GDC scope change throws dental therapy into chaos

GDC guidance sparks indemnity crisis for dental therapists in orthodontics

The General Dental Council’s revised Scope of Practice Guidance, effective November 2025, has added orthodontic procedures as being outside the remit of dental therapists. What looks on paper like a technical clarification has already caused confusion and disruption in practices across the UK.

Therapists who have long supported Invisalign and other orthodontic workflows are finding themselves blocked by indemnity providers. One indemnifier has already confirmed in writing that they will not cover therapists for orthodontic tasks whereas previously this had been considered within their scope. Under those conditions, therapists are left unable to carry out the work — and many are having to turn patients away rather than risk practising without cover.

This abrupt change has placed principals in an impossible position. For years, dental therapists have been advised by indemnifiers they can be trained in practice to undertake elements of orthodontic treatment under the direction of dentists. Removing those duties pushes responsibility onto orthodontic therapists, a group who must train under specialists and - due to this bottleneck - are already in desperately short supply. As one principal remarked, “orthodontic therapists are like hens’ teeth” — highly sought after and virtually unavailable in many regions.

Indemnity organisations appear to have been caught off guard. Some have asked clinicians to set out their queries in writing, while others have simply declined cover altogether. Invisalign representatives have admitted they too have had no clarity from the GDC, despite lobbying for over five years to define training pathways for dental therapists in orthodontic support.

The result is chaos. Therapists are frustrated, dentists are left with gaps in workflow, and patients risk delays. With indemnity providers refusing “menu cover” — either you are insured for everything within your scope or nothing — many practices are stuck. Unless urgent clarification is issued, the new guidance may undermine the efficiency and profitability of clear aligner dentistry nationwide.

p.s. Could it get any worse?

As one therapist I spoke to commented, "The GDC have also indicated no pulp treatment on permanent teeth - so if a dental therapist happens to expose now, they have absolutely no way of treating the patient."