.1.
• Prohibiting dental service providers from requiring patients to sign an agreement that limits the patient's ability to file a complaint with the California Dental Board. See Section 1683.2.
• Requiring that all laws and regulations governing professional responsibility, unprofessional conduct, and standards of practice that apply to a health care provider under the health care provider's license shall also apply to that health care provider while providing telehealth services. See Section 2290.5.

The American Association of Orthodontists (AAO) was a registered supporter of the bill and advocated for the bill's passage, believing it addresses several patient health and safety issues that may arise when orthodontic care is delivered through telehealth. Other stakeholders who were registered supporters of the bill, include the: California Association of Orthodontists, California Association of Dental Assisting Teachers, California Dental Assisting Association, California Dental Association, California Society of Dental Anesthesiologists, California Society of Pediatric Dentistry, California Society of Periodontists, California State Association of Endodontists, Children Now, Dental Hygiene Board of California, Dental Board of California, Latino Coalition for a Healthy California, and Dr. Paul Glassman.^[4]

Certain direct-to-consumer orthodontic companies were registered in opposition to the bill, including: Byte, Candid, SmileDirectClub, and SmileLove.^[5]

On October 14, 2019, SmileDirectClub issued a statement on Assembly Bill 1519 containing several assertions that the AAO disputes.^[6] These include SmileDirectClub's claim that "[n]othing in AB1519 requires SmileDirectClub to cease or modify its operations, and nothing regarding teledentistry in this legislation can take effect until the Board has given all stakeholders the opportunity to submit public comment and debate the merits of any proposed rules with clinically-based data ? as the Governor has requested in his signing statement."^[7] SmileDirectClub's statement appears to conflict with the fact that the Governor signed the bill and acknowledged that the "bill includes significant policy changes related to the regulation of self-applied orthodontic treatments administered via telehealth and other technological platforms."^[8] It also seems at odds with the Governor's signing message for this current legislation, which reads in its entirety^[9]:

To the Members of the California State Assembly:

I am signing Assembly Bill 1519, the Dental Board of California's sunset bill, which would extend the Dental Board's operations until January 1, 2024, granting the Dental Board continual authority to oversee and regulate dental services. The bill includes significant policy changes related to the regulation of self-applied orthodontic treatments administered via telehealth and other technological platforms.

It is essential for the safety of Californians and for the stability of the dental industry that the Dental Board be able to continue to operate. While I am signing this legislation, sunset bills are not the appropriate vehicle for policy changes that lack broad stakeholder input. 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.

Sincerely,

Gavin Newsom

Nothing in the above message or the new statute requires further input by stakeholders before this legislation goes into effect (rather, the Governor's comments pertain to future sunset bills).

Beyond Assembly Bill 1519, the field of dentistry and dental practices are subject to numerous laws and regulations.^[10] When it comes to certain dental issues, individuals and patients can choose to contact their state, territory, or provincial dental boards or authorities (https://www.aaoinfo.org/aao/state-dental-board-info) (last visited October 15, 2019), their state Attorney General's consumer protection office (https://www.usa.gov/state-consumer) (last visited October 15, 2019) or provincial consumer affairs office (http://www.consumerhandbook.ca/en/contacts/provincial-territorial-offices) (last visited October 15, 2019), regulatory agencies like the Food and Drug Administration ("FDA") ? (https://www.fda.gov/about-fda/contact-fda) (last visited October 15, 2019), and their elected officials (e.g. Governor, state representative, etc.) about such issues.

About the American Association of Orthodontists

The American Association of Orthodontists (AAO) has long held the position that orthodontic treatment is a complex medical process and that it is in the best, and safest, interest of the public to have that treatment conducted under the direct and ongoing supervision of a licensed orthodontist. To find an AAO orthodontist visit https://www.aaoinfo.org/locator.

The AAO is dedicated to, among other goals: (a) ethically advancing the art and science of orthodontics and dentofacial orthopedics worldwide; (b) improving the health of the public by promoting quality orthodontic care, the importance of overall oral healthcare, and advocating for the public interest; and (c) educating the public about the benefits of orthodontic treatment and the educational qualifications of orthodontic specialists. To this end, the AAO has developed a consumer alert that contains questions for potential patients to consider when researching direct-to-consumer orthodontic companies and previously published a press release regarding direct-to-consumer orthodontics.

^[1] See https://www.gov.ca.gov/wp-content/uploads/2019/10/AB-1519-Signing-Message.pdf; see also https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB1519.
^[2] See https://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml?bill_id=201920200AB1519.
^[3] See https://www.gov.ca.gov/wp-content/uploads/2019/10/AB-1519-Signing-Message.pdf.
^[4]See http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201920200AB1519, click on "09/12/19-Assembly Business And Professions," and go to page 16 (last visited October 14, 2019).
^[5] See http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201920200AB1519, click on "09/12/19-Assembly Business And Professions," and go to page 16 (last visited October 14, 2019).
^[6] See https://www.prnewswire.com/news-releases/smile-direct-club-statement-on-california-assembly-bill-1519-300937847.html.
^[7] See https://www.prnewswire.com/news-releases/smile-direct-club-statement-on-california-assembly-bill-1519-300937847.html.
^[8] See https://www.gov.ca.gov/wp-content/uploads/2019/10/AB-1519-Signing-Message.pdf.
^[9] See https://www.gov.ca.gov/wp-content/uploads/2019/10/AB-1519-Signing-Message.pdf. ^[10] See https://www1.aaoinfo.org/legal-advocacy/state-laws-and-regulations/ (last visited October 17, 2019).

SOURCE American Association of Orthodontists