Yes! The answer is yes, they are dangerous to the health and well being of your teeth.
DIY aligners have grown in popularity over the past several years and today we even see them popping up in malls and our local drugstores. The allure is that you can have straight teeth in a lot less time, without leaving the comfort of your home, and for a significantly reduced cost. I get it! If I were interested in straightening my teeth, I would want all of that too. It’s exciting and convenient.
Before we dive deeper into DIY aligners, I want to share one of my first experiences with DIY orthodontics. I was in my 3rd year of dental school when I was assigned to be the student-dentist of a 31-year-old African American female. We hit it off from the moment we met at her initial exam. She was an attractive woman and very charismatic. She had wanted to be seen for a cleaning. No problem! As I began the exam, I noticed hard chunks around several of her teeth. It did not occur to me right away what it was, but I knew it was not calculus. It was also odd that this woman had every tooth in her mouth but every single one of them was mobile. Far beyond the amount of mobility than any 31-year-old should have. When we looked at the radiographs, the bone levels were significantly reduced beyond half of the root in most areas. It took a while for my newly developing dental mind to piece it all together, but it occurred to me that this woman had someone place braces on her in the basement of their home. She was embarrassed but she finally told me what she had done and how she just wants it fixed. The chunks I noticed were the remnants of the adhesive they used to keep the orthodontic brackets on her teeth. The irreversible bone loss that was made worse with the “basement” orthodontics had set us up for a conversation that I hope that I never have to have with another 31-year-old female again in my life. What started off as a friendly meeting, ended in a tear-filled realization that this beautiful young woman was going to lose over half of her teeth due to the unregulated orthodontic care that she had received. This was an experience that I will never forget, and I share it here because this is exactly the type of unmonitored dangers that you risk when you sign on with DIY aligners.
Note the significant bone loss on this x-ray. These teeth need to be closely monitored by a specialist.
What are DIY Aligners?
There are several companies out there now and due to the litigious nature of these companies, I will not mention any names here. These companies provide a putty like material and impression trays and have you make impressions of your teeth. They also teach you how to take photos of your teeth. They have you send the photos and impressions into the company which then digitizes them and creates a series of aligners that you wear to straighten your teeth. Some of the companies even have “scan centers” where they take 3D imaging for you and then fabricate your plan. This plan is then, allegedly, checked by a dentist (not necessarily an orthodontic specialist) that is at a computer somewhere in another state. They either approve the plan or they may say that your case is too difficult to be corrected with their system. I will admit that it is a very cool model. In the next section I am going to talk a little bit about what goes into my treatment planning and you will see that there is quite a bit missing here.
The standards that professionals are held to.
When an orthodontic specialist, such as I, sees a patient there is an incredibly in-depth exam process that we go through. I will highlight some of the areas that we cover.
- The Orthodontic Records: In order to have a good plan of direction, you need to know your starting point. This is why orthodontic records are so critical. Having inaccurate records is like driving to a destination that you have never been to before and starting in a state that you have never been to before. Ask any assistant that works at Lifetime Orthodontics and they will tell you about the hell that they go through in their first few weeks trying to learn how to take proper x-rays, photographs and bite registrations on patients. There are many trained dentists that have difficulties taking a proper bite on a patient. The DIY aligners do not even require x-rays and then they assume that a quick video can teach anyone off the street how to take accurate photos and bite registration. I think not.
- Medical History: Are there any medications or conditions that may affect bone metabolism? What about the growth of your face and jaws?
- Oral Habits/Systemic issues: Why are the teeth crooked in the first place? Is there an underlying cause that needs to be addressed? If not, how long will my straight teeth last?
- Temporomandibular joints: The stability of your jaw joints is critical in determining the success of your bite. If you have issues with your TMJ then you will not be able to pick up an accurate bite with the help of a professional. This is something that can only be evaluated in person as the dental professional needs to see and feel your jaw in motion.
- Skeletal discrepancies: This can only be determined by a radiograph called a cephalogram. These help us to determine if the upper and lower jaws line up. They also help us to determine if the teeth have enough bony support to be moved forward or backward in the bone.
- Dental Evaluation: Midlines, molar relationships, crowding, wear of the teeth and size of the teeth can be evaluated with accurate photos and impressions. Things such as the mobility of the teeth cannot!
- Periodontal (gums) evaluation: Bone levels are evaluated with x-rays and probing depths. Neither of which can be evaluated with the records that are provided to DIY aligner companies. This is where most of the significant damage is done. The process of moving teeth is a balanced inflammatory one in which bone is broken down and regenerated as the teeth move.
Are DIY aligners the same as an orthodontist doing Invisalign?
I have chosen to perform aligner therapy on myself. I began this therapy for two major reasons. 1) I wanted to improve the alignment of my teeth and my bite. 2) I wanted to place myself in the patient seat and experience it all for myself. I can tell you already that it has made me a significantly better provider and has changed the way I approach aligner therapy. This section of this blog asks about DIY vs an orthodontist performing Invisalign (aligner therapy). You can visit our YouTube channel and check out Dr Wesley’s Invisalign Journey to gain an understanding of how much really goes into the work up of a case. I think it will be self-evident that there is no comparison. The ironic part is that most orthodontist will do what these DIY companies are doing at a similar price. They will certainly do it at a much larger value!
- Dr Wesley’s Invisalign Journey Episode 2: Capturing Records
- Dr Wesley’s Invisalign Journey Episode 3: Reviewing the Clin-Check
- Dr Wesley’s Invisalign Journey Episode 4: Placing the Attachments
- More to come….
Articles to review
As I was typing out this blog, I came across some awesome articles that I wanted to share. I wish I had discovered these earlier as Spring Hartfield, a registered dental hygienist, could not have said this any better in her article ‘Dear CVS: I Have Concerns About Your Do-It-Yourself Orthodontics Partnership
By Spring Hatfield, RDH – May 6, 2019’. In particular, she does a fantastic job of describing how this is legal.:
“I have been asked by multiple concerned colleagues about how this process is legal. Honestly, I didn’t understand it myself. I investigated the legality of treating patients without physically seeing a patient; it turns out SDC is conducting this under the guise of teledentistry. Teledentistry is primarily used for consultation, treatment planning, and referral to the appropriate licensed dental professional to achieve optimal dental health. Teledentistry has the potential to improve access to care for the underserved population. What disappoints me the most is that this company can help improve oral health and overall health by simply using teledentistry in the manner it was intended. Or an even better option would be to have a licensed dental professional on site to screen for possible dental disease. This would not only improve the patient’s health, but it could also improve treatment outcomes. It would be a win-win situation.”
She also highlights the harms of moving teeth without the continuous supervision of a dental professional:
“The American Dental Association “strongly discourages” do-it-yourself orthodontics. After conducting a survey, the American Association of Orthodontics (AAO) reported that “nearly 13% of its members are seeing patients that have tried do-it-yourself teeth straightening, with some of those attempts causing irreparable damage.” In response to these results, the AAO issued a “consumer alert,” it states, “The American Association of Orthodontics is urging consumers to beware of Internet videos and websites which encourage people to try and straighten their own teeth. Moving teeth is a medical procedure and needs personal supervision by an orthodontist. Please be wary of any suggestions to move teeth with rubber bands, dental floss or other objects ordered on the Internet. Moving teeth without a thorough examination of the overall health of the teeth and gums could result in the permanent loss of teeth, which may result in expensive and lifelong dental problems. Orthodontists receive two to three years of specialized education beyond dental school and are specialists in straightening teeth and aligning the bite.”
I was reluctant to share this second article and I think it significantly understates the harm of DIY aligners. It also shares some experiences from some orthodontist that are seeing the same things that I am seeing right here in Macomb, Michigan.
“I’ve had a lot of patients — particularly millennials — who jumped on board with the do-it-yourself aligners and now are coming to my practice because they aren’t happy with the results at all,” says Dr. Janet Stoess-Allen, founder of Park Avenue Orthodontics on the Upper East Side.
Dr. Brent Larson, director of the orthodontics division at the University of Minnesota in Minneapolis, says that he, too, is increasingly called upon to correct unintended consequences of DIY aligners. “One of the common complaints is, ‘Well, my teeth might be a little bit straighter, but I can’t bite well anymore.’ ”
It is great to shed light on these experiences. Unfortunately, I felt that the overall tone of the article was in favor of the DIY aligner company. I am glad that it is because it has created an opportunity for me to also shed light on the dangers of what you read on the internet. They introduce the representative for the DIY aligner company as an orthodontic specialist when he is in fact no such thing. He is a dentist that has not gone through the advanced specialty training that every orthodontist has gone through. He is a general dentist who found a sweet and lucrative job at this DIY company. Therefore, it was a bit concerning when I read the statements that are made in this article.
I hope this article assisted you with many of the questions that you may have had regarding Do-it-yourself aligners. With the increasing trend in the DIY aligners, I felt it was my professional obligation to provide our LTO and Macomb County community with a professional’s opinion. I hope you enjoyed this article in the slightest. I hope that you at least enjoyed the irony of:
- Me telling you how dangerous the internet can be and then creating this post for the internet.
- Me telling you the dangers of DIY aligners and then telling you to go watch a video of me treating myself with aligners. (lol)
I suppose they are my teeth and I can choose to do as I please to them. Just as you are free to do as you choose with yours. Don’t let this blog alone persuade or dissuade you! Do your research and do what you feel is right for you. If after all your research you are still not sure, then schedule your complimentary (fancy way of saying FREE) consultation with Lifetime Orthodontics by clicking here. We can assess your individual needs and you can hear out our professional opinion before you decide what is right for you and your smile.
Gerald W. Wesley, DDS, MS