You Could Ruin Your Mouth With Home Orthodontics
Until recently, if you wanted to straighten your teeth with braces or aligners, you had to visit an orthodontist several times, which cost you about $ 4,000 or more. But over the past few years , companies like SmileDirectClub have offered an in-home alignment service for about half the cost that patients can use without even going to the orthodontist in person – they just take pictures of their teeth, bite into their uniforms, and get aligners in the mail. Compared to traditional orthodontic treatment, the patient is much more responsible for making sure everything is in order. And that makes my teeth ache.
I went through half of the unusually long 2 year program of Invisalign, the most popular brand of aligners. (The company behind Invisalign also makes SmileDirectClub aligners.) Every ten weeks I visit my orthodontist for a checkup, new aligners, and advice. On a recent visit, I admitted that I started leaving my aligners for longer periods (at parties or picnics) and made up for that by leaving them for every extra day.
My orthodontist gently explained that while my aligners are still putting my teeth in place, my teeth want to move back and they will take every opportunity to do so. In fact, I moved my teeth very slowly. And the moving teeth make them fall out.
I no longer leave aligners for long periods of time.
And that’s why, when the American Association of Orthodontists is waging an extended legal war against home care aligner companies , claiming that remote orthodontists cannot provide adequate help and advice, I understand their point. I would surely ruin this process if I did not check regularly with my specialist. (My orthodontist also seeks my dentist; my garbage mouth requires a whole team of experts.)
There are similar stories from patients on orthodontic forums (including ArchWired ). Wearing aligners is a pain in the ass, and patients always break the rules – drink with their aligners, don’t brush their teeth after every meal, and God knows what else. There are so many things to watch out for – my orthodontist had to warn me against Advil and Tylenol – and it’s risky to do it alone.
With SmileDirectClub I could email a remote orthodontist, but I doubt I would share that much information with him. In 2015, the New York Times spoke with the only orthodontist, oversaw the service of orthodontics at home CrystalBraces (currently closed), who spoke with “a handful” of his 3600 patients. Patients at home don’t seem to be of much help to their doctors.
For years, the AAO has fought to get states to restrict or ban these in-home services, and SmileDirectClub has fought back with lawsuits. And every time a newspaper reports a fight, both sides speak out . The SDC says orthodontists are simply afraid of competition; The AAO says no, it’s just scary that patients will ruin their teeth. The SDC says its orthodontists can handle most cases simply by checking photographs of their patients’ mouths; The AAO says this is not possible.
When I asked the AAO to comment on the situation, they told me what they tell everyone else: they are ordering at least 35 states to punish SDC for breaking the rules because they consider it unsafe. (Update: In response to this story, SmileDirectClub representatives wrote to us: “10 of these cases have been closed without any action against SmileDirectClub.”) Last November, the American Dental Association also “strongly disapproved” of home orthodontics .
On the one hand, the fight looks like any other fight to “disrupt” a previously entrenched industry: Airbnb versus hotels, Uber versus taxis, Amazon versus Borders. Orthodontic treatments, which are often not covered by health insurance, may seem like another product worth saving on. But this is not a different product; it is medical care. And if the largest associations of orthodontists and dentists constantly say that this medical care cannot be provided over the Internet, I am not ready to ignore them in order to save two thousand dollars.
Obviously, this is because I was fortunate enough to afford the more expensive option. If you can’t do this, it can be very difficult to hear that your only option is bad. And maybe the cheap option will suit you – apparently, thousands of people have done it. But if you go remotely, be careful. Learn as much as possible and follow the instructions carefully. Do not move your teeth until they fall out.
Updated 4/14/18 9:14 PM ET to include a statement from SmileDirectClub:
SmileDirectClub is a physician-led at-home aligner treatment program that has served hundreds of thousands of clients with mild to moderate alignment problems. Our team of dentists is ready to answer clients’ clinical questions via live chat, phone or email Monday through Friday from 8:00 am to 6:00 pm (Central Standard Time), or they can also communicate directly with a government licensed dentist or orthodontist, remotely overseeing their treatment if they have a question about their individual plan. In addition, our customer service team is available 23 hours a day, 7 days a week, by phone, email, live chat or social media to answer any general customer service questions.
SmileDirectClub advises clients to follow the directions of their dentist or orthodontist for best results and, most importantly, wear aligners all day and night, with the exception of food, oral hygiene and drinking.
Updated on 4/13/18 5:42 PM ET: The title of this story has been changed to include a link to an additional orthodontic forum.