Braces, Invisalign, Retainers
With more than 700,000 patients trying at-home orthodontics through Smile Direct Club alone, we sat down with Dr. Katelyn Blanchard, orthodontist at Dental Depot, to chat about the process – and potential dangers – patients need to know about before they take the leap.
Last May we put out a guide for patients who might be considering at-home orthodontics with questions to make sure you ask before you commit. We understand that at-home orthodontics are tempting, especially during safer-at-home, but as more cases are completed our orthodontists encounter more and more patients who experienced less-than-great results and find themselves in a worse position than before they started.
Do orthodontists recommend any of the at-home orthodontic services like Smile Direct Club or Candid?
The short answer is no. The reason behind that is, as health professionals and providers, we care about the oral health of our patients. My opinion as an orthodontist – and I think most orthodontists would agree with me – is that taking part in at-home orthodontic treatment plans is putting yourself at risk – that’s the bottom line.
Probably 90% of the consultations I see are good candidates for orthodontics – they have good periodontal health, they’re seeing their dentist regularly, they’ve had all their cavities filled. However, there are many underlying reasons why someone may not be a good candidate for orthodontic treatment and these companies aren’t doing a thorough enough screening to determine that. When I treat someone, we’re guaranteeing a certain level of result. We have a higher bar, not only aesthetically in how the smile looks, but also in how the bite fits together and functions. How well that is done significantly impacts how well the teeth stay in that position.
Whereas these companies are not guaranteeing you anything – they look at you and say, “Four months, here’s your trays and here’s your price, good luck.” And if you don’t get to the result you want, it’s too bad. It’s much, much harder to get a result with them because … there are certain tooth movements they simply aren’t able to do but they aren’t going to tell you that. So, you’re going to pay them $2000 and you may end up worse off than you started and there’s nothing you can do about it. That money you’re spending is high-risk in my opinion because you aren’t guaranteed a result.
What cases have you seen of patients who have gone through at-home orthodontics? What happened?
The saddest case and most extreme was a patient who was, periodontically-speaking, not a candidate for orthodontics at all. Any movement of the teeth at all wouldn’t have worked because the roots of the teeth and her bone levels could not structurally withstand moving. Long story short, after a few months of [at-home orthodontic] treatment, she came in and I referred her to Dr. George Bohle because her front four teeth were too mobile for any treatment and they were unsalvageable. She ended up with a 6-unit bridge; there was no way we were going to be able to save her teeth.
That was an extreme case, yes, but I know it’s happening everywhere. And the sad part of it is, the thing that gets me the most fired up, is that poor lady felt like she was in good hands. She didn’t feel like she was using a cheap method or anything like that. She thought she was paying good, hard-earned money for professional treatment. A lack of understanding has put her in that position that she’s in. I think it’s very important to get the information out there, even to the general dentists about how detrimental it can be.
And the other side of that coin I’ve seen is a patient who completed 4-6 months of her at-home orthodontic treatment and she showed me her before pictures and her teeth looked much worse than before. The edges of the teeth were uneven. Her teeth only touched in the front when she bit all the way down and her back teeth weren’t touching at all. And she was still paying for it! She’d been out of treatment for months but was still paying for it because of how they finance it. How awful must that feel? You’re still paying for it but yet if you want more treatment, you’re going to have to pay for it again. And that’s happened several times, I see it a lot. And there’s a lot you don’t see just because they know they can’t afford it again. So that’s my take on it.
To my knowledge, you’re either going into a consultation on-site with an iTero or, if you don’t happen to live nearby one, they send you a box and you’re supposed to take an impression of your own teeth. That’s what they build your aligners from. God-forbid you mess it up at all and it’s not a perfect impression (our assistants spend months training on impressions). Then you take pictures of your mouth or teeth or they ask their assistants to do that. They’ve got pictures that could be blurry or dark or they couldn’t see everything and a mold of your teeth that probably isn’t accurate.
But when you come and see us, you have assistants with years of experience in taking records. We use panoramic x-rays to look at everything from the roots of the teeth to the levels of the bone. We can see everything from the health of the teeth, the depth and width and how they’re angled. It’s just a much more in-depth examination. The problem with just taking photos is that they don’t show the truth. People typically distort their lower jaw when they’re trying to take their own photos and in the office I can get them to relax, so our imaging is more accurate.
What happens if the treatment plan is built from incomplete information or bad impressions?
The risks of not having a thorough examination done is ultimately all on the patient. If something goes wrong with your at-home orthodontic treatment – it’s all on you and that isn’t fair. There’s a misconception that these companies are overseeing patient care when really, they just send you the aligners and say “go.” If the patients have any issues, they can’t get help or there are additional fees associated with it. Whereas with us, we’re checking treatment plans and making sure that you are doing okay. What they show might not be biologically possible. Yes, our fees are sometimes higher, but we give you continual care and will make sure that you’re getting the best smile you can.
How do at-home orthodontic companies get away with practices that can hurt patients in the long-run?
Informed consent – you’re signing something saying that you have been cleared by a dentist for this treatment. It’s in the fine print, I had to search for it. It says that your dentist has done a periodontal probing between every tooth, your gums are healthy, you’re cavity-free and that you don’t have any impacted teeth or anything like that. That’s basically how they get away without having any x-rays or having an orthodontist look at you.
How can at-home orthodontics affect your bite or damage your oral health?
Overall, with aligners in general – whether it’s Invisalign or other companies – one of the big things is getting posterior occlusion. It’s very common for the back teeth to not touch when you’re finished and it creates a space there. When we’re treatment planning your new smile, we prepare for that and make sure the patients come out with a smile that’s both beautiful and functional.
At-home orthodontic companies advertise treatments that average 4-6 months whereas typical aligners through an orthodontist take 12-18 months. Patients make the mistake of thinking it’s more efficient, but really what it’s doing is just moving the teeth too fast or not getting patients to a final result that is satisfactory.
What are the consequences of not being supervised by an orthodontist?
A foundational part of orthodontics is light, continuous force levels on the teeth – that’s what moves teeth in a healthy and efficient way. In terms of aligner treatment, when we are bumping up to the next tray, it’s only a slight difference – you want to wear your aligners full time.
However, if you don’t wear your trays full time you put yourself at risk for tooth loss because of the stress placed on your teeth. Moving too quickly or with too much force can cause root resorption and other complications like periodontal attachment loss. And with no one checking compliance, you might be in more trouble than you think.
Are there misconceptions for patients who go through orthodontic treatment a second time?
One thing I hope people understand is that orthodontics costs a lot less than what people think – for people who do need a second round (at-home orthodontics’ main demographic) it’s not nearly as expensive as you would think. Consultations are free to both you AND your insurance, including x-rays.
Whether it’s your first time doing orthodontic treatment or you’re back for a second round, the most important thing you can do for yourself and your wallet is research. Dental Depot is proud to offer free orthodontic consultations so that patients can fully understand their options and readiness for orthodontic treatment before they commit.
If you’re ready to set up your consultation, you can learn more and request an appointment online or even try out our new virtual consultation to get started.