Fake Orthodontics Gaining Ground

Fake Orthodontics (Invisalign) 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 35^th street and MoPac.

 

Dr. James R. Waters is a 1996 Summa Cum Laude graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Hospital 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. He is a Diplomate of the American Board of Orthodontics and member of the College of Diplomates of the ABO.  Dr. Waters has been honored as one of “Texas Best” Orthodontists by his peers in the Texas Monthly magazine focusing on Texas healthcare providers for 14 years straight.  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 www.BracesAustin.com .