Every year, the NHS completes millions of units of orthodontic treatment, including the fitting of braces, which many people fondly remember as painful, metallic traps, but what if there was another option?

Braces provided by the NHS are metal and held in place with a range of colourful elastic bands therefore they are visually rather noticeable. Metal braces are typically used to straighten or manoeuvre teeth, correcting their position to a more optimal layout within the mouth, so that patients can bite more comfortably. Brace treatment can also help people to take care of their teeth and gums with greater ease. Braces tend to improve people’s smiles too. People with metal braces are told to avoid toffees, sweets, and fizzy drinks as these can stain or discolour the elastics; worse than that, sweets and sticky foods can snap the braces, which are normally changed at monthly appointments. One other downside to metal braces is that the appliances can be painful with sharp points and thus require a wax to blunt the edges.

New and emerging technologies mean that a number of companies are offering so-called ‘fast’ alternatives to braces, known as aligners. These aligners are clear, almost invisible, and do not have many of the same problems that are associated with metal braces. They are made of a flexible, yet sturdy plastic that customers can remove from their mouth during the day, when eating or drinking. Companies such as Invisalign and SmileDirectClub are among the most popular aligner providers. If you think you may have heard of these companies before, you might be right! A handful of them have been operating in the US, and around the world, before arriving in the UK and Republic of Ireland. Now they are here, aligner providers have been broadcasting TV adverts and vibrant social media campaigns.

Aligners are offered to customers through a wide range of treatment plans. A few are only supplied through physical dentists or practices and they are not issued directly to the consumer; whereas, others provide treatment to customers remotely with home delivery kits and supervision from dentists virtually. Aside from a catchy, whistling theme tune, in at least one of these companies’ videos, they claim to be able to offer a course of treatment in as little as four to six months. Contrary to this, the NHS website says that their treatment usually lasts from 12 months to two and a half years. 

But do these aligners actually work and can they substitute traditional brace treatment? Well, that depends. Actor Jason Oliver, has been a SmileDirectClub customer for the past couple of months. Jason recently noticed his teeth were moving forward and he felt it was important to consult solutions as he had worked hard for his smile. Jason had previously worn braces as a teenager from the age 11 and until he was 16 years old.

He says: ‘When I was 11, I was only supposed to have those braces that I had for a year, but I wouldn’t wear them, cause’ it made me talk funny. And obviously, as an 11-year-old, the last thing you want to do is talk funny and also have this big bar going across the front of your teeth’. Now in his fifties, this time round his dentist recommended fixed metal braces or a brand known as Invisalign, except Jason says that he felt these were ‘really pricey’.

Jason initially heard of SmileDirectClub through adverts and a friend who was documenting their journey with the aligners on Facebook. Later, he clicked on the company’s advert, which is not something he would normally do, noting ‘I’m quite sceptical about the adverts you see on the internet’. Jason’s sense of scepticism has come from his previous experience with online scams. After all this, Jason still felt nervous about the aligners and took time to carefully consider his options before being invited for scans through a SmileDirectClub email. Grabbing the bull by the horns, Jason went along and described the process as ‘really easy; it was a 3D scan. They kind of put this like a big toothbrush into your mouth and they do a scan, which was quite simple and quite quick. They talked you through it and I signed-up there and then’. Since starting his treatment, Jason has been happy with the progress of his aligners, even though he suspects no one else will notice, as the corrections are just small adjustments, and admits to not wearing them for the full recommended 22 hours a day. Jason’s initial worry was that his tongue might catch on the plastic, although says that ‘they’re fine…really good!’ and ‘comfortable’ to wear.

Jason Oliver's aligner progress

Though, it is fair to acknowledge that people have claimed to have vastly contrasting experiences with their aligners. To date, at least 3141 complaints have been logged with the Better Business Bureau about SmileDirectClub, although they maintain an A+ Better Business Bureau rating. Meanwhile, Invisalign UK has a 1.9 star rating on Trustpilot. Complaints about these companies seem to be largely about customer service experiences, but people have reported that the aligners caused them to lose or break their teeth.

Responding to a question around the safety and efficacy of their model, in a statement, SmileDirectClub’s VP of International David Cran, told Underscore Media: “Our pioneering telehealth platform for orthodontia has enabled our affiliated network of dentists and orthodontists to provide safe, effective, premium care to more than 1.7 million customers around the world. Research has found that teleorthodontic treatment with clear aligners is just as clinically effective in correcting crowding or spacing as when it is conducted in an office setting. We will continue to work with and educate the field of dentistry on the many benefits of our telehealth platform as we increase access to safe and efficacious care for all”.

Northern Ireland’s Chief Dental Officer was not available to comment on these alternatives. The Department of Health told Underscore Media that the validly of alternatives to metal braces ‘is an issue for the regulator’. The General Dental Council and Invisalign did not reply to our request for comment.

In comparison, João has been a practicing orthodontist for the past five years, following in the footsteps of both his parents. It is a job João loves, and he is continually learning about dentistry. João believes that brace alternatives like aligners are good, but he has seen cases where online treatment has gone terribly wrong and resulted in patients’ teeth falling out. He reminds people that dentists are in the best position to make clinical judgements, adding ‘The dentists, they know how to apply these methods and if you do it online, the people know about nothing’.

João is more reserved about the possibilities presented by these aligners; he expressed that aligners are good for small corrections saying ‘[aligners] they correct only small disorders, for the big disorders it doesn’t work, but it’s a good way to do the treatment cause you won’t have braces in your teeth’. For patients who require bigger corrections, João thinks they will need to continue to use the common metal braces or different types of treatment altogether. David Cran replied, ‘Through our telehealth platform, our network of UK registered dentists and orthodontists diagnose, prescribe and treat patients from beginning to end of their teeth straightening journey. This is no different than any other telehealth medical service.’ The VP of International also stated that ‘Unlike traditional dental and orthodontic practices which have limited practice hours, [SmileDirectClub’s] customer care and dental teams provide patients with unprecedented 24/7/365 access to care and the ability to get connected with their treating dentists/orthodontists’.

For many people though, the decision to use traditional metal braces versus aligners will come down to the costs. Metal braces, which have been readily obtainable for a long time, are provided by the NHS for free to children and teenagers who have been recommended to wear them by a dentist. The NHS said that the ideal time for braces to be fitted is around the ages of 12 and 13, as this is when a child’s mouth and jaw is still growing. Free orthodontic treatment is not routinely available to adults. On the other hand, the aligners are newer, available to adults and can be costly; a cost which must be covered through self-funding or other private avenues. The costs of these aligners vary massively. Our investigation has seen treatment cost £999 and much more costing thousands of pounds with one estimate of £5500. Generally, payments are made over a period of several months and a deposit is required as well. Treatment providers can regularly offer deals and discounts, but you may need to sign-up to websites and mailing lists to access these benefits. João feels ‘Invisalign is too expensive’ and for that reason, people on lower incomes prefer the traditional metal braces. In the future, João expects that the overall costs can decrease saying ‘if this treatment can become popular, the treatment price will become low, so then more people will be able to get it’. 

Aligners have a lot of benefits in comparison to traditional metal braces, but they cannot correct bigger teeth alignment issues. Right now, the costs of aligners is not realistically affordable for most people. This is especially true when it comes to considering the value of aligners versus food, energy and cost of living and the fact that aligners can only fix minor issues.

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