DIY Orthodontics: How the World and Indian Orthodontics Is Evolving to the Changing Scenario

As the world is coping with another wave of covid pandemic, I hope and pray that all of you are keeping safe and healthy. The present-day world is changing considerably with several sectors experiencing a major shift in their trends. Self-driven cars, humanoids, AI-powered home systems, and voice assistants have caught the human attention and the technological revolution is even changing the human mindset.

The turn of the century had witnessed a new change of events which had given rise to a unique trend. People now wish to take matters that need professional assistance into their own hands. This practice is what the world calls “Do-it-Yourself (DIY).”

While it originated with people experimenting with semiskilled or nonskilled works like renovating lawns, gardening, or setting up décor of living room and had become a medium of fun family activity, it had soon transformed into people experimenting with professional-skilled works like changing electrical panels, repairing automobiles, and worst of all YOUR OWN HEALTH!

Orthodontics in particular has witnessed the quantum shift of patient’s mindset with some companies aggressively marketing the DIY orthodontics, DIY aligners, and DIY braces via the medium of nondental professionals!

The DIY orthodontics started as an Internet trend with high social media presence where videos and pictures surfaced on how to make your own braces. It involved people fastening household items like rubber bands, dental floss, and paper clips to their teeth to move their teeth to where they think they should be. The most popular method of DIY orthodontics treatment came to be use of clear hair ties to close a gap or straighten teeth. With the advent of 3D printing and aligner technology, the DIY orthodontics shifted to Home aligners/DIY aligners where in patients were asked to send dental impressions on a preselected tray or scanned by nondental professionals visiting their home and aligners were made correspondingly, omitting the clinical and radiographical assessment by a professional orthodontist altogether. The people who use these websites and products have been considered “consumers” instead of “patients.” Although, it may sound attractive, simple, and cost effective at first but in the long run it results in irreparable and extensive damage to the tooth, gums, and supporting bone structure rendering the dentition in a compromised state. The information present on the websites of these companies is largely unregulated and with no parameters to check on the treatment claims. ¹ Hazard of self-impressions is another aspect which the public at large is unaware about. Frequent instances of impression material getting dislodged and choking have been reported. Appliances/Aligners fabricated on these make-shift impressions and the ill-fit of these appliances resulting in further deleterious effects on the teeth and gums is an added concern. Excessive and nonregulated disposal of the aligner’s materials which is largely plastic in nature is another problem area adding to existing burden of plastic in the environment. ²

All over the world various dental and professional organizations, societies, associations, and institutes are proactively working in making the patients aware of the harmful effects of direct-to-consumer orthodontic treatment. American Association of Orthodontists (AAO) in 2019 had lodged complaints with the authorities in 36 US states, alleging the SmileDirectClub’s Service was “illegal and creates medical risks.” The snowball effect started when AAO observed more than 935 customer complaints, reviews, and stories against certain direct-to-customer aligner companies. It also highlighted the business model of these companies which targets to extract profits at the expense of cutting corners in the field of specialized medicine and putting patients’ safety at risk. With relentless public awareness campaigns, falling revenue of companies like SmileDirectClub is evidence of growing public skepticism toward such direct-to-customer aligner companies. ³

American Dental Association in 2019 had strongly opposed the trend of At-home clear aligner therapy and had brought it under the ambit of DIY dentistry which is becoming a big business model by filing a citizen petition with Food and Drug Administration (FDA). This petition was considered as the first and landmark step in directing the US government to make changes to the existing health-care policies and also encouraging the dentists and their patients to file their complaints individually at FDA. ⁴

Similarly, British Orthodontic Society in November 2021 along with 31 professional dental and orthodontic societies from 25 countries formed the European Federation of Orthodontic Specialists Associations and gave a joint declaration stating the basic requirements for any orthodontic treatment. They further stated that orthodontic treatment without thorough clinical face-to-face examination of the patient, X-ray imaging, and regular clinical monitoring is potentially hazardous to the patient’s health and any self-administered, remote treatment cannot be justified from a professional medical perspective and represents a serious violation of ethical, medical, and dental standards. ⁵

Our very own Indian Orthodontic Society (IOS) has aggressively taken steps against the DIY aligners and to put an end to the growing public belief that there is little or no need for a licensed orthodontist. The IOS in the month of November 2021 had given a representation to the Dental Council of India (DCI) highlighting the several violations of Code of Ethics by the DIY-aligner companies while offering in-home services. The Executive Committee of the Council had issued a public notice dated December 27, 2021 citing Clinical Establishment (Registration and Regulations) Act, 2010, Dentist Act, 1948, and Revised Dentists (Code of Ethics) Regulation, 2014. The advisory highlights on the need for highest quality of treatment based on proper evidence-based diagnosis and treatment planning, biomedical waste management and sterilization protocols, and ethical practices and marketing. ⁶

Orthodontists need to augment the efforts of the IOS and DCI to aggressively increase public awareness regarding the ill effects of DIY aligners. The battle has only started and a knee jerk response will not prove any long term solution. We should follow and maintain the highest quality of treatment standards of patient care. The onus of maintaining the sanctity of the profession lies on us and we are in this together.

Jai Hind Jai IOS!