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Why straightening your teeth without doctor supervision is dangerous.

Over the last several months, I’ve seen a wave of commercials, sponsored Instagram posts, and even brick-and-mortar shops that are trying to sell you on the idea of DIY orthodontics. As someone who really appreciates good marketing, I’ve gotta say that on the one hand I’m very impressed. D2C Companies are really able to create interest and intrigue. Their branding is cool and to be quite frank, their advertisements are convincing.

However, I’m writing this because I fear that the common consumer who isn’t immersed in the world of dentistry is being lead grossly astray by these companies. What they’re selling you is alluring – why pay more or waste time visiting a doctor when you can straighten your teeth from the comfort of your own home? Unfortunately, what these companies fail to mention is why doctor-supervision isn’t just a nicety but is absolutely essential. Below I’ve listed my reasons for why this approach to orthodontics should be strongly discouraged.

Without X-rays and an exam, you could potentially be exacerbating a preexisting infectious process.

Here and there patients will come to my office and ask why we take X-rays at their checkups. My simple answer is you can’t diagnose what you don’t see. Infectious processes like cavities and periodontal disease (bone loss) aren’t always able to be diagnosed visually. X-rays allow us to really understand where your health stands. With DIY ortho however, X-rays aren’t taken or required… scary.

I think most of my colleagues can relate in that several times a day we hear the following: “But doc… it doesn’t hurt!”

Here’s my response to all of you: the absence of PAIN is not an indication of good health! Pain is often one of our body’s last ways of letting us know something is wrong. Many of the disease processes in the mouth may never be painful but are extremely consequential… like periodontal disease coupled with bone loss. You will not feel pain when your bone recedes. But when you lose bone.. your teeth are more likely to become mobile and may need to be prematurely extracted. What causes periodontal disease? A number of factors. Your dentist can address this disease process with regular visits.The problem comes into play when you get your mail-order teeth-straightening aligners and you have an underlying condition. Aligners need to be worn 22-24 hours a day. If you have cavities and you’re covering your teeth for that long, you’re essentially speeding up the growth process for said cavities resulting in loss of tooth structure, possible pain, and eventually the need for a root canal or extraction if it isn’t addressed in a timely manner.

And what about bone loss? If you try to move your teeth and you have underlying periodontal disease, your bone loss will rapidly accelerate. It honestly frightens and saddens me to think people out there are attempting to straighten their teeth without doctor supervision when it could very likely result in diminished oral health.

Are you a consumer or a patient?

I often remind my patients that the mouth is connected to the rest of the body. It’s the gateway! More and more research is showing a clear connection between infectious diseases in the mouth and systemic diseases. So when it comes to oral health treatment, do you want to be treated as a consumer who is being sold a service or a patient who is making an informed decision based on your doctor’s recommendations?

From one angle, the battle between DIY orthodontics and traditional care may appear to be a “disruption” of a previously entrenched industry: Airbnb vs hotels, Uber vs. cabs, Amazon vs. Borders. Orthodontic care, which often isn’t covered by health insurance, can feel like another product worth saving money on. But it’s not another product; it’s medical care. And if the largest associations of orthodontists and dentists consistently say this specific medical care can’t be done over the internet, it shouldn’t be ignored or overlooked.

Competition is good. Promoting reckless treatment options is dangerous.One thing I applaud is that these DIY services have forced us clinicians to think long and hard about our prices. How can we compete if a company is not only offering blatant convenience but is also charging 1/3 of what we charge? My office is completely reevaluating our pricing structure and while the details haven’t been fully worked out, I know we’ll be reducing prices significantly to keep up with the competition.

What is truly unfortunate though is that our competition is flagrantly taking advantage of an uninformed consumer.

Taking impressions is an art… and redo after redo adds time.

I recently had a new patient visit my office who was in limbo with their D2C ortho service. They were unhappy with how the finished results looked and was working with them to try to get more aligners. However, they said the process was so long and drawn out because sending impressions takes time via snail mail and several times they were informed that the impression was not sufficient to make aligners.

As dentists, we have explicit and intentional training in the art of impression taking. It took me months to master it. The idea that someone who’s never been exposed to taking an impression before should be entrusted to take one of their own teeth for the first time ever is ludicrous! Of course there are going to be redo’s necessary! And sending impressions back and forth via mail takes time.

At our office we utilize digital impressions that take thousands of pictures of your teeth and get sent to our lab via the internet, allowing your aligners to be precise and mailed to our office within days.

Monthly visits with your dentist allow them to monitor your care.

While it may sound like a drag to have to visit your dentist every month to get a new set of aligners, these visits allow for your progress to be monitored to check for any unusual circumstances. At every monthly visit, my team and I look for any mobility in the teeth, recession, how the movement is coming along and answer any questions or concerns our patients have. It typically only takes about 15-20 minutes. It’s time extremely well spent if you’re undergoing aligner therapy.

What about attachments and “teeth smoothing?

”I’ve never once done a clear aligner case without some attachments and/or teeth smoothing. When you choose a mail order service, you limit the kind of success you can achieve because you don’t have the option of having tooth-colored attachments that anchor the aligners and allow for very specific movements. In addition, if you have a crowding in your mouth, most of the time some teeth smoothing is necessary. Again, the mail-order/D2C services you limit your success since the teeth smoothing can’t be accomplished.

The moral of the story here is to really weigh your options when making a decision on how to straighten your teeth. My sincere and heartfelt advice is to do it under doctor-supervision.

Dr. Sara Mahmood, DDS, MS
Hurst, Texas

This article is republished with permission from the author

To view the CDA’s position statement on Direct to Consumer appliances click here.