Overall, The Biggest Danger From Mail-Order Clear Braces Is Probably To Orthodontists' Bottom Line
There's a piece in the LA Times by Janine Wolf about how "Orthodontists aren't smiling about teeth-straightening start-ups."
Couldn't possibly be any self-interest over patient interests in their frowniefaces, could there?
Where metal braces installed in a doctor's office were once the only way to correct misaligned teeth, a new method that uses removable clear aligners can eliminate a visit to an orthodontist and save patients thousands of dollars. That's what led Deniece Hudson, who always dreamed of having straighter teeth, to a start-up called SmileDirectClub.Hudson, a 24-year-old Georgia Southern University graduate, visited one of the company's retail outlets in an Atlanta strip mall in February to have her teeth scanned. That experience would turn out to be her only in-person interaction with a medical professional during a nine-month journey through the growing field of tele-orthodontics.
From the scans, SmileDirectClub used 3-D printers to create 24 trays of transparent plastic braces, which were delivered by mail with instructions on when to switch trays. Dentists monitored her progress by looking at selfies she sent over the internet.
...The program cost $2,170, compared with the $5,000 to $8,000 for a traditional orthodontist using the industry-leading Invisalign system created by Align Technology Inc. With one month to go in her program, Hudson says she's satisfied with the results.
...Hudson may be grinning, but a growing number of orthodontists aren't. Instead, they're warning consumers about the possible dangers of undergoing a complex medical procedure without the in-person supervision of a dental professional. The main orthodonists' trade association has filed complaints against SmileDirectClub with 36 state dental boards and attorneys general, alleging regulatory and statutory violations.
..."I don't think the diagnosis can happen with three clicks," said Hera Kim-Berman, a clinical assistant professor at the University of Michigan's department of orthodontics and pediatric dentistry and the program director of orthodontic graduate training. "These companies treat them as consumers, as clients, and that's really the major difference."
Yes, and orthodontists become orthodontists rather than, say, freelance hang-gliders because money means nothing to them.
Could there be adverse effects? Sure. There are some reported in this 2017 paper on Invisalign -- perhaps due to allergies to the materials or pre-existing health conditions.
The reports "by either patients, family members of patients, or health professionals (including dentists, physicians, and so on)" -- were made over a 10-year period, from November 1, 2006 to November 30, 2016.
Were all of these due to the Invisalign? Um...um...
The researchers' recommendations. (Italics are mine.)
CONCLUSIONS
1. Serious life-threatening events could be associated with the use of Invisalign systems, and health care providers should be aware of these events and know how to handle them if they arise in their practices. Providers should also communicate about these events to patients to enable them to make informed decisions.
2. Health care providers should report adverse events they encounter in their practices to the FDA through the MAUDE Web service system.
3. Patients on the "do-it-yourself" orthodontics pathway should be wary of adverse events and the risks of unsupervised treatment.
4. Manufacturers should conduct more product testings and disseminate these findings widely in the interest of patients.
So, yes, be aware that bad things could happen -- which may or may not be due to the Invisalign. If you have health issues or allergies to plastics, maybe this just isn't for you. And if you have serious problems with your teeth, likewise, mail order braces might not be the best first option.
The thing people need to consider is their personal level of risk -- based on their age, overall health, and mouth condition, among other things. They still could gamble and lose, of course. But chances are, you aren't going to die from plastic braces that are less than ideal.
And perhaps a way to manage the risk is to see a dentist or orthodontist to find out the condition of your teeth and mouth -- and then periodically to monitor you, if you might have some issues. You pay maybe a little more but not quite as much to have old-school orthodontic treatment.
For numbers like those to be meaningful, there needs to be a second column giving the same numbers for a control group who didn't use the product. (And the sizes of both samples need to be revealed.)
jdgalt at September 21, 2018 11:14 PM
Right. Hence my: "Were all of these due to the Invisalign? Um...um..."
Amy Alkon at September 22, 2018 1:49 AM
Shouldn't dentists be opposed to this, since it will put orthodontists out of business?
You know, like the cure for cancer will put the multi-billion dollar oncology field out of business.
Or corrective surgery will put the optometrists out of business.
Patrick at September 22, 2018 7:43 AM
Dentists probably are. Mine only told me that I could get a drugstore version of the bite thing to stop teeth grinding (maybe $300 or more dollars; can't recall exactly) when I told him there was no way I could afford it. That thing is custom-made to your teeth.
Guess what: A lot of the non-custom-made ones suck, but I found the most amazing little strip that simply puts a little piece of rubber/plastic between your back molars. I think it's $3 or $4.
Yep: $6.30 for two at Amazon. https://amzn.to/2Dn1X6I
Plackers, it's called.
Amy Alkon at September 22, 2018 8:01 AM
Most of those "adverse events" could easily have been psychological in nature rather than caused by the Invisalign. I know someone who I can almost guarantee would have at least a couple of those symptoms if she tried Invisalign.
Kent McManigal at September 22, 2018 9:25 AM
I would also want to know what the risk frequency is for traditional orthodontic procedure. I guarantee it isn't zero. A set of numbers like this is meaningless.
Ben at September 22, 2018 10:08 AM
I had braces as a young teenager, so my teeth are pretty straight, but they have shifted a bit over the last couple decades. So, I inquired about Invisalign with my dentist. The estimate was $5k. Keep in mind that my teeth are not actually crooked, crowded, or gapped. I can go to an orthodontist and get a new retainer for under $2k, or go with SmileDirectClub for a similar cost. But now every time I go to the dentist they pester me about Invisalign (and the mouth guards for tooth grinding.) It’s really starting to piss me off. They’ve pitched me blood oxygen level tests, clipping my lingual frenulum (even though I’m not tongue-tied), extra x-rays, tooth whitening... I’m 38 and have exactly two minor cavities and no other dental issues. I just want to get my teeth cleaned, damnit!!! I feel like it’s high-pressure sales to a captive audience every time I get in that chair. (It’s actually the hygienists, not the dentist, that are putting the pressure on.
ahe at September 22, 2018 1:57 PM
Leave a comment