NHS Orthodontic Practice Websites: Are GDC’s Guidelines on Ethical Advertising being met?

NHS Orthodontic Practice Websites: Are GDC’s Guidelines on Ethical Advertising being met? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research NHS Orthodontic Practice Websites: Are GDC’s Guidelines on Ethical Advertising being met? Daakshini Patel, Felicity Borrie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6871606/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aims To evaluate information on websites of solely orthodontic practices offering NHS treatment in Scotland against GDC’s Guidance on Advertising. Methods A systematic Google search was conducted to find all solely orthodontic practices offering NHS treatment in Scotland with websites. Websites were assessed for adherence to nine prerequisites of the GDC guidance. Results Of twenty-six practices assessed, only 8% of practices showed full compliance. Parameters with least adherence were provision of link to GDC website, a complaints policy and the date of last website update. Conclusions Adherence of orthodontic practice websites offering NHS treatment to GDC’s Guidance on Advertising was suboptimal. Health sciences/Health care/Dentistry/Orthodontics Background The UK has a very high proportion of internet users, with 96% of households having access to the internet ( 1 ). Widespread use of the internet has made websites the first point of contact with many patients looking for information on services, treatment options, and fees. Orthodontic practices, like many other healthcare providers, increasingly rely on websites to market their services. However, this raises significant regulatory concerns, particularly in terms of ensuring that advertising practises comply with professional standards. In the United Kingdom, the General Dental Council (GDC) provides comprehensive guidance on ethical advertising for dental professionals. The GDC's Guidance on Advertising ( 2 ) specifies that all promotional materials, including those on websites, should be clear, truthful, and not misleading. It seeks to ensure that advertisements do not exaggerate the capabilities of the services offered, the qualifications of practitioners, or potential results. Adherence to these guidelines ensures healthcare advertising remains honest and maintains the integrity of the profession and patient safety. Previous studies have indicated that orthodontic practices in the UK have fallen short of regulatory expectations, leading to misrepresentation or inflated claims about treatments, costs, and practitioner expertise ( 3 – 5 ). Many practices may be unaware of the detailed ethical requirements for online advertising or may inadvertently overlook important aspects of the GDC's guidance. The consequences of non-compliance are significant, as misleading advertising could undermine patient trust and compromise the ethical standards which govern the profession. In Scotland, there has been little research examining how well orthodontic practices adhere to the GDC's ethical advertising standards. This gap in research formed the basis for this focused study assessing whether orthodontic websites in Scotland are following the GDC’s Guidance on Advertising , whilst identifying common breaches. Understanding these dynamics is crucial not only for safeguarding public trust but also for informing future regulatory measures on orthodontic marketing. The aim of this cross-sectional study was to evaluate the publicly available information on websites of solely orthodontic practices offering NHS treatment in Scotland against the nine prerequisites outlined in the GDC’s Guidance on Advertising . Methods This study assessed information available in the public domain only, and hence ethical approval was not required. Search Criteria A systematic online search was conducted by two independent investigators to identify all orthodontic practices in Scotland. This was done by performing a Google search using terms such as “orthodontist in Scotland” or “orthodontic practice in Scotland.” In addition, search was conducted for specific regions within Scotland (e.g., "Edinburgh orthodontist," "Glasgow orthodontic practice" etc.) to capture all orthodontic practices across the country. Google search was chosen due to it’s almost 90% market share of all search engines ( 6 ) and the likelihood that most patients would prefer it over other search engines. Websites were then reviewed to exclude ones which offered only private treatment; did not have a website; or offered multi-speciality treatments, including general dentistry. Twenty six practices met the criteria and were included in the study. Each of the practice website was assessed by two against nine parameter of the GDC’s Guidance on Advertising : Name and Geographical Address of Practice : Whether the practice name and geographical address are clearly listed on the website. Contact Details of Practice : Whether the website provides clear contact information, including a phone number and/or email address. Clinician Qualification : Whether the qualification of the clinician(s) is stated on the website. Any specialist qualification will be cross-checked with the GDC website. Country of Qualification : Whether the country where the clinician(s) obtained their qualification is clearly stated. GDC Registration Information of Clinician : Whether the website includes the General Dental Council (GDC) registration number or a link to GDC’s verification system for the clinician. Link to GDC/Authority Website : Whether the website includes a direct link to the GDC or relevant regulatory authority’s website for further information. Practice’s Treatment Type : Whether the practice clearly states whether it provides NHS treatment, private treatment, or a combination of both. Date When the Website Was Last Updated : Whether the website includes the date of the last update (either explicitly or through a timestamp). Practice Complaints Policy : Whether the practice complaints policy is accessible from the website. The evaluation was structured using a standardised data collection form. The website was assessed on whether each parameter was clearly visible and easy to locate on the website. If the information was not readily available on the homepage, further navigation through the website was conducted to check for the presence of the required details. Each parameter was classified with a binary response (yes/no). If there was still uncertainty about the presence or clarity of a parameter, the evaluators erred on the side of "no." Results The results in Table 1 show only 8% of practice websites fully adhere to the GDC’s Guidance on Advertising . The rest demonstrated varying levels of compliance with website transparency and regulatory guidelines. All practices (100%) displayed their name, address, and contact details including phone numbers or email addresses. Similarly, 96% of practices listed the type of treatment provided, though one only made this information clear during the referral process. Only 88% of practices listed clinician qualifications and the country of qualification, while only 85% displayed the clinician’s GDC number. None of the 26 practices provided a link to the GDC register for patient verification as an acceptable alternative. Furthermore, only 27% of practices provided a link to the GDC, and only 50% displayed the date of last website update. A complaints policy was only provided by 50% of the websites. One non-complying practice had a link to a page displaying the message ‘coming soon’. Another provided an email address for complaints but failed to display the policy. Table 1 Practices fulfilling GDC ethical advertising guidelines parameters GDC Parameters Yes (%) No (%) Name & Address of Practice 100 0 Contact details of Practice 100 0 Clinician Qualifications 88 12 Country of Qualification 88 12 GDC Registration Information for clinicians 85 15 Link to GDC/Authority Website 27 73 Clearly stated if the practice provides NHS and/or private treatment 92 8 Date of last website update 50 50 Complaints policy 50 50 Discussion The demand for orthodontic services in Scotland is high and waiting times for NHS treatment remain lengthy ( 7 ). Given the high demand-supply ratio, patients and their families are likely to ‘shop’ for services on practice websites, which offer a critical source of information regarding treatment options, clinician credentials, and access pathways. Recognising this, the GDC has issued guidance on essential information that should be provided by dental service providers to keep marketing practices clear, honest and professional. Orthodontic practices offering NHS treatments are contracted by the NHS but privately owned, essentially meaning they are businesses that require competitive marketing to attract patients and referring clinicians. It is not surprising, therefore, that all practice websites (100%) clearly displayed their name and contact details. Some websites also offered online contact forms, demonstrating good accessibility in line with GDC standards ( 8 ). The majority of orthodontic practices offer both NHS and private treatment, which is acceptable to the GDC, provided patients are aware of available alternatives. Practice websites also form a vital part of patient consent, however only 92% of them clearly displayed the types of treatment available (NHS, private or a combination). Some websites were clearer and provided this information on the homepage. Others focussed on marketing their private treatments options on their homepage, but had NHS options mentioned on other pages, this was deemed acceptable. One practice offering a combination of both NHS and private failed to display this altogether, and the NHS option only became apparent when one initiated a referral. This could be an oversight, or simply an aggressive marketing strategy for private treatment, which is potentially misleading and conflicting with the GDC’s emphasis on patient understanding and informed consent. Unlike England, the NHS in Scotland does not have a commissioning system, resulting in a combination of specialists and general dental practitioners providing NHS Orthodontic treatment. As per the GDC, non-specialists can provide any dental treatment they feel competent performing, provided qualifications are not misrepresented. The term ‘specialist’ is understandably protected by the GDC for those who have undergone rigorous post-graduate training and are on their specialist register. To ensure transparency, the GDC advises practice websites display clinician qualifications, country of qualification and their GDC number or as an alternative, a link to the GDC register. This study found that only 88% of the practices displayed clinician qualification and country of qualification on their websites, and only 85% stated their GDC number. There could be multiple explanations for these, including practice owners’’ lack of awareness of the GDC guidance. It is also possible they fear displaying qualifications may encourage patients to choose one clinician over another. Furthermore, it has been shown that internationally qualified medical doctors are almost twice as likely to generate complaints ( 9 ), and one wonders if orthodontic service providers feel mentioning the country of qualification could encourage complaints Regardless, 12% of practices failing these parameters risk infringing on patients’ right to choose, one of the pillars of healthcare provision. The investigators verified the specialists against the register, and surprisingly, two practices listed general dentists as specialists, which would be considered dishonest if discovered by the GDC. Furthermore, one specialist listed on a practice website was no longer on the register. Given that only 50% of the websites showed the date of last update, this may be due to the website not being updated following clinician retirement or erasure. For complying practices, last update dates ranged from 2019 to 2025, exposing a risk not all information is current and accurate. Patient feedback is an important quality improvement measure, and the GDC expects practice websites to guide patients wishing to do so. However, only 50% of practice websites included a link to the complaints policy. This falls short of NHS Scotland’s expectations for patient rights, which includes clear and accessible information on how to raise concerns or make complaints ( 10 ). It is understandable that in this litigious society, providers wish to avoid complaints that can easily escalate. By omitting this information, are practice owners trying to reduce the risk of getting a complaint? This is further evident by the fact that only 27% of practices reviewed included a link to the GDC on their website. Instead, several displayed logos of non-regulatory associations such as the British Dental Association (BDA), which is not an acceptable alternative. Unfortunately, negative perception of the GDC by dentists ( 11 ) does not encourage patient-clinician dialogue and openness. A better relationship between the regulator and its registrants could help improve adherence to the advertising guidance, and in turn improve patient care. Conclusion Overall findings of this study suggest that while orthodontic practice websites in Scotland generally meet baseline expectations for accessibility, many fall short in areas of patient communication, information governance, and regulatory compliance. The study is limited to the specific information available on the practice website and does not account for other forms of advertising such as social media. However, the essence of the study remains, in a healthcare system which increasingly relies on digital tools to inform and guide patients, the quality of a practice website reflects professional standards and patient-centred care. It is vital that orthodontic service providers strive to maintain public trust in the profession by ensuring clear, accessible and accurate information is available on all professional digital platforms. References Office for National Statistics. Internet access – households and individuals, Great Britain [Internet]. 2020 [cited 2025 Apr 4]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetan dsocialmediausage/bulletins/internetaccesshouseholdsandindividuals/2020 General Dental Council [Internet]. 2013 [cited 2025 Apr 4]. Guidance on advertising. Available from: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/gdc-guidance-for-dental-professionals/guidance-on-advertising Alsaqabi F, Madadian MA, Pandis N, Cobourne MT, Seehra J. The quality and content of websites in the UK advertising aligner therapy: are standards being met? Br Dent J. 2023 Apr 25; Parekh J, Gill DS. The quality of orthodontic practice websites. Br Dent J. 2014 May;216(10):E21. Patel A, Cobourne MT. The design and content of orthodontic practise websites in the UK is suboptimal and does not correlate with search ranking. Eur J Orthod. 2015 Aug;37(4):447–52. Search Engine Market Share Worldwide | Statcounter Global Stats [Internet]. [cited 2025 May 28]. Available from: https://gs.statcounter.com/search-engine-market-share Public Health Scotland [Internet]. [cited 2025 May 23]. Available from: https://waitingtimes.publichealthscotland.scot/view-waiting-times/ General Dental Council [Internet]. [cited 2025 May 23]. Standards for the dental team. Available from: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team Demographics, professions and concerns: What are the patterns in Practitioner Performance Advice cases? [Internet]. NHS Resolution. 2023 [cited 2025 May 23]. Available from: https://resolution.nhs.uk/resources/demographics-professions-and-concerns-what-are-the-patterns-in-practitioner-performance-advice-cases/ The Charter of Patient Rights and Responsibilities My health, my rights, my NHS - Charter of patient rights and responsibilities - revised: June 2022 - gov.scot [Internet]. [cited 2025 May 23]. Available from: https://www.gov.scot/publications/charter-patient-rights-responsibilities-revised-june-2022/pages/2/ Understanding and evaluating early career dental professionals’ experiences of the General Dental Council [Internet]. [cited 2025 May 23]. Available from: https://www.gdc-uk.org/about-us/what-we-do/research/our-research-library/detail/report/understanding-and-evaluating-early-career-dental-professionals'-experiences-of-the-general-dental-council Additional Declarations There is no duality of interest Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6871606","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":472673573,"identity":"da48ab8b-ebdb-4c67-93a0-0f9e7eeea3a9","order_by":0,"name":"Daakshini Patel","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYBACewYGZgbGBgkGNgb+B0C+hRyDBAEthg1wLTwGDAcYJIxhWnDqNDgA1gJiQrQkNhDUcvzwY8OfOyzy+Bh4DD9/qJBI3y7d/oDxR41NHU4tZ9KMk3nPSBQD/fJY4sAZidydc84YMPMcS8PjsATjw4xtEoltDDwMEgfbJHI33MhhYGZsOIxby/nnnw/+hGhh/nHwn0S6wY30B4w/8Wm5kWOcwAvRwiZxsEEiweBGggEDLx4thjPeFBuDtTDzsFmcOSZhCHSYwWGgXyQbcGix50/fLPmzrS5xfnsP842KGht5oMMePgSGGD8uWxCAGYl9gLDyUTAKRsEoGAX4AABne1c89+LTnQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-3813-6531","institution":"Dr Grays Hospital","correspondingAuthor":true,"prefix":"","firstName":"Daakshini","middleName":"","lastName":"Patel","suffix":""},{"id":472673574,"identity":"1390be09-0b8e-43f4-8294-f47480579afb","order_by":1,"name":"Felicity Borrie","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Felicity","middleName":"","lastName":"Borrie","suffix":""}],"badges":[],"createdAt":"2025-06-11 12:00:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6871606/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6871606/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86672325,"identity":"60cc1266-d75b-4cb4-b99b-83a40ba662a0","added_by":"auto","created_at":"2025-07-14 11:39:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":381935,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6871606/v1/49b8635c-6273-40f6-a88e-584ecd114fb2.pdf"}],"financialInterests":"There is no duality of interest","formattedTitle":"NHS Orthodontic Practice Websites: Are GDC’s Guidelines on Ethical Advertising being met?","fulltext":[{"header":"Background","content":"\u003cp\u003eThe UK has a very high proportion of internet users, with 96% of households having access to the internet (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Widespread use of the internet has made websites the first point of contact with many patients looking for information on services, treatment options, and fees. Orthodontic practices, like many other healthcare providers, increasingly rely on websites to market their services. However, this raises significant regulatory concerns, particularly in terms of ensuring that advertising practises comply with professional standards.\u003c/p\u003e \u003cp\u003eIn the United Kingdom, the General Dental Council (GDC) provides comprehensive guidance on ethical advertising for dental professionals. The GDC's \u003cem\u003eGuidance on Advertising\u003c/em\u003e (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) specifies that all promotional materials, including those on websites, should be clear, truthful, and not misleading. It seeks to ensure that advertisements do not exaggerate the capabilities of the services offered, the qualifications of practitioners, or potential results. Adherence to these guidelines ensures healthcare advertising remains honest and maintains the integrity of the profession and patient safety.\u003c/p\u003e \u003cp\u003ePrevious studies have indicated that orthodontic practices in the UK have fallen short of regulatory expectations, leading to misrepresentation or inflated claims about treatments, costs, and practitioner expertise (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Many practices may be unaware of the detailed ethical requirements for online advertising or may inadvertently overlook important aspects of the GDC's guidance. The consequences of non-compliance are significant, as misleading advertising could undermine patient trust and compromise the ethical standards which govern the profession.\u003c/p\u003e \u003cp\u003eIn Scotland, there has been little research examining how well orthodontic practices adhere to the GDC's ethical advertising standards. This gap in research formed the basis for this focused study assessing whether orthodontic websites in Scotland are following the GDC\u0026rsquo;s \u003cem\u003eGuidance on Advertising\u003c/em\u003e, whilst identifying common breaches. Understanding these dynamics is crucial not only for safeguarding public trust but also for informing future regulatory measures on orthodontic marketing. The aim of this cross-sectional study was to evaluate the publicly available information on websites of solely orthodontic practices offering NHS treatment in Scotland against the nine prerequisites outlined in the GDC\u0026rsquo;s \u003cem\u003eGuidance on Advertising\u003c/em\u003e.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study assessed information available in the public domain only, and hence ethical approval was not required.\u003c/p\u003e \u003cp\u003eSearch Criteria\u003c/p\u003e \u003cp\u003eA systematic online search was conducted by two independent investigators to identify all orthodontic practices in Scotland. This was done by performing a Google search using terms such as \u0026ldquo;orthodontist in Scotland\u0026rdquo; or \u0026ldquo;orthodontic practice in Scotland.\u0026rdquo; In addition, search was conducted for specific regions within Scotland (e.g., \"Edinburgh orthodontist,\" \"Glasgow orthodontic practice\" etc.) to capture all orthodontic practices across the country. Google search was chosen due to it\u0026rsquo;s almost 90% market share of all search engines (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and the likelihood that most patients would prefer it over other search engines.\u003c/p\u003e \u003cp\u003eWebsites were then reviewed to exclude ones which offered only private treatment; did not have a website; or offered multi-speciality treatments, including general dentistry.\u003c/p\u003e \u003cp\u003eTwenty six practices met the criteria and were included in the study.\u003c/p\u003e \u003cp\u003eEach of the practice website was assessed by two against nine parameter of the GDC\u0026rsquo;s \u003cem\u003eGuidance on Advertising\u003c/em\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eName and Geographical Address of Practice\u003c/b\u003e: Whether the practice name and geographical address are clearly listed on the website.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eContact Details of Practice\u003c/b\u003e: Whether the website provides clear contact information, including a phone number and/or email address.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eClinician Qualification\u003c/b\u003e: Whether the qualification of the clinician(s) is stated on the website. Any specialist qualification will be cross-checked with the GDC website.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCountry of Qualification\u003c/b\u003e: Whether the country where the clinician(s) obtained their qualification is clearly stated.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eGDC Registration Information of Clinician\u003c/b\u003e: Whether the website includes the General Dental Council (GDC) registration number or a link to GDC\u0026rsquo;s verification system for the clinician.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eLink to GDC/Authority Website\u003c/b\u003e: Whether the website includes a direct link to the GDC or relevant regulatory authority\u0026rsquo;s website for further information.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePractice\u0026rsquo;s Treatment Type\u003c/b\u003e: Whether the practice clearly states whether it provides NHS treatment, private treatment, or a combination of both.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDate When the Website Was Last Updated\u003c/b\u003e: Whether the website includes the date of the last update (either explicitly or through a timestamp).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePractice Complaints Policy\u003c/b\u003e: Whether the practice complaints policy is accessible from the website.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe evaluation was structured using a standardised data collection form. The website was assessed on whether each parameter was clearly visible and easy to locate on the website. If the information was not readily available on the homepage, further navigation through the website was conducted to check for the presence of the required details. Each parameter was classified with a binary response (yes/no). If there was still uncertainty about the presence or clarity of a parameter, the evaluators erred on the side of \"no.\"\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe results in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e show only 8% of practice websites fully adhere to the GDC\u0026rsquo;s \u003cem\u003eGuidance on Advertising\u003c/em\u003e. The rest demonstrated varying levels of compliance with website transparency and regulatory guidelines. All practices (100%) displayed their name, address, and contact details including phone numbers or email addresses. Similarly, 96% of practices listed the type of treatment provided, though one only made this information clear during the referral process. Only 88% of practices listed clinician qualifications and the country of qualification, while only 85% displayed the clinician\u0026rsquo;s GDC number. None of the 26 practices provided a link to the GDC register for patient verification as an acceptable alternative. Furthermore, only 27% of practices provided a link to the GDC, and only 50% displayed the date of last website update. A complaints policy was only provided by 50% of the websites. One non-complying practice had a link to a page displaying the message \u0026lsquo;coming soon\u0026rsquo;. Another provided an email address for complaints but failed to display the policy.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractices fulfilling GDC ethical advertising guidelines parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDC Parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eName \u0026amp; Address of Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContact details of Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinician Qualifications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry of Qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDC Registration Information for clinicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLink to GDC/Authority Website\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClearly stated if the practice provides NHS and/or private treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDate of last website update\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplaints policy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe demand for orthodontic services in Scotland is high and waiting times for NHS treatment remain lengthy (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Given the high demand-supply ratio, patients and their families are likely to \u0026lsquo;shop\u0026rsquo; for services on practice websites, which offer a critical source of information regarding treatment options, clinician credentials, and access pathways. Recognising this, the GDC has issued guidance on essential information that should be provided by dental service providers to keep marketing practices clear, honest and professional.\u003c/p\u003e \u003cp\u003eOrthodontic practices offering NHS treatments are contracted by the NHS but privately owned, essentially meaning they are businesses that require competitive marketing to attract patients and referring clinicians. It is not surprising, therefore, that all practice websites (100%) clearly displayed their name and contact details. Some websites also offered online contact forms, demonstrating good accessibility in line with GDC standards (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The majority of orthodontic practices offer both NHS and private treatment, which is acceptable to the GDC, provided patients are aware of available alternatives. Practice websites also form a vital part of patient consent, however only 92% of them clearly displayed the types of treatment available (NHS, private or a combination). Some websites were clearer and provided this information on the homepage. Others focussed on marketing their private treatments options on their homepage, but had NHS options mentioned on other pages, this was deemed acceptable. One practice offering a combination of both NHS and private failed to display this altogether, and the NHS option only became apparent when one initiated a referral. This could be an oversight, or simply an aggressive marketing strategy for private treatment, which is potentially misleading and conflicting with the GDC\u0026rsquo;s emphasis on patient understanding and informed consent.\u003c/p\u003e \u003cp\u003eUnlike England, the NHS in Scotland does not have a commissioning system, resulting in a combination of specialists and general dental practitioners providing NHS Orthodontic treatment. As per the GDC, non-specialists can provide any dental treatment they feel competent performing, provided qualifications are not misrepresented. The term \u0026lsquo;specialist\u0026rsquo; is understandably protected by the GDC for those who have undergone rigorous post-graduate training and are on their specialist register. To ensure transparency, the GDC advises practice websites display clinician qualifications, country of qualification and their GDC number or as an alternative, a link to the GDC register. This study found that only 88% of the practices displayed clinician qualification and country of qualification on their websites, and only 85% stated their GDC number. There could be multiple explanations for these, including practice owners\u0026rsquo;\u0026rsquo; lack of awareness of the GDC guidance. It is also possible they fear displaying qualifications may encourage patients to choose one clinician over another. Furthermore, it has been shown that internationally qualified medical doctors are almost twice as likely to generate complaints (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), and one wonders if orthodontic service providers feel mentioning the country of qualification could encourage complaints Regardless, 12% of practices failing these parameters risk infringing on patients\u0026rsquo; right to choose, one of the pillars of healthcare provision.\u003c/p\u003e \u003cp\u003eThe investigators verified the specialists against the register, and surprisingly, two practices listed general dentists as specialists, which would be considered dishonest if discovered by the GDC. Furthermore, one specialist listed on a practice website was no longer on the register. Given that only 50% of the websites showed the date of last update, this may be due to the website not being updated following clinician retirement or erasure. For complying practices, last update dates ranged from 2019 to 2025, exposing a risk not all information is current and accurate.\u003c/p\u003e \u003cp\u003ePatient feedback is an important quality improvement measure, and the GDC expects practice websites to guide patients wishing to do so. However, only 50% of practice websites included a link to the complaints policy. This falls short of NHS Scotland\u0026rsquo;s expectations for patient rights, which includes clear and accessible information on how to raise concerns or make complaints (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). It is understandable that in this litigious society, providers wish to avoid complaints that can easily escalate. By omitting this information, are practice owners trying to reduce the risk of getting a complaint? This is further evident by the fact that only 27% of practices reviewed included a link to the GDC on their website. Instead, several displayed logos of non-regulatory associations such as the British Dental Association (BDA), which is not an acceptable alternative. Unfortunately, negative perception of the GDC by dentists (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) does not encourage patient-clinician dialogue and openness. A better relationship between the regulator and its registrants could help improve adherence to the advertising guidance, and in turn improve patient care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall findings of this study suggest that while orthodontic practice websites in Scotland generally meet baseline expectations for accessibility, many fall short in areas of patient communication, information governance, and regulatory compliance. The study is limited to the specific information available on the practice website and does not account for other forms of advertising such as social media. However, the essence of the study remains, in a healthcare system which increasingly relies on digital tools to inform and guide patients, the quality of a practice website reflects professional standards and patient-centred care. It is vital that orthodontic service providers strive to maintain public trust in the profession by ensuring clear, accessible and accurate information is available on all professional digital platforms.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOffice for National Statistics. Internet access \u0026ndash; households and individuals, Great Britain [Internet]. 2020 [cited 2025 Apr 4]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetan\ndsocialmediausage/bulletins/internetaccesshouseholdsandindividuals/2020\u003c/li\u003e\n\u003cli\u003eGeneral Dental Council [Internet]. 2013 [cited 2025 Apr 4]. Guidance on advertising. Available from: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/gdc-guidance-for-dental-professionals/guidance-on-advertising\u003c/li\u003e\n\u003cli\u003eAlsaqabi F, Madadian MA, Pandis N, Cobourne MT, Seehra J. The quality and content of websites in the UK advertising aligner therapy: are standards being met? Br Dent J. 2023 Apr 25; \u003c/li\u003e\n\u003cli\u003eParekh J, Gill DS. The quality of orthodontic practice websites. Br Dent J. 2014 May;216(10):E21. \u003c/li\u003e\n\u003cli\u003ePatel A, Cobourne MT. The design and content of orthodontic practise websites in the UK is suboptimal and does not correlate with search ranking. Eur J Orthod. 2015 Aug;37(4):447\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003eSearch Engine Market Share Worldwide | Statcounter Global Stats [Internet]. [cited 2025 May 28]. Available from: https://gs.statcounter.com/search-engine-market-share\u003c/li\u003e\n\u003cli\u003ePublic Health Scotland [Internet]. [cited 2025 May 23]. Available from: https://waitingtimes.publichealthscotland.scot/view-waiting-times/\u003c/li\u003e\n\u003cli\u003eGeneral Dental Council [Internet]. [cited 2025 May 23]. Standards for the dental team. Available from: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team\u003c/li\u003e\n\u003cli\u003eDemographics, professions and concerns: What are the patterns in Practitioner Performance Advice cases? [Internet]. NHS Resolution. 2023 [cited 2025 May 23]. Available from: https://resolution.nhs.uk/resources/demographics-professions-and-concerns-what-are-the-patterns-in-practitioner-performance-advice-cases/\u003c/li\u003e\n\u003cli\u003eThe Charter of Patient Rights and Responsibilities My health, my rights, my NHS - Charter of patient rights and responsibilities - revised: June 2022 - gov.scot [Internet]. [cited 2025 May 23]. Available from: https://www.gov.scot/publications/charter-patient-rights-responsibilities-revised-june-2022/pages/2/\u003c/li\u003e\n\u003cli\u003eUnderstanding and evaluating early career dental professionals\u0026rsquo; experiences of the General Dental Council [Internet]. [cited 2025 May 23]. Available from: https://www.gdc-uk.org/about-us/what-we-do/research/our-research-library/detail/report/understanding-and-evaluating-early-career-dental-professionals\u0026apos;-experiences-of-the-general-dental-council\u003c/li\u003e\n\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6871606/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6871606/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eTo evaluate information on websites of solely orthodontic practices offering NHS treatment in Scotland against GDC\u0026rsquo;s \u003cem\u003eGuidance on Advertising.\u003c/em\u003e\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA systematic Google search was conducted to find all solely orthodontic practices offering NHS treatment in Scotland with websites. Websites were assessed for adherence to nine prerequisites of the GDC guidance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf twenty-six practices assessed, only 8% of practices showed full compliance. Parameters with least adherence were provision of link to GDC website, a complaints policy and the date of last website update.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAdherence of orthodontic practice websites offering NHS treatment to GDC\u0026rsquo;s \u003cem\u003eGuidance on Advertising\u003c/em\u003e was suboptimal.\u003c/p\u003e","manuscriptTitle":"NHS Orthodontic Practice Websites: Are GDC’s Guidelines on Ethical Advertising being met?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-19 14:17:25","doi":"10.21203/rs.3.rs-6871606/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c91e66a8-4ed6-4cf6-b976-44f4f49581fc","owner":[],"postedDate":"June 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50198562,"name":"Health sciences/Health care/Dentistry/Orthodontics"}],"tags":[],"updatedAt":"2025-07-14T11:31:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-19 14:17:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6871606","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6871606","identity":"rs-6871606","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}