DIY aligners – why dentistry needs to close the loophole
Jan Einfeldt discusses DIY aligners and why more needs to be done to regulate and educate.
A recent article on the Mailonline mentions dentists want to prevent damage to patients’ health from the long-term damage that DIY aligners can cause.
Then I saw a patient who had paid a DIY aligner company, but she never received her first aligners. It appears the company had stopped trading and was still taking her money.
If even the newspapers pick up that there is a problem in the UK (and other countries), why is so little done about it? After all, this has been going on for years.
Why do people choose DIY aligners?
Wondering why patients would choose DIY aligners over a registered and trained dentist or orthodontist, it dawned on me that to the untrained eye (the general public), it would look very much like the same product.
This may be the first and biggest mistake people make. They think ‘aligner treatment’ is the same as ‘aligners’; it’s just a commodity, a material, a device that is equal to all other devices. They don’t understand the importance of a service (a treatment) that requires careful assessment, diagnosis, planning, training, skill, adjustments, experience, retention and follow up.
In my practice, I use a programme called ‘Smile Mate’ for patients to send photos of their teeth. Similar contact forms exist. Therefore, the patient cannot tell the difference between a dedicated professional dental programme and a photo upload site.
We use video consultations, especially since lockdown. That concept can be used by anyone, and there are several programmes and apps already inbuilt in most mobile phones. The aligners look relatively similar. They are the cornerstone of the teeth straightening and the part that patients can touch and feel.
The impressions or scans appear to be of the same kind they get in a dental practice.
Before and after photos of completed cases on websites of DIY aligner companies look comparable to what you may find on practice websites.
‘Dental Monitoring’ is a programme I use to remotely monitor patients for teeth straightening (with the right equipment like a scan box). But again, people may have the impression that any photos the patient takes themselves are the same as a professional remote monitoring system designed for dental professionals.
The big difference seems only to be the cost. Costs at the dentist are often higher than that of DIY aligners.
Why should the public choose a dental professional?
There are some important differences the general public doesn’t see at first. Any dental professional who treats patients with removable aligners knows there are challenges, even for us. If I could not make use of attachments and IPR (selective removal of enamel), I would find it impossible to treat cases efficiently and with good outcomes. I even use a planning service for optimal aligner movement and result.
Capturing the details required and all the teeth in the dentition – taking good impressions – is difficult enough. For an untrained person to take a good impression of their own teeth is even more difficult. Remember how many years you have trained as a dentist to take good impressions. From time to time, all dentists will have to retake impressions. Now imagine a person who has no training in how to take impressions. And no training in how to check impressions for any problems.
If a scanner is involved by a DIY aligner company, the quality of the impression is likely to be better. However, this raises another problem. If someone is going to perform a scan, it is only legal (digital or non-digital) in the UK on the prescription from a dentist or orthodontist.
The before and after photos on websites of DIY aligner companies are usually blurry. They can be so zoomed out that you cannot see much detail. Social media photos are often quick snapshots that don’t show the teeth clearly. This makes it hard to compare before and after results.
What are dentists doing to help?
Would you book a holiday without ATOL or holiday insurance? You may get away with it. But after the recent lockdown, I guess the people who didn’t, have to accept they have lost their investment. This loss is limited to the money lost. But if DIY aligners cause damage, there is no guarantee there will be any compensation for it. And no dental professional is held accountable.
Dental professionals would like to see the dental regulator put a stop to evasion of the rules that are there to protect patients and the general public.
If a dental professional did not examine the patient face to face, make a dental assessment, diagnosis and a written treatment plan before providing aligners, then he or she would risk their registration.
These rules are evaded by letting a patient take their own impressions. Or by using staff who do not have a dental professional registration to lose.
There is a hole in the legislation that needs closing. Dental professionals have for years been asking for this when the teeth whitening companies appeared with a similar evasion. To then be told by the dental regulator that this request cannot come from dental professionals, it has to come from the patients and the general public. Furthermore, it would require a change in law.
This may require a focused effort to get a change in the law. This is where the profession would like to see the regulator focus their efforts and the retention fees paid by dental professionals. Because it will only go on as long as we, the profession, let it.
Many dentists I have spoken to are frustrated. It seems the effort of the dental regulator focus on catching dental professionals who do not stick to the rules. There’s a much greater need for protection to stop illegal teeth whitening and teeth straightening by people (and companies) who are not registered as dental professionals.
Even if this law evasion is – at least at this point – not illegal, it sends a message to the general public. A good friend of mine said to me: ‘Surely if so many companies are doing it, it cannot be illegal or it would not be allowed to continue’. And this is a friend who trusts me. If I could not explain to him why this is still going on, then how is the general public going to think there are any risks or problems with such treatments?
Try this yourself – Google ‘aligner companies gone bust’. You can see there is more than one DIY aligner company who has recently stopped trading. Read Google reviews left by ‘customers’ or search on Facebook for groups for individual DIY aligner companies.
What would Winston say?
The closest quote of Sir Winston Churchill I could find is: ‘Healthy citizens are the greatest asset any country can have.’
If we as dental professionals want to ensure patients can receive treatment and they want to improve their appearance and confidence in the safest possible way, then it has to be with the direct assistance and supervision of a dental professional team who has ‘skin in the game’, rather than just a financial interest.
There will always be people who are prepared to take unnecessary risks. And people who do not care about the quality of the outcome or the protection of their smile as much as they care about the cost.
People who prioritise the quality will see an investment in their smile worth going to a dental professional whom they trust, with all the reassurance of training and a professional team that takes a personal, legal and professional responsibility.
What can you do?
- Contact the dental regulator that you would like to see these loopholes closed – www.gdc-uk.org/contact-us. Or choose an organisation to do it for you (see next point)
- Join an organisation like the BAPD. It is proactively pushing for positive change in dentistry for all dental professionals (membership from £5 per year) – www.bapd.org.uk
- If you want any advice about the issues in this article, you can contact me on: [email protected].
Remember that: ‘United we stand. Divided we fall’.