Today, we live in a do-it-yourself (DIY) world -- travel agents are no longer necessary to book airline tickets, your next home may be found via the cyber highway, and no need to pay a guitar teacher for lessons when watching YouTube videos can make you concert-ready.
What about health care?
Patients have taken diagnostic matters into their own hands for decades, with digital thermometers, over-the-counter remedies, and even home pregnancy tests. Today, there are many diagnostic apps that cater to medical health. Have a rash? Log onto Klara.com: Upload a photo of your boo-boo; set-up an account; and a dermatologist will provide a remote consultation. There are now even apps that work with your smartphone to create EKGs that can be sent to a medical doctor to provide a diagnosis.
Recently, two companies -- SmileCareClub and Crystal Braces -- launched as mail order orthodontics businesses. The companies sell Invisalign knockoffs. SmileCareClub creates a sequence of plastic aligners from impressions consumers can take at home. For an initial fee of $95, the "patient" receives a kit with instructions on how to take her own dental impressions and upload photos of her teeth from a smartphone (Note: Selfies are for slumber parties not for straightening teeth.) Consumers also are asked to sign a pledge that they have seen a dentist and had X-rays taken. While neither of these companies asks to see the X-ray images, a dentist on staff determines if the case is suitable for treatment, with aligners at additional cost.
Can this kind of treatment work? In simple cases some patients will achieve benefits. Will this type of treatment address important issues regarding the bite relationship or the health of the jaw joints and gums as it relates to the orthodontic problem? No, it cannot. And, while no claims to the contrary are made, it behooves the patient to determine what is right for himself first by seeking a complete diagnosis from an orthodontic specialist. Bypassing the doctor results in the patient making decisions about his care based only on what he perceives as important -- not what is medically appropriate. Only a trained and certified orthodontist has the knowledge to determine what is best for a patient.
While SmileCareClub and Crystal Braces do provide email and phone support, no one is there to personally monitor and carefully determine key factors in a patient's case: how well the patient's teeth are fitting together; if teeth are getting too loose or colliding traumatically with opposing teeth; or how to remedy any situation that would require more advanced care. The doctor-patient relationship that is so crucial to proper care has been reduced to remote viewing via smartphone.
Another company, GapBands.com promises to close spaces between your teeth with elastic rubber bands. They sell patients packages of elastic rubber bands that are meant to be slipped around and between front teeth which have spaces. Does it work? Yes. Will the teeth stay in place? Not likely. Teeth that are moved quickly need to be maintained for a period of time so that the result will be maintained. Furthermore, elastics tend to cause teeth to tip toward one another rather than moving in a more parallel fashion. This also is a cause of relapse.
The most concerning aspect of GapBands is the danger of losing an elastic under the gum line. If a patient slips an elastic between two teeth and forgets about the elastic, it could slide under the gum line and lead to loss of those teeth. Yes, a forgotten elastic could lead to the loss of healthy teeth. In fact, in dentistry's earlier days, this was the chosen method for extraction of teeth from patients with bleeding disorders (hemophelia) who couldn't tolerate tooth removal because of the deadly potential for bleeding.
Just because the consumer can straighten her own teeth doesn't mean that she should. There is a legitimate reason that orthodontists acquire seven years of post-college education to become experts at the science and art of orthodontics. It is naïve or delusional to think that such qualifications can be matched by an "ortho-by-mail" process. DYI orthodontics risks permanent damage to teeth such as root shortening, bone or tooth loss, tooth decay or other serious problems.
In the never-ending pursuit to reduce health care costs, new solutions are brought to the marketplace. Creativity and innovation fuel technological advances, which brings value to healthcare. Unfortunately, the DYI of orthodontic treatments "dumbs down" a process that requires an expert's evaluation, in person.
When it comes to DIY treatment decisions, the doctor patient relationship is devalued, or as described here practically eliminated. This could seriously compromise your health. Bottom line: Don't mail order brides or braces!
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