A body that represents British dentists has called for a crackdown on DIY braces sold online which promise to straighten teeth in just six weeks but could, in some cases, lead to irreparable damage, including the loss of teeth.
The braces being offered are known as aligners – removable moulds that fit over the teeth to gently move them into new positions, and highly effective when used under the supervision of a dentist or orthodontist.
However, some experts warn that some patients may have underlying dental problems, often without knowing, that can make the devices more likely to cause loosening of the teeth, bleeding and bone damage.
The braces being offered are known as aligners – removable moulds that fit over the teeth to gently move them into new positions, and highly effective when used under the supervision of a dentist or orthodontist
These patients need regular monitoring to minimise risks, they say.
Our investigation has discovered companies selling aligners directly to the public via Instagram and Facebook – sometimes promoted by social-media stars to their millions of followers. Treatment costs up to £1,500 less than it would if purchased from a clinic. While this is legal, customers are not always given enough medical support or supervision, say worried dental chiefs.
The firms argue passionately that, for many patients, the treatment can be completed safely at home without a visit to the dentist. They consider themselves ‘disruptors’ to the orthodontics industry, arguing that their remote methods are in fact superior – and even safer – than traditional methods involving x-rays which, they say, could put patients at risk of cancer. They dispute the warnings of top British dentists – suggesting the concern is rooted in their desire to protect their financial interests.
Experts are adamant that this hands-off service is indeed a risk to patients – as a number of those with dental problems, which render them unsuitable for braces, may be exposed to complications. One concerned professional is Dr Saaqib Ali, dentist and owner of Sherwood Dental Practice in Birmingham.
He said: ‘Increasingly we are seeing patients reporting problems with loose teeth, bleeding gums and difficulty getting advice from a clinician after undergoing DIY braces treatment.
‘I rejected a patient for braces two years ago, because he had ongoing gum disease and bone loss. He was then treated by an online aligner company – I was amazed. When he came back to see me afterwards, he had bleeding gums and had lost further bone from around his teeth. The pressure that aligners put on the teeth can further accelerate gum disease, causing teeth to become wobbly and, in worst cases, premature tooth loss.’
The Mail on Sunday had planned to name all three companies investigated, yet the threat of legal action from one firm prohibited us from doing so. The same company has asked at least three patients seeking a refund and compensation to sign a general release form, including a non-disclosure clause preventing them discussing their treatment. When approached, the company said this is ‘standard practice’ when customers request a refund outside of the published refund policy.
Another customer alleged an attempt to censor his feedback, writing on a review website that the company had tried to remove his negative review.
The General Dental Council, which regulates dentists and orthodontists in the UK, is ‘gathering evidence about the potential risk of harm to patients from direct-to-consumer orthodontics’.
One social media user complained that she lost a tooth while using dental aligners
Dentist Mick Armstrong, chairman of the British Dental Association, is another who has warned that DIY braces could leave patients with ‘irreparably damaged mouths… resulting in lost teeth or worse’. And Peter McCallum, from the British Orthodontic Society, said: ‘Many of our members are already seeing patients who’ve had problems after DIY braces treatment. If a tooth is moved to an unstable position, the damage can be permanent.’
Aligners, when offered by a dentist, can cost upwards of £3,000. Treatment includes X-rays, other scans and numerous face-to-face consultations over the course of six to 12 months. All the DIY companies investigated say they employ qualified dentists or dental assistants who provide support for patients. However, most patients are not routinely offered physical checks or examinations, with most interactions via email or phone.
One unhappy customer is Paula Keirnan, a personal assistant from Birmingham. The 31-year-old claims to have suffered ‘severe bleeding’ and ‘scarily loose teeth’ while wearing aligners sent to her in January by the same company threatening legal action against this newspaper.
Paula says that, despite raising concerns with the firm via emails in April and then June, asking for a refund, she never spoke to or heard from a dentist.
The first time she spoke with ‘her’ nominated dentist was last Sunday, after the MoS approached the company for comment. Days later, the company offered Paula compensation and a full refund, and asked her to sign a legal document containing a non-disclosure agreement – also referred to as a ‘gagging clause’.
Paula was attracted to the braces, which cost about £1,500, after seeing adverts on Instagram. She hoped one receding tooth beside her front teeth would be straightened. She said: ‘Six months on my tooth is still not straight, and I’m in agonising pain when I eat anything that isn’t soft and often spurt blood into the sink when I brush. One night I burst into tears, convinced that all my teeth would fall out.’
Paula Keirnan, pictured, claims she suffered severe damage using dental aligners
The companies’ websites claim to have transformed the smiles of millions – providing links to thousands of rave customer reviews. Scores of young customers can be seen documenting their success stories on social media sites such as YouTube and Facebook. But The Mail on Sunday has also seen more than 200 online reviews by unhappy customers. Alleged complications range from mouth ulcers and pain to snapped, cracked teeth and, in one case, a crown falling out.
Two customers who contacted The Mail on Sunday, but cannot be named for legal reasons, claim to have required root-canal procedures after wearing aligners sold to them by the company threatening legal action.
Writing on the consumer review website Trust Pilot, one customer said: ‘I had a very badly cut mouth, which bled and ulcerated and took nearly a month to heal fully.’ Another reviewer wrote that his front teeth were left ‘visibly crooked’. Other reports online include patients complaining of ‘loose teeth’, and ‘gaps’.
Although we were unable to further verify the accuracy of these reviews, they remain online.
On the video-sharing app TikTok, one DIY braces customer is seen holding an aligner that appears to have pulled out a tooth. The woman, posting under the username @nelliesmilees, says: ‘I have been using smile aligners… and I’ve just taken out my aligners and… my tooth just fell out.’
In a later post, she clarifies that it was a crown. The content cannot be verified as the video has now been removed.
Dr Ali said: ‘A crown that is bonded properly shouldn’t come off with an aligner. It’s a risk if aligners are poorly fitted, or if a dentist hasn’t inspected the quality of the crown to begin with.’
Plastic aligners have surged in popularity as a cheaper and less visible alternative to traditional ‘train-track’ orthodontic braces.
The most popular brand, Invisalign, involves dentists taking scans and X-rays of the mouth which are used to create a bespoke series of aligners. They differ slightly in shape and each is worn for a number of weeks before it’s swapped for the next in the series, gradually coaxing the teeth into new positions.
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At the moment, the evidence suggests coronavirus is primarily spread by droplets expelled when an infected person coughs, sneezes, shouts or sings. These droplets may land on surfaces, where other people come into contact with them, or may land directly on other people nearby.
However, the World Health Organisation has said there is ‘emerging evidence’ of airborne transmission of coronavirus.
An official added that the possibility of this happening in crowded or poorly ventilated spaces should not be ruled out.
If confirmed, it could affect social-distancing guidelines for indoor spaces – and make the argument for wearing masks inside much stronger.
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A: The opening of gyms and pools has had to be done carefully, because of the increased risk of Covid-19 spreading indoors.
Indoor facilities will be able to open from July 25, while outdoor pools reopened yesterday.
Leisure facilities have the ideal conditions for the virus to pass from person to person. They are usually filled with lots of people in close proximity to one another, often breathing heavily while exercising, and equipment is shared.
To limit these risks, strict new social-distancing guidelines will be introduced. These include limits on the number of people able to use facilities at any one time, reduced class sizes, one-way systems and more space between equipment. Customers will be encouraged to shower and change at home.
Gym-goers do not have to wear masks, but, Government advice is that they should be worn in enclosed public spaces where social distancing is not possible.
Indoor gyms in Northern Ireland reopened on Friday, but no date has been set for Wales or Scotland.
Companies offering DIY braces design them using a 3D image of the teeth, based on a dental mould made at home by the patient or specialist scans taken by an assistant at one of the companies’ stores to create a computer model of the teeth. A dentist or orthodontist then designs a custom treatment plan, before the set of aligners is posted to the customer. It is standard, when aligners are prescribed by a dentist at a regular clinic, for a physical examination and dental X-rays to be carried out. However, these are not always offered by the DIY firms.
Dentist Dr Keshvi Patel, of Smiledent Dental Practice in North London, said: ‘X-rays are essential. You need to check how much bone, or root, is under the gum, as too little can cause teeth to become loose when they move.
‘Many people, even in their 30s and 40s, have lost a significant amount of bone due to gum disease, and don’t realise it. It is impossible to detect this with 3D scans.’
According to DIY firms, a patient can be deemed appropriate for aligner treatment based on digital photographs, scan results, a complete medical and dental history and, in the case of one company, a patient’s mould of their teeth. Dr Ali said: ‘Teeth might look perfect in photographs, but you wouldn’t be able to detect rot inside. Equally, scans and moulds won’t show the telltale sign of gum disease – pockets between the gum and the teeth which can trap bacteria, causing bleeding and pain. You need a specialist probe to do this, in person.’
Before beginning treatment, customers purchasing online braces must sign a form to confirm they have had a full dental check-up, including X-rays, within the past six months. According to the company that treated Paula, its registered dentists and orthodontists provide regular virtual check-ins, guiding treatment remotely throughout.
The firm promised her that a dentist would make contact after 90 days of treatment, in April. She claims this never came, despite her complaining to the customer care team. The company say that Paula had contact with dental assistants on multiple occasions, and the dentist overseeing Paula’s case completed a ‘progress check-up’ in mid-April, based on photographs emailed to him by Paula.
He concluded that ‘progress was being made’. Paula was not aware of this assessment.
Dr Patel says: ‘Dentists need to physically examine the patient at least every month to check if the aligners are too tight, which can cause ulcers and painful cuts. It’s also common for patients to need filing down of tooth enamel, to prevent overcrowding. They also need to check for evidence of gum disease, which three-quarters of us have but don’t know it.’
Aligners can trap bacteria that can cause or worsen gum disease. Infection can spread to the bone, increasing the risk of tooth loss or a poor cosmetic result.
A review of Paula’s oral health, carried out by an independent dentist last week, identified severe gum disease, including an abscess and infection spreading from the gum to one of her back teeth. It is not clear if the disease existed prior to wearing her aligners. The independent dentist said: ‘It’s unlikely Paula’s problems would have been detectable via scans, both at the outset and in follow-up photographs.’
In an email on June 16, the company told Paula she would benefit from ‘more time in aligners’. However, the independent dentist said: ‘I would not deem this patient appropriate for aligner treatment at present – she would need significant treatment to restore the health of the gums and teeth first.’
After it was approached by The Mail on Sunday, the company offered, with no admission of liability, a full refund to Paula – and £7,500 in compensation, as well as payment for an appointment with an independent dentist.
Paula says: ‘I’m miserable, uncomfortable and self-conscious when I go out of the house.
People need to realise that investing in braces is not like buying a pair of jeans.’
In a statement, the General Dental Council said it is ‘concerned about a number of consumer reviews brought to our attention’. A spokesman added: ‘Should anyone suspect a cause for concern, we would urge them to bring this to our attention’
In a statement, the General Dental Council said it is ‘concerned about a number of consumer reviews brought to our attention’. A spokesman added: ‘Should anyone suspect a cause for concern, we would urge them to bring this to our attention.’
In a statement, the company that treated Paula said: ‘Ms Paula Keirnan, has made representations about her treatment that are false. [The company] notified the Daily Mail [sic] that the third-party dental “experts” the producers consulted for their story have no experience with [the company’s] platform and therefore have no authority to comment as to the safety and efficaciousness.
‘The claims presented by third-party dentists around teledentistry and bone imaging are not supported by any clinical evidence. In fact, it is the exact opposite.
‘Ample evidence exists as to the efficaciousness of bone imaging and oral exams via a remote platform to diagnose suitability for low-risk orthodontic procedures such as clear aligner therapy, and there are plenty of studies as to the harmful health effects of unnecessary radiation exposure. The feedback from our customers is overwhelmingly positive (more than 99 per cent) and the conclusions being offered in this report are inaccurate.’