As a person with 30+ years experience in orthodontic laboratories, I am often asked my opinion of DIY orthodontic outfits like Smile Direct Club (SDC). Whether it is SDC or one of the others popping up, my reply is the same: “participation in the SDC is like participation in the “Clean Your Loaded Gun Club;” it could turn out okay or it could turn out very ugly. The only real difference is the public understands the dangers of cleaning a loaded gun.”
Orthodontists and dentists are outraged over DIY orthodontics. More and more videos are popping up on the web and in seminars of people losing teeth and their roots actually being ripped out of their gums. As I see the SDC advertisement plastered on the city bus, though, I find most of their “outrage” silly at the least and hypocrisy of the first order at the worst.
The American Association of Orthodontists (AAO) and American Dental Association (ADA) have come out against DIY Orthodontics with campaigns. I think to myself, “what the hell were you expecting? You didn’t see this one coming? It is not like it came out of left field. No, this was a line drive right back to the pitcher.”
Nobody wants to talk about the Frankenstein Monster in the room: Invisalign, who owned a large portion of SDC and really made all of this possible. Invisalign killed the orthodontic profession. Orthodontists and dentists not only unlocked the door for the monster, but they also threw the door open and set out a welcome mat. And now they are going to complain that the monster is having tea in their living room?
When I first started working in labs 30 years ago, there were two basic truths to orthodontics: 1) Only orthodontists should be doing orthodontics and 2) Hawley retainers were the best form of post treatment.
The truths have not changed, but Invisalign, with the help of the doctors, and an exceptional marketing campaign, changed the perception towards those truths.
Though Invisalign holds hundreds of patents, it is really nothing new. Orthodontic labs have been resetting teeth to ideal for decades, long before 3D technology. We used them for minor movements with spring aligners, tooth positioners and even sets of the plastic trays like you see now.
When Align Technology began patenting everything, and telling the orthodontists that they would NEVER sell to dentists, I saw that first pitch, right down the middle of the plate.
Orthodontics is a specialty in the dental field, one of nine recognized by the ADA. You get your dental degree, and then go for two to three more years of specialized training. Can the teeth even be moved? Are the gums and roots healthy enough? That is what the initial consultation with an orthodontists is for, absent in DIY Orthodontics: a physical exam, x-rays and CT scans.
That pain that you feel when in braces or replacing trays? That is your teeth and their roots being traumatized. They are being ripped, torn, torque, tipped and generally abused. It takes a trained professional to make sure it is okay to do it and to monitor the progress.
But then Frankenstein’s Monster was born. An orthodontist’s training and experience were replaced by computer algorithms. Certified orthodontic assistants, with yearly continuing education, were replaced by computer operators. Careful monitoring was replaced by cheaper products.
In short: a tool became a solution.
Invisalign does not have the best technology available, but they do have the best marketing. When Invisalign started marketing to dentists, and then directly to consumers, I witnessed a downward trend in the profession. Once a respected specialty, now everybody can be an orthodontist! They even have kiosks in the malls like the “Only Seen on Late Night TV Infomercials” stores.
Dental professionals and their associations did nothing to stop this trend. They even encouraged it. And they continue to encourage it.
When I walked into the AAO convention this year, the Invisalign booth was front and center. I was handed a quickly printed piece of paper on the evils of DIY Orthodontics. How cute. The people that were supposed to be protecting the profession and patients were instead following the bucks.
I cannot really blame them, I guess. I assume that a lot of dentists started doing orthodontics telling themselves it was just simple cases. And why not? Invisalign and other clear aligner therapies makes it so simple–and so lucrative. All they have to do is send the cases to a company and a computer program does all of the work. All the dentist has to do is keep an eye on things and collect the check—instead of referring their patients to orthodontists and seeing the checks walk out the door.
See where I am going with this? DIY orthodontics is just the next natural step.
The wrong step.
30 years ago, my orthodontic lab had what I believe to be one of the first thermoforming machines—used to make those plastic trays. It sat covered in dust. The bulk of our income came from Hawley retainers. Hawleys, invented back in the early 1900’s, was, and is, the standard of care for post treatment.
Retention is for life. Whether you have braces or clear aligner therapy, your teeth actually “remember” where they used to be and try to get back there. They also just naturally shift as we get older.
I have seen well made Hawleys last for over 15 years. Those clear plastic things that Invisalign and doctors have made seem so common, that we never used to see 30 years ago? They last for 12 months at best, if you don’t grind or clench. They will start to fracture and stretch at that point, leading to relapse.
But there will be a DIY Orthodontics Kiosk waiting for you in the mall to spend a few more thousand dollars for your second or third or fourth treatment.
Or you can see an orthodontist and get Hawley retainers.
This downward trend in the profession is as much market driven as it is driven by Frankenstein’s Monster rampaging through orthodontists’ bank accounts. You might not know any better. The doctors, however, do.
The solution needs to become a tool again in qualified hands.
Go see an orthodontist for orthodontics. And demand a long term retention option for post treatment—Hawleys or yearly replacements of those invisible things.