Contemporary Orthodontics & Dentofacial Orthopedics
Board Certified Treatment for Children, Teens and Adults
It seems the new buzz in the dental community is the notion of “do it yourself” orthodontics with various techniques passed around on YouTube. I even have had a dentist calling me asking for supplies because she had seen someone moving a tooth on YouTube and she wanted to set up a tooth for a crown in a better position.
To be honest, I never really took the notion seriously until the American Association of Orthodontics issued reports to us in private practice (and went national with advertising against such efforts) following the posting of a DIY case by a student who claimed a correction for $60 of materials.
The idea of permanently moving teeth which must fit in all three dimensions with opposing and adjacent teeth (during rest and function), without planning/records and without a care of how the final bite will fit … I mean it seems common sense would tell even the most simple or value-minded people that there would be unforeseen risks and problems. After all, scalpels can be purchased privately but you don’t see people performing surgery at home, right? Does the public really see Orthodontics so simple as if any un-trained individual can move the teeth successfully and without repercussions; and what has led to this erroneous and dangerous perception? I think sadly the answer is “maybe”.
“…scalpels can be purchased privately but you don’t see people performing surgery at home”
First of all I must state clearly and unequivocally: Orthodontics is the most complex specialty in dentistry, hands-down. It requires significant knowledge of biology, bone physiology, physics, anatomy and no small amount of artistic perceptional ability. Moving teeth to a functional and esthetic relationship requires experience and a knowledge based on 100+ years of research and development; and it requires constant continued education of new technologies, new techniques and new research. In short, it requires a trained specialist with years of specialty training beyond Dental School. Orthodontics is not quick, it is not cheap and it many times requires fixed braces for a full correction; if there was a short/cheap/dependable shortcut, your Orthodontist would be using it!
“Orthodontics is not quick, it is not cheap and it sometimes requires fixed braces; if there was a short/cheap/dependable shortcut, your Orthodontist would be using it!”
Some of the force diagramming used when planning orthodontic movements illustrating the physics employed by Orthodontic specialists in every case. The diagram on the lower right illustrates the different properties/stored energy potential for various wires regularly used (clear aligner trays only come in one size for every movement) v. the elasticity of healthy bone. Note these don’t even take into consideration the fit between upper and lower teeth OR the fit when the jaw is moving side to side.
So from where is this simplified view of tooth movement emanating?
First, there has been a rising trend of Clear Aligner treatment pushed by general dentists that can now leave your tooth movements (I don’t consider this Orthodontics) up to a lab; in essence it allows a general dentist with little to no orthodontic training to take impressions/scans and send them off to a lab for clear aligners to deliver similar to a mouth-guard, bite splint or retainer. I leave the efficacy of these aligner systems for another day but will say these aligners are aimed at esthetics over function and they remain VERY limited in any ability to move roots. Aligner trays end up pushing teeth outward and can tip teeth completely out of the bone leading to relapse and recession that can be difficult or impossible to fix.
|Relapse with recession following dental arch expansion.|
In conjunction with this, we have public companies funded by share-holders (and millions of dollars) which advertise directly to the public through television and magazines, pushing clear aligners that magically do all the work (simplifying tooth movement to a lab procedure) as equivalent to traditional braces. General dentists push it because it is all they can do and they want the money/patients unfortunately this can lead to a dentist placing profit above the needs and well-being of the patients). In fact, any Orthodontist will tell you that once a General Dentist starts providing Invisalign, all referrals stop including the most complex cases that would be difficult even for the specialist; even the younger kids that require early interceptive treatment are not referred because the Dentist wants to offer teen-Invisalign later and it cannot be performed until all molars are erupted (after growth and after many problems are set and un-correctible). In turn, many Orthodontists feel the pressure and have begun offering Invisalign rather than lose patients to their general dental colleagues (they feel at least they will be able to fix problems with braces at the end which they usually have to do) but the effect is a watering down of the quality and a false equivocation of Invisalign to true Orthodontics.
Second, technology used by clear aligner labs is partially available to the public; people with some tech-knowledge can scan their teeth and produce models with 3D printers. In Austin where I live, I have seen middle school kids using 3D printers in their science projects! Although crude to dental standards, it can appear similar to the trays used by doctors and some have placed videos online suggesting they “fixed” their own teeth enticing others with a cheap short-cut.
Finally, the push to find discount alternatives (over quality) and a habit of googling our own common sense away has allowed ignorance to persist as knowledge; consider people placing rubber-bands around two adjacent teeth with the simplified idea of closing a gap (only to open another on the back side, tipping one or both teeth and having the rubber-band slide up the root and destroy the supporting bone). I even see patients following online advice and travelling to 3rd world countries to “save” a few dollars only to learn they have condemned their teeth and now require implants or worse. We now see foreign sources advertising do-it-yourself impressions to send in and receive do-it-yourself aligners online.
|Rubber band placed over front two teeth.|
|Damage from rubber band sliding up the teeth|
This is really what our medical and dental system is evolving toward; a google/Internet based pseudo-knowledge driving patient treatments over the advice and recommendations of highly trained specialists. As a specialty, we have failed the public we serve by keeping our heads in the sand as these false treatments have grown into the storm we see now. Unfortunately we do not have the time or money to combat both the Internet and national advertising by big corporate entities such as Invisalign so we work within our regions to offer what we know is good treatment and, as long as we have patients enough to keep afloat, we just ignore the growing malignancy outside our door.
Orthodontists may eventually have to take a more active role against this DIY value/ignorance-based mentality for their own sakes but for now all I can say is “if it sounds too good to be true”, or if you are being told what you want to hear at your urging, buyer beware. The most expensive Orthodontic correction is the one requiring re-treatment or even restoration due to damaged/lost teeth. If it were as easy as a scan or impression to fix the teeth, no dentist would spend another 2 to 3 years in specialized Orthodontic training (and dig into another $200K debt). Until a sharp Lawyer brings a class action suit or two against these aligner companies for false advertising and against some of the dentists for poor treatment, we will continue to see a devolving of this highly specialized field known as Orthodontics and an increase in DIY gimmicks.
If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35th street and MoPac.
1814 W. 35th Street
Austin, TX 78703
4302 N. Quinlan Park
Austin, TX 78732