An occasionally irregular blog about orthodontics

Let’s talk about Six Month Smiles

Let’s talk about Six Month Smiles

Let’s talk about six month smiles

This post is one of the “let’s talk about series”.  This has previously included discussions on myofunctional  therapy, Acceledent and Fastbraces. So “let’s talk about Six Month Smiles”.

As may people know Six Month Smiles is a form of short term orthodontics (STO).  Six Months Smiles is based in the USA and they provide treatment directed at adults who want to improve the appearance  of their front teeth.  As an aside, I am still confused about the term “short term orthodontics” because this implies that the effects of treatment are short term and there must be better term for this type of treatment?

What is Six Month Smiles?

I have gathered most of my information about Six Month Smiles from social media and other websites. So a good place to start is the Six Month Smiles website.  On the site they state that this treatment is directed at adults who want to improve the appearance of their front teeth.  This is not  comprehensive treatment and is not indicated for  children.  They write;

“We have taken the best aspects of braces and modified the treatment and materials to give adults a common sense cosmetic solution that fits the adult lifestyle”.

They then expand by explaining that Six Month Smiles is innovative because;

  • The treatment usually takes six months
  • They use special clear appliances that are nearly invisible
  • The forces are low and this increases comfort and safety (this is the old self-ligating, Fastbraces chestnut)
  • They are less expensive than traditional braces or aligners.

sms-3

The website also includes pictures of clinical success.  Unfortunately, the pictures are generally low quality clinical photographs that only show the anterior teeth with limited retraction.  (this seems to be a feature of most STO case reports, and I wish that they would take better photos!).  When I looked at the cases I thought that they were all simple anterior alignment. This fits in with the ethos of the treatment.

I then had a good look at the section of the website directed towards dentists.  They again make the point that Six Month Smiles is indicated where a dentist feels that their patients are stuck with the complexity and cost of comprehensive orthodontic treatment provided by a specialist.  This, of course, makes the assumption that specialists do not consider compromise treatment and I am sure that this is not the case.

How do you learn to be proficient in Six Month Smiles?

It appears that a general practitioner enrolls on a 2 day course costing about  £2,000. At the end of the course they are able to provide treatment with  support from Six Month Smiles. When a practitioner decides to provide this treatment they complete a diagnosis form and send study casts or impressions to Six Month Smiles. They then decide if STO is suitable, but I am not sure how they decide this from the study casts etc?  Six Month Smiles then provides an indirect bonding set up and all the wires and instructions necessary for treatment.  This is clearly remote prescribing, but the responsibility for the treatment lies with the treating dentist.

Clinical case and testimonials

They also show testimonials from dentists who state that they are “blown away” by providing treatment and that their lives have changed.

The section on clinical cases again show similar example to those that I have mentioned previously.

I think that it is relevant to point out that they do not make claims about their treatment being comprehensive, suitable for children, no need for the dreaded extractions and faster or better than specialist treatment. This is in contrast to other providers of other STO type systems.

I have also looked at several UK-based practitioners websites. Again they show compromise, easy alignment treatments (some are the same as those on the Six Month Smiles website). As an aside, most of these practices are the first ones in the UK to use Six Month Smiles and they are nearly all “award winning cosmetic” practices run by dentists with a passion for cosmetic dentistry. I cannot help feeling that with this amount of passion everyone is a winner!

What did I think about all this?

When I started looking at Six Month Smiles I was expecting to see many claims being made for this type of treatment. I was, therefore, surprised that most of the advertising and testimonials were rather measured and most made the compromise nature of the treatment very clear. There are also many dentists carrying out this treatment, I did a search for providers on the Six Month Smiles website and there are 140 registered provider dentists within 25 miles of my house. So there is no shortage in Manchester, North of England.

I still have concerns with the expertise and training of the practitioners. I very much doubt that a 2 day course will prepare practitioners with the knowledge and skills to correctly diagnose a case and decide when a compromise is suitable. I have discussed this previously.  It is very clear to me the whole process predicates on the assessment of  a remote practitioner at Six Month Smiles. I have looked for information on how they do this and  I cannot find anything.

There is also an additional network of support from experienced practitioners.

The provision of Six Months Smiles, is no different from any other dentistry.  The main point is concerned with the practitioners assessment of their competence and patient consent.  If a patient is to be fully consented, it will be necessary for the practitioner to explain the following

  • They may have limited training
  • Support is provided remotely but the treating practitioner is responsible for the treatment.
  • They are providing a compromise treatment.
  • Fully comprehensive (and compromise) treatment is available from a specialty trained orthodontist.

I feel that only when they are given this information the patient can make a fully informed decision.  If they are simply informed that Six Month Smiles is the best treatment, then the practitioner is at high risk.

I also wonder if this method of provision is no different from a dental practitioner providing  aligner treatment, again working within their competencies.

Finally, I think that none of this is straightforward and this brings us back to the discussion on “whether general dental practitioners should provide orthodontic treatment”? Again, I can conclude that it is time that the specialist societies should work more closely with general dental practitioners in education and training to enable specialists and generalist to work as teams and not competitors…

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  1. Ramtin says:

    Hi Kevin, another fantastic blog. Do you think that it is enough to say that a comprehensive treatment could
    Be done by an orthodontist to gain consent for treatment? In my view in order to obtain a informed consent, the actual comprehensive treatment plan should be given so that the patient knows what it entails in its entirety

  2. John Serrano-Davey says:

    Hi Kevin,
    The term “Short Term Orthodontics” is indeed a curious choice. Perhaps “Aesthetically Focussed”, or “Limited Objective Patirnt-centred” Orthodontics might be more appropriate?
    I agree wholeheartedly with all you say, but cannot help feel that your wish that “Specialists and Generalists” become collaborators working as a “Team” is unfortunately a pipe-dream. The financial stakes are simply too high for this. I know of specialists running multiple-sites with huge NHS contracts, and using either Therapists or “cheap Eastern-European clinicians” to run “production-line Ortho”, and earn enough to run Private Helicopters! Of course they don’t want “ordinary Dentists” muscling in on their territory. The protectionism in the world of “Specialists” is unfortunately as great as in any field, and being “a Specialist” no longer carries any ethical or moral weight, nor guarantees of clinical superiority over the well-trained GDP.
    I believe that what really needs debating is “Why are Accademic Orthodontists so obsessed with finishing everyone in “Class 1”, when there is little scientific evidence that this confers huge health-benefits on the recipients.
    Or do Specialists insist on setting this as the goal simply “because they can achieve it”?
    Food for thought?

  3. Roland G Nentwich Dede MS says:

    having been general practitioner for 14 years prior to hiatus for further education in orthodontics. I can appreciate the need for alternate income sources in today’s dental environment. This does not give permission for substandard or inade inadequate clinical results. I fear the problem today is not only the limited understanding about orthodontics, but also the science in the technical components. There is also a diminished understanding of the science behind the process for many orthodontic practitioners. This void has allowed them to tacitly approve of all of the different systems available today, be it six-month smiles, aligner therapy, or any of the sundry orthodontic treatments available today. I believe it is time for the profession to step up, educating our general practitioners, as well as taking a stand on these questionable clinical options . To me this Brings to mind the various treatments in the early days of the TMD craze. It is taken years to wrest that Arena of our field from the charlatans ( unfortunately there are still many out there advocating questionable treatments even today). I fear we are going to have to go through the same perturbations in terms of the quickie orthodontic treatments existing today. This is going to require a concerted effort on the part of our profession and our colleagues to Stand against this insistence on mediocre treatment measures.

  4. It would be interesting to see the results of cases after a few years. Especially with patients who may not have been completely compliant with whatever recommendations (disclaimers) providers make concerning care and maintenance.

  5. Anthony Kilcoyne says:

    Hi Kevin,

    I think JSD makes some interesting points, all I would add just for clarification is:

    1. By training you mean a minimum of 5 years and 2 days, surely you are not suggesting 6MS teach this to non-dentists ie: they are already qualified dentists and orthodontics is Dentistry!

    2. FastBraces is entirely different as it’s not a round-wire system, Fastbraces is comprehensive Ortho, not STO, so it’s not helpful to compound/confound I feel.

    3. For fully informed consent surely Soecialists should remind patients GDPs can do routine Ortho. Cases too?

    We need good Specialists for the more difficult cases AND to help GDPs do more Ortho. For sure – sadly those that do help GDPs progress, tend to get lambasted by those Orthodontists with Monopoloistic or Protectionist tendencies, often hiding behind the guise that they can do many cases better, lots of extra training and expertise etc.

    Well OF COURSE Specialist have extra skills/training, just like EVERY other dentistry discipline such as Perio, Endo, Oral Surgery, Paedodontics, Restorative etc, etc.

    But THE difference is that Orthodontics in the UK, is still very GDP unfriendly generally (with some notable exceptions) and instead of empowering GDPs, act adversarially and aggressively frankly 🙁

    That is not only Myopic, but also against the public interest overall IMHO.

    So the REAL problem here is actually within the Othodontist fraternity itself – until the BOS agrees most Orthodontics (simple to moderate) cases should be done by GDPs, the Orthodontics will remain the ‘outlier’ dental Speciality with least insight sadly, kicking and screaming whilst GDPs go around such stubborn, old-fashioned obstacles!!!

    Or will the penny drop in time ???
    Yours observationally,

    Tony Kilcoyne.

  6. gerry samson says:

    Hello, Kevin. As you noted, loads of non-orthodontists are providing orthodontic treatment to their patients – the toothpaste is out of the tube and it is far too late to deny that reality. In my opinion your conclusion, “…….it is time that the specialist societies should work more closely with general dental practitioners in education and training to enable specialists and generalist to work as teams and not competitors…” is spot on. Again, thank for your time, effort and expertise.

  7. Anomynous says:

    As a current Orthodontic trainee, I would like to say thanks Prof O’Brien for your insightful blog and posts. I find this a great place to keep informed on relevant topics.

    Just in regards to what John Serrano-Davey mentioned in regards to “finishing everyone in Class 1” – I am not sure about other training programs, but where I am training this has never been the case? There is certainly no obsession to finishing in Class 1 molars when there is no justification or need for it. We are more than happy to finish with Class II molars as long as we have achieved Class 1 canines with a good OB/OJ.

    May I suggest this to be potential future Blog post Prof O’Brien?

    PS: apologies about being anonymous, it is just that my fellow trainees all read this blog and I wouldn’t want to embarrass myself 🙂

    • John Serrano-Davey says:

      Thanks for the comments, but let me clarify:
      Why do Speciaist Orthodontists insist on finishing with a Class 1 canine and incisor relationship even on Skeletal Bases that are not Class 1?

      As I understand it, the most respected and eminent Orthodontists I know tend to respond “whilst there is little pure scientific evidence that this confers particularly valuable benefits on the patio,t, in light of the lack of a “better” objective, this seems a reasonable goal”!
      Given that we cannot “grow mandibles”, and all teeth movements involve tipping to some degree or another, I believe that serious debate and discussion is required in this area.
      (I seem to recall that Edward Angle was deeply religious, and a Freemason obsessed (appropriately) with “the divinity of Rightangles”!

      Who was it once said, “Whilst we should treat Children Idealistically, we should treat Adults Realistically”?
      I recall only a few years ago Prof Jon Sandler invited the eminent and highly regarded prosthodontist John Beresford to speak at the BOS on this “obsession with Class 1”, so clearly I am not alone in questioning the validity of this premise.
      (And just to clarify, this in no way should be taken in any way as a defence of inadequate quality of outcome, such as anchorage loss etc)
      Come on Kevin, surely this is an excellent topic for you to cover!

      • Nicky Stanford says:

        I can’t speak for all orthodontists, but I treat a reasonable number of patients with a treatment where a class 1 result isnt aimed for.

        It’s difficult to finish any significant skeletal discrepancy to class 1 without adversely effecting facial aesthetics or periodontal health. Mild asymmetries, hypodontia, bolton discrepancies…all tricky to finish “class 1”

        As for mild skeletal cases in my hands, these can often be camouflaged successfully to a class 1 finish and are done so in consultation with the patients and at their request. Class 3 cases to yield a good overbite and hopefully prevent relapse and class 2 cases to ensure that if there is relapse then the OJ might settle at the lower range of “increased.” Offering patients who don’t like their OJ or ROJ a treatment which leaves them with the feature they dislike is usually met with rejection and opting for a more “class 1” result.

        I often wonder if these views/stereotypes of specialist orthodontists represent a bygone age…none of my orthodontic trainers were obsessed with finishing everything to class 1. None of my contemporary orthodontic colleagues seem to be obsessed with finishing everything to class 1. Discussion with patients and potentially accepting residual features of severe malocclusions is part of contemporary orthodontic training in the UK…at least in my experience.

  8. I am an orthodontist. I also teach orthodontics to pediatric dental residents Personally, I have no issue with non-orthodontists doing orthodontics. If you know what you’re doing, orthodontist or nonspecialist dentist, great. I do feel it is important for all of us, specialist or not, to be very clear about our training, the options available, and the results we intend to provide. I find that patients are smarter than they are often given credit for. They merely need to be armed with the facts and available options to make an informed decision. They also appreciate when they are placed in the best possible hands. When talking about the GP/orthodontist relationship I think it is important to emphasize that the patient is also a member of that team.

    Lastly, I sense quite a bit of hostility on this topic. Regarding the state of the profession, there is plenty to be upset about. However, the animosity is misplaced. General dentists and orthodontists are not enemies. I believe they are victims of the same dilemma. There are more dentists per capita in the USA than ever in history. I suspect the same is true in the UK. Obviously, this increases competition for all dentists. Do you believe this is the result of natural free market forces? If so, you have nothing to complain about. If you believe there is not a natural free market for dental professionals, then your issue is with parties manipulating the market, not your general dentist or orthodontist down the street.

  9. Bruce Mayhew says:

    Kevin, I treated many patients with so called Six Month Smiles.
    Why?
    Because in the area where I practiced I consistently found total disatisfaction with local orthodontic treatment. My local NHS consultant had retired, and my patients when referred to many of the alternatives were faced with cancelled appointments, arrogance, 2 years of treatment,etc, all resulting in very unhappy patients.
    Frequently these patients merely required simple anterior alignment eg, 6MS.
    Often the patients had had ortho from a consultant when young…..and it had relapsed.
    In my opinion to not offer these patients simple 6MS would be cruel, inconsiderate and stupid.
    Quite simply, because my patients were confronted with the above behaviour I was pushed, persuaded to do 6MS.
    This resulted in 100’s of very happy patients.
    In my opinion the NHS and the Orthodontic societies were completely to blame for overseeing the behaviour that confronted my patients.

    • Nicky Henderson says:

      Thanks Kevin for raising the topic. I’m a specialist who just does private treatment. Simple anterior alignment is of course a valid option for many patients, whether you’re a specialist or not. The reason why orthodontists might be perceived as being obsessed with class I is that all their young NHS patients are obliged to have quality control as part of the NHS contracts in the form of Par Scoring, and the score decreases as the end result deviates from class I. It doesn’t mean that there’s necessarily an advantage in being class I, but the Par scoring encourages a certain mind set. I think these days it’s very important during the consent process that patients understand they have a choice of treatment plans, and a choice of appliances. It’s also worth bearing in mind that specialists might offer the equivalent of SMS at a lower price because they don’t need the SMS lab fee, and they don’t need so much clinical time for adjustments, so advising patients that it will cost a lot more to see a specialist is not always the case.

  10. Short Term Orthodontics, a term coined by us, referees to application of orthodontic appliances for a short period of time to correct a patient’s chief complaint. Typical treatment times are between 4 and 9 months, and treatment objectives are aesthetically focused. Six Month Smiles was born out a need expressed by adult consumers who otherwise were not getting the treatment in the time it takes or the price they are willing to pay. Over the past decade, Six Month Smiles has helped over 100,00 adults achieve a better smile. We are very proud of this accomplishment.

    Aided by technology, training and compelled by today’s competitive environment, more and more dentists offer specialist procedures. We have seen this transformation in Endodontics, Periodontics, Oral Surgery and respectfully question what will be different for the Orthodontic specialty? Today, all of those specialists see more cases because GDP’s are having a dialog with patients about their chief complaint. In many cases, this results in referral that might not have happened without this dialog.

    Instead of putting up barriers, we assert that the orthodontic community consider collaborating with GDP’s and companies like ours to do better treatment for enhanced patient outcomes. GDP’s doing orthodontics is not a trend, rather a real market condition driven by consumers around the world–a demand that will likely be unencumbered by the specialty. I often wonder why more orthodontists wouldn’t embrace this opportunity to serve more patients and support their referral network of GDP’s?

    Six Month Smiles claims are substantive, grounded in science and our treatment modalities are clear and distinct from those with the aim of comprehensive orthodontics. We welcome questions, critique as well as the opportunity to collaborate with the specialty in addressing how to better support the GDP and the adult patients they serve.

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