The high cost of traditional treatments is driving many people to seek alternatives that in many cases put their oral health at risk.
The pressure to show perfect smiles on social networks like Instagram is causing serious problems for the teeth of people who have opted for the use of transparent appliances or “aligners” purchased online.
That is the claim of a group of dentists and orthodontists who told the BBC that clients of so-called remote dentistry are unaware of the damage aligners can cause if they are not fitted by a dentist in person.
But the largest company that sells clear aligners from a distance, Smile Direct Club (SDC), claims that its products straighten teeth faster and cheaper than traditional braces.
What worries dentists is that people buying treatments online may not be aware of the risks they are running.
And that their aligners have given good results to the majority of users.
Not the case for Jamie, a father from Glasgow, Scotland, who turned to SDC after receiving a quote of between $5,000 and $7,500 to straighten his teeth.
The American remote orthodontics company offered clear aligners for about $2,000 without the need to go to a dentist in person.
According to SDC, its platform has improved access to dental care and “has enabled more than 1.8 million people to receive successful treatment.”
It highlights that the “vast majority” of users have had an “excellent experience”.
Loose teeth
But Jamie now says he wouldn’t do it again.
“I can’t bite into an apple because I can’t trust my front teeth to be strong enough anymore,” he said.
Before starting the treatment, they sent him an impression kit to make his own dental casts. The other option, a 3D scan of his mouth performed at one of the SDC locations, was not available due to the pandemic lockdown.
Within a few weeks he received a 6-month aligner treatment, with the name of the supervising dentist written on the box.
But after completing six months of treatment, Jamie posted this on Reddit.
“One of my front teeth has shifted, my enamel feels funny, like the aligners have removed part of it. The aligners have made my gums shrink which is agony.”
In traditional dentistry, metal braces and clear aligners are fitted by dentists and orthodontists themselves, or by a qualified orthodontist assistant, after an in-person consultation.
Some of the factors that dentists take into account when recommending its use are the health of the hard and soft tissues of the mouth, teeth and gums, as well as whether the roots of the teeth can sustain movement. That is why x-rays are essential in this process.
Once braces begin, regular appointments allow dentists to monitor tooth movement and detect and treat potential complications.
On its website, SDC says users “will have regular virtual check-ups” with a UK-registered dentist “from start to finish”, but Jamie says he has never once been put in touch with the dentist who registered him. supervised or told to see a dentist to treat his problems.
In the end, customer service put him in touch with a “dental expert” via the page’s chat, who told him that the problems were normal and would eventually go away. It is not clear what kind of qualifications are required to fill this position.
Tooth revolution?
Jamie was dissuaded from continuing to wear the aligners.
For something SDC is presented as a breaker of the traditional dental industry. He maintains that many dentists and orthodontists offer Invisalign – a popular brand of transparent braces – and therefore compete with SDC.
Some of the positive comments from SDC users on YouTube state that they were discouraged from using Invisalign due to its high cost and longer treatment duration. A client who used SDC to correct minor crowding problems stated that the treatment “worked very well” and improved her appearance and confidence.
But Jamie is not alone. Hundreds of SDC users from around the world have shared negative experiences on social media, and dozens of users and dentists we’ve spoken with have detailed problems ranging from poorly fitting aligners to permanent nerve damage and tooth loss.
Dentist Victoria Sampson says that users may underestimate the force that aligners exert on their teeth. If cavities or gum disease are not detected in a physical examination, you are at risk of losing some teeth.
She says that she has treated someone who lost a front tooth after wearing the aligners because they moved her teeth too quickly, misaligning her bite.
The roots of the patient’s teeth were too short to withstand the pressure of the aligners, which would have been detected on an x-ray.
According to British dental associations, 3D scanners and self-cast teeth used in distance orthodontics are not enough to recommend the use of aligners.
“You want to create a beautiful smile, but you also want to have a healthy smile,” says Dr Anjli Patel of the British Orthodontic Society. The results could be “disastrous” if the teeth are not properly controlled.
Dr Eddie Crouch of the British Dental Association is concerned that SDC clients may have to decide whether to proceed with treatment without adequate information.
As an example, the BBC showed Dr Crouch three interactive 3D images of teeth showing how they might move during treatment which SDC presents to potential clients.
The doctor said two of them showed visible signs of gum disease, which meant the aligners could “loosen the teeth enough to cause tooth loss.”
The third plane, if accepted, could leave that person with an unstable bite.
SDC states that it is “the user’s responsibility to visit the dentist” and receive a certificate of good health of their teeth and gums within six months of starting treatment.
Potential risks to patients, such as nerve damage, gum disease, and tooth loss, are also listed.
However, patients do not have to prove that they have been to the dentist and, according to the contracts they sign, they are fully responsible for the damages.
The company claims that its affiliated dentists and orthodontists are fully responsible for the treatment they provide. There’s no clinical evidence that an office visit is necessary to get the same level of care, he adds.
However, clients who expect the same level of care as those undergoing traditional orthodontics “are not fully informed of what they are buying,” says Dr. Patel.
She says that few orthodontists would offer an evaluation for a remote treatment that they do not supervise because “you have no control over what is going to happen next.”
Confidentiality contracts
Some of the users we have spoken with who have suffered damage have been asked to sign non-disclosure agreements in order to receive full or partial refunds.
It’s a clause they have to sign when requesting refunds outside of their returns policy, which is in line with standard industry practice, SDC says.
The General Council for Orthodontics, which is responsible for regulating dentists in the UK, says that in some cases remote dentistry can be “offered safely”. And urges consumers to consult its guidelines.
However, Dr Crouch believes that these guidelines are insufficient when compared with “rules and regulations to protect patients.” Otherwise, dentists will be forced to pay the piper when “patients have received totally inadequate treatment.”
Britain’s health watchdog, the Care Quality Commission, announced last year that any company providing orthodontic services remotely will have to register with it.
Getting back to Jamie, she stopped wearing Smile Direct Club aligners almost two years after her first treatment.
He said they talked him into trying a new 3D scanner to get new aligners to fit him better, but that didn’t work for him either.
After months of negotiations, he was able to receive a full refund, but not without signing a contract that prohibits him from “creating a negative impression” of SDC’s “commercial reputation.”
“It’s my naivety, I should have known that (the treatment) was too fast.”