A design student's blog detailing his DIY approach to orthodontics may have been misleading
, Image via Amos Dudley
25 of March 2016 16:03:42
TARA C. SMITHTHE WASHINGTON POSTI'm 40 years old, and I'm in braces. Like design student Amos Dudley, I disliked my teeth and wanted to get them fixed. Unlike Dudley, whose Internet-famous braces cost him $60 out of pocket to fabricate and took just 16 weeks from start to finish, I will have paid about 100 times as much to a credentialed orthodontist, and spent a year and a half in treatment.But even though those numbers are tempting, experts say the DIY braces movement is a terrible idea.I understand the yearning for a cheap fix to bad teeth, trust me. I've put two kids of my own through braces, and am currently using clear braces to fix my own snaggletooth. This involved interviews and X-rays at four orthodontists over the past decade to get estimates and treatment recommendations, which varied from practice to practice. Was I a candidate for Invisalign — the clear, "can't tell you're wearing them" braces — or would I have to do traditional braces? (Responses were mixed.) How long would I have to be in them? (Eighteen to 30 months.) How much would they cost? ($4,000 to $6,500.)
If you move a tooth too fast, you can actually cause damage to the bone and gums. And if you don't put the tooth in the right position, you could throw off your bite."-Stephen Belli, orthodonistNo one will say that orthodontic work is quick, easy or inexpensive, and while expertise in this area requires knowledge of the biology of your teeth and the physics of moving them, creating the "perfect" smile has the nuance of an art form.And that perfect smile can mean a lot. I grew up in a lower-middle class family, and though we had dental insurance and saw our dentist religiously every six months for cleanings, braces were off the table. I remember my granny soaking her dentures at night, her teeth long gone. Several relatives had full sets of false teeth in their 30s, their original teeth pulled due to rot. Healthy, straight teeth don't come easily to those growing up without economic privilege. It's no surprise that some recent essays on poverty revolve around the appearance of teeth and how that appearance can perpetuate the cycle of economic disadvantage. And given the cost involved with orthodontic treatment, the rising popularity of DIY printing, and the growing distrust of expertise in all areas of science, it's similarly unsurprising that Dudley's methods and results have received so much attention.But despite Buzzfeed's initial headline claiming that the DIY braces were "safe," orthodontists say otherwise. Stephen Belli, a board-certified orthodontist who has treated more than 15,000 patients, cautions others about trying to replicate Dudley's results. "I'd like to see an X-ray, because he's probably caused some irreparable harm." What kind of harm could this include? From the outside, his teeth look pretty good — good enough to get his success story shared across the Web.Belli notes, "He moved these teeth in only 16 weeks. You can cause a lot of problems with that. If you move a tooth too fast, you can actually cause damage to the bone and gums. And if you don't put the tooth in the right position, you could throw off your bite," leading to additional damage and wear on the teeth.Belli also says that quick, unsupervised movements of teeth like Dudley has done set the patient up for a high potential of relapse, where the tooth will move back into its previous position faster than it took to move it originally. With Dudley, this has already happened once, as he acknowledged to Buzzfeed that "he originally had braces in junior high, but neglected the upkeep," leading to dissatisfaction with his teeth that kept him from smiling. Dudley is planning to follow up with nighttime retainers this time — also DIY'ed. But most who carry out their own orthodontic work will not have access to the expensive fabrication equipment available via Dudley's university, which he used to make cheap, custom-fit retainers to keep his newly straightened teeth in place.[caption id="attachment_8962" align="alignleft" width="300"] Dudley's finished product. Image via Amos Dudley[/caption]While Dudley justified the risk he was taking as part of "stick[ing] it to the dental appliance industry," he does note he denied his own "instict [sic] for self-preservation" and acknowledged that DIY orthodontics could go "horribly wrong." (He also has a disclaimer on his blog, warning readers not to attempt "anything written here" and assuming no liability for actions taken by readers.)But Dudley is far from the only DIY orthodontist on the Web. The DIY fad, largely driven by Internet videos, has become so widespread that the American Association of Orthodontists (AAO) addressed the issue last year in a press release and series of videos highlighting the potential for serious damage when patients try to move their teeth on their own.In one case study, a patient attempted to use rubber bands to remove a gap between their front teeth. The band instead migrated into the gums, pulling the teeth together and destroying the roots, leading to tooth loss.Yet admiration for the DYI-ers persists. Commenters on Dudley's blog suggested that his technique would be great for those lacking funds for braces — but ignored the possible harm that could come from braces used without orthodontic expertise and supervision. While it sounds great to be Robin Hood, taking patients away from The Man and bringing cheap, 3D-printed braces to the poor, the simple fact is that much of the cost of braces is for the expertise of the orthodontist — for good reason.After all, like orthodontics, much of the cost of surgery is for the expertise of the surgeon, not the equipment being used. While DIY braces may not seem as risky as DIY surgery, bad outcomes can still range from lingering problems with a patient's bite to the complete loss of teeth, costing far more than the price of braces to fix.Instead of hitting up YouTube tutorials or sketchy mail-order services, a better place to start for affordable orthodontics would be the donated services offered by professional orthodontists, or working with your designated provider to set up a payment plan. DIY fixes may seem like an inexpensive alternative, but unfortunately the adage holds up: you get what you pay for.