In my 26 years as a practicing dentist, I have watched many changes take place in this amazing profession. Most of these changes have made dentistry better for patients and dentists alike, making care more convenient, more comfortable or more predictable. In recent years a new trend has emerged that closely borders being unlawful, and will most certainly prove to worsen the dental health of our nation, probably killing a few along the way; Mail-order dentistry. In this month’s article, I will present the risks associated with ordering “Do-it-yourself” dental appliances to straighten teeth, stop snoring, or treat bite and tooth grinding problems.
Mail Order Braces: In just the last year, companies offering patients to take their own dental impressions and perform their own orthodontic tooth movement with pre-formed trays have emerged. According to the Dental Practice Act (the legal definitions and guidelines set forth by the states for the lawful practice of dentistry), this would constitute practicing dentistry without a license. The way these companies get around this is by paying a licensed dentist to “sign off” on the cases without ever seeing the patient, taking a proper history or understanding the co-existing dental conditions. “So what could happen, Its just moving teeth?”, you might ask yourself. The answer in short is that in this practice of “unattended orthodontics”, patients with undiagnosed gum disease or other dental problems could lose teeth, end up with bite problems, TMJ (jaw joint) problems, compromise existing dentistry, compromise existing teeth, compromise breathing during sleep, and cause dental pain. Other than that, it’s perfectly safe. I think most can detect the obvious sarcasm, but it is inconceivable to think that dentists need four years of training(with most adding on time in residency) to assess and understand the conditions of the oral cavity that would even allow a patient to be a candidate for orthodontics, but that it is ok for this treatment to occur without examination and unsupervised. Finally, what does a patient do when something goes wrong, the impression is inaccurate, or the teeth don’t move as expected? The answer is that many end up having to seek the care of a dental professional, and when combined with the cost of the mail order therapy, the out-of-pocket costs end up exceeding what it would have been to have a professional do it in the first place.
Mail Order Snoring Appliances: While these have been available for several years, there is no mail order therapy endangering more lives than “snoring appliances”. The big problem here is that while the “quick buck” mail order companies understand the relationship of snoring and the disease of sleep apnea, most of the public does not. The fact is that if snoring is loud or frequent enough to the point of someone seeking relief, there is a 70 %; yes, 70 % likelihood that the patient will test positive for Obstructive Sleep Apnea without any other signs or symptoms! The National Institute of Health also tells us that un-treated, un-monitored apnea can lead to a 12 to 15 year reduction in life expectancy, and represents the single most dangerous risk factor for heart attack or stroke, more than double the risk of smoking. No person should ever have a snoring appliance made without a test to rule out Sleep Apnea; Not even by a dentist! If my warning is unconvincing, try this; Call a mail-order snoring appliance company and tell them you have been diagnosed with sleep apnea and would like one of their appliances. The point is that even the telemarketers have been instructed to tell customers that these appliances are not intended to and cannot treat sleep apnea. To take this a step further, for an oral appliance to be used in the treatment of sleep apnea, it must be an FDA cleared appliance for this purpose and must be both delivered and supervised by a licensed dentist. In this same phone call, ask what bite position will be used to make the appliance. The silence should prove deafening as the appliance will be put into an arbitrary jaw relationship that could cause jaw joint pain or prove ineffective. Simply put, snoring is a symptom of a life-threatening disease and proper diagnosis/treatment is almost always paid for by medical insurance and/or Medicare.
Mail-Order/Over-The-Counter Bite, TMJ and Grinding Appliances: The products that have been most available to the public over the last decade are the bite, TMJ and grinding appliances. These have typically been over-the-counter and have been seen as cost-saving options to professional night-guards and TMJ appliances. Though these have been on the market longest, the possibility of doing physical harm is no less than the previously discussed categories of “do-it-yourself” appliances. The first and most obvious concern are the appliances that are made for grinding or clenching. Most of these appliances are made of a “boil and bite” soft material. The inherent problems with the soft materials is that when a patient has a problem with clenching or grinding the “squishy” material can actually stimulate the clenching the patient is trying to prevent, making the condition worse. Another concern is that many of the patients who present with night-time grinding, do so as part of the Sleep Apnea muscle response to arousals or awakenings. Therefore many patients are seeking the wrong treatment, and in doing so can actually make the apnea worse than it was prior to using the over-the-counter appliance. This could ultimately be life threatening. Finally, TMJ appliances should NEVER be store or mail bought. Dentists such as this author have spent thousands of continuing education hours understanding the nuances of the TMJ and how to selectively treat the muscles, bony component, ligament and disk problems that are associated with this generalized condition and buying a generic appliance is more likely to worsen the condition than fix it.
My hope is that I have convinced many, that being your own dentist or physician is never a good idea. I say that not from a place of protecting my business (there is more dentistry to do than I can humanly perform), but from a place of wanting the best possible care for the public or at least, a well informed public.
Dr Horowitz is a 1991 graduate of The Medical University of South Carolina, College of Dental Medicine and completed a General practice residency at the Mountainside Hospital In Montclair, N.J. He is a Fellow of the Academy of General Dentistry, the Pierre Fauchard Academy and a Diplomate of the American Sleep and Breathing Academy as well as a member of the American Academy of Cosmetic Dentistry, the American Orthodontic Society, The American Academy of Craniofacial Pain, The Dental Organization for Conscious Sedation and The American Academy of Dental Sleep Medicine. He is the founder and owner of the Carolina Center for Advanced Dentistry/ Advanced Sleep and Breathing Centers in Conway and Murrells Inlet, SC. He can be contacted at (843) 248-3843 or via the practice website. www.carolinacosmeticdental.comRead More