What You Don’t Know About Dentists May Hurt You
For most Americans, the assumption feels simple: if a medical or dental procedure is being offered in a professional office, it has likely been thoroughly tested, properly regulated, and performed by someone with extensive specialized training.
The reality is often far more complicated.
In many states, general dentists are legally permitted to perform a broad range of procedures, including orthodontics, certain surgical interventions, airway-related treatments, and complex appliance-based therapies, without completing the multiyear specialty residency programs required of orthodontists or oral surgeons.
For patients, however, those distinctions are rarely obvious.
“The public assumes one thing,” said Scott E. Charnas, founder of Charnas Law Firm, P.C., who has spent years litigating cases involving dental devices and appliance-related injuries. “The regulations technically allow another.”
That disconnect, Charnas argues, has quietly created one of the least understood oversight gaps in modern healthcare.
A Broad License and a Public That Rarely Understands It
The issue is not necessarily that general dentists are prohibited from performing these procedures. In many states, they are legally permitted to do so.
What patients often do not realize is that a provider offering orthodontic treatment may not actually be an orthodontist.
“When I was a kid and my parents took me to get braces, they took me to an orthodontist, not a dentist,” Charnas said. “So I was surprised to learn that a general dentist could legally perform orthodontic procedures.”
According to Charnas, many patients simply assume that if a provider is offering a specialized treatment, advanced specialty credentials must accompany it.
In some cases, that assumption can persist for years.
“Very recently, I had a conversation with a young woman who suffered serious damage from a dental appliance,” he said. “She referred to the provider as an orthodontist. I told her, ‘No, I have taken his deposition in several cases. He’s actually a general dentist.’ She was shocked. She believed she had been treated by an orthodontist the entire time.”
Former patients interviewed for this article described how easily that confidence can be built. One former patient from the greater Edmonton area recalled that the credentials displayed on her provider’s waiting room wall gave her “some reassurance.” The dentist had answered her questions and, she said, presented himself as experienced with the treatment. “I felt I was doing the right thing and wanted to believe him.”
The distinction matters because orthodontists and oral surgeons complete additional years of formal residency training beyond dental school, with supervised clinical experience specific to their specialties.
“Most people do not know that an orthodontist has to go to school for two to three more years beyond dental school,” Charnas said.
Yet in many states, the legal framework governing dentistry still permits general dentists to perform many of the same orthodontic procedures.
And despite differences in training, liability standards may not necessarily change.
“In the multiple states where I’ve litigated these cases,” Charnas noted, “a dentist performing orthodontics is held to the standard of an orthodontic specialist.”
The Rise of Appliance-Based Dentistry
Appliance-based treatments have drawn interest from patients seeking cosmetic improvements, relief from jaw problems, and treatment for airway-related concerns. Continuing education programs have helped introduce these treatments to dental practices, where they can also create substantial revenue opportunities.
“There are economic pressures on every profession,” Charnas said. “Dentistry is no exception.”
According to Charnas, appliance-based treatments can become highly lucrative.
“In regard to the AGGA device, I saw patients charged anywhere from $15,000 to as much as $60,000 for treatment,” he said. “Meanwhile, the actual device cost the dentist less than $500.”
AGGA, short for Anterior Growth Guidance Appliance, has become the subject of controversy and litigation. The device was marketed as a method of advancing an adult patient’s upper jaw, with claims that it could improve airway function, alleviate temporomandibular joint disorders, and enhance facial structure.
“There’s no scientific basis for any of this,” Charnas said. “It’s well established that you cannot advance an adult upper jaw without surgery.”
For patients, the sales pitch did not necessarily feel like a sales pitch. A former patient from Colorado said she had already trusted the dentist for other care. Two friends in her community were undergoing AGGA treatment, as were two dental professionals who worked in the office. Those signals, she said, made the treatment feel established rather than experimental.
“You just don’t go into your dentist’s office thinking they are going to sell you something that will harm you,” she said.
Nearly three years later, she said, her jaws were still not aligned, her bite remained off, and the desired tooth movement had not occurred. It was only then that she sought a round of second opinions.
According to Charnas, use of the device was taught through continuing education courses attended by dentists across the country and around the world. Those programs included courses offered through the Las Vegas Institute, or LVI, a dental continuing education organization.
Charnas says that years after courses promoting the appliance had already been taught, institute leadership acknowledged concerns about how the device’s function had been represented.
“The question becomes,” Charnas said, “why was that work not done before the course was offered—instead of after dentists had already returned home and installed these devices on patients?”
Continuing Education Versus Specialty Training
The debate surrounding AGGA has also raised broader questions about continuing education programs and the role they play in legitimizing emerging treatments.
Continuing education requirements for dental license renewal are established by state licensing authorities. Programs such as the American Dental Association’s Continuing Education Recognition Program, or CERP, and the Academy of General Dentistry’s Program Approval for Continuing Education, or PACE, recognize or approve continuing education providers. For example, the Dental Board of California’s requirements distinguish approval of a provider from approval of each individual course.
Charnas questions how deeply some organizations investigate the scientific validity of the treatments being taught.
“One has to wonder how often independent research is actually conducted,” he said, “as opposed to simply taking the word of the course proponent and cashing the check.”
Charnas recognizes the value of continuing education but believes there is a meaningful distinction between exposure to a concept and years of supervised specialty training.
That distinction may be especially important when treatments involve irreversible changes to the jaw or bite.
Former patients interviewed for this article described how personal assurances and professional affiliations reinforced their confidence in treatment. A New York patient said her provider’s explanation of how the appliance worked seemed convincing; learning that his own daughter had used AGGA strengthened her trust. An Alberta patient found additional reassurance in an LVI Facebook group, where dentists affiliated with the program answered patients’ questions. These experiences helped patients view the treatment as established and supported by professional expertise, without necessarily understanding the evidence behind it.
FDA Assumptions and Regulatory Reality
One of the most troubling misconceptions, according to Charnas, is the assumption that all dental devices have undergone meaningful FDA scrutiny before entering widespread clinical use.
Many patients assume that if a device is being used in a dental office, it must already be FDA approved.
That assumption, he says, can be dangerously incomplete.
“The FDA may not even have been made aware of the appliance, despite federal regulations requiring such product to be listed with the FDA,” Charnas said. “You may assume the FDA approved the product. You may assume that the dentist had specialized training. You may assume the courses they took had a scientific basis. But those assumptions may not be correct.”
A similar expectation of regulatory protection appeared in the account of a Canadian patient. She said she believed her dentist was a trustworthy health professional operating within a system that would prevent unapproved or unsafe treatments from reaching patients. Looking back, she said she had assumed her country would not allow an unproven, untested device onto the market.
In the United States, FDA registration and device listing are distinct from clearance or approval. The FDA expressly states that an entry in its registration and listing database does not mean a device has been approved, cleared, or authorized. FDA registration and listing guidance.
Medical devices are assigned to one of three regulatory classes based on their risks and the controls needed to assure safety and effectiveness. Class I includes the lowest-risk devices, while Class III includes the highest-risk devices. The requirements for premarket review depend on the device’s classification, intended use, and any applicable exemptions. FDA device classification guidance.
Charnas alleges that some dental appliances used in clinical practice were never properly submitted for FDA review. He points specifically to AGGA, which he says was marketed and taught extensively despite lacking meaningful scientific validation.
In a March 30, 2023, safety communication, the FDA identified AGGA and several similar appliances as devices of concern. The agency stated that their safety and effectiveness for treating obstructive sleep apnea or temporomandibular joint disorders, or for remodeling the adult jaw, had not been established, and that the devices had not been cleared or approved for those uses. It also described reports of serious complications, including tooth displacement, bone erosion, and tooth loss. FDA safety communication.
“Informed consent only works if patients understand the actual risks and benefits of the proposed treatment,” he said.
What Patients Should Ask
Charnas believes patients considering orthodontic, surgical, or appliance-based treatments should ask more detailed questions before proceeding.
Among them:
Are you trained in this specialty, and where?
How many cases like mine have you performed?
Are there peer-reviewed studies supporting this treatment?
Are there clinical trials demonstrating safety and efficacy?
Has this product been reviewed or cleared by the FDA for this use?
“If a provider becomes annoyed by those questions,” Charnas said, “that itself may tell you something.”
He also urges patients not to confuse marketing language with scientific validation.
“A seminar approval or continuing education certification does not necessarily mean a product has strong scientific support,” he said.
The patients interviewed for this article arrived at similar advice through their own experiences. A New York patient said she now wishes she had sought second, third, or even fourth opinions and looked more closely for peer-reviewed research before agreeing to treatment.
“Even if you consider yourself intelligent and someone who does ask questions, don’t take things at face value,” she said. “Dig deeper.”
The Transparency Gap
For Charnas, the larger issue is not necessarily whether dentists should be allowed to expand beyond traditional procedures.
The issue, he argues, is transparency.
Patients often believe multiple layers of oversight exist, from specialty credentialing to FDA review to dental board enforcement. Charnas argues that, in practice, those protections may be fragmented, inconsistent, or heavily dependent on self-regulation.
“You may assume someone is protecting the consumer, when no such protection may exist,” Charnas said. “By the time a lawyer gets involved, the damage has already occurred.”
That, he believes, is the central problem modern dentistry has yet to fully confront: the gap between patients’ perception of competence, training and oversight, and what is too often reality.
