Do you do a CBCT on every ortho case you treat? Do you mount models for every case? Do you spend an hour in the new patient consult? Do you record periodontal probing for every tooth on every patient? No? Then we are here to tell you that you are doing a disservice to your patients, not upholding the standard of care and causing a severe public risk!

What’s that you say? You’re a licensed dentist/orthodontist and you are entitled to and capable of employing your clinical judgment to determine which records you want and how you want to treat? Your license and the State Board of Dental Examiners gives you this privilege??

Fantastic.

Now, let’s apply the same logic to Direct to Consumer (DTC) orthodontics using clear aligners. Orthodontists, Dentists, the ADA, the AAO and various state boards are fond of calling this delivery channel Do It Yourself (DIY) Orthodontics but nothing could be further from the truth. Contrary to what most of you think, Direct to Consumer orthodontic treatment using clear aligners in the USA consists of a licensed dentist or orthodontist examining a patient via store and forward teledentistry, determining what further records or evaluations are needed, designing a treatment plan, delivering the clear aligners, monitoring treatment via the same store and forward teledentistry, addressing any patient concerns and doing refinements if necessary. These doctors are held to the same standards as any other doctors – you know this despite what you say and it’s obvious you do based on all your attempts to get DTC providers into trouble with the State Board. Doctors who chose a teleorthodontic method for limited tooth movement with clear aligners are exercising their State Board given right to use clinical judgment just like you and if you seriously want to impose your will on other doctors as to how things should be done then you must realize the slippery slope that it is. If you’re successful in damning DTC providers for choosing to practice Different than You (DTY) then what’s to stop some other group who believes you’re not doing it properly from doing the same to you?

The arguments that DTC is DIY are just part of a coordinated attempt to say that teledentistry is not legitimate. This is comical to us as the American TeleMedicine Association celebrated their 25thanniversary earlier this year. If real doctors, doing real healthcare can do it via telemedicine, can you honestly expect to win the argument against teledentistry long term – especially when we are talking about an elective, non-invasive, largely reversible procedure like orthodontics? Especially when the “orthodontic profession” refuses to make care accessible to all but the most economically advantaged and those on government support? The current attempts to require an in-person visit to establish a doctor-patient relationship and to require general supervision for use of a scanner (claiming that it is the “practice of dentistry”) are clearly protectionist ploys by the various dental cartels attempting to deny the future, protect the status quo and preserve orthodontists’ incomes. It will be seen for what it is long-term and the tremendous amount of time and money we dentists and orthodontists are wasting while railing against the inevitable will only serve to put us further behind the times. The general belief among dentists/orthodontists that DTC cases are all terrible, damage the public good and patients is also a blind alley for two reasons. First, everyone has an occasional bad result due to any number of reasons – compliance, mistakes, bad luck, whatever – and this happens in traditional offices at least as often (probably more often) than with DTC aligners because fixed appliances are more apt to result in irreversible damage. The ubiquitous belief that “all DTC cases are low quality” and “all cases treated by an orthodontist are great” is so juvenile and misguided as to not even merit a response . If you can’t see the flaw in this mindset then stop reading now and go back to protesting DTC. Second, even though orthodontists and dentists claim to have found some DTC cases that didn’t work out as well as desired and/or some unhappy customers, this is a tiny fraction of the cases that are treated in the DTC channel – we daresay it’s much less, as a percentage, than the unhappy customers and untoward events that occur in the traditional orthodontic or dental office. One of us has served as an expert witness for both the plaintiff and defense and more often than not the case has revolved around provider decision-making independent of what appliance, technique or delivery channel they use.

And here’s the crux of this piece:

  • Teledentistry is a real thing and it’s not going away
  • DTC orthodontic care is real dentistry
  • Licensed dentists who practice DTC orthodontics with aligners supervise and prescribe treatment in accordance with state laws and are held to the same standard as everyone else – and as such, they have just as much right to exercise clinical judgement as you do
  • In spite of the feeble attempts of State Dental Boards to place artificial boundaries to DTC treatment and access to care in general, history (and the present state of telemedicine) guarantee these protectionist measures will fail
  • The largest of the DTC companies was just valued at 3.2 BILLION dollars and they are just getting warmed up – plus there are many other companies following suit
  • Calling DTC by any other cute name that makes orthodontists happy (like DIY) may be fun but failing to recognize something for what it is and willful ignorance are never conducive to a positive outcome
  • DTC treatment is good for traditional orthodontics as it raises awareness, drives patients to your offices who might not have considered seeking treatment and not everyone can be treated with DTC aligners

Though we’ve made these very simple and extremely logical arguments for years now and we know that 99+ percent of orthodontists are immune to reason, we will continue to try and expose our peers to the new reality in hopes that someday they will stop clinging to “the way we’ve always done it” and abandon our ancient paradigms. From what we see and the feedback we regularly receive, we realize it may even take the passage of a couple generations of dental professionals before reality sinks in and we, as a profession, internalize the lessons learned from the undeniable success of DTC treatment. We hope not as losing touch with reality and associating only with those with whom you agree is a proven recipe for irrelevance. Oh well, there is precedent – the Prosthodontists and Periodontists will welcome us with open arms as misery loves company…

Marc and Ben

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DIY Medicine?

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