Orthodontic trends: Fads vs Facts

The way patients access dentistry has changed considerably in recent times, as have patient demands and expectations.  They want things done quickly and done right, but these two requests cannot always be synonymous with each other.  With increasing numbers of patients seeking their “perfect” smile, and a wealth of freely available advice (some rather questionable), what orthodontic trends should we be watching out for?

Vibration therapy:

For those looking to reduce their time in braces, vibration therapy sounds like a dream.  It uses high-frequency vibration to stimulate osteoclast activity and tooth movement.

The Acceledent is probably the best known vibration device and comes as a hand-held oscillating tool that is purchased and used by the patient for between 5-20 minutes a day throughout their orthodontic treatment.

Supporters of products like Acceledent, which claims its use can reduce treatment time by half and the pain and discomfort associated with wearing braces by up to 71%, recommend vibration therapy to patients.  However, there just isn’t the evidence and high quality research to back it up and, as such, the Advertising Standards Authority (ASA) has ruled that marketing claims in support of Acceledent are misleading.

It is not uncommon for orthodontic treatment to take about two years to complete, and whilst this may need to be taken into consideration when treatment planning, the quality of treatment and the end result should always be paramount.

DIY braces:

The growing trend in people seeking “DIY Orthodontics” continues and has enabled direct-to-consumer (DTC) aligner companies to flourish.

The process varies slightly between companies, but the general concept is patients send in selfie-style photos of teeth for an initial assessment.  Then a kit is sent out for impressions to be taken at home or patients can attend for a 3D scan to be done in-store.  Once processed, the aligners are sent out and arrive through the post at a fraction of the cost of traditional orthodontic treatment.

Some of the problems associated with people accessing direct-to-consumer braces, in their current format, are as follows:

• No clinical examination: 

Prior to braces patients should have a thorough clinical exam to determine their suitability for orthodontic treatment and address any underlying oral health issues.  Currently, none of the DTC companies are offering examinations by a dental professional prior to provision of aligners

• Quality of impressions/scan:

Taking impressions is not easy. Inaccurate and distorted impressions means that the aligner fit is compromised and can lead to gingival recession and periodontal problems.

• Limited treatment options:

DIY braces can only provide one option to straighten teeth, removable aligners.  Whilst this may suit some, it certainly won’t be ideal for everyone.

• Limited tooth movements:

DTC aligners relieve crowding by allowing teeth to tip forward but teeth must only be moved within their biological limits…too much tipping can result in periodontal damage, gingival recession and opening of the bite.

Also, interproximal reduction can be useful in providing space for alignment of teeth and for reduction of dark triangles.  There is no provision for this within DTC treatment.

• Unsupervised treatment:

Whatever brace you have, it is important that you are seen by an Orthodontist on a regular basis to check both tooth movement and dental health. Unsupervised treatment can lead to less desirable results and therefore, a greater need for further treatment.

Mewing:

Mewing is the practice of maintaining proper positioning of the tongue and strengthening the jaw muscles (through chewing exercises), and its roots lie in the practice of orthotropics.

Orthotropics was created by Dr John Mew in 1966 and is essentially a holistic approach to orthodontics.

Conventional orthodontics believes that crowded teeth and poor facial development are as a result of genetics and that straight teeth create a good looking face. Orthotropics believes that crowded teeth and poor facial form are caused by poor facial posture, improper breathing and poor diet.

The rationale is that if the tongue sits in the roof of the mouth, it will force the maxilla to widen, creating space for teeth to align, encouraging the jaws to strengthen and grow forward, and ultimately create a better looking face.

Nothing untoward so far, but is mewing actually effective?  There’s no real way of telling.  Some have reported amazing transformations of facial form by mewing, but these are not reliable. Dr Mike Mew, after whom mewing is named, advises mewing should start between ages 4 and 10 to promote good head and oral posture as early as possible, although older patients over 25 years of ag are said to have achieved good results albeit with longer treatment durations.  However, many of these claims cannot be deemed reliable.

As orthodontics continues to focus more on evidence-based treatment, there is currently nothing that proves mewing is an effective method of reshaping the face.

Tiktok trends:

TikTok is one of the most popular social media apps in the world, drawing people in with its unique algorithm that uses a combination of AI and machine learning to populate your feed with optimally tailored content for you.

The popularity of TikTok in itself is not a problem, having 689 million monthly active users, but more the influence that it can have on those watching. Bearing in mind the biggest users of the app are Gen Z, who are currently aged between 11-26 years old age, we need to be mindful of how orthodontic TikTok trends might affect our patients.

Some of the trends that caused concern within the dental profession are:

• Wrapping elastic hair ties around front teeth to close a midline diastema (this had 9.5 million views)
• Removal of braces at home using a spoon
• Purchasing debond pliers on amazon to remove braces at home
• Buying dental filling material for DIY composite bonding to close gaps

It may seem obvious to us, but the risk of gingival inflammation, enamel fractures and orthodontic relapse are high when such stunts are undertaken.

DIY orthodontics with hair ties also risks pulp death and discolouration.  And don’t even get me started on the composite residue that would remain if braces are removed at home. Whilst initially it might feel great to have the braces off, it won’t take long for teeth to start moving again without the provision of retainers- such a shame after months of treatment.