Anyone that has spent time researching the efficacy of clear aligners has probably come across the 1-star reviews and patient horror stories that are out there. A common theme in these horror stories is “they messed up my bite.” These stories can really freak you out if you are considering home clear aligner therapy. Should you be worried?
As with most controversial issues, the answer is not black and white. It is nuanced. The one thing that is certain is that the best outcomes are achieved when open and honest communication exists between the patient and the provider. The better that each can understand and sympathize with the experience of the other, the less chance there is for unmet expectations or contention. The goal of this post is to provide a valuable perspective that can help patients to know what to expect and what questions to ask along the way.
We all want the same thing
First, let’s keep in mind that everyone involved in home-based orthodontic care wants the same thing. Patients want a confident, healthy smile. Providers want that for their patients too. Both parties want to take the most cost-effective and convenient path to get there. And no one wants surprises along the way.
There are risks associated with any type of orthodontic treatment
Second, moving teeth has inherent risks associated with it. Teeth do not always move predictably (NEWSFLASH: people are different!). These risks are compounded when patients are not compliant with the prescriptions of their doctor, or if there are unknown or unknowable underlying conditions in the teeth, gums, or bones.
Are there people that have had bad experiences with at-home clear aligners? Yes. In the worst cases, those people have to go to a dentist or orthodontist to fix the problems. Are there people that have had bad experiences at brick-and-mortar dental or orthodontic offices? Yes! In the worst cases, those people also have to go to a different dentist or orthodontist to fix the problems.
Clear aligner therapy via teledentistry is the newest thing in orthodontics. It is reshaping the industry and making care available to much broader segments of the population. It is not uncommon for this type of progress to be met with opposition from established industry stakeholders. So, when something goes wrong with a case, there are plenty of LOUD voices that want to bring attention to it. The $2.8 Billion lawsuit between SmileDirectClub and NBC is a good example of that.
In reality, at-home treatment modalities receive similar average customer review scores as brick-and-mortar dental and orthodontic offices, with the overwhelming majority of reviews being positive on both sides.
All orthodontic treatments have certain things in common
Whether you seek treatment through a traditional brick-and-mortar orthodontic office or through a teledentistry platform, some realities are unavoidable:
- Most patients will experience a level of discomfort or pain as their teeth move.
- Braces and clear aligners require the patient to do their part by following doctors' instructions regarding cleaning, maintenance, eating habits, wear schedule, etc.
- A course correction may be needed if teeth don’t move as anticipated.
- Your bite will feel “off” while your teeth are moving and may not feel natural again until several weeks after the treatment concludes. This tends to be more true with aligners than traditional
Let’s unpack that last bullet regarding bite…
Your bite WILL feel “off” during treatment
Bite, or occlusion is the way that the upper and lower arches come together when the jaw is closed. Occlusion is a complex topic. This video provides more information. Even when occlusion is not ideal, teeth will naturally find a place of equilibrium where everything fits together. As teeth move during orthodontic treatment, that equilibrium is disrupted. This can be very disconcerting for patients. Patients that choose in-office treatment modalities are often better prepared for this by their doctor and receive additional reassurance during their office visits. Patients that choose at-home treatment modalities don’t always receive the same reassurance. This can lead to second-guessing and doubt… Was it a mistake to choose at-home treatment? Am I going to ruin my teeth? Am I paying the price for choosing a lower-cost option? Should I have believed those negative reviews? These feelings of doubt are only magnified by the loud, detracting voices on social media. In some instances, patients completely lose confidence and decide to stop treatment. Stopping mid-treatment may be the very worst thing the patient can do.
When treatment is completed, teeth go through a period of settling. This is the process by which teeth find their new equilibrium. To borrow a common contemporary phrase, teeth will return to a “new normal” bite relationship.
Open, honest communication
In an ideal scenario, the provider will prepare the patient for their bite to feel “off” during treatment. Then, if the patient has doubts or concerns during treatment, the patient should share those concerns openly and providers should do everything in their power to:
- Validate the patient concerns
- Investigate the issue thoroughly to determine if a course correction is required
- Educate and reassure the patient
So, can home teeth straightening cause bite issues?
At-home clear aligner therapy is not designed to correct bite problems. But a well-designed treatment plan definitely should not make the bite any worse. As with any form of orthodontic treatment, there is the risk that poor treatment design or unpredictable teeth movements could cause an undesired outcome. It is important that patients understand that their bite will feel off during the course of treatment and for a few weeks after treatment.
When it comes to clear aligners causing bite issues, the biggest thing to fear may be fear itself. Try not to let the things you may have read and heard get in your head too much.