Do it yourself orthodontics: You do not even need to see a dentist!
Over the past few years there has been the development and promotion of several types of orthodontic treatment to general dental practitioners, for example, Short Term Orthodontics and aligner systems. I have now come across the next stage. These are companies that provide “do it your self orthodontics” and provider aligner treatment direct to the public without them seeing a dentist. In this blog I will discuss this latest development.
The two most recent companies that take this approach in the UK are Straight Teeth Direct and Your Smile Direct. They both adopt similar approaches on their websites. They provide treatment with clear aligners and point out that their treatment is cheaper than that provided by dentists or orthodontists. This type of provision has been carried out in the USA for some time and was the subject of an article in the New York Times.
The process of getting this treatment for Straight Teeth Direct is that you complete a short questionnaire and then upload photographs of your teeth to the website. They then get back to you to let you know that you are suitable for their treatment. If you are still keen then they send you a “Smile Box” which contains material so that you can take your own impressions. Alternatively, a dental nurse can visit a group of friends and hold a “Group Smile” and they will take a 3D scan of the teeth.
The scans/models of your teeth will then be examined by a registered dentist and a treatment will be planned. They will then send you a series of aligners. If interproximal reduction is needed as part of the treatment they will put the patient in touch with a dentist who will carry this out. The approximate cost of treatment is between £899 and £1650 depending on the severity of the malocclusion.
Your Smile Direct is similar but their questionnaire asks you to tick a box that represents the amount of crowding or spacing in your teeth. They do not offer a “Group Smile” or offer IPR. The cost of their treatment is £1,199.
I could not find background information on Your Smile Direct, but on the Straight Teeth Direct it states that a registered dentist is behind this company, these details are given on the FAQ pages under “who is behind Straight teeth direct”.
If you are interested in finding out more about this treatment have a look at the websites.
What do I think?
I must admit that I am concerned about this because I am not clear on the safeguards that are in place for the patients who may seek this form of treatment. Importantly, there is no direct contact and clinical examination of the patient’s mouth and assessment of their dental health by a dentist. This is important because even though some aligner systems and short-term orthodontics involve treatment planning by people other than the treating dentist, the patients are examined and treated by a dentist. In these circumstances, there is no doubt that if there is a problem with the care, the treating dentist is responsible to their patient and the regulators. As this new system does not involve direct treatment by a dentist, it is not clear who is clinically responsible for the treatment. It appears that this will be the registered dentists who are planning the treatment from the study casts and photographs.
The other important point with the “Group Smile” (Straight Teeth Direct) is that the taking of 3D scans on patients who have not seen a dentist may be a “grey area” in terms of the clinical tasks that are within the scope of practice of a Dental Nurse. I have looked at the UK General Dental Council guidance on whether this is within a Dental Nurses’ scope of practice and this is not totally clear. However, the policy on Direct Access (where a patient can be seen by a Dental Nurse without seeing a dentist) is very clear and this states the following
“Dental nurses can see patients direct if they are taking part in structured programmes which provide dental public health interventions”.
My opinion is that this type of care is not a public health intervention. So there may be issues here.
The British Orthodontic Society has also issued a statement on “Do it youself orthodontics”. This can be found here. You will see that they are warning the public against this form of treatment because of the risks involved.
These are early days for this type of provision of care and this may be something that does not become popular with the public. I am almost in despair at the way orthodontic treatment is going…..