The Uberisation of Orthodontics.
This is a guest post about the “Uberisation of orthodontics”. The author is Martin Kelleher who is a specialist in restorative dentistry from London. It is great to read a non-orthodontists view of the “recent developments” in orthodontics.
The new orthodontics?
The race to the bottom for the quickest, allegedly ‘great’ or bargain deal in orthodontics has reached a place that few would have thought possible even five years ago. This gradual ‘uberization’ of orthodontics has produced a raft of new and largely unproven claims for treatments. These are promoted with gushing enthusiasm and superficial short-term evidence of their supposed long-term benefits for patients.
The thrust of the promotional ballyhoo, which appears on various websites, or in trade-sponsored dental comics, usually involves some pretty case report pictures. These are usually part of advertorial articles that sometimes seem to have been written by someone with strong commercial interests.
The fanciful claims are not only targeted at interested and enthusiastic dentists, but also increasingly aimed directly at consumers potentially interested in changing their dental appearance.
Importantly, the direct accessibility and apparent simplicity of the treatment are promoted on the internet with breathtakingly superficial marketing straplines as being quicker, cheaper and more acceptable. Little seems to be mentioned about potential risks, or that such rapid results are probably a newer version of the sadly well known term ‘relapsodontics’, while potentially being biologically even more dangerous for the vulnerable roots and the soft tissues of some unsuspecting patients’ teeth.
The claims by some new hyperventilating marketer for ‘quicker, quicker, faster, faster’ branded techniques (possibly soon to be named ‘two and a half month smiles and “no one can see the appliances at all at all’ or some other nonsense) need to be treated with considerable caution by conscientious and caring dentists. Bitter experience shows that when something appears to be too good to be true there is usually a very good reason for that.
The role of the professions.
Professions are established within society to help protect the vulnerable from an asymmetry of knowledge, skills or experience being exploited by unscrupulous people to advantage themselves unfairly at the expense of others less fortunate than them. Most ethical dental professionals are careful and relatively modest in their proposals about what they can deliver with dentistry and do not make outlandish claims. That approach is wise because many things are outside the direct control of dentists. For example, the patient’s genetics, compliance, oral hygiene, diet, smoking habits or smile aspirations.
Indeed, many experienced dentists are uncomfortable with the recent proliferation of self-aggrandizing advertisements and claims for egotistical, narcissistic dentistry, often promoted by younger, or apparently non-specialist, dentists. These less than altruistic approaches, replete with their vacuous advertising straplines but rather tenuous grasp on ethics, have recently been crowding out established morals, ethics and patient care in dentistry.
Snake oil and ethics
Theoretically, people are protected from bad dentists and dentistry, but what happens in the grey areas when it is not a named registered dentist, or dentists, supplying these orthodontic human-experimentation-without- licence treatments, perhaps via a website or facility based in a foreign country?
Unfortunately, every generation produces its own version of the ‘snake oil salesman’. A charlatan in full flow can be a fascinating and often amusing sight − always provided one can recognize one early on and maintain a safe distance from the spectacle, while watching others being entranced by the smooth sales patter and the clever manipulation in order to make the susceptible observers believe that they are getting something wonderful for supposed ‘peanut$’.
In the latest selfish demonstration of some business-focused guru’s pursuit of his own agenda, the normal protective concerns for the patient’s long-term wellbeing appear to have been blissfully ignored. Into this vanity driven casino some new entrepreneur, possibly complete with Stetson hat and jangling spurs, has entered, having decided, apparently that, prior to offering to straighten someone’s teeth, no detailed history or serious clinical examination of that patient is now required. Instead, some digital photographs and some impressions to be taken by that untrained ‘consumer-narcissist’ will suffice for a piece of software to be run by someone, somewhere, which will be able to make a full diagnosis, discuss treatment options, their risks and benefits and also be able to obtain valid consent. In addition, these magical remotely produced models can be used to make devices to produce biologically dubious movements of teeth which have unknown bone support, root length, or periapical status to some new unstable positions in order for them to become a desirable fashion accessory and all in someone of unknown mental or dental health.
“Uberisation of orthodontics”
This allegedly consumer friendly development is apparently being lauded by some visionaries targeting human vanity and being promoted with panting marketing enthusiasm as ‘disruptive technology like Uber’. However, moving teeth around is risky and unpredictable at the best of times and it is not like taking a cheaper cab ride, nor is it what most sensible dentists would recognize as the practice of responsible dentistry. Neither is it what many experienced dentists would be willing to have done either to themselves, or to a child of theirs, or to someone about whom they genuinely cared.
Is this further drift to be left unchallenged, perhaps as just another case of ‘let the buyer beware’, or ‘Caveat emptor’, as my old Latin master used to warn? If so, what about the probability that in the future some less than totally satisfied Facebooking, Twittering, Instagramming, narcissistic ‘entitled consumers’, or their ever helpful lawyers will seek to cast all the blame on dentistry for not warning them about the problems of their desired cheaper and quicker ‘Uberized’ treatment approaches?
This is a shorter version of an article published in Dental Update in September 2016.
Emeritus Professor of Orthodontics, University of Manchester, UK.