The Standards on Commissioning and Manufacturing Dental Appliances Consultation Ran For

Item 8

Standards Committee

17 February 2009

Use of titles and practice publicity

Introduction

1. We have always received queries about the use of titles and practice publicity, both when we issued prescriptive guidance in these areas and since the guidance was simplified. There has been an increase in these queries recently. Examples of the kinds of queries received include:

Use of title ‘doctor’ (Dr)

Use of the term specialistby DCPs

Advertisement of specialist dentistry by non-registered specialists

1. Current policy is that the title ‘Dr’ can be used by dentists as a discretionary courtesy title, providing that they ‘do not make any claims which could mislead patients’, as prescribed in principle 1.10 of the Council’s ethical guidance, Standards for Dental Professionals and so long as they make it clear that they are a registered dentist.
2. Since the opening of the new DCP registers there has been an increase in queries regarding the use of the term ‘specialist’ by DCPs. GDC Staff have received a number of copies of adverts, where DCPs have used the term specialist in descriptions of the service they are offering. ‘Denture Specialist’ is a term often used by dental technicians. An example of its use as part of the name of a company is attached as Annex A.
3. There have also been further requests for clarification on the use of specialist titles, such as orthodontist, by dentists not on a specialist list.

Discussion

‘Dr’ title

1. The Council does not use the title ‘Dr’ on practising certificates, in the Dentists Register or when communicating with dentists, unless the dentist concerned does, in fact, have a doctorate.
2. The current guidance that ‘Dr’ can be used as a discretionary courtesy title, when used by anyone other than those who have achieved a PhD or equivalent, was issued in 1995.
3. In March 2000 the Council’s Ethics Committee discussed a ruling by the Advertising Standards Authority (ASA) that dentistsshould not use the courtesy title in advertisements. The Committee reviewed the legal adviceavailable to the Council at the time the guidance was first issued and decided the Council’s guidance should remain unchanged.
4. On 22 October 2008, the ASAmade a further ruling that a dentist could not refer to himself as ‘Dr’ and that a practitioner could only refer to him or herselfas such if they were medically qualified or held a relevant PhD or doctorate qualification. A copy of the ASA adjudication is attached as Annex B.
5. The ASA enforce theadvertising standards codes, the main principles of which are that advertisements should not mislead, cause harm, or offend. Media owners agree not to run advertisements that breach the codes. When the ASA upholds complaints most advertisers agree to change or remove the advertisement.
6. In print media, for example the Yellow Pages, future publications will have advertisements removed; the advert will however remain in current print runs of the publication.
7. The ASA does not have the power to fine, they can only ask the media owners to take the advertisement down. The ASA's rulings are made independently of both government and the advertising industry,although itcan rely on the backing of the Office of Fair Trading and Ofcom should an advertiser persistently ignore its rulings.
8. The Committee is asked to note:

that the functions and remit of the Advertising Standards Authority and the General Dental Council are quite distinct. Neither body has jurisdiction over the other;

that the Council alone gives guidance to dentists on their professional conduct;

that the Advertising Standards Authority’s rulings do not oblige the Council to re-consider the guidance which the Council gives to dentists.

1. The use of the title ‘Dr’ when referring to a dentist is commonplace in most European states.

‘Specialist’ DCPs

1. Earlier cases of DCPs using the term ‘specialist’ were considered to bea possible breach of principle 1.10 of, Standards for Dental Professionals, by making a claim which could mislead patients and so were referred to the Investigating Committee. However, the Registrar and the Head of Standards issued policy guidance to the effect that not allowing DCPs to advertise a specialism in a certain area of dentistry unfairly discriminated against these registrants.
2. For dentists, there are 12 specialist lists which they may join if they undertake relevant postgraduate training in a particular area of dentistry. Dentists may only call themselves specialists if they are registered on one of the specialist lists.
3. There are no specialist lists for other registrant groups and so it is not possible for DCPs to be registered specialists in their field. The fact that there are no lists for DCPs also means that the use of the term ‘specialist’ is not legally restricted when used in relation to them.
4. We have seen clinical dental technicians using the term ‘denture specialist’ and a dental nurse in a sedation practice with a qualification in nursing under sedation has been described as ‘specialist dental nurse’.
5. DCPs are bound by the Council’s ethical guidance and must comply with the requirement not to make any claims which could mislead patients. Complaints about use of the word ‘specialist’ and similar fall to be considered under the Councils fitness to practise procedures, on a case by case basis, by reference to the generic standards in ‘Standards for Dental Professionals’.

‘Specialist’ titles

1. All dentists can work in a specialist area of dentistry, for example orthodontics, offering treatments which fall within the range of the specialist lists, without having to be registered on any of the specialist lists.
2. Equally, dentists can describe themselves as carrying out treatments such as periodontics or endodontics,without being on a specialist list. This is not misleading providing that they do not claim to be a specialist.
3. Dentistsmay for example, use the titles ‘orthodontist’ or ‘periodontist’, and is not required to state that he or she is not a specialist. Also, a dentist may state that they have a ‘special interest’ or ‘expertise’ in an area covered by a specialist list, even if they are not on the specialist list for it.

Equality and Diversity Implications

1. We do not believe that any of the decisions on use of titles by GDC registrants would impact unfairly on any particular role or roles within the dental team or on any group or groups of registrants.

Communications Implications

1. No requirement to issue new detailed guidance.

Standards Implications

1. Covered in the paper.

Recommendations

1. The Committee is asked to consider whether current practice regarding the use of titles and practice publicity remains appropriate.

Annex A

Annex B

ASA Adjudications

Ad
A magazine ad for Woodvale Clinic stated "DR JOHN W STOWELL L.D.S.R.C.S. (Eng) B.D.S. F.D.S R.C.S. (Edin) G.D.C. Registered Specialist in Surgical Dentistry and Oral Surgery". Text under the sub-heading "Dental and Facial Aesthetics" stated "Woodvale Clinic look forward to welcoming you for a comprehensive range of services to achieve an improved youthful and attractive appearance with the following treatments Whitening of teeth Bridges Dental Implants Crowns and veneers Facial fillers and Lip enhancements ... Associate Fellow of American Academy of Implant Dentistry ...".
Issue
The complainant challenged whether the reference to "Dr" misleadingly implied that the practitioner held a general medical qualification.

Response
Dental Protection (DP) responded on behalf of Woodvale Clinic. They believed the use of the title "Dr" in this context was not misleading, because it was clear from the ad that the practitioner was a General Dental Council (GDC) registered specialist in surgical dentistry and oral surgery.
DP explained that it was common practice in the UK and throughout the world for dentists to use the honorary title "Dr". They said this had not always been the case, however, but the position had changed over recent years and, with the enlargement of the European Community, dentists from Europe who were allowed to use the title in their home country were now free to work in the UK. DP believed, to disallow UK dentists from using the honorary title was, therefore, discriminatory.
They explained that the GDC had no objection to dentists using the title "Dr" and also that the title "Dr" was used by the British Dental Association (BDA) in written correspondence to its members and at all conferences and dentist meetings. DP appreciated that if members of the public were misled into believing dentists were medically qualified, this would be against public interest. They also believed, however, to deny the use of the title when others clearly used it, and its use was widespread around the world, was also against patients interest. They pointed out that a large number of medical practitioners did not have a doctoral MD or PhD qualification.
DP submitted several examples of dentist ads and literature in which the practitioner bore the title "Dr".
Assessment
Upheld
The ASA acknowledged DP's comments and understood their argument that the honorary title "Dr" was widely used. We also noted the ad clearly stated that the practitioner was a "Registered Specialist in Surgical Dentistry and Oral Surgery" and understood that, since 1995, the GDC had allowed dentists to use "Dr" as a courtesy title, providing they did not otherwise imply that they were qualified to carry out medical procedures.
We considered, however, that the title "Dr" before a practitioners name should not be used in ads unless the practitioner held a general medical qualification, a relevant PhD or doctorate (of sufficient length and intensity) or unless the similarities and differences between the practitioner's qualifications and medical qualifications were explained in detail in the ad. We noted from the list of qualifications included in the ad that the practitioner was not medically qualified and did not hold a relevant PhD or doctorate qualification.
Furthermore, we referred to the sub-heading "Dental and Facial Aesthetics" and accompanying text offering "a comprehensive range of services to achieve an improved youthful and attractive appearance" including "Facial fillers and lip enhancements". We considered, therefore, that it was not clear from the ad and list of treatments offered at Woodvale Clinic that, although he was a registered specialist in surgical dentistry and oral surgery the practitioner was not, in addition, medically qualified to conduct a wider range of procedures.
We concluded that the use of "Dr" in this context was ambiguous and could, therefore, mislead.
The ad breached CAP Code clauses 3.1 (Substantiation) and 7.1 (Truthfulness).
Action
The ad must not appear again in its current form. We told Woodvale Clinic not to use the title "Dr" in their ads, unless the practitioner was medically qualified or held a relevant PhD or doctorate qualification and advised them to seek a view from the CAP Copy Advice team before advertising again.
Adjudication of the ASA Council (Non-broadcast)