What does the public think of Direct to Consumer Orthodontics (DTCO)?
Direct-to-consumer orthodontics (DTCO) is becoming more popular. This new paper is about a study that looked at the public’s opinions and understanding of DTCO. The results are surprising.
Direct to Consumer Orthodontics (DTCO) is a way of providing orthodontics direct to the public. Importantly, people don’t need to have a direct clinical examination. Instead, a technician scans their teeth at a DTCO shop. Alternatively, someone can take their impressions in the comfort of their home. As a result, there are many concerns with this method of care. Most of these are around the absence of detailed face-to-face examination, the ability to obtain informed consent, and identification of the person responsible for the treatment.
This new study looked at DTCO from the public’s viewpoint. A team from Cleveland, Ohio, did the research. The AJO published the paper.
What did they ask?
They did the study to ask the following:
“What are the opinions and understanding of the public on DTCO treatment compared with attending an orthodontist”?
What did they do?
They did a survey of opinions using a 35 question survey. They distributed this through an online web-based crowdsourcing platform. In the first stage of their study, they piloted the survey to 10 laypeople.
Members of the public completed the survey from May 2020 to June 2020. All eligible participants had to live in the USA and be over 18 years old.
The investigators designed the survey into six sections. These were:
- Interest in obtained orthodontic treatment.
- Familiarity with DTCO.
- Familiarity and preference for visiting an orthodontist.
- Perception of orthodontic treatment in general.
- Influence of the COVID-19 pandemic on their preferences.
What did they find?
One thousand four hundred forty-one people completed the survey. 55% were males. Most of them were aged between 26 and 35 years old. More than 80% had a degree. Significantly, more than 83% had considered having orthodontic treatment. Finally, 61% were familiar with DTCO treatment.
The authors provided a large amount of data. I hope that I have extracted the main points.
- 23% of respondents said they would highly likely, and 50% were somewhat likely to choose DTCO.
- Most participants (45%) felt that convenience is the most significant benefit of DTCO.
- 31% felt concerned about the quality of the treatment of DTCO.
- Surprisingly, 43% expected DTCO to be faster than orthodontist treatment, and 53% thought that DTCO treatment would be the same quality as treatment from an orthodontist.
When they looked at their perceptions of orthodontist treatment
- 36% rated the quality of treatment as being important.
- 37% were concerned with the potential cost of treatment.
- 26% felt that they would seek DTCO because of the COVID-19 pandemic.
The authors suggested that their findings illustrated the success of the robust marketing campaigns by the DTCO companies.
Their overall conclusions were:
“Most participants felt that DTCO was a viable alternative for seeking orthodontic care. They also felt that convenience was the most compelling reason for looking for DTCO”.
“Orthodontists and the dental organisations should consider better awareness campaigns to educate the population about orthodontic treatment”.
What did I think?
This paper was fascinating. It raised many important questions. I would, firstly, like to have a look at their methodology. I thought that this was interesting. However, we need to consider whether the sample of participants was representative of society. This factor is very relevant when we realise that users of this crowdsourcing platform are representative. The authors discuss this in detail, and they point out that the sample may not represent the general population. As a result, they suggest that we should be cautious of the findings. Nevertheless, I wonder if the respondents may represent the population who are most likely to seek DTCO.
The most important finding was that people were most likely to seek DTCO because of the convenience of treatment and the cost. In effect, they were not too concerned about the quality of treatment. This issue is central to the popularity of DTCO.
As dentists/orthodontists, we are ethical health care providers, and we do care about the quality of treatment. Importantly, to consistently deliver this quality care, we may be less convenient and more costly than the “scanshop” and the dentist who remotely approves the treatment plans. In this respect, our clinical standards may not enable us to reduce costs. This is a dilemma. We may approach this problem by running public information campaigns to educate the public about the risks and pitfalls of DTCO. Some of the specialist societies have used this approach. Unfortunately, while I have seen several DTCO advertisements on television, I have not seen anything from specialist societies. It is also my experience that DTCO companies are far in advance of dentistry in the effective use of social media. I wonder if we have the resources for effective programmes?
We may also ask what our regulators are doing about this? I have posted about this before when I thought that the UK General Dental Council was making progress in addressing illegal practice. I am not aware of any progress in 2 years, and the silence is deafening.
On reading back this post, I wonder if it is depressing. However, I cannot help thinking that we can address this problem by making our care the highest quality possible. There are likely to be many failed treatments with DTCO, and I hope that the benefits of professional orthodontic care become evident to our potential patients.
In the meantime, it would be helpful to the speciality and public if some specialists were not working with and profiting from DTCO. If you dance with the devil…
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Emeritus Professor of Orthodontics, University of Manchester, UK.