The Truth About DIY Orthodontic Treatment

Helping my sons build things with their LEGO sets was basically the extent of my handiness but then came the do-it-yourself explosion. Recently, I even got in on the trend. I queued up some DIY YouTube videos, broke out a power drill and leveler and installed a hanging entertainment unit as deftly as an amateur could possibly do on the first try. Chip and Joanna Gaines would have been proud (maybe). Thanks to HGTV, Facebook, YouTube, blogs and Pinterest, there’s a hack for everything and we can do it all from the comfort of our living room! Well, not so fast”¦there are some limits, particularly when it involves your health.

The Rise of DIY and At-Home Orthodontics

For the first time, we’re seeing DIY orthodontics introduced to the masses. In fact, the American Association of Orthodontists (AAO) recently reported that nearly 13 percent of its member orthodontists have seen patients who tried DIY teeth straightening.

The AAO attributes the trend to social media content because the DIY braces “tutorials” are all over the Internet. The most popular DIY teeth-straightening videos on YouTube show kids using elastic bands and hair ties to help close spaces between their teeth. While you may be thinking it’s only the kiddos following along with these videos, the doctors who responded to the AAO survey said otherwise. The patients they saw who attempted to straighten their own teeth ranged from eight-years-old to over 60 with the majority being between ages 10 and 34.

It’s not just individuals getting crafty with household objects either. If you’re an avid social media user, you’ve most likely been targeted by advertisements from mail-order, clear aligner companies. The list of brands is growing and they’ll continue to multiply. These direct-to-consumer companies advocate at-home impressions or sometimes use 3D scans if you live in a city with a scanning center. The impressions are submitted to the labs that make the aligners, a dental professional (who may or may not be an orthodontist) reviews the treatment plan for a few minutes, and then they’re created and mailed to you. Before you fork over a couple of thousand dollars and wear aligners to manipulate your teeth, bones (yes, bones are involved), gums and bite, let’s go over the pros and cons.

The Pros and Cons of At-Home Clear Aligners

Note, that I’m only mentioning the pros and cons of self-directed, at-home aligner systems because there are absolutely zero pros when it comes to using rubber bands, fishing string, hair ties, dental floss, paperclips or random objects ordered online to try to straighten your teeth. Anyway, on to the pluses and minuses.

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THE PROS:

• The aligners are cheaper. By scaling 3D printing, utilizing different materials than Invisalign, eliminating the salaries of doctors and their staff, as well as appointments, diagnostic records, etc. (this will also be in the cons column as you’ll see shortly), companies can offer 3D-printed aligners at less than what an orthodontist charges.
• The systems are convenient. They let you take DIY impressions of your teeth and then they mail the aligners to you, so you never need to leave your house.
• There is time savings with no checkups or other appointments.

CONS:

• You can start treatment without having x-rays taken and there are no clinical examinations. These diagnostic records give us a clear picture of what we’re dealing with and we can take into account all of the factors that come into play when straightening your teeth. You’re not just cosmetically shifting the teeth when you pop in aligners; as you move teeth, bone remodeling occurs (bone is broken down and new bone tissue only forms in areas where the gums and bone are healthy as the teeth find their places). One of the issues is that gum disease is grossly underdiagnosed in the adult population. The Centers for Disease Control (CDC) estimates that 50% of the population has mild, moderate or severe periodontitis, which is a nerdy word for inflammation of the bone that is beyond swelling of the gums. Tooth movement in areas with diseased bone can lead to further breakdown of the bone without rebuilding. It’s entirely possible that if problems with your gums aren’t caught in an examination, a tooth could be pushed out of the bone and lost. This leaves periodontists to clean up the mess, which is why they’re just as concerned as orthodontists with the DIY trend. When exams do reveal gum disease, a periodontist must prepare the bones and gums for treatment and then repair them after. Additionally, orthodontic treatment can change your facial structure and the way your bite functions affecting your overall health, so it needs to be done with a well thought out, personalized treatment plan in place. I can’t stress enough that the planning process with any orthodontic treatment, including digital treatment with aligners, is completely driven by the doctor and based on your particular biology.
• There isn’t an orthodontist or dentist directly supervising the tooth movements. Orthodontic treatment isn’t static and it’s important to have someone checking your progress to keep it on track, ideally the person who prescribed the tooth movements in the first place. Only they know where your teeth are supposed to go and that’s determined by a mouth and x-ray evaluation. You might be thinking, “Well, if I take the DIY route, I’m still seeing my dentist regularly and they’re watching things for me.” While it’s great that you’re on top of your dental checkups, the truth is, they didn’t plan the tooth movements and they’re not supervising your treatment. They’re more like a passerby waving to you on the interstate not knowing where the end of your journey is, rather than someone driving you to your destination with GPS.  
• Complex tooth movements can’t be achieved since attachments aren’t used with at-home aligners. Okay, so here’s a little-known fact about Invisalign treatment: 95% of cases require the addition of tooth-colored attachments on the teeth. The aligners snap onto them and we’re able to provide the specific forces necessary to perfect your smile. FYI, you should know ahead of time that certain tooth movements aren’t possible without attachments or braces. This is worth repeating:  There are movements that aligners cannot accomplish without attachments.
• The systems don’t incorporate techniques like tooth polishing (or interproximal reduction in doctor speak). This is sometimes performed to make a little more space for the teeth to move into alignment, to take care of crowding or to help when teeth are mis-sized or misshapen, which is very common (40% of the population has undersized teeth). We can also do it to improve the appearance of your smile so it doesn’t look like you have spaces at the bottom of your teeth (black triangles) when you’re done treatment. Even with these “cheap,” supposedly fast, aligners, you’re still spending thousands, so, of course, you’ll want your smile to look good at the end of it.
• Direct communication with the doctor that planned the case isn’t allowed. You’re left to voice ”“ or email ”“ your concerns to a customer service representative. These reps are generally people who haven’t studied dentistry, let alone orthodontics and who are unfamiliar with your prescribed tooth movements. You can imagine the frustration when “that tooth” you wanted to straighten isn’t moving and you weren’t told why ahead of time.
• The results will vary. Part of treatment planning involves attachment design (those tooth-colored things bonded on the teeth) and the staging of tooth movement. At-home aligners can’t be crafted with the correct force system for the more complex tooth movements we need to truly fix most issues and bring about lasting, beautiful results.

Hey, I’m the first to admit that there are instances where at-home aligners could do the trick. If we used the salsa scale (mild, medium and hot), there are definitely mild cases that will respond to at-home treatment. The medium and hot cases though, are very unlikely to be remedied with a system that is unsupervised. The DIY approach is convenient and cheaper. It could even eventually work in limited cases when the business model is perfected to include comprehensive diagnostics and periodic office visits or by linking consumers up with a local orthodontist. If, for example, someone has a minor gap between their front teeth and the rest of their bite is perfectly aligned, they might be fine. But here’s the catch: the only way to determine if this is true is by visiting an orthodontist for a thorough examination that includes x-rays. Since that’s not part of the package, you’re taking a huge risk. It’s a little like breaking a leg, never going to the doctor or having an x-ray done and using a cast someone mailed you. You have no clue how it’s going to turn out!

The Dangers of Straightening Your Teeth at Home

So, why else is DIY orthodontic treatment a concern? The top reasons are that it can cause severe damage, infection and even tooth loss, which will require extremely expensive repairs. So, while you might save on treatment initially, you could potentially end up spending 10 times what you would have had you seen an orthodontic specialist in the first place. In a press release, the AAO president notes that dealing with and replacing a lost tooth can easily cost more than $20,000 over a lifetime. You’re putting your teeth and the tissues that hold them in place at risk. Rubber bands, hair ties, and other measures are really dangerous and the at-home, 3D printed, clear plastic aligners are a commodity. They’re not an actual treatment plan executed by an orthodontist or dentist with the skills, education, and certification necessary to achieve dramatic, safe and healthy tooth movements.

Orthodontics involves using biological forces to shift the teeth and when you mess with that, things can go wrong. Maybe you saw the story of David Campbell on the news. As a child, Campbell lost his two upper front teeth when he tried to straighten them with elastic bands. The bands migrated through his periodontal ligaments and got stuck under his gums making the teeth fall out at the root. He spent an estimated $40,000 to $50,000 to correct the damage. In one social media group, a consumer who used the mail-order, at-home aligners announced that they were going to lose a lower incisor because of it. In a great article for the New York Daily News, orthodontist Dr. Jamie Reynolds aptly summarizes the difference between in-office treatment and at-home treatment when he says that by eliminating the diagnostic information and “the doctor from the treatment planning and actual treatment process, you are eliminating many of the safeguards that ensure you are properly treated. Remember, doctors swear the whole ”˜do no harm’ oath thing. CEOs do not.”

Am I being protectionist of my profession by my concern with DIY orthodontic treatment? Sure, because orthodontists are specialists in the complexities of the bite, what a good, quality orthodontic result is and how to get there. I truly care about my patients and I want what’s best for them. I think of myself as their advocate and their protector. It’s my duty to keep their best interest in mind and walk them through the entire treatment process. For it to be successful, treatment requires a team approach from the practitioners involved and the patient. It starts with understanding your needs and concerns and laying out a plan.

I offer free consultations at my El Dorado Hills orthodontic office, so you have absolutely nothing to lose by coming in and getting an expert opinion before risking your smile and health with a DIY or self-directed, at-home treatment. If affordability is a concern, myself, and many other orthodontists, are willing to work within your budget with in-office financing and payment plans. You can get the care you need without resorting to risky alternatives. To revisit my anecdote about the hanging entertainment unit I installed, I did a ton of research before starting it and had a contractor friend on speed dial in case I needed a pro to step in and that’s just for the sake of my wall and not any body parts. There’s a big a difference between a DIY home project and DIY orthodontics, so leave your smile in the hands of a specialist.