British dentists and orthodontists have warned that customers of so-called remote dentistry risk being damaged by wearing clear braces or “aligners” ordered online if not fitted by a dentist in person.
Smile Direct Club (SDC), the largest company selling clear aligners remotely, says they straighten teeth faster and cheaper than traditional braces, BBC News reports. Its aligners have been successful for the majority of users, it claims.
Jamie, from Glasgow, turned to SDC after being quoted £4 000-£6 000 for straightening his teeth. The US-based remote orthodontics company was offering clear aligners for about £1 800 without the need to see a dentist in person.
According to SDC, its platform has improved access to oral care and “enabled successful treatment for more than 1.8m people”.
But Jamie now says he would never do it again. “I can't bite into an apple because I can’t trust that my front teeth are strong enough any more,” he says.
Before starting treatment he was sent a DIY impression kit to take his own teeth moulds. The other option, a 3D scan of his mouth done in an Smile Direct Club shop, was unavailable because of lockdown.
Within weeks he’d received a six-month course of aligners, with the name of the dentist overseeing him labelled on the box.
But after six months, he posted on Reddit: “One of my front teeth has become wobbly, my enamel feels all funny, like the aligners have rubbed some of it off, the aligners have made my gum recede … agony.”
In traditional dentistry, train-track braces and clear aligners are fitted by dentists and orthodontists themselves, or a trained orthodontic therapist, after an in-person consultation.
The health of the hard and soft tissues of the mouth, the teeth and gums, and whether the roots of the teeth can sustain movement, are some of the factors dentists consider. X-rays are instrumental in this process.
Once someone starts wearing braces, regular appointments allow dentists to monitor how teeth are moving and to spot and address complications.
SDC’s website says users will “have regular virtual check-ins” with a UK-registered dentist “remotely from beginning to end”, but Jamie says he was not once connected to the dentist overseeing him or told to see a dentist about his issues.
Dental disruptor
Hundreds of SDC users worldwide have shared negative experiences on social media and dozens of users and dentists the BBC spoke to detailed issues ranging from aligners fitting poorly to permanent nerve damage and tooth loss.
Dentist Dr Victoria Sampson says users may underestimate the force aligners put on teeth. If decay or gum disease is missed in a physical check-up, people risk losing some of their teeth.
She says she has treated someone who lost their front tooth after using the aligners because they moved her teeth too quickly, skewing her bite. The roots of the patient’s teeth were too short to withstand the pressure from aligners, which would have been picked up in an X-ray.
According to UK dental associations, 3D scans and DIY teeth moulds used in remote orthodontics are not sufficient for approving aligners.
The British Dental Association’s Dr Eddie Crouch is concerned SDC customers are being left to decide whether to go ahead with treatment without the right information.
SDC says it is the user’s “responsibility to see a dentist” and receive a clean bill of health for their teeth and gums within six months of starting treatment. Potential risks for patients, including nerve damage, gum disease and tooth loss, are also listed.
However, patients don’t have to provide proof they have seen a dentist, and under contracts they sign, are fully responsible for damage.
SDC says its affiliated dentists and orthodontists are entirely responsible and accountable for the treatment they provide. There is no clinical evidence an office visit is necessary for the same level of care, it adds.
The General Dental Council (GDC), responsible for regulating UK dentists, says there is no effective substitute for an in-person clinical examination, which should take place before treatment is prescribed. It urges consumers to consult its guidelines.
But Crouch believes such guidelines are insufficient compared with “rules and regulation to protect patients”. Otherwise, dentists will be left picking up the pieces when “patients have undergone wholly inappropriate treatment”.
The UK’s health watchdog, the Care Quality Commission, announced last year that any company providing remote orthodontic services will have to register with it.
BBC article – Dentists warn of permanent damage from clear braces ordered online (Open access)
See more from MedicalBrief archives:
Derided theories of two British orthodontists now have a cult following
Online GPs evade regulation by contracting offshore doctors
Selfies distort nose size, sparking demands for plastic surgery
Demand for cosmetic surgery continues to grow