Doctor Directed Clear Aligners Vs. DIY Online Aligners:
The Good, The Bad, The Ugly
Over the past 20 years technology has made it easier to precisely and predictably move teeth using clear aligners made from a hard plastic material. Align technology, also known as the well branded and heavily consumer marketed Invisalign®, has been a household name for the clear “braces” product. In October of 2017, 40 of their patents began the expiration process which has allowed many competitors to enter into the clear aligner space. Competition is a good thing as it can make products more affordable and inspire innovation. In the healthcare industry however, consumers need to be aware on the realities of DIY Telemedicine. This article is intended to educate and inform those who are interested in clear aligners. You have many options and there is a place and circumstance for all, but you need to know the hard facts coming directly from a dentist.
*DIY Online aligners is referring to the myriad of companies like Smile Direct Club®, Candid Co.®, Smile Love®, and Byte®
*Doctor Directed Clear Aligners is referring to companies like Invisalign®, Clear Correct® and other generic lab made aligners that require a doctor to evaluate, diagnose and treat any dental issues before recommending and prescribing clear aligners.
DIY Online Aligner companies have remote dentists that evaluate my teeth and smile, why would I need to see a dentist in person?
3 very important reasons that you can ONLY find out with x-rays and a dental exam
In-between the teeth cavities: I like to call the silent killer cavities because you can’t see them on top of the teeth and the don’t hurt at all. Once they enter into the inside layer of the tooth they can move so fast it’s scary. The decay can rot out the entire inside of the tooth without even chipping at all on the outside.
This is a real x-ray of one of my patients that didn’t know she had cavities. I explained to her that they all start out looking like the tooth with the yellow arrow and over a few months turn into the one with the red arrow.
BOTH cavity stages were completely painless and invisible to the naked eye.
This patient came in a few weeks later missing half of this tooth after biting into a piece of toast. Again, completely painless and only visible on an x-ray.
What does this have to do with DIY Online Aligners? Most of these companies do not ask for x-rays only pictures of the teeth for their remote tele-dentist to professionally review. Once you send in your at-home impressions of your teeth to get your online aligners made, you begin paying them monthly and the aligners will only fit as long as your tooth stays the same shape. If anything changes, like needing a tooth pulled, cavity filled, or crown fitted to a broken tooth, the online aligners will not fit or function properly and you will need to begin the process all over again. Since your are paying monthly this will likely prolong your treatment and cause the end result to be unpredictable. These DIY Online aligner companies have you sign disclosures stating that you self report that you have been seen by a dentist to rule out any cavities and underlying tooth infection. Even though they do this, it is misleading in my opinion to assert that their remote dentist is able to approve your teeth for clear aligners without knowing whats is REALLY going on.
Short teeth roots
If you take your finger and push on your front tooth for three days straight your tooth will move. Teeth move because any pressure applied in a certain direction tells the bone on the other side of the tooth to make space and the bone one the front side to add more to fill in the space. This is a simplistic description of the mechanics but you get the point. When too much pressure is placed on the tooth the roots tend to do something very strange— They start to get really short!
Take a look at two different patients of mine’s x-rays that show blunt short roots. BOTH of these patients wanted me start Invisalign® treatment on them. While its is not impossible to treat these situations with clear aligners—- It has to be done VERY carefully with constant monitoring.
Curious what could happen to these teeth if they are moved with DIY Online aligners?
It’s not pretty— Once teeth become mobile it is EXTREMELY difficult to stabilize them. Gaining stability would be the best case scenario of this were to happen. A more likely outcome could be tooth loss which is really not pretty and so not worth the risk.
There is absolutely no way DIY Online Aligner companies can track the progress of your bite via mail or even pictures/video. Although many people have gone through the mail order aligner process have achieved straighter teeth they may not be biting properly on their back and front teeth. Take a look at this case a colleague of mine had to handle in their office after a patient went down the DIY route.
Top teeth are designed to overlap slightly over the bottoms. When treating patients with lower crowding and upper spacing you ABSOLUTELY have to make space on the bottom with whats called “interproximal reduction”. Again, there is no way to get this done via DIY Online Aligners so as the top teeth spacing is closed you may lose the overlap causing an “edge to edge” bite which is harmful for the teeth long term.
DIY Online Aligner companies are very upfront about the risks which is why all patients sign an informed consent and agree not to sue them if something goes wrong. Here is a link to popular DIY Online Aligner company’s informed consent page addressing dental problems quoted directly from their website. They are being up front about it all but they are placing FULL responsibility on you to visit a dentist before hand to clear you for orthodontic treatment.
Let’s be honest though… if you are going to take your own impressions and cross your fingers that nothing bad happens to your teeth, are you really going to want a dentist to tell you NOT to do DIY orthodontics?
Of course not…
With MILLIONS of investor dollars to spend on flashy marketing and “Smile Studio” storefronts, these DIY Online Aligner companies are after ONE thing and ONE thing only… your money $$$. They do not care about the health of your teeth or even if these aligners cause damage. The FDA classifies clear aligners as a medical device to be prescribed by a licensed Dentist or Orthodontist only.
Do-It-Yourself Orthodontics is risky for so many reasons and as a dentist who is held accountable by the Florida and South Carolina Boards of Dentistry I feel obligated to educate people on the risks of choosing to go this route. The dental and oral system of the body is complex and there is a reason why it takes eight years of education to become a dentist and 2-3 additional years to become an Orthodontist. So much can go wrong that you cannot reverse if you decide to take a chance with DIY Online Aligners. As I said jokingly earlier, if you push on your front tooth all day for three days.. it WILL move. If you are leaving the amount of pressure and direction of pressure up to a mysterious Tele-dental advisor you risk having trouble chewing properly or worse chewing at all.
Disclaimer: All brands and branding collateral mentioned and referred to in this article are the sole property of each respective company. I have not received any monetary compensation or been incentivized in anyway by Invisalign® or Clear Correct®. These are my professional opinions and the purpose of this article is to inform and educate the general public of the the risks of at home dentistry.
Dr. Natasja Bevans, DMD
General and Cosmetic Dentist
Bijou Dental Spa
109 Augusta St.
Greenville, SC 29601