Pacific Coast Society of Orthodontists Bulletin Winter 2019 - 7

Editorial

Teledentistry and Do-It-Yourself
Orthodontics

Dr. Jae Hyun Park
PCSO Bulletin Editor-in-Chief

The world is changing! Despite our specialty's
genuine concerns, commercial teledentistry is
gaining in popularity at an exponential rate.
Teledentistry refers to the form of dental service
that combines telecommunications and dentistry
to provide dental care across long geographic distances. What this means is that a person receives
dental treatment by sharing digital information
via communication technology rather than
coming into direct personal contact with a service
provider. In a 2016 Journal of Clinical Orthodontics article, Kravitz and colleagues1 concluded,
"Teledentistry has the potential to improve access
to oral health care, reduce overall costs to the
patient and orthodontist, and facilitate control
of patients who infrequently visit orthodontic
offices." While the article includes a number
of the positive things about this trend, it also
raises some serious concerns about licensure,
liability, patient confidentiality, and unmonitored
do-it-yourself (DIY) treatment that remain to be
addressed.
These issues notwithstanding, possibly the most
serious concern about the current teleorthodontics industry is the fact that companies advertising these clear aligner products and services
inadvertently end up promoting DIY orthodontics.
The public is being led to believe they can get the
same quality of orthodontic treatment at a lower
cost with no, minimal, or possibly selective help
from a qualified professional.
Consider the case of Amos Dudley, a young college student studying digital design, who recently
made several appearances in the media to report
how he had developed a DIY system for straightening his maxillary teeth using a high-quality
laser scanner, a three-dimensional printer, and a
vacuum-forming machine along with computer-aided design and animation software.2 The
general public is taking note when teledentistry
companies advertise the convenience of not
having to visit a dentist or an orthodontist for orthodontic treatment and therefore of not having
to "pay a fortune" for an attractive smile.

Winter 2019

PCSO Bulletin

In a letter sent out to the members of the
American Association of Orthodontists (AAO)
on September 12, 2019, AAO President Dr. Gary
Inman stated, "Orthodontic treatment is a
complex medical process and it is in the best, and
safest, interest of the public to have that treatment administered under the direct and ongoing
supervision of a licensed orthodontist." His letter
sought to counter the growing public belief that
there is little or no need for a licensed provider to
straighten their teeth, owing to the aggressive
marketing efforts of some of these teledentistry
companies.
Providers are the essence of orthodontic treatment, not aligners. Without a qualified provider,
there is nothing that can be called treatment.
Every step of orthodontic treatment from data
collection and diagnosis, treatment planning,
rendering of the treatment, monitoring, and
adjustment of the treatment process, to ensuring the success and maintenance of a successful
treatment outcome are all the job of the provider
and trained staff. This also includes the weighing of potential complications and untoward
outcomes and monitoring and minimizing these
complications.
In reality, what are the potential consequences of minimizing or eliminating the role of the
provider in orthodontic treatment? The lack of
a thorough, in-person pretreatment exam by a
licensed provider along with data collection by an
untrained individual could lead to poor diagnosis
and a faulty treatment plan. A person with a malocclusion that cannot be easily treated with these
aligner systems might be erroneously classified
as a candidate by a teledentistry company. Potentially, after the individual has gone through their
aligner therapy, they may discover that correction
of their malocclusion was not reasonably possible
with the DIY clear aligner system.
Consider some of the other potential problems.
Diagnosis and treatment planning for the correct
alignment of teeth should not be performed

7
Pacific Coast Society of Orthodontists Bulletin Winter 2019

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2019
