What do “consumers” think of DIY orthodontics?
DIY orthodontics is a controversial area. This treatment is provided by a company and the patients do not see a dentist.
I have posted about DIY orthodontics several times. In these posts, I have discussed the ethical and safety aspects of this treatment. In another, I have discussed some poor-quality research. I thought that this new paper adds to our knowledge. It outlines the patient’s perceptions of DIY orthodontics.
A team from Pennsylvania did the study. The Journal of the American Dental Association published the paper.
What did they ask?
They did this study to ask this question.
“What are users experiences with at-home aligners”?
In effect, they wanted to provide evidence that could inform contemporary debates regarding DIY orthodontics.
What did they do?
They did a cross-sectional survey of people who were using DIY orthodontic appliances. They designed a survey that collected information on their reasons for seeking this treatment. This also looked at their interactions with a dentist, experience with orthodontics, satisfaction with aligners, any adverse effects and other relevant issues.
Whenever I read a survey study, I spend some time looking closely at how they selected and obtained a sample of participants. I thought that their method was unusual and relevant when we consider the results of the study. They used two approaches.
- They posted recruitment messages to online forums related to DIY aligner treatment.
- Also, they identified common hashtags used by users of this form of treatment. They then searched Twitter and Instagram for these hashtags. This allowed them to identify people who were posting about their experience of using DIY aligners.
Finally, they sent them a link to the online survey. They ran the study from March to August 2019. They found 451 contacts via Twitter and 2,366 via Instagram. Unfortunately, they did not provide any information on the number of potential connections that they obtained via Facebook.
What did they find?
They provided a large amount of data in the form of graphs and tables. I have extracted the main findings. These are:
They analysed 470 individual responses. Importantly, they did not report an overall response rate.
- The typical respondent was a white, female, millennial-aged 23-38 years old.
- A higher percentage of respondents had a bachelors degree than the general population.
- There were fewer respondents in the higher ($150,000) and the lower ($24,500) income bands of the USA population.
- Most respondents were in the middle of a course of treatment.
Interaction with dentists
- Just over half of the respondents consulted a dentist about orthodontic treatment before they started DIY ortho. In these discussions, the dentist recommended professional care.
- Nearly all the respondents chose DIY because of the cheaper cost.
Experiences with aligners
- Most respondents were very happy or happy with their DIY treatment.
- Although most would recommend this treatment to others, a large number would have preferred treatment from a dentist or orthodontist.
The authors also pointed out that Smile Direct Club consumers had to sign a Non-Disclosure Agreement. This may have led to bias in the responses.
In their discussion, they raised several points. I thought that this was the most relevant quote.
“Given that cost and convenience were the main reasons for turning to DTC aligners, dentists who provide more affordable aligner treatment with ﬂexible payment plans and a reduced number of in-ofﬁce visits might be better suited to compete with DTC aligner companies.”
Their overall conclusions were:
“Looking ahead, it is likely that some form of DTC orthodontics is here to stay. This is underscored both by the high satisfaction levels reported in this survey, as well as the increasing partnerships of companies like SmileDirectClub with retailers 32and insurance companies “.
I also thought that this was an important viewpoint.
“The challenges posed by at-home aligners are not unique. Fields such as genetics, psychiatry, neurology, and cardiology are all experiencing similar disruptions due to the advent of DTC health products. 40 Some scholars have argued that in today’s world of expanded patient access to DTC tests and interventions, physicians will need to “reconceptualise their role,” occasionally acting as consultants or advisors, instead of the sole gatekeepers of treatment”.
What did I think?
I thought that this was a fascinating paper. I was also really interested in reading an interpretation of direct to consumer orthodontic care written by people who were not orthodontists. I suggest that you read this paper. Unfortunately, it is behind a paywall.
I will discuss the research methods first. The authors used novel methods of obtaining their sample. In this respect, it was probably the best way of getting a sample of the patients. However, it was a shame that they did not report the number of people in the Facebook groups. This would have given us an indication of a response rate.
Furthermore, most of the patients were still in treatment. As a result, they did not know the results of their care. This is a significant problem because they did not evaluate the patients overall satisfaction with treatment.
Nevertheless, this study does give us valuable information on the participant’s reasons for seeking this care. It appears to boil down to cost and convenience, and they were willing to take the risk of not having clinically supervised care. This is a compelling message to orthodontists. I have interpreted this as meaning they would have sought care from orthodontists/dentists if the costs had been lower. However, we do not know the cut-off point in terms of the expenses for seeking DIY care.
My stance on direct to consumer orthodontics has not changed. I still have major ethical concerns with consent and oral health with this unsupervised treatment. However, it is likely that this form of therapy is here to stay. The authors of this paper suggest that one way forwards is for orthodontists to provide more affordable treatment with flexible payment plans. Furthermore, we should find ways to co-exist with DTC companies by providing professional oversight.
I have tried to think of ways forwards with this problem. This is difficult for me because I have no experience of charging for my treatment or clear aligners. I am not sure that I agree with the author’s suggestions, but let’s have a debate in the comments section of this post.
Emeritus Professor of Orthodontics, University of Manchester, UK.