Straighter Teeth by Mail | Hacker News Reader

Straighter Teeth by Mail

well.blogs.nytimes.com

106 pointsscarmig56 comments

The thing that bothers me is things like this: "the American Association of Orthodontists, a trade group, warned consumers against moving teeth without an initial exam and continuing supervision by an orthodontist. “Our concern is that patients who don’t see an orthodontist for regular checkups and/or for a complete diagnosis are more likely to be harmed,” said Dr. Rolf Behrents, a spokesman for the association"

Everyone knows that visiting a dentist is better than not visiting a dentist. Same thing for doctors. Industry groups insisting that people visit health professionals seem oblivious to the reasons that people don't (or haven't) visited the professionals: cost.

If someone doesn't have complete dental coverage and must front the cost out of pocket, the 6k for braces can be catastrophic. Thank goodness there are cheaper alternatives. Even if they aren't a complete solution (can't twist teeth, or whatever) the fact that some people can get their problems fixed without going deep into debt is a good thing.

The other reason people don't see these professionals is time, and under the Australian medicare system at least, there's a problematic time/cost tradeoff system.

My last visit to a doctor went like something like this (it's been a while, excuse any slight irregularities):

1. Take a day off at your own expense to see the doctor

2. Submit a claim to medicare

3. Get called into medicare office because my medicare card has expired (???). Medicare is only open 9:30-4:30 weekdays

4. Take a day off to see Medicare and get issued a new card with exactly the same number on it.

5. Resubmit claim

6. Receive a cheque in the mail several weeks later addressed to the doctor, along with instructions to give it to the doctor before tomorrow

7. Have to take a day off to get it to the doctor because the post won't be that fast.

Three days of lost time and money, it would have been cheaper not to claim the value of the consult.

I don't see doctors often.

I went significantly out of my way to find a dentist in my city who accepted my insurance and worked on Saturdays. I finally found one and have gotten a lot of important dental work done since then without having to take any time off work.

The sad thing is that if I hadn't found this dentist I'm sure I wouldn't have gotten the work done. My teeth were in bad shape and needed two crowns (two visits each), two fillings, and I ended up getting four veneers as well (totaling three visits).

All that said, I'm extremely skeptical of the approach outlined in the article. It's going to work safely for the majority of patients and probably cause serious harm in a minority where the lack of one-on-one consultation causes significant dental issues to be overlooked (such as periodontal disease). We need more dentists and orthodontists in general to keep costs down, and in particular we need more who practice when patients are most readily available to see them (i.e., not when their patients are themselves at work), but we don't need DIY kits.

Go to a doctor which bulk bills and you wont have to pay anything.

My experience: Call doctor at 9am to book appointment. Walk into medical center at 1pm. See doctor. Sign form on my way out to say I received treatment.

I didn't have to open my wallet once.

Edit: Also, why didn't you use sick leave?

Contractor.

The last time I saw a doctor -late last year- the payment was processed at the counter on the way out and I received payment from Medicare in to my bank account two todays later.

Check out my.gov.au and get digital with government services.

I've never had medicare pay me, it's always been "here is a cheque for the doctor, please take it to him, we cannot send it directly to him because of reasons".

I don't know what they're doing, and I'm not really interested in wading through mygov again after the pain in the arse it made submitting tax last year unless I have to.

If going to the doctor isn't easy, then I'll only go when I have a problem. When I do go, I'll pay full price myself, so I don't have to deal with Medicare.

I don't think many dental coverage plans cover orthodontics for adults and the cost can be significant.

I don't disagree with you. The downside, as so often is the case with the US healthcare system, is that this would prevent problems the insurance agencies will end up paying for when I need the tooth removed.

I have better than average dental coverage and a pretty good dentist. The crowding in my lower front is starting to cause problems.

Even with coverage, Invisalign would be 4-5K out of pocket. Faced with that or putting the money in my 401 or 529 - cheerio offending tooth when the time comes, it's been a pleasure chewing with you.

I didn't know about the mail order option. Definitely going to look in to it.

As an aside. Overbite, and hence one of the main reasons for lower crowding, only came about once we invented cutlery. Humans up to the middle ages ripped meat with their teeth. The wear & tear kept lengths in check and edge-to-edge.

http://www.theatlantic.com/health/archive/2013/01/how-forks-...

Edit: I applied to one of the companies mentioned in the article.

Background. My dentist had suggested that Invisalign could rectify my issue.

This particular company took my credit card details, then asked me to submit photos of my teeth (great design, otherwise I may have not gone through with the laborious process). After inspection of the images they advised me to talk to my dentist and canceled the charge to my card.

I knew it was a longshot and would have gone ahead. I'm impressed this particular service turned down the business when my dentist was willing to roll the dice.

South Asians also have overbite, even in regions where people still eat with their hands. The thesis of the article in The Atlantic seems preposterous.

> Previously, when eating something chewy such as meat, crusty bread or hard cheese, it would have been clamped between the jaws, then sliced with a knife or ripped with a hand -- a style of eating Professor Brace has called "stuff-and-cut."

Does not seem applicable to the South Asian food I'm familiar with.

Without delving too deep in to race differences, I think you're comparing apples to oranges.

The research behind the article is based on analysis of western skulls/teeth.

I'd probably add cleanliness of food. A little sand in your lettuce and gravel in your bread will wear on your teeth.

At the molar end of things, maybe.

I think the argument is that the bottom teeth were constantly being pulled forward and worn on the top.

I would NOT recommend these or invisalign to anyone. I had invisalign and while it's great at pushing teeth closer or further apart, the aligners cannot twist or pull teeth into position, and it's unnecessarily painful. You can get traditional braces for the same cost and get your "perfect smile" results with less pain.

Why are they painful? Because every time you "conveniently" take them off to "eat or brush your teeth" your teeth are loose and moving them around hurts like hell when brushing or eating. Snapping the braces back on and they'll hurt like hell again for about an hour until the braces stabilize them and they start settling again.

It was a huge waste of money, and now I'm saving up to get traditional braces. My teeth aren't even all that crooked, traditional braces can straighten mine out in less than a year.

Just so you know, traditional braces hurt like hell for a day or two after each appointment, sometimes longer. They are also uncomfortable the entire time.

I'm 29 and got standard metal braces 5 months ago (top and bottom teeth). My bottom teeth are particularly messed up

Maybe it's different for others, but I strongly disagree about the pain. It's only painful up to a few days after having wires adjusted or installed, and even then I wouldn't call it painful -- just soreness. My dentist recommended Tylenol but I never had to take it, because the pain wasn't that bad. Currently day to day I barely notice I have braces on. The only real annoyance is eating food, as food easily becomes stuck in your braces. Investment in a water flosser, like the Waterpik, is highly recommended, as well brushing after every meal -- including lunch.

My braces cost $5k (my own pocket) and I pay monthly. I have to wear braces for two years, but I foresee no issues because it's been a breeze so far wearing them. I do wish I got them earlier, and suggest anyone thinking about it to get them sooner than later.

Thank you for review. I had traditional braces for 8 years and I cannot convey much it would have meant to me to brush my bare teeth or eat some, say, corn on the cob, if only for a brief (albeit painful) moment.

All the same, good luck with your braces. I cannot recommend a "gum stimulator" enough!! http://smile.amazon.com/Gum-Butler-G-U-M-Stimulator-Pack/dp/...

Good point about being able to feel your bare teeth every now and then.

I had braces for six years, and after they finally came off, I could not stop licking my teeth for days! It was such a great feeling.

I had metal braces as a teenager, and now about 20 weeks into Invisalign as a 40 year old to close a gap from a lost tooth, and my god, the Invisalign is wonderful compared to the metal braces.

Almost no pain, super convenient, and eating is normal. I remember all the times I used to have to eat by smashing food against the roof of my mouth with my tongue, because my teeth hurt so much from newly-tightened metal.

I think the risk of dental decay is another factor. If I am not wrong, you have to keep the traditional dental braces in place without ever taking them off for the entire duration of the n months / year? Not being able to take them out and brush / otherwise clean the tooth under them is apparently a cause for dental decay when using traditional braces.

Something I've chatted to about with fellow UK folk occasionally (insert joke about "English teeth" here) is how, from our perspective some USA folk's teeth seem to cross the uncanny valley in the wrong direction.

They're so white and so even they look false to our eyes.

The whitening can be over the top, but have you seen a young person with crooked teeth? I feel my 'characteristic' smile really ages me :).

Define 'crooked" ;) I certainly see kids in the EU with teeth that would be "corrected" in the US. I get the impression that the aesthetics vs clinical need / risk line is drawn differently.

Many of the celebrities that you see from the US actually have porcelain veneers put in, so you're not even actually seeing real teeth. Perhaps this is the kind of teeth that creep you out?

I had braces for six years, and if I had to get my teeth straightened today, I would probably go this route.

Don't forget, braces mean:

- More cost - Monthly trips to the orthodontist

The physical act of having to go to the orthodontist every month for years costs you time and money in terms of gas, parking, etc, not to mention the time cost. Think of your schedule today. Can you fit in another 2-3 hour monthly appointment? You probably can, but it will probably be at the expense of another activity you'd probably rather be doing.

Emergency maintenance is sometimes needed (the braces can get damaged from accidents, sports, etc.)

Also, braces are UGLY.

Wow, I wish this was around when I needed braces.

I wish I could have done this too. Braces were painful and actually scarred the inside of my cheeks. I can actually feel where the wires sliced my cheeks.

Something similar, in another domain, is PocketDerm. They are also pretty cheap, and hopefully a good sign of things to come: cheaper access to specialists for simple problems.

Six years seems like an eternity for braces.

Your case was probably "complicated". You probably wouldn't have been a good candidate for mail order braces.

It astounds me that in all the years of braces being in use they haven't found a way to make them less ugly. It's like they're frozen in time.

Virtually everybody I know who's had braces on their teeth had them when they were 13, 14, 15 years old - presumably at that point your adult teeth are through but they (and you!) are still new enough to be flexible.

So there's probably not, historically, been much demand. The parents don't want to spend extra on making the stuff look nice, so they just tell their children to put up with it. And their children don't really have another option, so they put up with it. "Character-building" was the stock phrase my school teachers and parents would use for stuff like this.

I'm sure I've seen people with whitened fixed braces (perhaps made out of plastic rather than metal?), so clearly there have been at least some attempts to make them look less ugly - but I'm not sure it represents a huge improvement. If that costs extra, it's not great value.

Not sure about the flexible thing. Every month after seeing the orthodontist I spent two or three days laying in bed for hours crying, unable to eat. The pressure was awful, but mostly only when I had the time to focus on it.

Yep. My dentist keeps mentioning the need for braces for my children, despite one being age 8 at the time. I hated having my braces, and my teeth ended up shifting at a later age anyways. The pain was terrific, and the idea of putting my kids through that when they don't even have all their adult teeth seems like the worst of scams. Makes me wonder if my dentist gets a referral fee from the orthodontist.

There's Invisalign, but it can easily cost twice as much as braces.

My dad's an orthodontist. He's seen good results with Invisalign (and bad) but says that it has a relatively small sweet spot. He's skeptical of the braces-by-mail approach for anything other than the simplest cases and the most conscientious patients.

> Dr. Son Tran, the creator of CrystalBraces and a Dallas dentist who is the sole reviewer

Many people don't know that in the US general dentists (GPs) can practice most specialties without advanced training, while specialists (orthodontists, oral surgeons, prosthodontists, etc.) must complete an accredited program/residency after dental school and limit their practice to their chosen specialty.

Invisalign/Align Tech is in San Jose, btw.

Would rather that society stop obsessing over having perfectly straight teeth. If they are otherwise healthy, why spend that money and go through the painful experience of straightening your teeth. It's entirely cultural (learned) to expect them to be perfect. Some cultures don't care (though in this globalized world, every culture is gradually expecting it).

Symmetry is not cultural but part of our genetics, some cultures care less because they have more important issues when looking at attractiveness like food and shelter security.

Should burns victim who are healthy be able to get plastic surgery. Most people would think so.

Genetic issues is no different to anything else that cause unusual looks.

Where does it go from acceptable i.e. burns to the face, to it really shouldn't matter i.e. perhaps breast enlargement from average to larger than average, is hard to say.

But I have no problem with a society where no one has looks that make them stand out in a negative way that they don't wish to have.

> because they have more important issues when looking at attractiveness like food and shelter security

Most of the rest of the developed world doesn't care about perfect teeth as much as the US does, despite often having more lifestyle security than the US.

I don't know if symmetry is really that ingrained in our dna as necessary for beauty. Most people part their hair to a side (rather than down the middle). There are few things cuter than a kid who smiles to reveal a missing tooth on one side. And what about dimples? A dimple on one side is nice but having them on both sides would look odd.

A lot of that is just what we are used to seeing. And as others have commented, people in places like the UK often see teeth that are too perfect as artificial looking.

There's a clear difference between sexual attraction and the cuteness of a kid.

What? We're not talking about sexual attraction. What do you think beauty means?

In context of people it means sexual attraction.

I had a friend in high school who was kind of gung-ho and claimed to have fixed a misaligned tooth by applying pressure with his finger in the desired direction for an hour every night before going to bed. According to him, this worked. I wonder if that is possible or if the teeth would undo the progress in the other 23 hours.

A few months ago, I was thinking about the opportunity to use 3d printing/imaging to drastically lower the cost of these types of devices. Ultimately the biggest hurdle is going to be getting an extremely accurate scan (not sure if you could do some combination of using dental x-rays, along with 3d imaging tech from mobile cameras to build the mouth model for each customer).

Part of the solution could be in home try-on (similar to Warby Parker). Ie send 10-20 sets of 3d printed retainers, all slightly different but potential fits. The customer selects which one fits best & the full set is based on that starting model. Since you're not actually creating molds to base the retainers on, the cost of each slightly different model should be pennies.

Anyway, that's about as far as I got... then I went back to building enterprise software.

I made an entire workflow with open source tools and materials that cost less than $100.

Here it is: https://www.youtube.com/watch?v=OfjuUN0E5yc

Like you said, the limiting factor is the extremely accurate scan. My workflow is not rigorous, just a proof-of-concept until the printing and scanning tech comes around.

sleepmedx

Optometrists aren't too happy about Warby Parker either. This seems like the Internet being the Internet for the benefit of the consumer.

Optometrists derive significant revenue from the sales of lenses and frames. If the eye exam is accurate, where you buy your glasses is interchangeable.

Orthodontics, on the other hand, seem very much to me to require a different relationship with the dental professional. I'm not so sure the "Warby Parker for teeth" notion is accurate here, nor desirable.

Before braces, I had to undergo two upper jaw surgeries (1st was a SARPE, 2nd was a Lefort I Osteotomy). Needed to widen my upper bite, then detach and pull the entire upper jaw (maxilla) forward 5mm. Only then could the braces align my teeth.

The surgeries were under my medical insurance, the braces were dental.

Search YouTube for SARPE...it's not for the squeamish.

I'm going to an orthodontist tomorrow for a consultation. The extra few thousand are well worth it in my opinion to get it done right without potentially damaging my teeth.

What is needed is more orthodontists, increase supply.

sleepmedx inc

I would try this product for one simple reason: I care about my health more than anyone else possibly could. Frankly, I don't trust that a dentist would do a better job at casting the mold than me.

This is absurd. I think you really underestimate the intensity of training that dentists must undergo, at least in the US. Dental school is just as rigorous and all-consuming as medical school.

There are reasons to advocate for the sort of DIY kit discussed in the article -- cost and time being the main ones. But thinking that you are somehow going to be more proficient at this sort of thing than a very extensively trained orthodontist is not one of them.

Would you also cast your own broken bones?

How much do you think the robots at the Toyota factory care about your safety?

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