AAO Response to New York Times Article on DIY Orthodontics

AAO Response to New York Times Article on DIY Orthodontics

There is concern about the increasing prevalence of do-it-yourself (DIY) teeth straightening treatment videos on the Internet because of the potential harm that could result from attempts to straighten teeth on one’s own.

Video and internet sites are targeting both teens and adults; all are encouraging people to attempt to straighten their teeth without the supervision of an orthodontist.

Without an in-person examination to understand the patient’s overall dental health, the patient’s bite (the alignment of teeth, how they fit with opposing teeth, how they fit in the jaw, the size of the jaw, the relationship of the upper and lower jaws), and X-rays to see what the naked eye cannot see, patients may be unaware of underlying problems.

These could include the health of gum tissue, the amount of bone present to support teeth, teeth that are fused to bone (ankylosed), extra or missing teeth, excessive enamel wear, short roots, bone cysts, and more.

The American Association of Orthodontists is launching a public service campaign to alert the public to the inherent risks of attempting to move teeth without the supervision of an orthodontist.  Currently, a news alert has been added to the consumer website homepage.  The American Association of Orthodontists will also reach out to school nurses to alert them of the problem.

Media Q&A on Buyer Beware / DIY

1)  What is DIY Orthodontics?

This is a trend we are seeing on the Internet that is causing concern because of the potential for harm that people can inadvertently cause themselves.  There are dozens of videos online which promote the idea that people can “straighten their teeth at home” using household items such as rubber bands and paper clips.  There are major health risks associated with this trend, and the goal is to alert parents, as well as the general public, about this concern so that consumers can make an informed decision.  It’s a case of buyer beware.

2)  We’ve watched some of the videos – it looks like people are improving their smiles by themselves.  What is wrong with that?

There can be numerous health issues ‘beneath the surface’ that can only be seen with a thorough exam in an orthodontist’s office and through diagnostic tests such as X-rays.  For example, there could be cysts on the bone, periodontal disease, root abnormalities, cavities, extra teeth, missing teeth, or other issues which need to be known and addressed before any sort of ‘straightening’ treatment should begin.  Moving teeth in the presence of undiagnosed oral health problems could result in irreparable damage, including permanent tooth loss

3) What if people just try to close the gap between their front teeth?

There is more to it than that.  Closing one gap creates another elsewhere in the mouth, and can affect the way the top and bottom teeth meet.  This movement could create new or more serious orthodontic problems, including misaligning the bite which can potentially lead to problems with the jaw and excessive wear of the tooth enamel.  For example, many orthodontists have seen cases where elastics (or rubber bands) were used to close a gap between the two front teeth, and the elastics ended up recessed into (under) the gum, leading to gum disease, loss of the bone that holds the teeth in place, and ultimately leading to loss of those permanent teeth.

4)  Aren’t you just trying to protect your territory as an orthodontist?

Members of the American Association of Orthodontists are obligated by our code of ethics to protect the public health.  We want to alert consumers about the potential dangers of self-treatment.  In fact, the American Associated of Orthodontists will be launching a public service campaign soon to alert consumers on a broader basis about these concerns.  Consumers should understand that orthodontic treatment is a complex medical procedure, and there is no “one size fits all” approach for patients.  Orthodontists are trained to spot underlying issues that, in many cases, may make any orthodontic treatment inadvisable.

5)  What if my dentist says my teeth and gums are healthy?  Wouldn’t it be reasonably safe to begin my own treatment?  I could save considerable money, according to some websites.

No.  As a consumer, you likely don’t have the expertise or training in the science of moving teeth, under the best oral health scenarios.  Any time an untrained, unsupervised individual attempts do-it-yourself orthodontics, there is a substantial risk for irreparable damage.  Orthodontists receive two to three years of training beyond dental school to become experts in moving teeth and aligning jaws.  Orthodontic treatment is a medical procedure, and requires supervision by a professional.  You only have one set of permanent teeth in your lifetime.  Replacing natural teeth with crowns, bridges, implants or dentures is costly, and may require periodic replacement over a lifetime.

6)  What should people do who really need treatment and can’t afford it?

Fortunately, there are many good options that make orthodontic treatment today affordable.  Most orthodontists offer payment plans, and will work with you to find something that fits your monthly budget.  Healthcare credit cards or banks may help to extend payments.  There are tax-favored plans, such as Flexible Spending Accounts (commonly called FSAs) and Healthcare Savings Accounts, which make use of pre-tax dollars, and can be used to pay for orthodontic treatment.  Many people have dental insurance that includes orthodontic benefits.  There are organizations throughout the country that help low income patients receive treatment at no or low cost.  The American Association of Orthodontists website, my lifesmile.org has more information on these programs in the Frequently Asked Questions section.

7)  What are the positions of other medical associations such as the ADA or the AMA?

I am not familiar with the positions of these groups.  Please contact their public affairs departments if you have additional questions for them

8) How many patients have been affected by DIY products?

It’s difficult to track this type of data because there are literally scores of websites and videos that suggest ways people can move their own teeth.  It’s important to note that my colleagues in the American Association of Orthodontists and I want to prevent people from permanently damaging their teeth, gums and bone – even if it’s just one person.  Right now, our focus is on educating the public about these dangers.  The American Association of Orthodontists’ scientific journal, The American Journal of Orthodontics and Dentofacial Orthopedics, has set up a system for members to report cases as they see them, to the extent that members can report such activity without violating patient privacy rights.  We suspect that many of the “do it yourself” people will not consult an orthodontist, but it is hoped that this outreach will make those considering self-treatment away or the risks to their dental health.

9) What types of injuries are orthodontists reporting?

Thankfully orthodontists are not seeing wide spread problems yet.  But, if this trend continues, we can certainly expect that will change. It is hoped that future problems can be avoided by educating the public about the risks of do-it-yourself orthodontic treatment.

10)  Have you reached out to the companies that you believe are wrong?

As orthodontists, we are focusing on educating and protecting the public.  The hope is that by helping people understand the risks of do-it-yourself orthodontics they will avoid it.  I like to say, “If it sounds too good to be true, it probably is.”

11)  What scientific evidence does the AAO have to prove DIY products don’t work?

Most orthodontists have personally encountered at least one patient, or know of at least one through a colleague, who has experienced problems resulting from an attempt at self-treatment.  The idea of “do-it-yourself” treatment is not a new one, and scientific literature documents the adverse effects.  The surest way to achieve a healthy, beautiful smile is by seeing an orthodontist.  That is our focus and expertise.  Orthodontists are experts in orthodontic care because of our 2-3 years of education in orthodontics after graduating from dental school, coupled with limiting our practices exclusively to orthodontics.