Tuesday, February 12, 2019

Fake Orthodontics Gaining Ground


Fake Orthodontics Gaining Ground

(And the Culture of False advertising)

 

As a practicing Orthodontist I meet with dental specialists regularly for continued education, review of difficult cases and overall health of the profession; I have done so regularly for the last 23 years.  Now, at the middle of my career as a Board certified specialist, I feel somewhat qualified to reflect on the state of dentistry, and specifically specialty dentistry, in today’s marketplace.


Although politics has focused on medical insurance and general healthcare (for better or worse) there has been a curious lack of attention to engage the field of dentistry in the negotiations.  This has allowed dental related companies to hide in the shadows as they promote their own profit based treatments directly to the public, many now advertised as not even needing the doctor (and certainly not needing the specialists).  This phenomenon is a result of very large companies combined with social media campaigns that inundated the public with the company’s own agenda, directly to Facebook and other email lists.  Nowhere has this been more harmful than to the field of Orthodontics.

 

 

As the reader, you may ask “how can a company dictate dental care without doctors?”; you may even ask “aren’t there laws to prevent practicing without a license?”

 

In response, it has been a slow but deliberate strategy by certain unethical, profit hungry groups that employ un-ethical dentists and specialists to push them into the range of credibility.  Behind the scenes, there is a battle over standards of care but ultimately dentistry is a business and many succumb to the notion that if you don’t feel you can beat them, you have no other choice but to join them.  This is in fact exactly how Fake Orthodontic Companies like Invisalign (and their subsidiary Smile Club) have become the juggernauts in the room.  Currently there are nearly one hundred lawsuits by national and state dental organizations, boards and individual Orthodontists in the courts against Smile Club and other aligners, but they take time and they get buried by google ads paid for by …. you guessed it, Invisalign.

 

As a history, the idea of clear aligners was not a new one; many of us used clear aligners (made in-house) to hold and correct small rotations or mild relapse after treatment even 35 years ago.  However we all recognized and experienced the extreme limitations of removable plastic trays.  Also at that time, few dentists tried to perform orthodontics without specialty training; in fact family General Dentists would refer complex cases readily to their specialty counterparts/colleagues including surgery to Oral Surgeons, tough root canals to Endodontists, extensive gum disease to Periodontists, kids to Pedodontists and orthodontics to the Orthodontist.  This provided the environment for the General Dentist to become an expert in restorative care as well as the gatekeeper to more advanced treatments that required a higher level of training.

 

“Behind the scenes, there is a battle over standards of care but ultimately dentistry is a business and many succumb to the notion that if you don’t feel you can beat them, you have no other choice but to join them.  This is in fact exactly how … Invisalign [and other “Fake Orthodontic” clear aligner companies] have become the juggernauts in the room.”

 

So what happened?

As competition heated up in larger urban areas, we started to see general dentists pushing the limits to treat more complex issues to avoid losing the income stream from what they perceived as more profitable procedures (more “profitable” because they generally required specialty training to adequately and predictably treat).  Soon, there were whole groups of general dentists claiming specialty status to the public simply because they had seen what they felt like was a significant number of patients.  Of course they were learning on those very patients and were undoubtedly repeating the same mistakes over and over on those same [unsuspecting] patients. 

 

Many would then teach other non-specialized dentists so it became a cycle or grey area in dentistry.  But dentists far outnumber specialist by the definition and specialists had little power to dissuade the American Dental Association (the parent organization of all dentists including specialists) from allowing this progressing breach of standards and ethics.  It is now not uncommon for untrained newly graduated general dentists to see patients already in treatment and then question these cases that they don’t even have the records for and certainly not the training to fully understand.   This sews more discontent and distrust in the public as patients start hearing multiple stories from different doctors and it only serves to confuse patients and leave them open to professional advertising by companies directly.

 

What is the current state of the specialty of Orthodontics?

Today, Orthodontics has become synonymous with Invisalign (by their design, not ours) to new generations through social media and false advertising that would have never been allowed in traditional media.  Add to this a new generation of unethical dentists (and now Orthodontists) driven by pure profit, doctors that know very well they are not offering or providing the best care available (or sometimes even proficient/adequate care without introducing more problems).

 

As these general dentists stopped referring patients to the Orthodontists, the very Orthodontists began to move toward Invialign based practices.  They have done this despite the research that clearly and unequivocally proves Invisalign and the other dozen aligner systems far inferior to traditional braces.  But the public continues to be bombarded by advertising to the point now that Invisalign has purchased other companies like Smile Club that push aligner treatment with no dentist at all.  Ironically, now the general dentists are trying to fight the doctorless trend even though it is they themselves that are funding the company via their own Invisalign cases.

 

Clear aligner treatment; straight teeth but with no posterior contact; good luck chewing that steak!

“Straight” teeth from clear aligners with little to no contact and recession across the arch.


Teeth “straightened” by Invisalign but left protruding forward and out of the bone.
 
 
 
 
What is the Result for the Public?

By normalizing inferior treatment as the new acceptable standard, by accepting that Orthodontics is only used to line up the front six teeth (you will notice there is no mention of function on the many Invisalign commercials/testimonials), doctors and the public alike are rapidly turning a very scientific and complex profession into nothing more than a nail salon or mall kiosk (and there are no cliff notes to treat a patient).  In fact, these companies are not even attempting to hide this as they push to put kiosks in malls and drug stores.  Forget that it takes two to three years of post-doctorate study to even be remotely capable to treat moderate orthodontic cases.  Forget that poor function of your bite can lead to severe headaches, Chronic TMD, severe wear of teeth and early loss of teeth.  Forget about the airways, facial proportions and the chewing efficacy, forget about sleep apnea and periodontal disease.  According to these companies, if the front teeth are straight, then the job must be good/acceptable.

 


Determining Facial esthetics when treatment planning; moving teeth can affect the facial height and smile line relative to lips; but not with aligners like Invisalign or other Fake Orthodontics.
 
 
 
 
 
 
Typical forces figured in moving teeth.
 
 
 
 
 
 
Physics mixed with Biology: A key component in Orthodontics.
 

Is there any case that can be treated better or faster with Invisalign (Fake Orthodontics) v. traditional braces?

I cannot think of a single case that is treated better or even remotely as quickly as traditional braces and research bears this out over and over (see research cited in my other blogs on Does Invisalign work?) In fact there are inherent disadvantages including compliance, weak material that fatigues, trays that loosen and cannot move certain longer teeth, lack of root movement and even opening of the bite in many cases.  There are certainly mild cases that can be treated  (which is why Invisalign was accepted early on) but today, aligner trays are pushed on everyone as “invisible orthodontics” because doctors can run four or even five locations and just give out trays instead of monitoring patients and actually treating them. And if the standard of care is just to straighten the front six teeth, well that really is simple.  Lucky for these snake-oil doctors, you may well not get the joint pain, recession, tooth loss or damage for years so they will be long-gone and past the statutes of limitation for any recourse.

 

Does my Dentist Care about the Best for Me and My Family?

If your doctor is not a specialist, then they do not have the knowledge to be the best.  It could be a poor diagnosis, an inability to see problems, a lack of collecting the correct data or lack of interpreting data correctly; it could be the unethical approach of treating to a lesser standard or allowing a computer tech to design and move the teeth for them with no doctor or experience at all.  Either way, only the Specialist has the complete knowledge, experience and skill to give you the best.  Do you need the best?  Maybe not; but can the untrained spot the difference between those cases? My experience is they cannot.

 
 

“If all you are being told is what the doctor thinks you want to hear (or what your kid thinks is popular), then you may as well head to the kiosk and save yourself some money.”

  

Now if you go to a specialist and they only offer aligner trays claiming they are superior/faster or more reliable to traditional braces, then you are being a fed a tall tale from someone who definitely knows better.  If you have a simple alignment case/relapse or if you are offered aligner trays with the disclaimer of expecting less of a result on more moderate cases, then that is a decision you can make (but it is you making an informed decision).  If all you are being told is what the doctor thinks you want to hear (or what your kid thinks is popular), then you may as well head to the kiosk and save yourself some money.  Ultimately, it is the public that will determine the fate of Orthodontics in the US; laws are driven by public desires (just look at legalized drugs).  There will be those of us that adhere to a higher standard, those Orthodontists that won’t put their name on inferior treatment even if it costs them those patients and families.   But we/they will be a dying breed and if you or your family present with a moderate to severe malocclusion, you may certainly be out of luck.

Central Austin Location, 1814 35th St.
 
 
 Steiner Ranch Location, 4302 N. Quinlan Park, Austin
 
 
 
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.
 
Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 23 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at BracesAustin.com.
 
 

 
 

 
 
 

Thursday, November 15, 2018

Bad Breathe and Palatal Expansion


How does Palatal Expansion RPE affect Halitosis (Bad Breathe)?




Halitosis can be a significant problem in teens and young adults; there are entire industries built on covering up bad breathe or providing products to improve oral hygiene. 
 
 


One of the many companies that focus product development for halitosis
 
 

Of course not brushing or flossing will lead to chronic bad breathe but did you know bad breathe can also be the result of certain combinations of malocclusion, poor airways and/or chronic inflammation of the nasal soft-tissue.  One of the more important factors in children can be a narrow maxilla.

 


These boys demonstrate a typical narrow maxilla with airway obstruction and chronic “mouth-breathing”.  Note the lip posture at rest being open, allowing the oral cavity to remain dry and preventing the natural cleaning from the saliva.
 

The reason the maxilla would be narrow can be from over-active musculature around the mouth and cheeks (thumb sucking, late pacifier), diseases and syndromes that affect growth, adverse tongue activity or obstructed airways causing a patient to breathe through their mouth instead of their nose.

 

This patient may seem to be the classic appearance of a character dreaming of sugar plums dancing through her head but in reality, this young lady presents with a serious malocclusion including skeletal dysplasia and a high, narrow maxilla which can and will lead to severe crowding, possible TMD and, yes, halitosis.


This child is demonstrating mouth breathing during sleep; not the decay visible on front teeth from having a constantly dry mouth.  Halitosis can start very early in development which s why children should see an accredited Orthodontist by age 6 to 7.
 
 
 
No matter the cause, the result can be chronic bad breathe (halitosis).  At a chemical level, Halitosis is caused by volatile sulfur compounds (VSC’s) which are formed by the proteolysis of sulfur-containing amino acids (cysteine, methionine) and proteins by the bacteria found in the oral cavity.  When someone has specific bacteria (gram-negative), acidic saliva, decreased saliva or basic gingivitis, the conditions are ripe for proteolysis.    


An illustration of the bacteria present in the oral cavity, bacteria that can turn proteins and amino acids into volatile sulfur compounds (VSC’s) which cause chronic halitosis.



So with patients experiencing bad breathe as adolescents and pre-adolescents, what does the Orthodontist look for and what can they do to help rid these young patients of this offensive and embarrassing infliction?


Your Orthodontist will evaluate your child’s upper jaw (maxilla) to see if the arch is narrow and constricted; they will assess the airways and determine whether expansion is appropriate and needed.  Expanders are generally used on pre-adolescents and early adolescents to restore narrow upper (maxillary) arches to their ideal widths.  Of course this increases space for teeth and helps to alleviate crowding but it also widens the floor of the nasal cavity and increases air flow.

 
 
 
In fact, according to a recent study published in the Journal of American Association of Orthodontists (Erhamza and Ozdiler, Am J Orthod Dentofacial Orthop 2018 ; 154:702-7), Rapid Palatal Expansion has been shown to significantly reduce Halitosis (measured by halimeter and organoleptic values) in patients following successful expansion at age 11 to 15.
 
 
“… according to a recent study published in the Journal of American Association of Orthodontists … Rapid Palatal Expansion has been shown to significantly reduce Halitosis”
 
Unfortunately DURING treatment, this may be a different story if the expander itself is not kept clean and the gum tissue massaged regularly around the appliance.  I use a bonded expander which protects the molars and provides a splint-like overlay for the jaw to shift on and settle to its natural position during expansion however this appliance certainly can cause temporary halitosis if oral hygiene instructions are not followed.  And certainly wearing appliances can led to difficulty cleaning the teeth and short-term bad breathe.  Regardless, even if the patient is not a great brusher during treatment, they still will benefit in the long run from expansion.
 

Several of the different sized brushes that are available to help with cleaning an expander.
 
 
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.
 
Central Austin Location, 1814 W. 35th
 

Steiner Ranch Location, 4302 N. Quinlan Park Rd. in Steiner Ranch
 
Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 22 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at BracesAustin.com. 

 

Tuesday, October 30, 2018

Alzheimer's and Periodontial Disease


Chronic Periodontitis (gum disease) may have connection to Alzheimer’s disease

  

There is an unsettling trend to view dentistry as a simple cosmetic procedure with little to no focus on the well-established link of dental health to overall systemic health of the body and mind.  Social media, commercialization of dentistry, overstressing new technologies and a general erosion of ethics may all be somewhat to blame.  I don’t recall seeing anything on my Facebook come up on the dangers of Chronic Periodontitis or its relationship to life altering diseases but I certainly see many ads about Invisalign and tooth whitening.  However now and then there is a study that really is worthy of informing the public, even if it is very preliminary.

 

So how can dental health affect your body?

 

Already researchers have linked Chronic Periodontitis (Gum disease) to Cardiovascular Disease (CVD), Chronic Obstructive Pulmonary Disease (COPD) and recently to Rheumatoid Arthritis (RA), the later by promoting the onset and even the severity of RA.  In particular, bacteria that causes gum disease actually increases the severity of RA with increased bone and cartilage destruction.
 
P. gingivalis attacking bone in Rheumatoid Arthritis


But a new study recently published in the peer-reviewed journal of the Pubic Library of Science (PLOS One*, Oct. 3, 2018) was designed to investigate if there is a correlation between bacteria normally seen in periodontal disease (Porphyromonas gingivalis or P. gingivalis for short) and that same bacteria seen sometimes in the brain tissue of Alzheimer’s patients. 
 

P. gingivalis


This bacteria, P. gingivalis, is a known pathogen in the oral cavity associated with Chronic Periodontitis (the very same bacteria linked to CVD, COPD and RA), the chronic infection of gum tissue that causes people to lose alveolar bone and eventually teeth. The article was presented by Keiko Watanabe, DDS, PhD, a Periodontology professor at the University of Illinois at Chicago who focuses her research on systemic effects of specific oral bacteria known to cause Chronic Periodontal Disease in humans.

 


 


Dr. Watanabe’s prospective study took 20 mice and injected half with regular doses of the bacteria P. gingivalis while the other half received a saline injection.  After 22 weeks, the mice were sacrificed and the brain tissues compared.  As expected, the mice that received the saline injections had normal brain tissue however the mice receiving the bacterial suspension revealed brains with signs of degeneration, inflammation and senile plaque typically characteristic of Alzheimer’s disease in humans.  Dr. Watanabe points out that it is the chronic nature of the infection that related to the changes in the brain tissue, the same chronic exposure any patient would be receiving from years of chronic periodontitis.      


Brain tissue showing degeneration with plaques


It is possible there is a direct effect from the bacteria on increasing beta amyloid production (a major constituent of senile plaque and widely believed to cause Alzheimer’s) or, as Dr. Watanabe postulates, it may be an effect of neuroinflammation caused by the chronic presence of the bacteria. 
 

 
No matter the direct causation/mechanism, the study definitely suggests there is a link and there needs to be more research on chronic bacterial infections as they relate to Alzheimer’s.  Periodontal disease is a common ailment for humans even in the developed world making this potentially a landmark study.  And any advancement in the understanding and/or treatment of Alzheimer’s disease is certainly of unmeasurable value to society as a whole.  I am always quick to point out to patients the multi-faceted nature of diseases; that there can be many factors and/or triggers for what we perceive as a single disease or ailment.  Sometimes just reducing these factors is enough to keep the disease at bay or prevent expression of certain symptoms.  This is why I feel strongly that anytime you can reduce the risks, you should make that effort (and of course good oral health is in itself its own reward).
 
 
Most people reading this will have been touched one way or another with the terrible effects of Alzheimer’s disease; and Periodontitis will affect many more of us if left untreated.  This study demonstrates how even preliminary research can be employed to possibly reduce risks of potentially severe diseases simply by strengthening our individual resolves to maintain something we should already be maintaining.

 


Health as a game of Chess?
 
 




I believe we should view our individual health like a chess game (as opposed to a single faceted approach like checkers) visualizing cause and effect many moves ahead.  The sooner we realize we are in the game, the better we will fare many moves later.  Therefore I would be amiss not to point out that dental crowding is a factor in chronic Adult Periodontitis due to difficulty cleaning, approximation of roots and plaque accumulation.  Which is another reason for this article in my Blog as a Board Certified Orthodontist; just as we chase down every known factor correlating to Alzheimer’s, it is wise to also look at the predisposing factors for known antagonists.  By straightening teeth, we reduce the risk of Periodontitis which then reduces the risk (or possibly severity) of such diseases as CVD (the leading cause of death in men AND women in the US making up some 25% of all deaths each year; not including the many diseases CVD may also lead to such as stroke and heart disease.), COPD (irreversible chronic disease that ultimately leads to death), and RA (can lead to lung disease, nerve damage and osteoporosis).  And now, another piece of the puzzle, Alzheimer’s disease for which there is currently little treatment and no cure. 

 

“I think we should view our individual health like a chess game ... so I would be amiss not to point out that dental crowding is a factor in chronic Adult Periodontitis due to difficulty cleaning, approximation of roots and plaque accumulation.”

  

*PLOS One is a peer-reviewed open access scientific journal published by the Public Library of Science since 2006. The journal covers primary research from any discipline within science and medicine. The Public Library of Science began in 2000 with an online petition initiative by Nobel Prize winner Harold Varmus, formerly director of the National Institutes of Health and at that time director of Memorial Sloan–Kettering Cancer Center; Patrick O. Brown, a biochemist at Stanford University...


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.

 

Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 22 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at BracesAustin.com. 

 
 

 
 


Thursday, October 25, 2018

Cost (Value) of Braces


Costs Comparable to Braces

(Cost v. Value)



Every so often I have a patient that vents their frustration concerning the cost of braces for little Johnny.  Normally I try to explain the value of Orthodontics, the improved self-image and the life-long improvement of function and oral hygiene.  In truth, Orthodontics can be justified ten times over in most cases of malocclusion and will ultimately save money in the long run while the improvement in self-image/esteem and the sheer beautiful smile is incomparable.  In fact even as an adult, a beautiful smile has been shown to improve job opportunities and lead to an increased starting pay. 

 

But I would also point out that, as far as expenses go, the cost of Orthodontics/Braces is quite reasonable and affordable for almost every family.   To look at the COST of braces, we have to look at the basic economics of a practice.

 

As a sole practitioner for over 20 years, I routinely evaluate year-end overhead versus collections to determine profit and decide on pricing for the next year.  Sometimes this means there are no price increases, rarely (though it has happened in the past), we may even drop prices due to something affecting overall overhead such as taxes.  In fact, most Orthodontic office run about 65% to 70% overhead (which is a little better than our General Dental colleagues).  I try to stay at the 65% level so that I don’t have to nickel and dime for everything we do (I do not charge for broken brackets or extended treatments from missed time).  In fact, once I set a fee, that fee remains solid for the duration of treatment.  I also allow payment plans for all patients with no interest and minimal down payments.  If overhead is too high, the fees the following year may increase to reflect such.

 


But I really cannot go into that kind of detail when a parent is staring me down for some kind of discount.  And the initial fee can give sticker shock to those who have never paid for braces before.  So first, let’s consider the history of costs for a full set of adolescent braces (adult braces have always run @$1000 more) going back to the 1990’s:

 



1995   Adolescent Braces for 18 to 24mo $3800 to $4000
2000   Adolescent Braces for 18 to 24mo $4200 to $4500
2005   Adolescent Braces for 18 to 24mo $4400 to $4800
2010   Adolescent Braces for 18 to 24mo $5200 to $5400
2015   Adolescent Braces for 18 to 24mo $5600 to $5800
2018   Adolescent Braces for 18 to 24mo $6000 to $6500

 
Orthodontics have increased steadily but reasonably over the last 23 years with a total increase from a low of $3800 to a high of $6500 or 58% total increase, 2.5% per year on average (my medical insurance alone has increased 60% over the last two years!).
 
Other prices from 1995:
Median Household Income $34,076
Gasoline was @$1.00/gallon
Average Home: $158,700
Cost of base F-150 Truck $17,000
Full porcelain Crown $300
Dow Jones 5200
 



Compared to same numbers in 2018:

 
Median Household Income $62,450
Gasoline $2.49
Average Home: $188,900
Cost of base F-150 Truck $27,700
Full Porcelain Crown $1200
Dow Jones 26,000

 

On a more recent comparative note, I just received two quotes for repairs at my house; bids to replace my 6 year old water heater from a low of $4000 to a high of $6500 and replacement of a timing chain on my 6 year old car for $5500 (plus anything else they see while in there).  In both cases, more than half was for the labor, each for 1 day’s work!  And I don’t believe they have the same education or debt.    

 

So understanding that an Orthodontist will be correcting all of the teeth into ideal esthetics and function, setting jaw relationships and improving lip support and facial profile for life, it really is a good value for the money.  I would ask anyone questioning their Orthodontist about a $6000 fee what another specialist in medicine would charge you to treat anything else for 2 solid years (and follow up for another 2 years of retention) including any supplies and overhead he/she may spend along the way for your treatment.   And most Orthodontists will allow you to pay over the treatment time with little to no interest at all making the cost of braces no more than a family’s monthly cell phone bill (if not less).


Real Orthodontics is a tremendous value compared to other dentistry and medicine; probably the cheapest comprehensive correction you can make on an otherwise healthy patient.  The changes can affect behavior, self-esteem, self-confidence along with providing a healthy bite to prevent future jaw pain/headaches, excessive wear on teeth or even fracture of teeth requiring significant life-long restorative work.  It is also a very complicated specialty of dentistry and should not be performed by amateurs or weekend-trained dentists looking to increase their collections at your expense.  When you pay for Orthodontics, you are paying for a very specialized dental and sometimes medical treatment that will change the bite and function of the teeth FOREVER. 

 

What professional does a typical fee for Orthodontics include?  The “Standard reasonable cost” is based on an expert doctor, a specialist in Orthodontics.  Orthodontists have completed dental school at the top of their respective classes and all have pursued another 2 to 3 full years training in an accredited Specialty school for Orthodontics and you are paying for that post-doctorate education and experience.

 

 

“The Standard reasonable cost [Orthodontic fee] is based on an expert doctor, a specialist in Orthodontics.”

 
 

In Specialty programs, Orthodontic residents (already dentists) may have treated over 100 patients under the tutoring and guidance of other very experienced Board Certified Orthodontists while taking a full load of post-doctorate classes to understand development, bone physiology, physics, anatomy and biochemistry.  Contrary to current marketing and attempts to dumb down Orthodontics as a equivalent to a trip to the local spa, moving teeth is very complex and wrought with risks and long-term effects.



Remember that every Orthodontist started as dentists but they are far more than dentists after specializing (and their education was far more costly).  Good Orthodontists will explain things and simplify things to basic understanding but there is a world of science, art, knowledge and experience they rely on with every case they treat; knowledge and experience deficient from General Dentists and certainly from companies with direct-to-public schemes or fake-orthodontics/aligners. 

 

 

“Paying a General Dentist even 50% of the normal Orthodontic fee is akin to paying the hygienist full price for surgical removal of teeth or paying your school janitor full tuition to teach your child math simply because he can add & subtract and has seen it on the chalk board before.”

 

 

There is simply no General Dentist with the knowledge of a Board Certified Orthodontist because the knowledge is only available with a two to three year specialty program, programs that are steeped in 100+ years of research and experience.  If you do not understand the complete mechanisms of tooth movement, you are really just a technician relying on the product/lab technicians making the appliances (i.e. Invisalign, general dentist provides of traditional braces, smile club, etc.).  Paying a General Dentist even 50% of the normal Orthodontic fee is akin to paying the hygienist full price for surgical removal of teeth or paying your school janitor full tuition to teach your child math simply because he can add & subtract and has seen it taught before.   And even that is not proper unless they fully inform you they are not educated as an orthodontist.   Paying a non-dental company (smile direct club, etc.) is more akin to straight out malpractice and practicing without a license.  Might as well get your “Orthodontics” at the local swap meet on Saturday.






As a specialty, we as Orthodontists have been complacent in allowing companies and untrained providers to advertise and market directly to the public without providing accurate information and allowing them to compare their services to real Orthodontists, advertising fake-orthodontics as the real thing and even charging the same fees when they have no expertise.  We are finally awaking to this though it is a bit late. 




Unfortunately, Orthodontics has been terribly simplified in the eyes of the public due to a campaign of misinformation, omission of facts and sometimes outright false advertising and false claims.  Costs of Orthodontics may not vary much between untrained providers and real Orthodontists but you certainly are not getting what you are paying for in many cases.

 

Orthodontics is a huge responsibility for the both your family and the doctor you choose; so choose carefully by selecting a Board Certified Orthodontist who can properly diagnose, treat and retain your family’s teeth for a beautiful smile that lasts a lifetime.  You will find that the cost is no different and the experience will be much smoother.


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.

 

Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 22 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at BracesAustin.com.