Sir, it seems that N. Stanford has been using his letter published in the BDJ1 as a platform to campaign and make false statements on other social media sites including GDPUK2 against FastBraces. It is the height of hypocrisy for an officer of the British Orthodontic Society (BOS) to try and criticise any individual's website content when the BOS issued one of the most offensive and misleading dental adverts I have ever seen, in the national press (BOS advert, Guardian, 23 Feb 2013, p. 15), denigrating many GDPs doing patient-focussed orthodontics. Where were his advert objections to the ASA or any other body then? Where was the open BOS apology to the public and dental profession if any such 'crusade' is truly unbiased and unselfish?

Just to be crystal clear, claims made for FastBraces are based upon evidence-based medicine3 as encouraged by the Cochrane Collaboration. Having spoken to the ASA, they confirm only their full Council can make any determination of fact, not any informal goodwill process, and in any case the ASA criteria are entirely different to evidence-based medicine criteria for clinical care and services. Thus perhaps if the ASA Council assessed Class2 div2 orthodontic cases, for example, might they narrowly conclude that no advertised health benefits can be made for traditional orthodontic treatments, given doing 'nothing' produces just as good outcomes?4

It is notable that the public and professionals in the USA, where both legal and patient expectations generally are very high indeed, have no issues with Fastbraces' advertised claims made for the last 10 years, with many tens of thousands of FastBraces clinical results produced in just months, confirming they are extremely well established and evident in the 'real' world of frontline clinical experience and meeting patient wishes too. This is very reassuring for those whom may be new to FastBraces options in the UK.

Whilst my recent role as a UK Advisor for Fastbraces is simply pastoral for colleagues offering such options, it seems there is a significant small core of 'others' who believe GDPs should not be doing the majority of routine orthodontics in UK general practice. That is a great shame – it is not good to try and monopolise services/choices5 or oppress/suppress/scaremonger2 elsewhere – orthodontics is dentistry and like all other dentistry disciplines, the majority of routine cases should be done by competent GDPs and their teams, with our highly valued specialists mainly seeing the more complex cases suited to their more complex-training and expertise.6 Increasingly, patients want braces that are fast, comfortable and with minimal side-effects too.

Nicky Stanford responds: I'd like to thank the Editor for the opportunity to respond to the comments of T Kilcoyne, following my recent letter to the BDJ.

My letter was not part of a campaign against Fastbraces or those practitioners who use them but, as I stated in my letter, an attempt to bring to the attention of BDA members the potential pitfalls of advertising claims on their practice websites that might be misleading to the public. To do so could be contrary to the GDC's Principles of Ethical Advertising7.

I am not an officer of the BOS as T. Kilcoyne states, although in my position within the Training Grades Group of BOS, I work with other orthodontic trainees to develop educational study days for dentists on matters relevant to orthodontic training. The BOS advert to which T Kilcoyne refers was written before I even started my specialist training. Further, it is hard to consider one advert placed over three years ago as a 'crusade'. I do not consider my position to therefore be hypocritical in pointing out misleading aspects of Fastbraces' promotional literature.

Given that 'claims made for Fastbraces are based upon evidence-based medicine', I am unsure as to why this evidence is not quoted in T. Kilcoyne's letter. When one looks at the evidence presented on the Fastbraces American website8,

One aspect of note that T. Kilcoyne neglected to mention in his letter is that he is the director of the company against which my complaint was lodged, Smile Specialist/Smilespecialist Ltd. One would have thought the Advertising Standards Association would have been suitably 'advised' on the Fastbraces evidence base having received an 'extensive response' to my complaint. Even so, the complainant then removed the following misleading claims from their advertising:

'Fastbraces are truly fast braces that can give straight teeth faster and more comfortably than traditional orthodontic braces for both adults and children'

And

'Unlike many other tooth brace systems, Fastbraces are not just quicker, but use gentler forces ... with less friction so there are less issues with pain, sensitivity and root resorption and less of the side effects one can experience with traditional brace systems that often take two or three years of treatment.'

I find it difficult to reconcile T. Kilcoyne's attempts to 'reassure' UK dentists that the claims made by Fastbraces' American advertising are proven, whilst at the same time he is the director of a company that removed similar claims from their own advertising after investigation by the Advertising Standards Authority.

In summary, my concern is not about GDPs carrying out orthodontic treatment. I have no issues with any dentist with relevant training and experience providing orthodontic treatment with or without Fastbraces. It is that practitioners should be cautious when repeating claims made by any company in any UK advertising or promotional material.