Amid Protests, California Cracks Down on Dental Services Via Telehealth

California is cracking down on the use of direct-to-consumer telehealth for dental services.

Gov. Gavin Newsom this week signed into law AB 1519, which reauthorizes the Dental Board of California and includes restrictions on how dentists and orthodontic companies can use connected health technologies.

Industry advocates criticized the move, saying it gives an unfair advantage to traditional dentists by creating unnecessary burdens for online services. Even Newsom questioned the regulations, saying they should have been discussed more thoroughly before being tacked onto the bill.

The teledentistry battle is similar to that being waged over ocular telehealth. Several states have banned or strictly limited telehealth platforms for eye exams and contact lenses, saying the service should be conducted in-person or at least after an initial face-to-face exam. And recently, the US Food and Drug Administration ordered Chicago-based Visibly to recall its mHealth app for eye screening, saying the company hadn’t received clearance to market it.

Under the new law, which takes effect in 2020, teledentistry companies and online orthodontic services must obtain written or verbal permission to use telehealth and review a patient’s dental x-rays prior to treatment. In addition, the law states that online services must identify the dentist offering treatment and give patients a clear path to file complaints with the Dental Board of California.

The bill was supported by the CDA.

“The first of its kind in the nation, the new law will protect patients from DTC orthodontic companies that are putting profits before patients by taking potentially unsafe shortcuts to the accepted standards of care,” the organization said in a press release.

“Providing dental care to patients, especially moving teeth, without sufficient diagnostic information can potentially lead to serious patient harm, including loose or cracked teeth, gum recession and tooth loss,” the CDA added. “With emerging business models offering various dental services outside of a dental office’s four walls, including companies that provide direct-to-consumer orthodontic services, it is imperative that dental treatment continues to meet the standards of care.”

Among those opposed to the bill is the SmileDirectClub, a five-year-old Nashville-based provider of online dentistry services such as aligners and braces.

“While this bill does not preclude SmileDirectClub's continued operations in California, it will create unnecessary hurdles and costs to Californians that need care but struggle to afford it,” the company said in a press release. “The undebated, clinically unsupported, and ill-advised policy changes that are included in this bill - a bill that was intended to reauthorize the Dental Board of California until last-minute policy additions were added - have created arbitrary barriers to technological innovation.”

“There are no clinical studies or guidelines that affirm the mandatory radiography or other equivalent bone imaging requirement included in AB 1519,” the company continued. “Simply put, this bill represents the dental lobby's thinly-veiled attempt to protect traditional dentistry at the expense of Californians.”

In signing the bill, Newsom noted that the telehealth language was added to what was supposed to be simple legislation continuing the services of the Dental Board of California - a tactic called sunset legislation.

“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,” he said in a message attached to his signature. “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,” he added.