The straight and narrow – direct-to-consumer orthodontics

the straight and narrowEmma Laing discusses the direct-to-consumer orthodontic boom and encourages clinicians to highlight possible dangers to patients.

We are in so much of a better position now; the vaccination programme is flying, shops are open and we have finally had some vitamin D. We’re all now sitting outside cafes and enjoying this recent beautiful chilly sunshine.

I’ve been surprised that my local high street has not been busier. It hit home that for many areas of shopping, retail has turned predominantly online, even more so in the last 12 months.

The pandemic hit, and we all arranged everything online, in the comfort of our homes. From Amazon purchases to our supermarket shopping.

Considering this thought process led me to this month’s column topic; one of the most controversial in dentistry right now.

Current controversies

Online shopping is so easy. Potential new patients are now considering, and often choosing, to buy everything, including their braces online. Especially since the COVID period.

Evening television advertisements promise straight teeth with low monthly payments. Even my family is asking: ‘Are the braces on the TV any good?’

I am usually a very middle-of-the road, two-sides to each argument type of person. But on this occasion my answer is ‘no.’

I cannot see how you can purchase these appliances with home impressions and gain anywhere near the standard of care that you receive from a dentist or orthodontist in-surgery. Even if direct-to-consumer companies have some clinicians involved in the treatment planning.

After the experience of eight years training and over 12 years since becoming an orthodontic specialist, I simply feel this is incomparable treatment.

I appreciate that whilst most of the dentistry is conducted online, these companies do have some retail locations and at least the latter is not using home impressions.

The size of the problem

I find it staggering how these treatments are gaining so much popularity. The most popular company right now has 118,620 Google reviews with an average 4.9* rating. Am I missing something?

With any other medical or dental treatment, a face-to-face consultation then ongoing supervision from a clinician is a natural decision. Yet these appliances are sold as a product or device that you can buy online in the same way as you would make any other online purchase.

Direct to consumer braces are no small issue. In 2018 Forbes reported a $3.2 billion valuation of Smiledirectclub by Bloomberg. Then the company expanded the following year into Canada, the UK and Australia.

The Grammy Awards’ Shawn Mendes endorsed the aligners, showing the confidence achieved from an amazing smile.

Yet by the end of 2018 the American Association of Orthodontists (AAO) filed complaints with 36 state boards alleging that these appliances violate regulatory standards.

Direct-to-consumer orthodontics

One of the challenges and reasons that I enjoy orthodontics is, as outlined by the AAO: ‘There is no one-size-fits-all approach to orthodontic treatment.’

Treatment planning for orthodontics requires training and experience. Along with a thorough examination, dental records and a custom treatment plan.

I have always welcomed my dentist colleagues treating orthodontic cases where they wish to. And I love receiving referrals for complex cases that are more the remit of a specialist.

When a dentist or orthodontist is planning orthodontic treatment, we consider the dental health as a whole of each patient. Each patient is assured of their training.

I notice on social media many of my colleagues quite rightly raising concerns with direct-to-consumer treatments.

Our professional bodies are helping to raise the concerns about these treatments. But it is important that as clinicians we do this too.

We need to advise patients that prior to committing to orthodontic treatment, consider doing some research and having an in-person consultation with a dentist or orthodontist. Ask questions like the AAO suggests:

  • Do I need X-rays taken?
  • (For informed consent) what alternative appliance or treatment options (including no treatment) is offered?
  • What are the possible risks?
  • Who is responsible for detecting and dealing with any issues occurring during my treatment?

My personal stance is that we are a strong, ethical profession. We should inform our patients to be careful of practices where we feel it is not in line with what we consider reasonable clinical treatment.

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