Dr Michael Mew v The General Dental Council [2026] EWHC 1116 (Admin)

[2026] EWHC 1116 (Admin)

IN THE HIGH COURT OF JUSTICE

KING’S BENCH DIVISION

ADMINISTRATIVE COURT

Venue Royal Courts of Justice, Strand, London, WC2A 2LL

Date 15/05/2026

Before

CHARLES BAGOT KC, sitting as a Deputy High Court Judge

Between

DR MICHAEL MEWAppellant

THE GENERAL DENTAL COUNCILRespondent

Stephen Vullo KC instructed by Twelve Tabulae Ltd for Appellant

Lydia Barnfather instructed by Capsticks LLP for Respondent

Hearing Hearing dates: 20, 21, 22 January 2026; further written submissions to 26 February 2026 and email communications to 30 April 2026.

Draft circulated: 8 May 2026

Parties’ corrections on draft & submissions on costs received: 13, 14 and 15 May 2026

Approved Judgment

[1]This is an appeal against a decision of the Professional Conduct Committee (“PCC”) of the General Dental Council (“GDC”), of 6 November 2024, by which it decided that the Appellant Registrant’s (“Dr Mew”) fitness to practise was impaired by reason of misconduct and erased his name from the Dentists’ Register. The charges related to advice and treatment provided, and claims made on dates between September 2013 and May 2019.

[2]There were no less than 46 days of hearings before the PCC, spread across a two-year period from 14 November 2022 to 6 November 2024 (indeed the matter was first listed in December 2021 but removed from the list at the Appellant’s request as he was not ready). I will say more about the length, spread, and proportionality of those hearings later in this judgment.

[3]The Appellant was, prior to the order for erasure, registered with the Respondent GDC as a Specialist Orthodontist. He was also the owner of and principal practitioner at a private clinic which provided forms of treatment which have become known under the umbrella term “Orthotropics”.

[4]The appeal was brought under section 29 of the Dentists Act 1984 (“the Act”) principally against the PCC’s findings of fact; however, given that it was submitted the PCC’s findings of fact were wrong, this appeal was also brought against the PCC’s consequent findings of misconduct and impairment of fitness to practise and also of sanction. The Respondent to the appeal is the GDC.

[5]I am grateful to all the parties’ legal teams for their assistance in the preparation of this matter and the extensive documents, as well as the written and oral submissions of both Counsel. I have received further communications, submissions and documents since the oral hearings, on 20-22 January 2026, about the approach the parties invite me to take to the appeal, the application to adduce further evidence on appeal, and in relation to a query about the Grounds of Appeal, up to and including an email received on 30 April 2026.

[6]Although it is not realistic or necessary to mention or rule upon every point raised in oral and written submissions in this judgment, I have taken them into account when reaching my conclusions, alongside the pertinent evidence. II. THE BACKGROUND

[7]The Appellant was the only practitioner offering “Orthotropic” treatment (which was originated by his father) in the UK, although there was evidence that forms of Orthotropic treatment albeit with material differences from that practised by the Appellant were being offered in other countries, including the USA and Australia. Dr Mew described himself as “probably the world’s expert” in Orthotropics.

[8]The PCC noted [B1/50/8] that Orthotropic Treatment is not recognised or available within the NHS nor recognised as a speciality by the GDC.As an extensive trainer and well-known proponent of Orthotropics, many Orthotropic practitioners appear to have had some professional contact with the Appellant. The Appellant accepted that it is outside the mainstream, remains a controversial approach, with a limited evidence base.

[9]On the Appellant’s case, the central premise underpinning Orthotropic treatment was that, rather than genetics being the sole or primary cause, environmental factors were the predominant cause of malocclusion (i.e. imperfect positioning of the teeth when the jaws are closed, which can lead to functional and aesthetic dental problems). Therefore, effecting environmental change early in development whilst a patient was still growing, could prevent or improve malocclusion. The phrase ‘Orthotropic treatment’ was in fact simply a label for a suite of treatments that were widely practiced in mainstream dentistry/orthodontics, those treatments being: the use of bi-maxillary expansion; functional devices to affect the posture of the mouth and the use of myofunctional exercises, which were also aimed at affecting the posture of the mouth; as well as improving the strength of the muscles around the mouth and jaws. Orthotropics was merely the use of all three treatments based on the philosophy that environmental changes could bring about change to the structures of the mouth and face. Whilst there were very limited studies specifically on Orthotropics, there was on the Appellant’s case before the PCC, a significant body of mainstream scientific evidence to support the efficacy of all the constituent parts of the treatment.

[10]As the PCC noted, related to the hypothesis of Orthotropics was the concept of “Cranio-facial Dystrophy” (an environmentally driven lengthening of the face). Orthotropics was defined on the Appellant’s Clinic website as " ... a branch of dentistry that specialises in treating malocclusion by guiding growth of the facial bones and correcting the oral environment. This treatment creates more space for the teeth and tongue. The main focus of this treatment is to correct patients oral and head posture".

[11]The Respondent would also draw attention to the Appellant’s belief that by his treatment he could influence the growth of a child’s craniofacial complex and bring about permanent changes in structure and form resulting, amongst other things, in what he considered more aesthetically pleasing faces, the self-alignment of all 32 teeth and the amelioration of sleep disorders and improved cognitive functioning. He believed if he commenced treatment when children were five or six years old, he could obtain “a complete correction” of what he diagnosed as their “craniofacial dystrophy”. The treatment was, on his own account, predicated on a controversial hypothesis and was arduous, complex, lasted for many years and carried recognised risks of harm. The Respondent would underline that the two young patients, whose treatment gave rise to the bulk of the charges, had normal occlusions and normal craniofacial growth. III. THE CHARGES

[12]The charges were set out in full starting at the second page of the PCC’s decision [B1/43] and reproduced as Appendix A to this judgment. They focussed on the absence of a proper basis or justification for the Appellant’s treatment claims and the treatment provided to Patients referred to as A and B, between September 2013 and May 2019.

[13]The relevant GDC Standards, which the charges engaged, were set out in various passages including within the PCC determination at [B1/110/162-164]. These included Standards 1.3.3: “You must make sure that any advertising or promotional material or other information that you provide is accurate and not misleading’; Guidance on Advertising vi): “avoid claims intended or likely to create an unjustified expectation about the results you can achieve”; Standards 7.1: “Provide good quality care based on current and authoritative guidance”; Standards 7.1.2: “If you deviate from established practice and guidance you should record the reasons and be able to justify your decision”.

[14]The 30 charges (admissions being made to 17 of them: 1(a), 1 (b), 2(a), 2(b), 7, 8, 22 and 25 in advance and via Counsel at the hearing, contextual admissions being made to: 3(a) to 3(f), 4, 11(a) to 11(c), 12, 13(a) to 13(c), 16(b), 18(a) to 18(d),19(a) to 19(c), 20, 23(a) to 23(d), 27, 29(a) and 29(b)), can be categorised thus:a. Charges 2 – 15 related to the treatment provided to Patient A between 2016 and 2019,which included upper and lower expansion appliances and head and neck gear, together with claims made about her treatment.

b. Charges 16 – 28 related to similar treatment provided to Patient B in 2018 (and an impression taken in 2013), together with claims made about his treatment.

c. Charges 29 and 30 related to statements made by the Appellant in a video posted on the Appellant’s YouTube channel in September 2017.

[15]The PCC accurately summarised the charges as follows [B1/50/13-16]:

“13. The allegations against you relate to the provision of Orthotropic Treatment to two young patients (Patient A and Patient B) and the promotion of your treatment philosophy by way of inappropriate and misleading claims. It is alleged the misleading claims were made to the patients' parents in correspondence as well as to the public via a YouTube video titled, 'Orthodontics Beyond the Teeth ... '. The allegations centre on claims made concerning the need for treatment, your diagnoses, and the assertions you made about the benefits and outcomes of Orthotropic Treatment, specifically for Patients A and B. 14. The children's parents were allegedly told by you that your treatment would remedy purported defects in facial form and growth, alleviate breathing and sleeping disorders, and cause the teeth to naturally align. The GDC allege that there was no clinical indication for the treatment proposed and that the claims made in respect of the aims and outcomes of Orthotropic Treatment to the parents, as well as the claims made on YouTube, were inappropriate and misleading given the absence of a proper evidential basis in support of them. The GDC further allege that you went so far as suggesting in your You Tube video that Orthotropic Treatment could expand the brain. 15. The GDC allege that Patients A and B both underwent treatment with you from the age of six years, commencing in 2016 and 2018, respectively. It is alleged that an earlier failed attempt to initiate treatment for Patient B occurred when he was only two years old. It is alleged that the Orthotropic Treatment provided was demanding of the patients and involved the provision of both upper and lower removable 'arch expansion' appliances, as well as head and neck gear together with exercises. Patient A, whose mother remains a supporter of your treatment, still continues to undergo treatment with you. Patient B's treatment with you ceased within four months, after his parents were concerned about the alleged harm being caused to Patient B. 16. It is alleged that Patient A was seen by a Consultant Oral and Maxillofacial Surgeon (Witness 1) on 8 May 2017 after you had recommended that she underwent a lingual tongue-tie release. Witness 1 has stated that he became concerned that the Orthotropic Treatment Patient A was undergoing was causing her harm. As a result, Witness 1 was so concerned about Patient A he reported the matter to the GDC on 12 May 2017.” young patients (Patient A and Patient B) and the promotion of your treatment philosophy by way of inappropriate and misleading claims. It is alleged the misleading claims were made to the patients' parents in correspondence as well as to the public via a YouTube video titled, 'Orthodontics Beyond the Teeth ... '. The allegations centre on claims made concerning the need for treatment, your diagnoses, and the assertions you made about the benefits and outcomes of Orthotropic Treatment, specifically for Patients A and B. remedy purported defects in facial form and growth, alleviate breathing and sleeping disorders, and cause the teeth to naturally align. The GDC allege that there was no clinical indication for the treatment proposed and that the claims made in respect of the aims and outcomes of Orthotropic Treatment to the parents, as well as the claims made on YouTube, were inappropriate and misleading given the absence of a proper evidential basis in support of them. The GDC further allege that you went so far as suggesting in your You Tube video that Orthotropic Treatment could expand the brain. the age of six years, commencing in 2016 and 2018, respectively. It is alleged that an earlier failed attempt to initiate treatment for Patient B occurred when he was only two years old. It is alleged that the Orthotropic Treatment provided was demanding of the patients and involved the provision of both upper and lower removable 'arch expansion' appliances, as well as head and neck gear together with exercises. Patient A, whose mother remains a supporter of your treatment, still continues to undergo treatment with you. Patient B's treatment with you ceased within four months, after his parents were concerned about the alleged harm being caused to Patient B. Surgeon (Witness 1) on 8 May 2017 after you had recommended that she underwent a lingual tongue-tie release. Witness 1 has stated that he became concerned that the Orthotropic Treatment Patient A was undergoing was causing her harm. As a result, Witness 1 was so concerned about Patient A he reported the matter to the GDC on 12 May 2017.”

[16]Anyone reading the transcripts of the PCC hearings or listening to the Appellant’s evidence and submissions on his behalf below and on appeal could be forgiven for thinking that “Orthotropics” was on trial. That analysis and approach was how the Appellant sought to re-frame the charges in the narrative argument at [B1/16/11]:

“Whilst superficially these charges appeared to focus solely on treatment provided to two specific patients, in reality the GDC’s case amounted to an all-out attack on the legitimacy of orthotropics as a treatment philosophy.”

out at paragraph 7 and/or 8:

[17]By contrast, in my judgment it was Dr Mew, not the GDC, who viewed these proceedings as an opportunity to have a public debate about and seek vindication for Orthotropics. This was the major factor in prolonging the underlying hearings, which as I discuss later in this judgment, became disproportionate in length, scope, and no doubt cost. It was no part of the role of the PCC and was not within its jurisdiction to make broader findings and determine the legitimacy of Orthotropics.

[18]In any event, that could not realistically be done as, on the Appellant’s (and his orthodontic expert’s) own evidence, Orthotropics was carried out in different ways, to patients at significantly different ages (children or adults), using different devices, with differing aims, by different practitioners. The Appellant styled himself as ahead of and more advanced than others, deploying the principles in his own unique way.

[19]As I also discuss later, with hindsight, the PCC should have had greater confidence to exercise firmer case management and timetabling rigour to retain a proper focus on the charges, rather than the proceedings at times descending into an academic battleground over Orthotropics.

[20]It is essential for the proper and proportionate consideration and resolution of this appeal, as it was for the PCC hearings, not to treat it as a trial of Orthotropics. It is an appeal against the PCC’s determination of allegations of misconduct specific to this Appellant’s treatment of two young patients and specific treatment claims on YouTube.

[21]The charges were entirely properly focussed on the Appellant’s own conduct, what he purported to identify as the indications for treatment in Patient A and Patient B, as well as the specific claims he personally made with regards to the aims and benefits of the treatment he proposed and carried into effect for them. IV. THE WITNESSES AND EVIDENCE RECEIVED

[22]In addition to the Appellant, the witnesses whose evidence was heard or received by the PCC were:a. Witness 1 – Mr Keith Altman, maxillo-facial consultant who saw Patient A and raised concerns.

b. Witness 2 – Dr Aliyah Janmohammed, dentist employed by the Appellant and involved in the treatment of Patient B.

c. Witness 3 – Dr Alison Murray, orthodontist and former President of the British Orthodontic Society (“BOS”).

d. Witness 4 – Patient A’s mother.

e. Ms Lucinda Hawthorn – the Solicitor for the Appellant from Twelve Tabulae.

f. Dr Stephen Powell – orthodontic expert for the Respondent.

g. Mr Keith Smith – maxillo-facial expert for the Respondent.

h. Prof. Daniele Garcovich – orthodontic expert for the Appellant.

i. Prof. Stephen Sheldon – paediatric sleep expert for the Appellant.

j. Dr Simon Wong – private dental practitioner in Australia and a former trainee and friend of the Appellant.

[23]As well as reports from the experts, there were also Experts’ Joint Statements prepared by:a. Dr Powell, Mr Smith, and Prof. Sheldon; and

b. Dr Powell, Mr Smith, and Prof. Garcovich.

[24]In terms of documents, as set out at [B1/97-105], in addition to attachments to statements, the PCC also had variously:a. The footage and transcript for two YouTube videos, entitled 'Orthodontics Beyond the Teeth' and the second entitled, ‘A response to Mike Wertheimer';

b. Some dental and hospital records for Patients A and B;

c. A thesis titled 'Skeletal and Dental Changes from the Compliance-based Orthotropic Treatment Approach with Exercises to Improve Orofacial Posture' carried out by Dr Faraz Tavoossi (“the Tavoossi Thesis”);

d. An abstract of an unpublished thesis titled 'The Effects of Early Biobloc Treatment on Hyper Divergent children' (“The Harvey Abstract”); and

e. Historical character references provided in support of the Appellant’s case from Prof. Sheldon and Prof. Garcovich, both of which were prepared prior to their engagement as experts in this case. V. THE PCC’s DETERMINATION

[25]I have introduced the PCC proceedings above, including the key dates and their duration, the charges and admissions made, plus the witnesses heard or read. The full determination is to be found at [B1/42 to 116]. It is a comprehensive and considered document, reflecting the duration of and detailed evidence heard at the PCC hearings. It runs to 197 paragraphs across 75 pages.

[26]The PCC set out the background at [8-12] of its determination. In the section of this judgment above dealing with the Charges, I have reproduced the PCC’s summary of the allegations at [13-16] in the determination.

[27]The PCC then set out under a series of headings a review and its determinations, previously made, of various interim applications heard during the underlying hearings, ruling on various matters such as repeated applications to adduce further evidence and a submission of no case to answer: see [18-95].

[28]The PCC then outlined at [96-105] the evidence it had heard and read, as summarised in the preceding section of this judgment.

[29]At [106] the PCC summarised its approach, confirming that it had taken into account all the evidence presented to it, the submissions heard, and the advice of its Legal Adviser. It appropriately noted that it had considered each allegation separately and correctly directed itself that the burden of proof was on the GDC, that the standard of proof was the civil standard, namely, whether the alleged matters were found to be proved on the balance of probabilities.

[30]The PCC then chose to set the context for its findings by outlining its broad views on the following 8 points at [107-140]:• Orthotropics;

• Expert Evidence;

• The Tavoossi Thesis;

• The Harvey Abstract;

• The Jaw Epidemic;

• Clinical Indication;

• Adequate Objective Evidence;

• Application of The Bolam/Bolitho Test.

[31]As the challenge to the PCC’s findings arising from the expert evidence is central to the primary challenge made on appeal, it is appropriate to reproduce the PCC’s observations under the “Expert Evidence” heading, whilst noting that this was not the only part of the determination which considered that evidence. There was a review of it in the context of the ruling on the no case to answer submission, at [44] onwards. It was also discussed within most of the rulings on the charges at [141] and in the summary of the findings at [144-151].

[32]In addition to those other references, the PCC observed as follows under this heading: “Expert Evidence

[112]Turning to the question of expert evidence generally, the Committee reminded itself of the guidance provided by the Legal Adviser. Given the volume of information and evidence in this case, the Committee found it beneficial to outline its thinking on the expert opinion, both generally and individually. There are four experts in this case: Mr Powell and Mr Smith, instructed by the GDC, and Professor Garcovich and Professor Sheldon, instructed by you. No expert has been called by you who purports to be a specialist or practises in Orthotropics, although the Committee has of course heard from you on this issue.

itself of the guidance provided by the Legal Adviser. Given the volume of

[113]The Committee has carefully weighed and considered the expert evidence before it. It had some criticisms of both Mr Powell and Mr Smith in the way that they presented their evidence. However, it felt that this was outweighed by their skill, experience and expertise as detailed below.

[114]In relation to Professor Garcovich and Professor Sheldon, the Committee also had concerns about their evidence. Professor Garcovich is a friend of yours and prepared a character reference for you in these proceedings prior to being instructed as your expert. It had similar concerns about Professor Sheldon. He too acted as a character referee for you in these proceedings before being instructed as your expert.

had concerns about their evidence. Professor Garcovich is a friend of yours and

[115]Further, neither Professor Garcovich nor Professor Sheldon seemed to be familiar with the formal requirements of acting as an expert in proceedings of this nature or the obligations of experts as set out in the legal advice given to the Committee and highlighted in the case of 'The lkarian Reefer' as recently applied and discussed by Mr Justice Cotter in the case of Brian Muyepa v MOD

(2022) EWHC 2648

. This may very well be because of their lack of familiarity with the responsibilities of being an expert in disciplinary proceedings in the UK or general regulatory inexperience.

familiar with the formal requirements of acting as an expert in proceedings of this

[116]On balance, the Committee found Mr Powell and Mr Smith to be the more persuasive experts. That is not to say that it did not accept in part, and in relation to some of the issues in the case, the evidence of Professors Garcovich and Sheldon. Mr Stephen Powell

[117]The Committee had regard to Mr Powell's full CV. It considered that he is an Orthodontist with many years' experience and he is well-qualified to provide expert evidence in this case. The Committee did note, however, that he was firm in his view that genetic factors are the main cause of malocclusion, and he appeared unwilling to consider alternative views. Mr Powell was very clear about the hierarchy of evidence and the required standards of objective evidence, consistently stating the primacy of the randomised control trial. However, Mr Powell also showed even-handedness by taking the Committee to the Proffit textbook on a number of occasions ('Contemporary Orthodontics', 2018). Proffit's book is one of the most well-respected texts within Orthodontics, together with Graber's textbook ('Orthodontics: Current Principles and Techniques', 2023). Proffit is clear on the need for evidence but also the acceptability of using clinical assessment where the evidence is lacking. Mr Keith Smith

Orthodontist with many years' experience and he is well-qualified to provide

[118]The Committee noted that Mr Smith's CV and experience in Maxillofacial surgery qualified him to opine on facial structures and maxillofacial matters. They considered him less well qualified to opine on orthodontics. The Committee also found at times, as noted in its 'No Case To Answer' determination, dated 19 July 2023, that Mr Smith made some unfortunate comments during his oral evidence, relating to assertions of your involvement with the Kahn paper ('The Jaw Epidemic'). These assertions, for which he apologised, were later withdrawn. Nonetheless, it noted that he was willing to disagree with Mr Powell on some issues, for example he did not agree with Mr Powell about the need for randomised control trials to show the efficacy of Orthotropics. Mr Smith has also agreed with your experts on some issues. Professor Daniele Garcovich

surgery qualified him to opine on facial structures and maxillofacial matters. They

[119]The Committee noted from Professor Garcovich's CV that he was qualified as an Orthodontist to provide expert evidence in this case. The Committee noted his view that there were shared aspects in the practice of both Orthotropics and Orthodontics. The Committee also considered that he attempted to be fair and balanced.

an Orthodontist to provide expert evidence in this case. The Committee noted his

[120]The Committee noted that he had provided a character reference for an earlier listing of this hearing, and that he had been a friend of yours. The Committee considered whether this undermined his evidence as an independent expert witness. However, the opinions in his character reference were balanced and consistent with his opinions in his expert report. For example, the Committee noted the following from his character reference, 'A literature review at this stage suggests a lack of evidence to prove that early treatment carries additional benefit over an [sic] above that achieved with treatment commencing later; however, this does not necessarily imply that early treatment is ineffective'. The Committee noted that he re-iterated this view in his expert report.

earlier listing of this hearing, and that he had been a friend of yours. The

[121]The Committee did consider that it was highly unusual for an expert to act on behalf of a Registrant in professional disciplinary proceedings, having also provided a character reference in support of the same Registrant. It was also noted that this was not disclosed in his expert report. Furthermore, the Committee noted that his expert report did not include the standard expert declaration contained in such reports. The Committee bore these matters in mind when considering his evidence in determining the charges in this case.

behalf of a Registrant in professional disciplinary proceedings, having also

[122]The Committee also noted that he acknowledged that the evidence in support of Orthotropics was controversial. Furthermore, although he was appearing as your expert witness, the Committee noted that he was not afraid to criticise you during his evidence, for example when he suggested that you made too many "sharp comments" at times and were prone to exaggeration. Overall, the Committee was satisfied that he tried his best to assist it by giving a balanced and unbiased opinion on Orthotropics. Professor Stephen Sheldon

of Orthotropics was controversial. Furthermore, although he was appearing as

[123]The Committee noted that Professor Sheldon had also provided an earlier positive character reference for you. The Committee noted that as a specialist in Sleep Medicine, he had limited knowledge of the practice of Orthotropics. The Committee noted that he referred patients, potentially for Orthotropics, but did not see the results of those treatments.

positive character reference for you. The Committee noted that as a specialist in

[124]The Committee noted that when giving oral evidence, Professor Sheldon appeared not to understand the duties of an expert witness within a UK regulatory system. Furthermore, the Committee noted that he was not present at the hearing to hear the GDC experts' evidence. The Committee concluded that Professor Sheldon was very well-qualified to opine on sleep apnoea as an expert. However, whilst his suitability to opine on Orthotropics was limited, the Committee found his evidence helpful regarding the multi-disciplinary approach required in the treatment of patients, and the circumstances in which he would refer patients on for the consideration of Orthotropic treatment. The Committee's View on the Expert Opinion

appeared not to understand the duties of an expert witness within a UK

[125]The Committee was taken to a large amount of academic review, discussion, and research papers. Tab 1 0A, titled 'Index for exhibits to defence witness statements', contained 15 articles; Tab 10B, 'Index to reference materials used by defence experts', contained 86 papers; and Tab 14, 'Additional research articles', contained a further 19 articles. You were taken and cross examined on these articles and papers.

and research papers. Tab 1 0A, titled 'Index for exhibits to defence witness

[126]The Committee was aware throughout that no Orthotropic practitioner has been called as an expert in this case. In making its way through the volume of academic papers put before it, the Committee has had regard to the experts' guidance and opinions. Ultimately this Committee has to accept or reject the opinions of the experts in this case, based upon its own weighing of their evidence. The Committee noted that these research papers do relate to distinct elements of the Orthotropic premise. For example, they examine the issue of environmental effects on growing patterns, or historically analyse changes in skull dimensions. The Committee was of the view that these papers, while having varying degrees of significance, do not address the issue of whether Orthotropics, as practised by you, achieves the specific and wider results described.

[127]The Committee preferred the expert advice of Mr Powell and Mr Smith. It found that Mr Powell and Mr Smith were more appropriately placed to independently comment because of their professional qualifications and experience, as shown in their CVs, and because their backgrounds were more relevant to the wider issues in this case, including orthodontics and maxillofacial growth. They were able to comment on the standards expected of dental/orthodontic treatment within the United Kingdom. Also, they were able to articulate the need for an evidence base for the outcome of Orthotropics in a persuasive manner.”

found that Mr Powell and Mr Smith were more appropriately placed to

[33]The PCC went on to set out its findings of fact and its determinations in relation to whether each head of charge was proven or not at [141], in a detailed section occupying 28 pages of the overall determination.

[34]The PCC then further explained its decision by summarising its findings as follows: “Summary of the Committee's Findings

[144]The Committee has found proved that the Orthotropic Treatment you provided to Patient A and Patient B, when they were children, was not clinically indicated, not in their best interests and was liable to cause them harm. It also found proved that the misleading claims you made to the patients' parents in correspondence concerning the need for treatment, your diagnoses, and the assertions you made about the benefits and outcomes of Orthotropic Treatment were inappropriate and on occasion misleading.

[145]In respect of Patient A, you recommended in September 2016, when she was six years old, that she underwent Orthotropic treatment. This was despite the fact that she had a Class 1 occlusion on a Class 1 skeletal base with normal craniofacial development. The Committee determined that there was no clinical indication for treatment and that it would have been more appropriate to wait 18 months before reviewing whether any clinical treatment was required. Furthermore, the Committee found proved that there was no objective evidence to support the Orthotropic treatment you were recommending or the aims of the treatment. The Committee considered that, " .. . taken as a whole treatment pathway from initial diagnosis to completion, there is currently insufficient objective evidence to support it".

six years old, that she underwent Orthotropic treatment. This was despite the fact

[146]In November 2016, you recommended that Patient A underwent a lingual tongue tie release in order to, amongst other things, complement her Orthotropic therapy. The Committee determined that there was no evidence to show that a lingual tongue tie was causing any issues for Patient A and, therefore, concluded that a lingual tongue tie release was not clinically indicated for Patient A. It was also found proved that you failed to carry out appropriate or adequate monitoring of Patient A’s treatment by not undertaking any cephalometric analysis. Instead, you relied on photographic overlays. However, the Committee determined that you had provided insufficient scientific evidence to show that your use of photographic overlays would produce similarly accurate measurements as achieved by using cephalometrics.

tongue tie release in order to, amongst other things, complement her Orthotropic

[147]The Committee found proved that the treatment you provided to Patient A (the fitting of upper and lower expansion appliances) had caused her harm as it resulted in a traumatic ulcer. However, the Committee acknowledged that this liability to cause harm arose from the recognised risks from both Orthotropic and Orthodontic interventions.

fitting of upper and lower expansion appliances) had caused her harm as it

[148]In respect of Patient B, in November 2013 when he was two years old, you took an upper impression with the intention of providing an expansion appliance in order to improve tongue space and upper nasal airway. The Committee determined that this treatment was not clinically indicated. Furthermore, the Committee determined that there was no objective evidence to suggest the treatment you had proposed would achieve the aims stated and that this was inappropriate.

took an upper impression with the intention of providing an expansion appliance

[149]In February 2018, when Patient B was six years old, you recommended that he underwent Orthotropic treatment, despite the fact that he had a Class 1 occlusion on a Class 1 skeletal base and normal craniofacial development. The Committee determined that treatment was not clinically indicated for Patient B or in his best interests as there was no objective evidence to support treatment.

he underwent Orthotropic treatment, despite the fact that he had a Class 1

[150]In August 2018, you fitted Patient B with upper and lower arch expansion appliances. The Committee determined that this treatment was not clinically indicated. Furthermore, you failed to ensure that decay was treated prior to commencing treatment, to carry out any cephalometric analysis, to obtain study models, to communicate with Patient B's paediatrician (in the light of Patient B's complex medical history) or to carry out appropriate/adequate monitoring.

appliances. The Committee determined that this treatment was not clinically

[151]Furthermore, the Committee found proved that the claims, you made in a video posted on YouTube in or about September 2017 titled "Orthodontics Beyond Teeth", which included implying that you could increase the intelligence of a child, were inappropriate and misleading as they were made without adequate objective evidence.”

video posted on YouTube in or about September 2017 titled "Orthodontics

[35]Then the PCC summarised the submissions it had received and heard on misconduct, impairment and sanction at [152-160] before setting out its approach, the guidance and legal advice it had received [161] and its decisions. On misconduct [162]: this was found to be misconduct. On impairment [167-172]: the Appellant’s fitness to practise was impaired on the ground of public protection. The appropriate sanction [173-187] was to erase the Appellant’s name from the Dentists’ register, despite the impact on him, because this was far outweighed by the need to protect patients and the public interest. Finally there was a consideration of, and decision to make, an immediate Order for suspension [188-196]. VI. THE LEGAL FRAMEWORK ON APPEAL

[36]Section 29 of the Act provides a right of appeal to the High Court against determinations made by the PCC for erasure of a person’s name from the register, as has occurred here.

[37]The Act sets out the powers on appeal at S.29(3): (3) On an appeal under this section, the court may –(a) dismiss the appeal;

(b) allow the appeal and quash the decision appealed against;

(c) substitute for the decision appealed against any other decision which could have been made by the Professional Conduct Committee, the Professional Performance Committee or (as the case may be) the Health Committee; or

(d) remit the case to the Professional Conduct Committee, the Professional Performance Committee or (as the case may be) the Health Committee to dispose of the case under section 24, 27B, 27C or 28 in accordance with the directions of the court. and may make such order as to costs (or in Scotland, expenses) as it thinks fit.

[38]The procedure is governed by:a. CPR PD52D at 19(1)(c) namely that it is by way of rehearing not a review; and

b. CPR 52.21(3) which provides that: (3) The appeal court will allow an appeal where the decision of the lower court was -

(a) wrong; or

(b) unjust because of a serious procedural or other irregularity in the proceedings in the lower court.

[39]The parties did not take issue with my observation during submissions that up to the point at which the Court might come on to consider the PCC’s approach to sanction, there is no material difference to the Court’s approach in this case to an appeal by a rehearing as opposed to a review. In relation to the question of sanction, there is a material difference. On a review, it would not be enough for an appeal Court to be persuaded that it would have imposed a different sanction unless the sanction imposed was outside the scope of the first instance decision-maker’s discretion. On a rehearing the focus is on whether the underlying decision was wrong (or unjust on serious procedural or irregularity grounds) or not. I am reassured to note this chimes with Morris J’s view in Byrne v GMC

[2021] EWHC 2237 (Admin)

, at [16]:

“…on the balance of authority there is little or no relevant distinction to be drawn between “review” and “rehearing”, when considering the degree of deference to be shown to findings of primary fact… there may be a relevant difference when the Court is considering findings of evaluative judgment… or inferential findings of fact, where there will be less deference on a rehearing than on a review.”

[40]The parties referred me to an array of authorities (and there are more in the bundle of authorities which I have considered) touching upon the appropriate approach to deciding on this rehearing whether the PCC’s approach was wrong and specifically weighing up the assessment made of factual and expert witnesses and findings made.

[41]Those confirm, as one would expect, that the Appellant has the burden of showing that (here) the PCC's decision was wrong or unjust within the test set out in CPR 52.21.

[42]As for the approach to take, whilst there was some consensus, there was a difference between the parties about the degree of deference to be given to the PCC’s findings and the appropriate approach to disputed expert evidence. To address this, I will delve in more detail than might otherwise be necessary into the guidance in the authorities.

[43]At times the Appellant’s written and oral submissions strayed into asserting that no deference should be shown to the PCC’s findings. I reject that proposition. As will be seen, there is a spectrum, but it is always a question of degree rather than a binary question of deference or no deference.

[44]That the Court should show appropriate deference to the PCC’s findings is settled law: see for instance Meadow v GMC

[2007] QB 642

, per Auld LJ [197]. The Court’s approach has been further addressed in Southall v GMC

[2010] EWCA 407

at [47], where Leveson LJ distilled the principles from a number of previous authorities including (as discussed in the Respondent’s skeleton, with my additions):a. findings of primary fact, particularly if founded upon an assessment of the credibility of witnesses, are “virtually unassailable”;

b. the Appellant must establish that the fact finder was “plainly wrong” (although I record here that this should not be confused with the test in CPR 52.21(3)(a) on appeal which should not be given the gloss of “plainly”); the Court should only reverse a finding of fact if it can be shown that “the findings…were sufficiently out of tune with the evidence to indicate with reasonable certainty that the evidence had been misread”;

c. the first instance body enjoys an advantage which the Appeal Court does not have because it is in a better position to judge the credibility and reliability of the evidence given by the witnesses as “the first instance body has observed the witnesses and weighed their evidence, its decision on such matters is more likely to be correct than any decision of a court which cannot deploy those factors when assessing the situation.”

[45]The principles were further considered by Sharp LJ, in GMC v Jagjivan & PSA

[2017] EWHC 1247 (Admin)

at [40] (as reproduced in the Appellant’s skeleton) as follows: 39. As a preliminary matter, the GMC invites us to adopt the approach adopted to appeals under section 40 of the 1983 Act, to appeals under section 40A of the 1983 Act, and we consider it is right to do so. It follows that the well-settled principles developed in relation to section 40 appeals (in cases including: Meadow v. General Medical Council

[2006] EWCA Civ 1390

;

[2007] QB 462

; Fatnani and Raschid v. General Medical Council

[2007] EWCA Civ 46

;

[2007] 1 WLR 1460

; and Southall v. General Medical Council [2010] EWCA modified)), can be applied to section 40A appeals. 40. In summary:(i) Proceedings under section 40A of the 1983 Act are appeals and are governed by CPR Pt 52. A court will allow an appeal under CPR Pt 52.21(3) if it is ‘wrong’ or ‘unjust because of a serious procedural or other irregularity in the proceedings in the lower court’.

(ii) It is not appropriate to add any qualification to the test in CPR Pt 52 that decisions are ‘clearly wrong’: see Raschid’s case at para 21 and Meadow’s case at paras 125–128.

(iii) The court will correct material errors of fact and of law: see Raschid’s case at para 20. Any appeal court must however be extremely cautious about upsetting a conclusion of primary fact, particularly where the findings depend upon the assessment of the credibility of the witnesses, who the Tribunal, unlike the appellate court, has had the advantage of seeing and hearing; see Assicurazioni Generali SpA v Arab Insurance Group (Practice Note)

[2003] 1 WLR 577

, paras 15–17, cited with approval in Datec Electronics Holdings Ltd v United Parcels Service Ltd

[2007] 1 WLR 1325

at para 46, and Southall’s case at para 47.

(iv) When the question is what inferences are to be drawn from specific facts, an appellate court is under less of a disadvantage. The court may draw any inferences of fact which it considers are justified on the evidence: see CPR Pt 52.11(4).

(v) In regulatory proceedings the appellate court will not have the professional expertise of the Tribunal of fact. As a consequence, the appellate court will approach Tribunal determinations about whether conduct is serious misconduct or impairs a person’s fitness to practise, and what is necessary to maintain public confidence and proper standards in the profession and sanctions, with diffidence: see Raschid’s case at para 16; and Khan v General Pharmaceutical Council

[2017] 1 WLR 169

, para 36.

(vi) However, there may be matters, such as dishonesty or sexual misconduct, where the court ‘is likely to feel that it can assess what is needed to protect the public or maintain the reputation of the profession more easily for itself and thus attach less weight to the expertise of the Tribunal …’: see Council for the Regulation of Healthcare Professionals v General Medical Council and Southall

[2005] EWHC 579 (Admin)

at [II], and Khan’s case at para 36. As Lord Millett observed in Ghosh v General Medical Council

[2001] 1 WLR 1915

, para 34, the appellate court ‘will accord an appropriate measure of respect to the judgment of the committee … But the [appellate court] will not defer to the committee’s judgment more than is warranted by the circumstances’.

(vii) Matters of mitigation are likely to be of considerably less significance in regulatory proceedings than to a court imposing retributive justice, because the overarching concern of the professional regulator is the protection of the public.

(viii) A failure to provide adequate reasons may constitute a serious procedural irregularity which renders the Tribunal’s decision unjust: see Southall’s case at paras 55–56.

[46]As the Appellant noted, the passage from Assicurazioni Generali SpA v Arab Insurance Group

[2003] 1 WLR 577

, cited with approval in GMC v Jagjivan, stated as follows:15. In appeals against conclusions of primary fact the approach of an appellate court will depend upon the weight to be attached to the findings of the judge and that weight will depend upon the extent to which, as the trial judge, the judge has an advantage over the appellate court; the greater that advantage the more reluctant the appellate court should be to interfere. As I see it, that was the approach of the Court of Appeal on a “rehearing” under the Rules of the Supreme Court and should be its approach on a “review” under the Civil Procedure Rules 1998.

16. Some conclusions of fact are, however, not conclusions of primary fact of the kind to which I have just referred. They involve an assessment of a number of different factors which have to be weighed against each other. This is sometimes called an evaluation of the facts and is often a matter of degree upon which different judges can legitimately differ. Such cases may be closely analogous to the exercise of a discretion and, in my opinion, appellate courts should approach them in a similar way.

[47]The nature of a “rehearing” and the “reluctance” to interfere were also considered in ST Dupont v EI du Pont de Nemours & Co

[2003] EWCA Civ 1368

. May LJ confirmed at [90] that rehearings did not involve hearing the evidence again; they were “well understood not to extend to rehearings in the fullest sense of the word. The court did not hear the case again from the start.It reviewed the decision under appeal giving it the respect appropriate to the nature of the court or tribunal, the subject matter and, importantly, the nature of those parts of the decision making process which were challenged.”At [94], it was held that the Appellate Court:

“… will accord appropriate respect to the decision of the lower court. Appropriate respect will be tempered by the nature of the lower court and its decision-making process. There will also be a spectrum of appropriate respect depending on the nature of the decision of the lower court which is challenged. At one end of the spectrum will be decisions of primary fact reached after an evaluation of oral evidence where credibility is in issue and purely discretionary decisions. Further along the spectrum will be multi-factorial decisions often dependent on inferences and an analysis of documentary material.”

[48]The most recent consideration of the approach to an appeal by rehearing (as opposed to review) in statutory appeals, at Court of Appeal level, was in Sastry & Ano v GMC

[2021] 1 WLR 5029

, where Nicola Davies LJ considered the appropriate approach at [101 to 112] and held at [5058B-C; para 102]:

“102. Derived from Ghosh are the following points as to the nature and extent of the section 40 appeal and the approach of the appellate court: (i) an unqualified statutory right of appeal by medical practitioners pursuant to section 40 of the 1983 Act; (ii) the jurisdiction of the court is appellate, not supervisory; (iii) the appeal is by way of a rehearing in which the court is fully entitled to substitute its own decision for that of the tribunal; (iv) the appellate court will not defer to the judgment of the tribunal more than is warranted by the circumstances; (v) the appellate court must decide whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate; (vi) in the latter event, the appellate court should substitute some other penalty or remit the case to the tribunal for reconsideration.” extent of the section 40 appeal and the approach of the appellate court: (i) an unqualified statutory right of appeal by medical practitioners pursuant to section 40 of the 1983 Act; (ii) the jurisdiction of the court is appellate, not supervisory; (iii) the appeal is by way of a rehearing in which the court is fully entitled to substitute its own decision for that of the tribunal; (iv) the appellate court will not defer to the judgment of the tribunal more than is warranted by the circumstances; (v) the appellate court must decide whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate; (vi) in the latter event, the appellate court should substitute some other penalty or remit the case to the tribunal for reconsideration.”

court should substitute some other penalty or remit the case to the tribunal

[49]The Appellant invited me to take the approach to conflicting expert evidence set out by Green J (as he then was) in C v North Cumbria University Hospitals Trust [2014] Med. L.R. 189. Whilst that case provides helpful guidance, it must be seen in its proper context. I agree with the Respondent that this is not the approach I should take on this regulatory appeal. That case was concerned with a different situation, namely the application of the Bolam test to a liability dispute in a clinical negligence claim for damages. This is confirmed by the first limb of the guidance given:

“Where a body of appropriate expert opinion considers that an act or omission alleged to be negligent is reasonable a Court will attach substantial weight to that opinion.”

[50]As for the proper approach of the appeal Court, further reference can be had to:a. Raychaudhuri v GMC & PSA

[2018] EWCA Civ 2018

at [56-57], where Sales LJ (as he then was) sounded a note of caution against adopting too “cut and dried” an approach in analysing the disciplinary tribunal’s findings and held: “In my view, the evaluative judgment made by the MPT in this regard should be given great weight. That is both because it had the advantage of seeing the appellant and the witnesses, so that it was well placed to make an evaluative judgment regarding the nuances of their interactions and the nature and seriousness of what the appellant did, and because of the practical expertise of a MPT in being able to understand the precise context in which and pressures under which a doctor is acting in a case such as this.”

b. See also, Byrne v GMC

[2021] EWHC 2237 (Admin)

at [12-16]; and

c. Khan v GMC

[2021] EWHC 374 (Admin)

at [58-65], where Julian Knowles J helpfully drew together a number of observations from previous cases: 58. In Yassin v the General Medical Council

[2015] EWHC 2955 (Admin)

, [32], Cranston J explained the scope of an appeal under s 40 in the following terms: “32. Appeals under section 40 of the Medical Act 1983 are by way of re-hearing (CPR PD52D) so that the court can only allow an appeal where the Panel’s decision was wrong or unjust because of a serious procedural or other irregularity in its proceedings: CPR 52.11. The authorities establish the following propositions:

(i) The Panel's decision is correct unless and until the contrary is shown: Siddiqui v. General Medical Council

[2015] EWHC 1996 (Admin)

, per Hickinbottom J, citing Laws LJ in Subesh v. Secretary of State for the Home Department

[2004] EWCA Civ 56

at [44];

(ii) The court must have in mind and must give such weight as appropriate in that the Panel is a specialist tribunal whose understanding of what the medical profession expects of its members in matters of medical practice deserves respect: Gosalakkal v. General Medical Council

[2015] EWHC 2445 (Admin)

;

(iii) The Panel has the benefit of hearing and seeing the witnesses on both sides, which the Court of Appeal does not;

(iv) The questions of primary and secondary facts and the over-all value judgment made by the Panel, especially the last, are akin to jury questions to which there may reasonably be different answers: Meadows v. General Medical Council, [197], per Auld LJ;

(v) The test for deciding whether a finding of fact is against the evidence is whether that finding exceeds the generous ambit within which reasonable disagreement about the conclusions to be drawn from the evidence is possible: Assucurazioni Generali SpA v. Arab Insurance Group

[2003] 1 WLR 577

, [197], per Ward LJ;

(vi) Findings of primary fact, particularly founded upon an assessment of the credibility of witnesses, will be virtually unassailable: Southall v. General Medical Council

[2010] EWCA Civ 407

, [47] per Leveson LJ with whom Waller and Dyson LJJ agreed;

(vii) If the court is asked to draw an inference, or question any secondary finding of fact, it will give significant deference to the decision of the Panel, and will only find it to be wrong if there are objective grounds for that conclusion: Siddiqui, paragraph [30](iii);

(viii) Reasons in straightforward cases will generally be sufficient in setting out the facts to be proved and finding them proved or not; with exceptional cases, while a lengthy judgment is not required, the reasons will need to contain a few sentences dealing with the salient issues: Southall v. General Medical Council

[2010] EWCA Civ 407

, [55]-[56];

(ix) A principal purpose of the Panel's jurisdiction in relation to sanctions is the preservation and maintenance of public confidence in the medical profession so particular force is given to the need to accord special respect to its judgment: Fatnani andRaschid v General Medical Council

[2007] EWCA Civ 46

, [19], per Laws LJ.” 59. In R(Dutta) v GMC

[2020] EWHC 1974 (Admin)

, [20]-[21], Warby J said: “20 … This is a challenge to the Tribunal's fact-finding processes at Stage 1. A specialist Tribunal may of course have specialist expertise that is relevant at that stage, but this is not such a case. If the Court finds that the Tribunal went wrong at the first stage, it should quash the conclusions at all three Stages, unless persuaded that the error would have made no difference to the outcome. That, as Ms Hearnden rightly accepts, is a high threshold, which is not readily satisfied: R (Smith) v North Eastern Derbyshire Primary Care Trust

[2006] 1 WLR 3315

, 3321. 21. Bearing that in mind, the points of most importance for the purpose of this case can be summarised as follows: (1) The appeal is not a re-hearing in the sense that the appeal court starts afresh, without regard to what has gone before, or (save in exceptional circumstances) that it re-hears the evidence that was before the Tribunal. ‘Re-hearing’ is an elastic notion, but generally indicates a more intensive process than a review: E I Dupont de Nemours & Co v S T Dupont (Note)

[2006] 1 WLR 2793

[92-98]. The test is not the "Wednesbury" test. (2) That said, the appellant has the burden of showing that the Tribunal's decision is wrong or unjust: Yassin [32(i)]. The Court will have regard to the decision of the lower court and give it ‘the weight that it deserves’: Meadow [128] (Auld LJ, citing Dupont [96] (May LJ)). (3) A court asked to interfere with findings of fact made by a lower court or Tribunal may only do so in limited circumstances. Although this Court has the same documents as the Tribunal, the oral evidence is before this Court in the form of transcripts, rather than live evidence. The appeal Court must bear in mind the advantages which the Tribunal has of hearing and seeing the witnesses, and should be slow to interfere. See Gupta, [10], Casey, [6(a)], Yassin, [32(iii)]. (4) Where there is no question of a misdirection, an appellate court should not come to a different conclusion from the tribunal of fact unless it is satisfied that any advantage enjoyed by the lower court or tribunal by reason of seeing and hearing the witnesses could not be sufficient to explain or justify its conclusions: Casey, [6(a)]. (5) In this context, the test for deciding whether a finding of fact is against the evidence is whether that finding exceeds the generous ambit within which reasonable disagreement about the conclusions to be drawn from the evidence is possible: Yassin, [32(v)]. (6) The appeal Court should only draw an inference which differs from that of the Tribunal, or interfere with a finding of secondary fact, if there are objective grounds to justify this: Yassin, [32(vii)]. (7) But the appeal Court will not defer to the judgment of the tribunal of fact more than is warranted by the circumstances; it may be satisfied that the tribunal has not taken proper advantage of the benefits it has, either because reasons given are not satisfactory, or because it unmistakably so appears from the evidence: Casey [6(a)] and cases there cited, which include Raschid and Gupta (above) and Meadow [125-126], [197] (Auld LJ). Another way of putting the matter is that the appeal Court may interfere if the finding of fact is ‘so out of tune with the evidence properly read as to be unreasonable’.

[51]Additionally, concerning the adequacy of reasons, Green J (as he then was) in Goodchild-Simpson v GMC

[2014] EWHC 1343 (Admin)

held at [40]:

“The Appellant criticised the FPP for not setting out in detail which part of which expert’s evidence it relied upon and which it did not. In my judgement, this criticism is not valid. There is no need to include a blow by blow, forensic analysis of the evidence. It suffices for the FPP to express a view about weight and credibility of witnesses and then to set out or refer briefly to the evidence relied upon.”

[52]Reference is also appropriate, although I do not consider it necessary to set them out, to the familiar rules and case law relevant to expert evidence. There are the well-known duties of experts in civil and criminal proceedings, including CPR 35 and Practice Direction (“PD”) 35 and CrimPR 19, as well as the touchstone list of duties which Cresswell J set out in National Justice Cia Naviera S A v Prudential Assurance Co Ltd (‘the Ikarian Reefer’) [1993] 2 Lloyd’s Rep. 68 at pp.81-82.

[53]I bear all of those matters in mind when approaching this rehearing. VII. THE GROUNDS OF APPEAL: COMPLIANCE & DESCRIPTION

[54]To explain the unorthodox and, in some respects, non-compliant approach taken by the Appellant, it is appropriate to set out what the rules and forms require.

[55]CPR PD52A.4.2 mandates the use of Court Form N161 as the Appellant’s Notice. The Appellant duly used that form [B1/2].

[56]There is a mandatory requirement to file Grounds of Appeal with an Appellant’s Notice. CPR 52.2 requires all parties to an appeal to comply with Practice Directions 52A to 52E. CPR PD 52B on appeals in the (County and) High Court, at Section IV ‘Initiating an Appeal’ paragraph 4.2 provides: 4.2. Documents to be filed with the appellant’s notice: The appellant must file with the appellant’s notice– […] (d). grounds of appeal, which must be set out on a separate sheet attached to the appellant’s notice and must set out, in simple language, clearly and concisely, why the order of the lower court was wrong or unjust because of a serious procedural or other irregularity (Rule 52.21(3)).

[57]The N161 Appellant’s Notice makes clear that the Grounds of Appeal, dealt with in Section 6 of it, and Arguments in support of the Grounds of Appeal, dealt with in Section 7, are separate, stand-alone documents, as can be seen at [B1/5-6] in this case. Section 6 requires: “Please state, in numbered paragraphs, on a separate sheet attached to this notice and entitled ‘Grounds of Appeal’…, why you are saying that the Judge who made the order you are appealing was wrong.” [bold emphasis in the original]

[58]The Appellant ticked the box in that section adjacent to the words, “I confirm that the grounds of appeal are attached to this notice.”

[59]Section 7 then has a choice of tick boxes, as to whether the Skeleton Argument is attached or to follow within 14 days (a Skeleton Argument plainly being appropriate on complexity grounds and to assist the court: PD52B.8.3). The first box was ticked by the Appellant stating “I confirm that the arguments (known as a ‘Skeleton Argument’) in support of the ‘Grounds of Appeal’ are set out on a separate sheet and attached to this notice.” [bold emphasis in the original]

[60]The context here is also CPR PD 52A, Section V on Skeleton Arguments, which requires: (1). The purpose of a skeleton argument is to assist the court by setting out as concisely as practicable the arguments upon which a party intends to rely. (2). A skeleton argument must–• be concise;

• both define and confine the areas of controversy;

• be set out in numbered paragraphs;

• be cross-referenced to any relevant document in the bundle;

• be self-contained and not incorporate by reference material from previous skeleton arguments;

• not include extensive quotations from documents or authorities. (3). Documents to be relied on must be identified. (4). Where it is necessary to refer to an authority, a skeleton argument must – (a). state the proposition of law the authority demonstrates; and (b). identify the parts of the authority that support the proposition. If more than one authority is cited in support of a given proposition, the skeleton argument must briefly state why.

[61]Whilst not directly applicable to this appeal to the High Court, even were this an appeal to the Court of Appeal, CPR PD 52C.31(1) requires (and a Skeleton Argument would be rejected by the Court unless it complied: PD 52C.31(2)(i)): (1). Any skeleton argument must comply with the provisions of Section 5 of Practice Direction 52A (and in particular must be concise) and must in any event– (a). not normally exceed 25 pages (excluding front sheets and back sheets); (b). be printed on A4 paper in not less than 12 point font and 1.5 line spacing (including footnotes); (c). be labelled as applicable (e.g. appellant’s PTA skeleton, appellant’s replacement skeleton, respondent’s supplementary skeleton), and be dated on its front sheet.

[62]There was no conventional or compliant list of Grounds of Appeal here, whether attached to the Appellant’s Notice or otherwise, setting out on a separate sheet attached to the Appellant’s Notice, in simple language, clearly and concisely, for each ground, why it was said that the PCC’s decision was wrong or unjust.

[63]The unorthodox Grounds of Appeal were more in the nature of headings, such as “Wrong Approach to expert evidence” (Ground 1a), without specifying in the Ground why; or “Wrong to find charge [number stated] proved” (Grounds 6 to 8) without any stated reason at all. Only grounds 2, 4 and 5 gave more insight, such as “Failure to give due weight to the paper entitled (‘The Jaw Epidemic’).”

[64]But, in any event, those headings serving as Grounds of Appeal were not set out in a list within a single short document attached to the Appellant’s Notice, as required. In a confusion of terminology, the Appellant’s document entitled ‘Grounds of Appeal’, attached to the Appellant’s Notice, was in fact a very detailed narrative argument running to 28 pages of single spaced written submissions. So, in reality this was the Appellant’s Skeleton Argument (which I will refer to it as, to avoid confusion) in support of the appeal, in all but name, rather than just a list of the Grounds of Appeal themselves.

[65]Whilst the point had been discussed during oral submissions, in the course of preparing this judgment, out of fairness to the Appellant, I wanted to confirm my understanding of the position regarding the Grounds of Appeal. Via an email exchange with the Appellant’s legal representatives on 29/30 April 2026, it was confirmed that there was no document filed which contained only the list of the Grounds of Appeal with no narrative argument included, whether attached to the Appellant’s Notice or otherwise. However, a list was helpfully provided in a table in that email as follows: Number Ground Page in doc ‘Grounds of Appeal’ 1a Wrong approach to expert evidence 11 1b PCC wrongly rejected submission of no case to answer 20 2 Failure to give due weight to the paper entitled (‘The Jaw Epidemic’) 21 3 Incorrect understanding of the defence case 22 4 Failure to define what was considered to be ‘adequate objective evidence’ 23 5 Wrongly preventing Appellant from cross-examining GDC experts on open-source material tending to show that treatment techniques utilised by Registrant were recognised by mainstream dental organisations. 24 6 PCC wrong to find charge 6 proved 26 7 PCC wrong to find charges 9 and 10 proved 27 8 PCC wrong to find charge 16a proved 28 9 Finding of misconduct wrong 28 10 Finding of current impairment wrong 29 11 Sanction 29 VIII. THE GROUNDS OF APPEAL: DISCUSSION

[66]The great forensic detail into which the parties have delved here is similar to that encountered by other Judges in High Court regulatory appeals to which I was specifically taken or which are contained in the extensive authorities bundle, such as that recorded by Julian Knowles J in Khan v GMC

[2021] EWHC 374 (Admin)

[67]I had two detailed and lengthy Skeleton Arguments. For the Appellant, Mr Vullo KC’s Although, as noted above, his is entitled ‘Grounds of Appeal’ it is in facta very detailed narrative Skeleton Argument (hence the label I have applied to it)rather than just a list of the Grounds of Appeal themselves. ran to 28 pages of single-spaced text. If a minimum of 1.5-line spacing had been used, it would have run to 43 pages. Ms Barnfather’s Skeleton Argument, for the Respondent, ran to 48 pages. As noted above, had this been an appeal to the Court of Appeal, those Skeleton Arguments would have been rejected by the Court as exceeding 25 pages of 12-point font, 1.5-line spaced text, on A4 paper.

[68]Those lengthy skeleton arguments contain a significant number of points. Both go into a great deal of granular detail about the evidence in these protracted proceedings. In his oral submissions, Mr Vullo KC took the Court painstakingly and at length through the evidential issues; I have had regard to those oral arguments, and also the broader way in which he advanced the appeal in his Skeleton Argument. I have also carefully considered Ms Barnfather’s comprehensive reply.

[69]As can be seen from the table in the preceding section, the main focus of the Appellant’s Skeleton Argument was the approach taken by the PCC to the expert evidence. That was also reflected in Mr Vullo KC’s oral submissions.

[70]Without doing less than justice to the industry of Counsel and the detail of this case, it seems to me that the headline issue is as follows. Was the PCC’s resolution of the competing expert and factual evidence wrong, or determined in a manner which was unjust by reason of serious procedural or other error? It is the resolution of that issue which will unlock the outcome to this appeal. I have re-phrased Grounds 1a and 1b as follows: 1a & 1b: did the PCC take ‘the wrong approach to expert evidence’ by accepting the evidence of the GDC’s experts Mr Powell and Mr Smith over that of Professors Garcovich and Sheldon, where they disagreed?

[71]In considering whether these Grounds of Appeal have been made out, in my view it is appropriate to give a meaningful degree of deference to the PCC’s decision. I have already outlined above, when setting out the legal framework in Section VI, why I reject the Appellant’s apparent contention in oral submissions and also, e.g. at [29] in the Skeleton Argument, that I can make this decision without giving ‘due deference’, by which I take the Appellant to mean any deference.

[72]As this is properly to be seen as an evaluative judgment, rather than a finding of primary fact which would be “virtually unassailable”, the approach is lower on the spectrum of deference. But there should be meaningful deference, not least because the PCC heard this matter over 46 days, much of which was taken up with the expert evidence and submissions upon it. I have only seen transcripts of that evidence and heard submissions upon it over a 3 day appeal. The PCC observed the experts giving extensive evidence and carefully weighed that evidence, as is evident from its detailed determination. Its decision is more likely to be correct than any I could reach where I cannot deploy those factors when assessing their evidence. The PCC is a professional body with expertise amongst the panel in the field of dentistry, which I do not have. It is also better placed and qualified to calibrate the proper approach to the technical questions which arise such as professional standards on whether treatment is properly indicated, the scientific justification and underpinning for it, whether treatment is liable to cause harm, and questions of public protection.

[73]I will turn to the Appellant’s complaints of error by the PCC. The Appellant was correct to note that Prof. Garcovich’s report did contain an expert’s declaration. My interpretation is that the PCC’s observation [121] did not contradict this but was recording that it did not contain “the standard expert declaration” (my emphasis), rather than no declaration at all. That was a fair observation (and might also imply a concern about whether Prof. Garcovich, who readily accepted English was not his first language, that he was not experienced in the duties placed upon expert witnesses or UK dental standards, truly understood what he was including): see the declaration at [B3/4898-4900]. For instance, the statement of truth did not make grammatical sense or refer to the expert report, stating “I believe the facts stated in his (sic) witness statement (sic) are true”.

[74]The PCC was entitled to consider that this did not instil faith in the reliability of that statement, coupled with other factors mentioned. These included the point made in the same paragraph of the determination that Prof. Garcovich had made no mention in the report of having provided a character reference for the Appellant in the proceedings, prior to his appointment as an expert. That fact, when put alongside the part of the declaration in which Prof. Garcovich stated “I know of no conflict of interest of any kind, other than any which I have disclosed in this Report” entitled the PCC to factor this in. But this point should not be given prominence which it did not deserve. It is clear from a proper reading of the wider determination, that the observation about the expert’s declaration was just one of a range of factors which led the PCC to prefer the GDC’s experts’ evidence over Prof. Garcovich’s where they disagreed.

[75]A further objection by the Appellant was to the perceived error by the PCC in finding that Prof. Sheldon did not see the results experienced by the patients he referred for Orthotropic treatment: determination at [123-4]. It seems to me that this was a proper conclusion to draw and does not amount to an error. This must be seen in the context that Prof. Sheldon was not qualified in dentistry but was a sleep disorder specialist and his input necessarily focussed on those aspects of the treatment aims. In his oral evidence, Prof. Sheldon accepted that he had incomplete knowledge of what orthotropics involved, saying “I am not an expert on orthotropics at all” [B3/1934], and did not know the specifics of what treatment had been provided to those patients he had referred. He clarified that he did not refer for orthotropics but merely referred for evaluation to a colleague in the USA, Dr Boyd, who could potentially provide orthotropics and who “in his armamentarium of therapeutics, has orthotropics as one modality” [B3/2003]. He was not clear in oral evidence what treatment patients in whom he purported to have seen changes had in fact received. When asked by the PCC, how many patients of those sent to Dr Boyd for evaluation he thought then actually underwent Orthotropics, Prof. Sheldon answered [B3/2096] “That I cannot tell you. I can’t tell you how many have been treated with orthotropics or treated with other interventions.”

[76]In any event, Prof. Sheldon was unaware of what the differences were between the version of Orthotropic treatment provided by Dr Boyd in comparison to the Appellant. Dr Boyd’s patients did not typically return with large anterior open bites, in contrast to the Appellant’s treatment which included gross expansion of the maxilla.

[77]In relation to a group of patients treated by a Bill Hang, which Prof. Sheldon had reviewed via radiographs, Prof. Sheldon was unable to say what treatment they had undergone, at [B3/1995] “The only thing that I think I cannot answer is the fact that what techniques were used in order to achieve this outcome [movement of the mandible forward and enlargement of the posterior airway].” Furthermore, he was unable to publish any data as he could not properly conclude that any changes observed flowed from Orthotropic treatment, natural growth or other treatment modalities. He could not attribute the change to Orthotropics [B3/1942] because the patients he had seen had undergone other treatments and multiple therapies [B3/1993-4].

[78]Perhaps most troublingly, Prof. Sheldon implied that he consciously did not set out in his report the limitations with the data because he was going to be giving evidence and, if questioned about it, then he could explain: see [B3/1994; lines 3 to 5]. This belied a fundamental misunderstanding of the obligations upon a CPR compliant expert, as embodied in the part of the expert’s statement of truth (CPR PD35.3.3) which says “The opinions I have expressed represent my true and complete professional opinions on the matters to which they refer.” There is also the obligation in PD35.3.2(8), “(8) if the expert is not able to give an opinion without qualification, state the qualification;”.

[79]The Appellant complained that the PCC did not apply the same rigour regarding expert duties to the GDC’s experts as it did to the Appellant’s. I do not accept those submissions in relation to the allegations of bias. But this does not deal with the legitimate concerns which there were, underpinning and going beyond those expressly stated by the PCC, with the approach taken by the Appellant’s experts to compliance with their duties.

[80]In the light of these factors, it might be said that the PCC took a charitable view of Prof. Sheldon’s evidence, finding that despite the provision of the supportive character reference and the issues around his lack of familiarity and compliance with his duties as an expert, Prof. Sheldon “had attempted to be fair” and he had not been afraid to criticise the Appellant for making sharp comments and being prone to exaggeration. In any event, I do not consider that the PCC’s treatment of his evidence can be faulted, and it does not demonstrate any error vitiating the determination.

[81]The PCC highlighted the greater skill, experience, and expertise of Mr Powell and Mr Smith as reasons for finding them to be the more persuasive but made it clear, “That is not to say that it did not accept in part, and in relation to some of the issues in the case, the evidence of Professors Garcovich and Sheldon” [B1/72/116]. Far from being wrong, such an approach reflects a careful balancing of the evidence and was unassailable.

[82]The Appellant did not shy away on appeal, any more than he did before the PCC, in submitting not just that the evidence of the Respondent’s experts should not have been preferred but that it should have been entirely rejected on grounds of bias. As Mr Vullo KC put it in the section challenging, at Ground 1b, of the refusal of the no case to answer submission (itself founded on the alleged bias of those experts):

“The nature of the evidence given by the GDC experts, prior to the half-time submission (as set out in relation to ground 1a) was so egregious, it is submitted, that a properly directed PCC would have been faced with no alternative but to conclude that the evidence was irretrievably tainted by bias and that the experts had crossed over into becoming advocates for the GDC6F . This meant that none of the views they had expressed about orthotropics and the academic literature in particular could be relied upon as being truly independent and impartial expert assessments of its merits. In the absence of such expert guidance, as became clear in the PCC’s final determination, the PCC would have been unable to reach a conclusion as to there being an absence of ‘adequate objective evidence’ to support orthotropics and hence would have been unable to find the charges proved. Thus the defence submission should have been upheld. 2 Indeed, the fact that the defence were concerned about whether or not the GDC experts were truly independent and unbiased had been raised at the start of the case by the defence. However despite this, the GDC experts still went on to act in the way particularised in ground 1a above, a factor which in itself demonstrated the extent to which they had become personally involved in advocating the GDC’s case.”

[83]There were a number of strands to the proposition that the GDC’s expert evidence should have been rejected on grounds of bias. I propose to deal with most of them so as to explain my conclusions on this overall point.

[84]The Appellant describes as one of the most obvious examples, Mr Smith’s suggestion (which he later withdrew and apologised for [B3/1280-90]) that the two anonymous reviewers of the paper, ‘The Jaw Epidemic’ (“TJE”), might have been the Appellant and his father. I agree with the Respondent that this does not amount to an allegation of conspiracy between the authors and the Mews. Whilst Mr Smith rightly withdrew this suggestion, given it was speculation going outside his remit, it was not entirely without a potential basis in inference. Given the striking similarities in the article to the Appellant’s own rhetoric, including pejorative comments about orthodontists, it was not without foundation to suspect that the Appellant and his father might have assisted in its preparation. Indeed the Appellant thought one of the co-authors, Dr Sandra Khan wanted all the glory of what the Appellant was saying and to leave him behind [B3/1413]. Furthermore, the contents and beliefs expressed within the article were so close to his own that the Appellant himself was affronted that he had not been referenced within it [B3/1414; 1505]. In that context, the PCC was entitled to (and correct in my view) to excuse this descent into speculation, which it never actually characterised as bias, so there was no question of purging the bias as the Appellant contends, and not to reject Mr Smith’s evidence on grounds of bias. I note that part of the PCC’s reasons for refusing the submission of no case to answer was, having noted the withdrawal of the suggestion around the anonymous reviewers, “However, the Committee was of the view that overall, both Mr Powell and Mr Smith gave fair and impartial evidence based on their experience and expertise as an Orthodontist and Oral and Maxillofacial Surgeon respectively.” [B1/58/45].

[85]An additional complaint is made about Mr Smith’s opinion in his report that the term ‘cranial dystrophy’ is a meaningless term and one used to convince the parents of Patient B of a treatment need, seeking to characterise this as an allegation of dishonesty, misleading patients for financial gain. In cross-examination, it was put to Mr Smith that he was implying that the Appellant was involved in a criminal enterprise of fraud to which he responded that he was not and that, “I am not suggesting he’s at all involved with fraud. I am just suggesting that he is convincing the patient or parent…the child needs treatment when everybody else agrees the child doesn’t need treatment” [B3/1227]. I agree with the Respondent that Mr Smith’s comments on the terminology and its use in the Appellant’s correspondence were not demonstrative of bias. The PCC was not wrong in declining to find bias on this basis.

[86]I do not consider that Mr Smith’s expression from his own experience as an editor, that it was extremely uncommon for a thesis to be embargoed, was evidence of bias, when it turned out that this appears to have been a standard approach at Texas University. Simply because part of an expert’s opinion turned out not to apply to an overseas institution does not translate into a basis to find bias. The PCC was not wrong in its conclusions on these points.

[87]The Appellant asserts that Mr Powell showed “dogged insistence” during cross-examination that the only type of evidence as to the effectiveness of Orthotropic treatment, which would amount to ‘adequate objective evidence’ for its use on patients, would be randomised clinical trials (“RCT”). Furthermore, that the PCC was wrong not to find that he had been partisan in the way he had referenced supportive parts of the Proffit textbook. Mr Powell was consistent in his views that for treatment which is extremely demanding and challenging and carries significant risk of harm and in respect of which such striking claims were made, top tier evidence was required. This was a view which Mr Powell was entitled to take and it was not evidence of bias that other experts, including Mr Smith, took a different view. The PCC was not wrong in failing to find that this amounted to bias or a basis to exclude Mr Powell’s other opinions from consideration.

[88]The key point was, as the PCC rightly concluded, that given the nature of the claims made and the treatment provided, it was incumbent on the Appellant to have adequate objective evidence in support which, by his own admission, he did not. Given that concession, it is difficult to see how the PCC can be criticised for not precisely defining the threshold of objective evidence required. It is evident that the findings made did not rest upon an acceptance that RCTs alone were required. Again, this was an example of the PCC not simply accepting the GDC’s experts’ evidence in a blanket way but analysing the evidence in order to reach its findings. There is no basis here for finding that the PCC’s approach was wrong.

[89]The Appellant also strongly criticised both Mr Powell and Mr Smith for bias in diagnosing permanent harm. This was also a particular focus of the oral submissions. Taking the example of Patient A, the criticism of Mr Powell and Mr Smith was their diagnosis of permanent harm from gingival recession from photographs, whereas Prof. Garcovich did not make that diagnosis. I do not accept that this was anything approaching bias or any more than the experts doing their best on the then available information and without the benefit of hindsight. The fact that a periodontist’s report subsequently became available, reporting that no permanent gingival recession had been found on examination, in circumstances where the GDC’s experts had not had the benefit of an examination, does not mean that those earlier expressed opinions were biased. Far from being wrong, this is an example of the PCC taking an even-handed approach to which aspects of the expert evidence from the GDC’s experts to accept, rather than adopting a blanket acceptance, once they decided in general to prefer their evidence. Indeed, the PCC rightly had some misgivings about what amounted to hearsay evidence from the periodontist’s evidence, but showed its even-handedness in accepting that evidence in preference for the GDC’s experts on the point.

[90]It is also worth underlining that a finding of actual harm, whether in relation to Patient A or B, was not necessary for the PCC to find the relevant charges made out. Finding actual harm was not what the charges turned upon. The question was whether the treatment was liable to cause harm, in the sense that it carried the potential to cause actual harm (meaning something that had an adverse effect on the patient) even if harm was not actually caused [B1/92/15(c)]. As the PCC noted, the Appellant had admitted that there is a risk of harm in Orthotropic treatment, which included a large anterior open bite and gingival recession, as well as the likelihood of discomfort necessitating 'tough love'. But the PCC also fairly acknowledgedthat placing any appliance in a patient's mouth could be harmful, but considered that Orthotropics was no different to mainstream Orthodontics in this regard. Given the anterior findings that the treatment was not clinically indicated, the PCC was entitled to (and correct to) find that merely recommending and instituting the treatment was liable to cause harm.

[91]A yet further criticism of bias is made in relation to Mr Powell’s approach to attempting to perform a calculation of lower anterior face height from photographs [B3/3467]. But this must be seen in the context of the views expressed earlier in the report [B3/3464/11.3.75-9] that “Facial photographs although important in assessing an overall facial appearance therefore cannot be used to develop metrics in the elucidation of craniofacial growth. The accepted method…is using metrics derived from cephalometric radiographs…The fiducial points on the photograph exhibited are invalid.” The Appellant’s criticisms of Mr Powell’s approach are aligned with the assertion in the Skeleton Argument [B1/31/54] that the exercise only required the accurate drawing of lines on the photographs and the Appellant’s beliefs, e.g., that the overlay of photographs was a superior method of analysis. However, the PCC recorded the consensus between both the GDC’s and the Appellant’s experts of the importance of using cephalometric analysis and that use of photographic overlay would not give precise data [B1/100]. That was the critical point. It also left the Appellant as an outlier, disagreeing with his own experts again. I do not accept the assertion that there was bias in Mr Powell’s evidence here or that the PCC was wrong not to find that there was.

[92]More widely and going beyond the allegations of bias, the Appellant is critical of the PCC’s approach to preferring the GDC’s experts’ evidence generally. In my judgment, those conclusions were carefully reached, after a proper weighing exercise and the Appellant has not established they were wrong.

[93]It was open to the PCC, after carefully weighing the pros and cons of the competing expert evidence, that overall, despite some criticisms of Mr Powell and Mr Smith’s evidence for the GDC, “it was felt this was outweighed by their skill and expertise” [B1/71/113]. The Tavoossi thesis was “the only comprehensive evidence available to the Committee relating to Orthotropics, as accepted in evidence by [the Appellant]. The Committee was mindful of the experts’ evidence on the thesis and the criticisms made by Mr Vullo, on your behalf. This paper and its findings are consistent with the opinions given by Mr Powell and Mr Smith” [B1/75/129]. Mr Smith and Mr Powell “gave fair and impartial evidence based on their experience and expertise.” [B1/57/45]. There were additional detailed reasons given around their experience, expertise, and familiarity with giving evidence in UK Courts, in contrast with the Appellant’s experts’ lack of familiarity with their duties; their lack of familiarity with the standards and guidance for the UK profession; the compromise to their independence and impartiality borne of them having been character witnesses for, and personally connected to, the Appellant before ever becoming experts, and not mentioning this in their reports (despite the content of the expert’s declaration on conflicts).

[94]Further in relation to Prof. Sheldon, whilst well qualified on sleep apnoea and providing helpful evidence on the importance of a multi-disciplinary approach to patients’ treatment (which, again, was not the Appellant’s approach), he had no dental qualifications. He had a limited understanding of Orthotropics generally or as practised by the Appellant. As the PCC noted, “his suitability to opine on orthotropics was limited” [B1/74/124], other than circumstances in which he would refer patients for another clinician to consider whether to institute orthotropic treatment amongst a suite of other possible treatment modalities.

[95]Importantly, the PCC was entitled to- and certainly to do so was in no way wrong- to place greater weight on the Tavoossi thesis and to find that the articles referenced by the Appellant and his experts, “while having varying degrees of significance, do not address the issue of whether orthotropics, as practised by you, achieves the specific and wider results described” [B1/74/126].

[96]The points outlined above are examples of the range of legitimate reasons for the PCC preferring the GDC’s experts’ opinions, where they differed.

[97]Before leaving this analysis of whether the PCC was wrong in its conclusions on the expert evidence, it is also worth noting that this was not a binary choice between two starkly opposed pairs of experts. The PCC’s careful review of and conclusions about the expert evidence, which fed into its factual findings and acceptance that the charges were proved, reflected the large measure of agreement between the experts on both sides. This agreement between the experts on occasion either contradicted the Appellant’s contentions or confirmed the many concessions made in the Appellant’s evidence.

[98]I do not propose to lengthen this judgment further by setting out an exhaustive review of such points. But some examples follow.

[99]I have referenced above, the consensus between the experts around the importance of the use of cephalometric radiographs, which the Appellant eschewed, and that the approach of overlaying photographs did not provide precise data compared to cephalometrics. Prof. Garcovich in his oral evidence stated that "you need to take cephs ... cephs are or should be part of the orthodontic armamentarium" [B1/91/14]. Indeed, the Appellant acknowledged during his oral evidence that the use of photographic overlays was not a recognised alternative to cephalometrics [B1/90].

[100]Furthermore, the PCC rightly noted from the joint expert reports (“JER”) that all the experts agreed that there was no evidence to support the Appellant’s claim that, “if treatment is commenced at 5 or 6 years he will achieve an almost complete correction” of craniofacial structure and occlusion with teeth aligning themselves naturally [B1/106]. This was an example of where the Appellant sought to argue against his own expert(s). His response to this consensus was to comment that he was worried all the experts were wrong about that point [B3/1540-1].

[101]The PCC also noted the consensus between the experts in the JER that study models were necessary but there was no evidence that the Appellant had taken any [B1/101-2].

[102]Similarly, the experts agreed in the JER that there was a requirement to make a referral to a paediatrician to establish a diagnosis before commencing treatment, given that Patient B’s sleep apnoea had resolved and he had a complex medical history [B1/102]. The Appellant conceded in evidence that he did not have a proper basis to tell the parents [of Patient B] that this treatment was necessary [B1/103] and should have made a referral first.

[103]There was a consensus as Prof. Garcovich agreed with the GDC’s experts (this not being an issue within Prof. Sheldon’s expertise), see for instance the JER at [B3/5331-5407], that contrary to the Appellant’s assertions (and as correctly summarised in the Respondent’s Skeleton Argument at paragraph 59) that:a. the aetiology of malocclusions could not be said to be predominantly environmental. Prof. Garcovich agreed “there is a very important genetic component in craniofacial development” and he “would not say it’s predominantly a result of environmental factors, the current evidence does not lead us to this conclusion”. The Appellant again sought to argue against his own expert evidence on this point;

b. there was no evidence to support the claim that a downswing in facial form leads to less space for the airway;

c. there was no reasonable body of adequately evidenced-based literature to support the Appellant’s claims that as a result of expansion and alterations in behaviour brought about by his treatment the teeth would align themselves.

[104]In the context of whether the Appellant’s claims were adequately supported by objective evidence, in addition to the criticisms by the GDC’s experts, in cross-examination Prof. Garcovich was critical of the Appellant’s approach, for making “sharp statements” about the treatment [B3/2139-40; 2311]. He said the Appellant made statements that were too sharp, “to be so sharp in our statements and always to take into account that there is some variability and that things are not really that black and white, so I think that this is one of the main criticism I can make to Michael Mew statements.” He acknowledged that the Appellant’s stated aims of treatment were “ambitious” [B3/2170-2172] and that the Appellant’s statements were “too absolute” and failed to provide caveats [B3/2245]. In respect of the statements made in correspondence to the parents of Patient A and Patient B, “I already thought that this letter has very many sharp sentences that are not – I would have never written something this way…I agree with you that these statements are very sharp and we cannot support those statements 100% in light of the correct evidence”; “…this letter falls short of underlying all the possible caveats to the patient.” [B3/2316-7].

[105]Prof. Garcovich confirmed in cross-examination that he had watched the YouTube videos and although he had not commented on them in his report, he did not agree with the “sharp” statements therein [B3/2336]. In respect of the Appellant’s statements in the video, he said, “stating this way is not evidenced based…so I do not generally agree with what is said in the YouTube videos by Dr Mew…it is a tendency of exaggerating everything…” [B3/2338-2339]. As well as highlighting that the Appellant had exaggerated and had failed “to caveat” his claims, he later said, “I would suggest Dr Mew to have a more cautious approach when he states his aims or harms of treatment” [B3/2426].

[106]Having considered the extremely detailed written and oral arguments seeking to impugn the PCC’s approach to and conclusions in relation to the expert evidence (and the resolution of the earlier no case to answer submission based upon it), I do not consider that the Appellant has established that the PCC was wrong. Indeed, my overall conclusion is that the PCC’s careful and measured conclusions are unassailable. It follows that Grounds 1a and 1b are dismissed. The remaining grounds generally

[107]Mr Vullo KC rightly conceded, on the Appellant’s behalf, that if the challenge to the PCC’s conclusions on the expert evidence failed, this would be fatal to the success of the appeal. In the light of this, I can express my conclusions in relation to the other grounds succinctly. Ground 2- failure to give due weight to the paper entitled ‘the Jaw Epidemic’ (“TJE”)

[108]This Ground is closely linked with Grounds 1a and 1b. The thrust of the Appellant’s argument is, again, that the PCC should have rejected the GDC’s experts’ evidence on grounds of bias. This would have led to a rejection, rather than an acceptance, of their opinion which formed the basis of the PCC’s finding that TJE was “an overview paper, and so by definition does not provide any new research-based evidence.” [B1/75/132]. As I have rejected the notion that the GDC’s experts’ evidence should have been entirely rejected on grounds of bias, it follows that it was open to the PCC to prefer the GDC’s experts on this point for all the reasons given; it was not wrong to do so.

[109]It is also of note that TJE was published in a section entitled “Overview Articles”, consistent with the conclusion reached. Furthermore, the authors recognised [B3/4970/763], “Sadly, we lack the data to say how blame should be apportioned for the epidemic among the factors discussed…In summary, here are hypothetical evolutionary and then environmental steps [for the perceived epidemic]”. The quality of the authorship needed to be looked at separately from the quality of the conclusions. These were limited to hypothesis rather than advancing research findings and did not offer evidence-based support for the Appellant’s strongly held views, such as that malocclusion was environmental and not predominantly genetic in origin and his treatment claims.

[110]The PCC was not wrong in its approach to TJE and this ground is dismissed. Ground 3- incorrect understanding of the defence case

[111]As framed, this is a non-specific and broad assertion. In the written and oral submissions, it became evident that the point was a much narrower one. The complaint boils down to one of terminology. The Appellant’s complaint is that in its opening observations on its approach to a number of topics, the PCC described a core belief of Orthotropics as being unique in that “its premise is that environmental factors are the major cause of malocclusion, as opposed to the mainstream Orthodontic view that, while there may be environmental factors at play, genetics is the primary cause.” The Appellant asserts that this was to misunderstand the Defence case which was that “environmental factors were a significant cause”.

[112]I consider this Ground of Appeal to be hopeless. It reverts back to the incorrect proposition that Orthotropics was on trial. Whilst the PCC set the scene by describing its approach to some of the recurring concepts and evidence, the key focus was rightly on whether on the evidence the charges were proved or not. That was a focus, amongst other things, on whether the much wider treatment claims and justifications should ever have been made and whether they were sound or not, set against the applicable professional standards. For instance, whether Orthotropics alone could resolve conditions such as sleep apnoea, even if that was a relevant diagnosis here, which the Appellant’s experts agreed would by contrast require a multi-disciplinary approach.

[113]In any event, this appears to be an exercise in semantics, focussing on specific words and phrases, rather than the determination as a whole. The PCC’s determination should not be read like a statute. In any event, even this focussed approach demonstrates no material error by the PCC. ‘Significant’ (the Appellant’s preferred word) is one of the synonyms for ‘major Reference, e.g.Collins Dictionary. ’ (the word used by the PCC). If the complaint is that major implies more than 50% and significant could be less than that, it should be noted that the PCC was describing accurately the Appellant’s own Orthotropic belief, as set out in his witness statement that environmental factors were the “predominant”, i.e. majority, cause [B1/3781-3782]. In his oral evidence, he described it as he saw the evidence, of “overwhelming environmental aetiology” [B3/1676]. Whatever case the Defence might have wished to advance, on the evidence, the PCC was not wrong in its description of the Appellant’s beliefs or the underpinnings of Orthotropics, reflecting his own evidence. The PCC did not fall into error in how it approached and resolved the charges. Ground 4- Failure to define what was considered to be ‘adequate objective evidence’

[114]In the light of the Appellant’s concessions, as set out by the PCC [B1/76/134-138], that there was no such adequate objective evidence, it is difficult to see how this Ground of Appeal about definitions gets off the ground. Whilst Mr Vullo KC valiantly sought to downplay and insulate the Appellant from the significance of those repeated concessions in his witness evidence and in the YouTube videos, plainly the PCC was right and entitled to rely upon them.

[115]That said, this was not the only basis upon which the PCC found an absence of such evidence, even by the time of the hearings let alone at the time of the treatment and online claims being made. The PCC rightly weighed up the competing academic papers relied upon, correctly noting “the extremely limited objective research (namely one published thesis and an abstract) into the outcomes of orthotropic based interventions, and that this evidence was not available at the time of the matters that are the subject of this hearing.” [B1/76/134]

[116]As the PCC rightly noted, that published thesis, the Tavoossi Thesis, which it appeared the Appellant was aware of but did not bring it to the attention of the GDC, reported that there was insufficient evidence to conclude that the Orthotropic treatment protocol had a meaningful effect on skeletal and dental changes. This lent no support to the Appellant’s claims for treatment benefits and justifications. The Appellant accepted in evidence that this thesis was the only comprehensive evidence available to the PCC on Orthotropics (the other being an embargoed abstract of an unpublished thesis). Despite criticisms made of it, its findings were consistent with the views of Mr Powell and Mr Smith, which the PCC was entitled to accept.

[117]Even without a precise definition, which in my view was not necessary in the particular circumstances, the evidence fell short on any reasonable conception of adequacy given the nature of the claims made and treatment given.

[118]The Appellant has not established that the PCC was wrong in its approach, and this Ground of Appeal is dismissed. Ground 5- Wrongly preventing Appellant from cross-examining GDC experts on open-source material tending to show that treatment techniques utilised by Registrant were recognised by mainstream dental organisations.

[119]Again, I consider that this Ground of Appeal does not have any merit. It would have been a clear error on the PCC’s behalf to have admitted this open-source evidence gathered by the Appellant’s Solicitor, who was not an expert witness in the case, entering search terms on the internet. It was right to exclude it and prevent cross-examination upon it.

[120]The charges were properly determined on the factual and expert evidence heard first-hand by the PCC. Introducing untested material from internet searches, the purpose of which (such as marketing) varied and containing claims properly to be characterised as of unknown authority and legitimacy, would have been wrong. It could not satisfactorily be relied upon given it included opinion evidence not given by experts in the case and was not open to proper testing, probing, and challenge. The drawing of conclusions upon it would have been fraught with potential unfairness and error.

[121]I note that Dexter Dias J expressed similar misgivings about admitting in evidence material from internet searches at [106] in Myhill v GDC

[2025] EWHC 474 (Admin)

“I begin by looking under this heading at the previous study. It is difficult to conceive how it can be said to “probably” have an “important influence on the result of the case”, that is whether there is misconduct (contravention of professional standards in the ways alleged and found by the Original Tribunal) and impairment (similarly). A series of hyperlinks from the internet without reliable evidence explaining the value of the studies and their recognition by any responsible body of medical opinion or supported by independent expert evidence is insufficient. That is what the fresh evidence presented by the appellant substantially amounts to: study after study without any authoritative analysis of their value or acceptance by any responsible body of medical opinion.”

Grounds 6 to 8- PCC wrong to find charges 6, 9, 10 and 16a proved that is whether there is misconduct (contravention of professional standards in the ways alleged and found by the Original Tribunal) and impairment (similarly). A series of hyperlinks from the internet without reliable evidence explaining the value of the studies and their recognition by any responsible body of medical opinion or supported

Grounds 6 to 8- PCC wrong to find charges 6, 9, 10 and 16a proved

[122]The Appellant did not make oral submissions on these subsidiary Grounds, but they were the subject of written submissions in the Skeleton Argument.

[123]As for Ground 6, in the light of the findings on Ground 4 on the absence of adequate objective evidence, this Ground largely falls away. Whether the claims made were misleading or inappropriate was an objective question to be judged against the professional standards expected of a specialist orthodontist, rather than engaging in value judgments about particular individuals receiving the information. The PCC gave appropriate reasons and was not wrong to reach the conclusions it did. This is reinforced by the appropriate deference being shown to the PCC’s expertise in judging where the thresholds lie in professional standards and appropriate practice.

[124]Regarding Grounds 9 and 10, the PCC was entitled to rely upon the contemporaneous documents and correspondence, whatever the Appellant’s motivation in including additional material in the letter wrongly recommending this treatment. It was also entitled to rely on the admission by the Appellant in evidence in this regard. There was additionally the expert evidence from the GDC experts agreeing that this treatment was not clinically indicated, with Prof. Garcovich stating that this was outside his field of expertise. No error of approach making the decision wrong has been demonstrated.

[125]As for ground 16a, despite the Appellant’s denials, as the PCC rightly recorded [B1/93-94], the contemporaneous evidence of a letter to the parents suggesting that Patient B, aged 2 years old, should return for another appointment to allow the Appellant to take an impression in order to “attempt some upper expansion” indicated the Appellant’s intention. That the intention was not able to be realised did not undermine the clearly expressed intention. There is no basis to suggest this finding was wrong.

[126]I reject the contention that the PCC was wrong and dismiss these Grounds of Appeal. Grounds 9 to 11- findings of misconduct, impairment and sanction were wrong

[127]The Appellant accepted that these challenges to the findings of misconduct, current impairment and sanction would not arise, if the substantive and preceding Grounds of Appeal against the PCC’s findings concerning its approach to and findings on the charges were to fail.

[128]It is also noteworthy that before the PCC, in the light of its findings that the charges were proven, the Appellant accepted that misconduct and impairment would be found. No mitigation was advanced and the Appellant acknowledged that erasure could be the only outcome [B1/109/160].

[129]For completeness, these final Grounds of Appeal are dismissed. IX. THE FRESH EVIDENCE APPLICATION

[130]In submissions, Mr Vullo KC accepted that if the Court did not determine the substantive Grounds about the expert evidence in the Appellant’s favour, it would be difficult to argue that the fresh evidence, if admitted, would tip the balance. I agree. But, by an email of 26 February 2026, subsequent to the oral hearings, the parties said, “The parties' agreed position is that we would like to invite [you] to rule on the fresh evidence application on a notional basis if [you] consider it appropriate to do so without further legal argument from the parties. This is so that the parties can determine the position as to costs.”

[131]By an application notice dated 13 May 2025, the Appellant sought permission to adduce fresh evidence on appeal, supported by the witness statement of Ms Lucinda Hawthorn, the Appellant’s Solicitor, of the same date. The two items exhibited to the statement which the Appellant sought permission to adduce are:a. The Effects of Early Biobloc Treatment on Hyperdivergent Children, by Dr Benjamin Harvey (May 2023) (the “Harvey Thesis” as distinct from the Harvey Abstract” which the PCC had before it); and

b. Cephalometric Data. In: Mini Me. Publication by the Kois Center, Advancing Dentistry Through Science. Retrieved from: https://www.koiscenter.com/wpcontent/uploads/2022/08/Cephalometric-data.pdf on 13 May 2025 (the “Interpretation Guide”).

[132]The Appellant’s written argument in support of the application is contained within Ms Hawthorn’s statement. The Respondent’s Skeleton Argument in opposition to it, from Ms Barnfather, dated 8 August 2025. The parties chose not to make oral submissions at the appeal hearing on the application.

[133]In the section on the “Hearing of Appeals”, CPR 52.21 confirms that the court has jurisdiction to admit fresh evidence, although this is the exception rather than the rule: […] (2) Unless it orders otherwise, the appeal court will not receive—(a) oral evidence; or

(b) evidence which was not before the lower court.

[134]The definitive test is of course to be found in Ladd v Marshall

[1954] 3 All ER 745

, per Denning LJ at 748A:

“It is very rare that application is made to this court for a new trial on the ground that a witness has told a lie. The principles to be applied are the same as those always applied when fresh evidence is sought to be introduced. In order to justify the reception of fresh evidence or a new trial, three conditions must be fulfilled: first, it must be shown that the evidence could not have been obtained with reasonable diligence for use at the trial: second, the evidence must be such that, if given, it would probably have an important influence on the result of the case, although it need not be decisive: third, the evidence must be such as is presumably to be believed, or in other words, it must be apparently credible, although it need not be incontrovertible.” as those always applied when fresh evidence is sought to be introduced. In order to justify the reception of fresh evidence or a new trial, three conditions must be fulfilled: first, it must be shown that the evidence could not have been obtained with reasonable diligence for use at the trial: second, the evidence must be such that, if given, it would probably have an important influence on the result of the case, although it need not be decisive: third, the evidence must be such as is although it need not be incontrovertible.”

case, although it need not be decisive: third, the evidence must be such as is

[135]Dexter Dias J helpfully observed as follows at [79] in Myhill v GMC

[2025] EWHC 474 (Admin)

“I accept two submissions of general approach made by the appellant. First, that each case is fact-specific without any universally applicable or artificially restricting rules of law. I conclude that the court must examine the factual circumstances fully and fairly on their own terms and then apply those facts to the tripartite Ladd v Marshall test. Second, the condition that the evidence would “probably” be of important influence simply means more likely than not. There is no need for the evidence to have an inexorable or inevitable effect altering the result. I examine the elements of the Ladd v Marshall test in this order (summarising the description of the constituent parts) (1) reasonable diligence; (2) credibility; (3) influence.” case is fact-specific without any universally applicable or artificially restricting rules of law. I conclude that the court must examine the factual circumstances fully and fairly Second, the condition that the evidence would “probably” be of important influence inexorable or inevitable effect altering the result. I examine the elements of the Ladd v Marshall test in this order (summarising the description of the constituent parts) (1) reasonable diligence; (2) credibility; (3) influence.”

Marshall test in this order (summarising the description of the constituent parts) (1)

[136]I will take the same approach albeit, as the resolution of this application will not alter the outcome of the appeal, it is to assist the parties on matters of costs, that I summarise the reasons for how I would have resolved the application.

[137]The burden is on the Appellant as the party seeking to persuade the Court to take the unusual course of permitting fresh evidence to be adduced at the appeal stage.

[138]Reasonable diligence: notwithstanding the misgivings expressed by the Respondent, in that it was suggested that a draft of the thesis was available to the Appellant, but not deployed during the PCC hearings, I consider that this first consideration is satisfied in relation to the Harvey Thesis, but not in relation to the Interpretation Guide.

[139]The Appellant accepts that the latter was available at the time of the PCC hearings but was not put in evidence at that stage.

[140]Whilst it is unsatisfactory that the evidential position is unclear around whether a draft was available to the Appellant, given the author and his supervisors had not given consent to the lifting of the automatic 2-year embargo post-publication at Texas University, I can see why the draft, if available, was not adduced at that stage.

[141]But the position is somewhat nuanced, as this is not entirely fresh evidence in the traditional sense. An abstract of the Harvey Thesis was before the PCC and the subject of analysis and comment by the experts and the PCC in its determination. But that feeds more into the influence of the Thesis than the question around its availability.

[142]Credibility: whilst I am not in a position to delve into the detail of the Thesis, I consider this consideration to be just about satisfied. The test is not whether on the application the Court accepts the content of the document, given the reference to it not needing to be incontrovertible. As can be seen from the evidence given about the Abstract, the experts for the GDC had reservations about how relevant and reliable this evidence was. But that is different from it lacking all credibility on its face. It is unclear whether the planned revisions, referred to in the email traffic about whether the embargo would be lifted, have been carried into effect. It does not appear that the Thesis has been peer-reviewed or published.

[143]Were the evidence to be admitted, there would need to be further case management on it and at this application stage I do not consider it appropriate for me to take into account either party’s additional expert evidence upon it. There would also need to be further submissions thereafter, were the application to be granted.

[144]Influence: it is at this stage that I consider the application fails in relation to the Thesis, preferring the Respondent’s submissions, in Ms Barnfather’s August 2025 Skeleton Argument over the Appellant’s in Ms Hawthorn’s witness statement. I do not propose to rehearse those points in detail given I am only being asked to rule on a notional basis.

[145]This Thesis post-dates the treatment by some years. It is a MSc Thesis completed in 2023, whereas the charges here relate to treatment claims and decisions in 2013-2019 at a time when this evidence was not available. Contrary to the Appellant’s submissions, the PCC was not tasked with studying or ruling upon “the evolution of the science” but focussing on whether the Appellant’s claims about treatment and treatment carried out met appropriate professional standards.

[146]The Thesis drew on research carried out involving hyperdivergent individuals, unlike Patients A and B who were accepted to be Class 1 Division 1 with normal craniofacial development. It was also research based on treatment by Dr Simon Wong, in Australia. Whilst a proponent of Orthotropics, caution is necessary not least as on the Appellant’s own account, as set out earlier in this judgment, he was “ahead” and “advanced” of other practitioners practising Orthotropics and no one else was treating patients in the same way as him. The Thesis’s conclusions do not validate the same suite of treatments used by the Appellant or the claims made in respect of Patients A and B which were the subject of the charges. It has no bearing on and does not provide support, for instance, for the Appellant’s claims about getting a complete correction if patients start treatment at 5 or 6 years old, increasing nasal capacity, improving sleep issues (let alone cognition), or the additional claims made in relation to Patient A (including e.g. the benefit of a tongue-tie release).

[147]Contrary to the Appellant’s attempt to portray the determination as being a contest between the Tavoossi and Harvey Theses, made public in 2023 and May 2025 respectively, the PCC’s approach was rightly to consider all the extensive evidence and determine these charges with a particular focus on the expert evidence. The PCC correctly noted the multiple research articles submitted on behalf of the Appellant and concluded “while having varying degrees of significance, [they] do not address the issue of whether Orthotropics, as practised by you, achieves the specific and wider results described…” [B1/74/126]. The same applies to the full Harvey Thesis. The PCC went on to state, “[The PCC] noted your reliance onanumber of academic papers which deal with the foundational thinking. The Committee balanced this with the acceptance that there is extremely limited objective research (namely one published thesis and an abstract) into the outcomes of orthotropic based interventions, and that this evidence was not available at the time of the matters that are the subject of this hearing”.

[148]Given all of the above, in addition to the factor that the PCC already had the Harvey Abstract available to it, as well as expert opinion about it so this was not entirely fresh evidence, I do not consider that admission of this additional evidence on appeal would have had an important influence on the result. The Interpretation Guide falls at the first hurdle as it could have been produced with reasonable diligence before the PCC, but was not. It also fails the same test of influence on the outcome, especially once the Harvey Thesis has been ruled out as fresh evidence.

[149]For these reasons, I would have refused the application. X. CONCLUSION AND OUTCOME

[150]In conclusion, I reject the challenge to the PCC’s findings and determination. I do not consider that the Appellant has established that the PCC’s decision was wrong or unjust because of any serious procedural or other irregularity on any of the Grounds of Appeal advanced. Indeed, after conducting this rehearing, I take the view that its determination was correct in all material respects and is unassailable.

[151]Therefore, I dismiss the appeal.

[152]Although it was not formally pursued at the hearing and therefore not the subject of further legal argument beyond the application and written response to it, by separate joint submissions received by email on 26 February 2026, the parties asked me to rule on the fresh evidence application on a notional basis. This was to enable the parties to determine the position as to costs. For the reasons summarised above, if it had arisen, I would have dismissed that application.

[153]Before I conclude this judgment, whilst these secondary observations do not form part of my reasoning, I return to the question of the duration of the underlying hearing before the PCC, spanning no less than 46 days of hearings (generally sitting from 9.30am until 4.30pm) spread across a two year period. Notwithstanding the importance of these proceedings to Appellant’s ongoing career and the Respondent’s regulatory function, I consider it manifestly disproportionate for it to have occupied the equivalent of more than 9 solid weeks of hearing time. Especially given the core issues turned on the evidence of two experts on each side, plus the Appellant. Whilst I have not seen details of the costs incurred, it is inevitable that they must be very substantial on both sides and for the PCC. That is in addition to the cost in hearing time, which will probably have delayed the resolution of other registrants’ regulatory matters, as well as the delay in resolving this matter by reason of the repeated adjournments and length of the hearings.

[154]One only needs to reiterate that Dr Powell, one of the GDC’s experts, was giving evidence for 11 or more full days; one of the Appellant’s experts, Prof. Garcovich for approximately 6 days; and the Appellant himself for a similar period. The issues for determination were reasonably capable of being evidenced and determined fairly within a considerably shorter period, avoiding the need for repeated adjournments and delays, with all the complications of renewed applications for fresh evidence and the like which those facilitated.

[155]True it is that the PCC managed the mammoth task of distilling the volume of evidence and submissions heard resulting in an admirably well-structured and coherent written determination. But I consider that with hindsight, the PCC would have been wise to exert considerably more active case management, evidential control, and trial timetabling before the start of the hearings and throughout. That would have made the PCC’s task less Herculean and would also have made this appeal more proportionate for the parties and more manageable for the Court. XI. COSTS

[156]Following circulation of the draft judgment, I have received further written submissions and seen correspondence between the parties on consequential matters. The parties agree that as a result of the appeal being dismissed, costs should follow the event, consistent with CPR 44.2(2)(a). Hence, there should be an order that the Appellant is to pay the Respondent’s costs. The remaining disputes which I need to resolve relate to:a. Whether to resolve the quantum of those appeal costs by summary assessment now or whether to refer this to detailed assessment in default of agreement; and

b. If there is to be a summary assessment, the appropriate quantum of those costs.

[157]CPR 44.2 deals with the Court’s discretion about whether to make a costs order and the factors it will take into account. CPR 44.3 guides the Court as to the basis of assessment. Where, as here, one is concerned with standard basis costs, via CPR 44.3(2), the Court is to determine any doubt about whether costs were reasonably and proportionately incurred or were reasonable and proportionate in amount, in favour of the paying party. The considerations which point towards costs incurred being proportionate are if they bear a reasonable relationship to the factors in CPR 44.3(5). The potentially relevant ones of those here include the value of the non-monetary relief in issue; the complexity; additional work generated by conduct; and wider factors from reputational issues or public importance.

[158]As for the procedure to adopt for the assessment, CPR 44.6(1) and PD 44.9.1 provide the Court’s jurisdiction to conduct either a summary assessment (and the timing of that) or refer costs for a detailed assessment by a costs officer. PD 44.9.1 provides that:

“The general rule is that the court should make a summary assessment of the costs- […] (b) at the conclusion of any hearing which has lasted not more than one day.”

[159]I reject the Appellant’s written submission that it should be implied from that passage in the PD that summary assessments should not be made in cases where the hearing has lasted more than one day. The Court retains a discretion summarily to assess costs following hearings lasting longer than one day and there is no presumption, let alone rule, against doing so.

[160]I am fortified in that view by the White Book Editors’ guidance (p.1379 of 2026 Ed.) at 44.6.3:

“The court will make a summary assessment of costs unless it is not practicable to do so at the conclusion of a trial of a case which has been dealt with on the fast track or at the conclusion of any other hearing which has lasted not more than one day. There is no rebuttable presumption against summary assessment in relation to costs where hearings last longer than one day. The exercise of the power to make a summary assessment should be considered in every case.”

(emphasis added)

[161]Although dealing with a slightly different point about whether to conduct a summary assessment at the conclusion of a hearing dealing with the costs of the whole claim (which I am not doing here), it is relevant for me to bear in mind the guidance at PD 44.9.2, which the Appellant highlighted, that there may be good reason not to conduct a summary assessment “for example where the paying party shows substantial grounds for disputing the sum claimed for costs that cannot be dealt with summarily.”

[162]I do not understand the assertion in the Appellant’s written submissions that a summary assessment is not appropriate, in part, because the draft judgment is embargoed, the content has not been communicated to the Appellant by his legal representatives and they do not intend to do so until the judgment has been handed down. Therefore, it is said it has not been possible to take instructions from the Appellant on costs. If that is the approach which has been taken, then it was not necessary. The second line of the header to the draft judgment was explicit that “This draft is confidential to the parties and their legal representatives and insurers and accordingly neither the draft itself nor its substance may be disclosed to any other person or made public in any way.” (emphasis added). There was no bar upon sharing the draft judgment or its content with the Appellant, as a party to the proceedings, or taking instructions from him, subject to compliance with the wider terms of the embargo.

[163]The fact that in open correspondence, the Respondent agreed to reduce the sum in costs claimed in the schedule by £10,000, to reflect a reduction in the amount claimed for experts’ fees, reflects a realistic approach and a sensible concession to see if a figure could be agreed, not a concession that the remaining costs are disproportionate and unreasonable, as is asserted by the Appellant. I do not consider the other points taken by the Appellant in opposition to a range of heads of costs are sufficient to render a summary assessment inappropriate.

[164]I do need to factor in the additional consideration here that there has not been a hearing to determine consequential matters following circulation of the draft judgment. Neither party has called for such a hearing and I have the benefit of written submissions from the parties on the issue of whether to conduct a summary assessment or refer to detailed assessment. I also have written submissions and have seen correspondence in which the Appellant has set out a series of objections to different items within the costs claimed and the Respondent has addressed a number of those points. I consider that I am well placed in the circumstances to resolve those objections on paper. There is no unfairness to either party in me doing so without the additional costs and delay which would flow from listing a hearing at which to receive oral submissions as well. Having a further hearing would not be proportionate, in my view.

[165]Naturally, the Court must also take account of and seek to further the wider overriding objective when approaching all these issues in relation to costs.

[166]Finally, in emails received by the Court on the morning of the handing down on 15 May 2026, a dispute has emerged between the parties about whether there was agreement for the Court to be shown recent correspondence which included offers on costs. The Appellant’s position is that there was no such agreement and the Respondent contends that there was. I do not need to resolve this dispute (and am not in a position to do so) to rule upon the costs issues. It is in no way a surprise to the Court that there have been offers on costs as(a) the CPR require the parties to seek to narrow the issues; and

(b) in the postscript to my draft judgment I specifically directed the parties to cooperate and use their best endeavours to resolve consequential matters including costs and provide a draft Order, agreed if possible.

[167]The Appellant’s position is as follows, “In light of this, the Appellant's respectful submission is that the court cannot now summarily assess costs without unintentionally having one eye on the respective costs offered by the parties.” I do not accept that proposition. The Court is well used to putting matters out of mind, such as documents it has seen de bene esse to consider whether they are disclosable or should be admitted late or as fresh evidence and then ignoring that material, if not admitted in evidence, when making the substantive decision. In the costs field, the Court will see the parties’ Precedents R recording discussions between the parties, following the exchange of Precedent H costs budgets, and the Court is often be told about further offers or concessions made, prior to then ruling on the costs budget for non-agreed phases in a costs management hearing. Judges are able to reach independent and fair decisions in those budgeting exercises. Whilst those are different processes from a summary assessment of costs, where it not the norm for the Court to be aware of offers on costs unless the parties agree for this to occur, I do not consider that I would be unable fairly to conduct a summary assessment or that the process would be tainted by me having been aware of, but having put out of my mind, offers made. Indeed, the process is fairer to the Appellant in the light of me having seen the correspondence. I have been able to take account of the more detailed narrative of the objection taken to various aspects of the costs, set out in the letter and which expands on the written submissions, but which letter also includes an overall offer on costs. But for the avoidance of doubt, when approaching the determination of the quantum of costs, the parties’ offers have had no bearing on my decision. That reflects my own independent judgment and exercise of my discretion regarding what is reasonable and proportionate.

[168]Returning to issue (a) set out in paragraph 156 above, in my view, the appropriate exercise of my discretion is for me to proceed summarily to assess the costs of the appeal now, rather than deferring them to a detailed assessment, in default of agreement. Whilst I recognise a referral to detailed assessment would be the normal order following a hearing of more than one day, but it is not an invariable rule or presumption. Here, applying the rules and overriding objective points in a different direction. I am well placed having heard and determined this appeal, via a detailed judgment, to conduct a summary assessment. I have considerable experience of costs and summary assessment, both as a Deputy HCJ and when sitting as a Deputy KB Master. The scale of the costs points towards summary assessment, given the amount claimed by the Respondent for the appeal is in five-figures not, say a substantial six-figure sum or more.

[169]Whilst the Appellant complains that he only had about one day to review the Respondent’s costs Schedule, dated 12 May 2026, this must be seen in the context that this was an update to a schedule served in October 2025, when the appeal was previously listed but adjourned. That earlier Schedule already particularised almost 90% of the costs claimed. The 25 October 2025 Schedule claimed costs totalling £85,853.20 whereas the 12 May 2026 Schedule increased that sum to £96,248.48 (before the £10,000 concession made by the Respondent). So the Appellant has had an appropriate time period to consider the costs and could reasonably have anticipated that the adjourned hearing would produce a modest increase to the sum claimed. I do not accept the Appellant’s assertion that there are multiple areas of the Respondent’s costs schedule which require interrogation and the provision of additional detail. The whole ethos of summary assessment is to avoid that sort of process and the attendant costs and delay, when this can fairly be done. It can here, in my view. Having scrutinised the Respondent’s Schedule, it provides the expected detail and breakdown and, subject to the points I will set out below when considering quantum, there is nothing in it which I consider on the face of it to be disproportionate or unreasonable.

[170]Most fundamentally, in deciding to proceed with a summary assessment, I bear in mind that these proceedings relate to conduct between 2013 and 2019, now between 7 and 13 years ago. It is in accordance with the overriding objective to resolve all consequential matters within this judgment, rather than deferring the resolution of the appeal costs to further negotiation or, more likely, detailed assessment. Whilst I have put the parties’ offers on costs out of my mind when it comes to assessing the quantum of costs, it is sufficient at this stage to note that the parties’ positions are far apart. I am pessimistic that simply allowing further time would result in an agreement on the amount of costs. It is probable that further costs would be incurred in proceeding at least part way towards a detailed assessment. It is likely that the costs involved in that process would swiftly become disproportionate to the sums involved, themselves generate additional costs and entrench the parties polarised positions’ in this hard-fought matter further. If one factors in the duration of the underlying disciplinary tribunal, notwithstanding the importance of this matter to the parties and the public interest in professional regulation, it has already taken up more than its fair share of the tribunal and court system’s limited resources. Whilst he opposes the Court proceeding to a summary assessment, in my judgment it is in the Appellant’s interests, as much as the Respondent’s, to draw this protracted matter to a close. It would be doing the Appellant no kindness to permit him to spend further time, energy and money in disputing the appeal costs which he is to pay.

[171]As for the quantum of costs, with the Respondent’s open concession against the experts’ fees claimed of £10,000, the sum claimed totals £86,248.48. I bear in mind the Appellant’s various objections across a range of the amounts claimed, as set out in the written submissions and correspondence.

[172]The Appellant has chosen not to file or serve a schedule of his costs and has declined an invitation by the Respondent to do so in order to contextualise the objections made. Whilst a direct comparison would not have been appropriate, even in cases where one is comparing the product of panel rates with what I assume, for the Appellant, were entirely privately paid legal costs (the Appellant’s experts having, as I understand it, worked pro bono), having an eye to the costs incurred by the paying party can be of some assistance. I infer that the Appellant’s costs of the appeal are greater than those claimed by the Respondent. This would not be surprising assuming he is privately paying and as he was advancing the appeal, rather than responding to it.

[173]Whilst I am not setting hourly rates, on a summary assessment, it is noteworthy that the Respondent’s Solicitors’ blended hourly rate claimed of £138 for all fee earners involved, is below the Guideline rate, even for a Grade D fee earner of £146 (London Band 3), let alone that for Grade A of £319. No doubt that reflects negotiations around lower agreed panel rates in return for a regular flow of GDC work. This relatively modest hourly rate mitigates areas where, had the rates been significantly higher, the numbers of hours claimed would have pushed the overall costs claimed in differing categories up to amounts which would potentially have been disproportionate and unreasonable.

[174]As it is, after making what I consider to be an appropriate further overall adjustment downwards for experts’ fees consequential on the Appellant’s application to admit fresh evidence, as well as reducing somewhat the Solicitors’ time costs relating to the experts and producing the costs Schedule, I reach an overall figure of £75,000 (inclusive of VAT), before examining the other categories of costs further.

[175]Unsurprisingly, nearly half of that amount relates to Counsel’s fees for the appeal inclusive of VAT. I disagree with the Appellant’s contention that £30,450, before VAT, in Counsel’s fees for appearing at this 3-day appeal as well as preparing for it and drafting the written documents, even before factoring in the adjournment of the original listing in October 2025, is disproportionate and unreasonable. Those consisted of a brief fee of £28,000, plus two refreshers at £1,000 each, with a modest uplift of £450 which whilst not explicitly broken down, may reflect the adjournment of the original listing and a modest amount of time reading back in. I do not consider that any realistic objection can be taken to such fees in the circumstances. Ms Barnfather is a leading junior of considerable experience specialising in regulatory work. The underlying proceedings were complex, very lengthy, hard fought and document heavy. All of those factors applied to the appeal, save that at three days, it was not particularly lengthy. That said, the parties had suggested that 4 days of pre-reading time for the Court were necessary (although in the event the necessities of listing meant that it only had 1 day). Extensive and diligent preparation had plainly been carried out by both parties’ Counsel as well. That must also be seen in the context that it was necessary for Counsel to have a complete mastery of all the issues, the extensive documents and of 46 days of hearings before the PCC, as Ms Barnfather demonstrably did (as did Mr Vullo KC). It was also necessary to distil those lengthy proceedings, the wide ranging grounds of appeal and the Appellant’s painstakingly detailed submissions into a detailed and convincing written and oral response on behalf of the Respondent. Much was at stake for both parties and there were the wider interests of reputation and the public importance in the proper pursuit of regulatory proceedings. Counsel’s fees claimed were eminently reasonable and proportionate.

[176]As for the Respondent’s Solicitors’ time costs, a number of the same considerations discussed in the preceding paragraph also apply in justifying detailed and time-intensive preparation. Other than in relation to expert evidence and time on producing the costs Schedule, whether standing back and looking at the global amount or considering the breakdown, I do not consider that the sums incurred are disproportionate or unreasonable.

[177]The Appellant has complained about the 95 separate items detailed in the Schedule of work done on documents, as indicative of excess. In my view, one needs to delve beyond the mere number of items to see that this reflects an admirable attempt at transparency in breaking down tasks into individual components, many of which are less than an hour in duration and reflecting appropriate delegation most (but not all) of the time. The overall total number of hours spent on documents by all fee earners combined is 179.5. Given the relevant factors in relation to the appeal, subject to the points around time on expert evidence being somewhat too high, there is nothing notable or objectionable about the time spent. This reflects work over a period of more than a year from the Appellant’s Notice being served to the substantive hearing, with additional work on consequential matters when the draft judgment was received.

[178]I have made a further downward adjustment, beyond the concession of £10,000 made by the Respondent, to the experts’ fees and Solicitors’ time costs on dealing with the experts and their reports, as well as a reduction to the time costs in relation to preparation of the costs schedule which, whilst a complex exercise here, appear on the high side.

[179]For all the reasons summarised above, the reasonable and proportionate costs of this appeal are summarily assessed at £75,000, including VAT of £6,090 on the Counsel fee element of those costs (VAT is not claimed on any other aspect), in the net sum of £30,450. Therefore the Appellant is to pay to the Respondent the total sum of £75,000 for the appeal costs.

[180]Whilst CPR 44.7(1) provides that the standard period for the payment of a costs order is 14 days from the date of the Order, sub-paragraph (1)(c) provides that the Court may specify another period. The Appellant could reasonably have anticipated that the Court might well proceed to a summary assessment and require payment within 14 days. However, a summary assessment is not the approach which the Appellant sought and I have not received or heard submissions on time to pay. Had I done so, I doubt the Respondent would have actively opposed any request, had it been made, to allow further time. To anticipate this and ensure fairness to the Appellant in making arrangements to pay, I will allow an additional 14 days, so 28 days in total, for the Appellant to pay to the Respondent the sum in costs ordered of £75,000. As per my consequential Order, this is due by 4pm on 12 June 2026. ------------------------------------------------------------------------------------------------------------ APPENDIX A: THE FULL CHARGES MEW, Michael Gordon, a dentist, BOS Lond 1993, is summoned to appear before the Professional Conduct Committee for an inquiry into the following charge: "That, being a registered dentist:

APPENDIX A: THE FULL CHARGES

[1]Between September 2013 and May 2019, you provided advice and treatment to: (a). Patient A, identified in Schedule A 1; and (b). Patient B, identified in Schedule A.

Patient A

[2]In September 2016, when Patient A was 6 years old, you recommended she underwent treatment you referred to as 'Orthotropic' treatment involving: (a). upper and lower arch expansion appliances; (b). the wearing of neck gear.

[3]You informed Patient A 's parents that the principal aims of the treatment you proposed were: (a). to expand Patient A's upper and lower arches and thereby "make way for the tongue, far more than would be required for the teeth"; (b). to "gain a substantial increase in nasal capacity"; (c). to "improve the midface (the area under the eyes and either side of the nose)"; (d). to "change the swallowing pattern"; (e). to "correct the cause of the problem and guide facial growth and development through gaining structural changes of facial and dental form" and through "correcting the oral environment in this way, more space for the teeth and tongue is created, so that all the 32 teeth (including the wisdom teeth) align naturally without the need for fixed braces"; (f). based on, "the Tropic Premise which states that anyone who exhibits a number of features will have permanently well aligned teeth and good facial form", the features to be exhibited including standing up straight, establishing a lip seal with nasal breathing, maintaining a "Butterfly bite", resting with the tongue on the roof of the mouth and swallowing with the tongue on the roof of the mouth. 1 Schedule A is a private document which cannot be disclosed.

number of features will have permanently well aligned teeth and good

[4]Patient A had a Class 1 occlusion on a Class 1 skeletal base with normal craniofacial development.

[5]Your recommendations for treatment and comments as set out at paragraph 2 and/or 3 were inappropriate and/or misleading in that: (a). treatment was not clinically indicated for Patient A; (b). you had no adequate objective evidence to suggest the treatment proposed for Patient A would achieve the aims stated.

[6]You inappropriately informed Patient A's parents: (a). "Most orthodontists have been told that we are not evidence based and are "bad" but few really have any idea of what we do"; (b). "for younger children it is also important to push many orthodontists into giving their opinion as to what may happen in the future, as it is too easy to sit on the fence and placate parents for years until it is too late to avoid extractions or surgery."

[8]On 20 September 2016 Patient A was fitted with upper and lower expansion appliances.

[9]On 6 October 2016 Patient A was fitted with neck gear.

[10]On or about 2 November 2016 you recommended Patient A underwent a lingual tongue-tie release for a tongue tie which you stated: (a). was restricting her ability to rest with her tongue on the roof of her mouth comfortably at rest; (b). was creating an imbalance in the strength of her jaw and tongue muscles; (c). was responsible for night-time teeth grinding and clicking; (d). was negatively affecting her oral posture and which, if left untreated, would negatively impact her facial growth and dental malocclusion; (e). if treated, would complement her 'Orthotropic' therapy with the result that she would not need orthodontic or other intervention at some point in the future.

she would not need orthodontic or other intervention at some point in the

[11]Your recommendation that Patient A underwent a lingual tongue-tie release and your comments as set out at paragraph 9 were inappropriate and/or misleading in that: (a). a lingual tongue-tie release was not clinically indicated for Patient A; (b). you had no adequate objective evidence to suggest a lingual tongue-tie was causing the issues stated or potential issues; (c). you had no adequate objective evidence that a lingual tongue-tie release would achieve the outcomes indicated or implied.

[12]On 8 May 2017 Patient A was seen by a Consultant Oral and Maxillofacial Consultant and found: (a). not to require a lingual tongue tie-release; (b). to have developed a large anterior open bite; (c). to have a traumatic ulcer on the lingual frenum.

[13]A photograph taken in September 2017 shows Patient A had recession of the labial gingiva of the permanent lower incisors.

[14]A photograph taken in April 2019 shows Patient A had: (a). recession of the labial gingiva of the permanent lower incisors; (b). an unresolved anterior open bite; (c). an unaligned UL2.

[15]In respect of Patient A: (a). you failed to carry out appropriate and/or adequate monitoring of her treatment; (b). you failed to carry out any cephalometric analysis or similar.

[16]You ought to have known that that the treatment provided to Patient A as set out at paragraph 7 and/or 8: (a). was not clinically indicated for Patient A; (b). was not in Patient A's best interests; (c). was liable to cause harm.

Patient B

[18]In November 2013, when Patient B was 2 years old: (a). you took an upper impression with the intention of providing an expansion appliance; (b). you informed Patient B's parents that the aim of the proposed expansion

appliance would be to improve tongue space and upper nasal airway

[19]The treatment proposed and comments as set out at paragraph 16 were inappropriate and/or misleading in that: (a). treatment was not clinically indicated for Patient B; (b). you had no adequate objective evidence to suggest the treatment proposed for Patient B would achieve the aims stated.

[20]In February 2018, when Patient B was 6 years, you reviewed him and informed Patient B's parents: (a). that, "both upper and lower jaws have dropped down as is consistent with the concept of Craniofacial Dystrophy"; (b). the aim of treatment you proposed for Patient B would be, "to improve the craniofacial development so that he no longer had any sleep issues and create an environment in which the teeth align themselves"; (c). ''As the upper and lower jaws have dropped down and back, the face has lengthened affecting the airway leading to a forward head posture and a modified resting tongue position. The latter dictating a pattern of malocclusion that we see"; (d). the aim of treatment you proposed for Patient B would be, "not to align teeth but create an environment in which teeth will align themselves as they do in 5,400 species of mammals and our ancestors since the dawn of time."

teeth but create an environment in which teeth will align themselves as

[21]You recommended Patient B underwent treatment you referred to as 'Orthotropic' treatment involving: (a). the widening of both arches, with greater widening of the maxilla; (b). the wearing of head gear at night; (c). the potential provision of a 'Myobrace' or 'training appliance'.

[22]Patient B had a Class 1 occlusion on a Class 1 skeletal base and normal craniofacial development.

[23]Your recommendations for treatment and comments as set out at paragraph 18 and/or 19 were inappropriate and/or misleading in that: (a). treatment was not clinically indicated for Patient B; (b). you had no adequate objective evidence to suggest the treatment proposed for Patient B would achieve the aims stated.

[24]On 16 August 2018 Patient B was fitted with upper and lower arch expansion appliances.

[25]On 23 August 2018, following questions and concerns raised by Patient B's parents, you informed them: (a). that the treatment you proposed "was designed to create more space for the tongue and then train an individual to change. In this way, it becomes easier for patients to correct themselves. Malocclusions improve and there is a positive impact on the airway with improved sleep, fewer nasal obstructions and better oral posture"; (b). "the changes they achieve are stable and as long as patients continue to be aware of their oral posture, these changes are permanent"; (c). that in Patient B's case, ''there is a lack of space for his tongue and this is the reason his facial form has down swung"; (d). "It is necessary in his case to gain this additional space by widening his arches as well as lengthening".

[26]Your recommendations for treatment and comments as set out at paragraph 23 were inappropriate and/or misleading in that: (a). treatment was not clinically indicated for Patient B; (b). you had no adequate objective evidence to suggest the treatment proposed for Patient B would achieve the aims stated.

[27]On 30 August 2018 Patient B was provided with head gear.

[28]In respect of Patient B, you failed: (a). to carry out any cephalometric analysis or similar; (b). to treat or ensure decay was treated at ULD, ULE, LLD, URE, LRE and/or LRD prior to commencing treatment; (c). to obtain study models; (d). to communicate with Patient B's paediatrician; (e). to carry out appropriate and/or adequate monitoring.

[29]On 10 December 2018 Patient B was seen by another practitioner and found to have recession of the labial gingiva of a permanent lower incisor.

[30]You ought to have known that the treatment provided to Patient B as set out at paragraph 22 and/or 25: (a). was not clinically indicated; (b). was not in Patient A This typographical error was amended to read “Patient B”: see the PCC’s determination at [143]. 's best interests; (c). was liable to cause harm. "You Tube"

[31]In a video posted on YouTube in about September 2017 titled "Orthodontics Beyond Teeth" you stated: (a). words to the effect, that if you create enough tongue space, and children use that tongue space, that can influence facial growth and the craniofacial structure and, "expansion of the brain, expansion of the dental arches as well"; (b). that, " .. . if a patient walks into my office over the age of 8, they're into the area where it's going to be compromise, it depends how hard they work. If someone comes in at the age of 5, 6 I can almost get a complete correction. If someone comes in younger I can give them advice on how they can correct themselves".

area where it's going to be compromise, it depends how hard they work. If

[32]Your claims as set out above at paragraph 29 were inappropriate and/or misleading in that they were made without adequate objective evidence. And that, by reason of the facts alleged, your fitness to practice is impaired by reason of your misconduct."

Cited in 1 later judgment

Liam Dickinson v Newcastle upon Tyne Hospitals NHS Foundation Trust 2026