Scott Air Force Base News

COMMENTARY: (Don’t) do it yourself orthodontics

It is strongly recommended people avoid performing do-it-yourself orthodontics or direct-to-consumer orthodontics. People considering orthodontic treatment should seek the care of a dental professional who will be available to examine them in person and oversee their treatment directly.
It is strongly recommended people avoid performing do-it-yourself orthodontics or direct-to-consumer orthodontics. People considering orthodontic treatment should seek the care of a dental professional who will be available to examine them in person and oversee their treatment directly.

The field of orthodontics deals with the alignment and function of the teeth. A few weeks ago, a patient presented with the concern that his “teeth only touched in the very back” when he bit down and the rest of his “teeth did not touch anymore.”

This type of a complaint isn’t usually something too far out of the ordinary for an orthodontist to encounter. What made this patient’s concern different was that he said his bite didn’t used to be like this.

There are typically two types of “at home” orthodontic care to consider, do-it-yourself orthodontics and direct-to-consumer orthodontics.

Maj. Michael Silverman, 375th Dental Squadron

He said all his teeth used to contact just fine and his bite was changed after completing orthodontic treatment prior to his PCS. I suggested we contact the orthodontist to get his pretreatment records so I could try to figure out what had happened. He said there was no orthodontist to contact. He had used an online company to have clear “retainers” made to move his teeth.

He went on to tell me that he was not examined before, during or after this treatment by a dentist or orthodontist. He simply took molds of his teeth at home and shipped them to the company. He showed me images of his pretreatment digital models. It certainly looked like this patient had experienced a significant detrimental change to his bite as a result of this treatment. Correction now would require comprehensive orthodontic treatment with upper and lower braces on every tooth.

As this example illustrates, individuals seeking a more economical alternative to orthodontic treatment rather than seeking the care of a licensed dental professional may be assuming some potentially unnecessary risk. There are typically two types of “at home” orthodontic care to consider, do-it-yourself orthodontics and direct-to-consumer orthodontics.

DIY orthodontics has existed in some manner for thousands of years with attempts to correct the alignment of teeth going back at least to 1000 B.C. Some common DIY orthodontic tools include the use of floss, fishing line, paper clips or rubber bands. Probably the most common DIY orthodontic trick is the use of a rubber band to close a space between teeth, usually the upper front teeth.

While this certainly can close the space, it brings significant risk, including tooth loss. Just ask David Campbell of Atlanta. He lost both of his front teeth from trying to close a space with rubber bands and has paid an estimated $40,000 on subsequent dental care. The rubber band can easily slide under the gum tissue due to the curvature of the tooth’s crown and lead to tissue destruction and ultimately tooth loss.

While it is impossible to eliminate all risk with any medical or dental care, having your care overseen by a qualified health care professional that will be able to physically examine you and guide your treatment will give you the best chance to minimize the risks associated with the treatment and maximize the benefits.

Maj. Michael Silverman, 375th Dental Squadron

Aside from the risk of permanent damage, there’s the problem of retention. How are you going to keep the teeth in the new position long term? Without a retainer, the teeth are likely to just move right back. Technology has changed DIY orthodontics with the advent of 3-D printing. A couple of years ago, a New Jersey college student created his own series of plastic aligners using 3-D printing technology.

This certainly was a new level of DIY orthodontics. He cited the low cost of materials but did not consider the cost of the university equipment that he used to produce his aligners. No matter the method, unsupervised orthodontic treatment can expose the individual to potentially unnecessary risk and irreversible damage.

Direct-to-consumer orthodontics is a relatively recent phenomenon offering a potentially less expensive alternative. These companies tout that their customers receive the benefits of orthodontic treatment without the “hassle” and cost of actually seeing a dentist or orthodontist.

Therein lies the problem. Even though a dentist may review the digital models and design the treatment plan, no one ever physically examines the patient to ensure that their teeth are healthy enough for orthodontic tooth movement. Not everyone is a candidate for orthodontic treatment. For example, patients with active gum disease could be at risk of tooth loss from orthodontic movement or patients who suffer from problems with their jaw joints may find their symptoms are worsened by the tooth movement or just by simply wearing the aligners.

Also, during treatment, no one is monitoring the tooth movement to ensure the treatment is proceeding as planned, which can lead to adverse bite changes like the ones my patient experienced. Tooth movement is a complex process determined by many factors. Rarely does the tooth movement in the mouth go exactly as it is portrayed on the computer screen. The absence of a trained professional to help you overcome these variations can certainly contribute to an adverse outcome. The American Dental Association has come out with a resolution discouraging self-managed orthodontic treatment due to the potential for harm.

The resolution states that the ADA believes that “supervision by a licensed dentist is necessary for all phases of orthodontic treatment, including oral examinations, periodontal examinations, radiographic examinations, study models or scans of the mouth, treatment planning and prescriptions, periodic progress assessments and final assessments with stabilizing (retention) measures.” Additionally, the American Association of Orthodontists has issued a consumer alert providing questions to consider when researching direct-to-consumer orthodontic treatments.

Tooth movement is a complex process determined by many factors. Rarely does the tooth movement in the mouth go exactly as it is portrayed on the computer screen. The absence of a trained professional to help you overcome these variations can certainly contribute to an adverse outcome.

Maj. Michael Silverman, 375th Dental Squadron

Before you consider DIY orthodontics or direct-to-consumer orthodontics, consider the risks involved vs. the initial cost savings. Our main concern is the health of our military community. I would strongly encourage anyone considering orthodontic treatment to seek the care of a dental professional who will be available to examine you in person and oversee your treatment directly.

While it is impossible to eliminate all risk with any medical or dental care, having your care overseen by a qualified health care professional that will be able to physically examine you and guide your treatment will give you the best chance to minimize the risks associated with the treatment and maximize the benefits.

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