"Why is your Invisalign more expensive?"

That's a question I often get asked, and it's usually specifically about Invisalign rather than other type of orthodontic treatment I provide.

Do a quick internet search and you will see lots of offers for Invisalign treatment, some significantly cheaper than others. Have a look at your local orthodontic specialist and they will probably charge more than the general dentist down the road. In areas of high competition like London the price differences are even bigger and there may well be aggressive marketing on the internet or in magazines.

So why has this happened and why is a specialist more expensive than a general dentist? Have a read of this article by American orthodontist Ted Rothstein to see a bit of the background.

To summarise, Invisalign is one of a few orthodontic treatments that are easy for any dentist to start using, requiring a one day course to become certified and able to provide treatment (though there are now other similar treatments like ClearStep and Inman Aligner with similar issues to Invisalign). If you were a dentist who could now offer the treatment direct to your patients then why not, rather than referring to a specialist who will take the fees that could otherwise come to you? Why subject your patients to treatment with fixed braces when they can wear invisible removable braces instead? If you are the consumer why should you pay more to see a specialist when the same treatment can be bought for less?

Here's a quote from the article; "Dr. Rothstein reports that he is seeing in recent years a growing number of patients on consultation in treatment with Invisalign by the generalist who simply lacked an understanding of the limitations of the Invisalign appliance. General dentists are not fully trained to recognize the many nuances associated with effective treatment, or even foresee the potential problems lying in wait as they proceed. Training and experience really do make a difference.
There are also cases in mid-course where the general dentist had no idea how to handle the problem that the patient was encountering and cases where the end result of the Invisalign treatment were so lacking that the only recourse was to finish the case with fixed braces."

I'm sure there are some general dentists who get comparable results to a specialist, but only with the right experience and attention to detail, and how do you know who these are? Be sure to ask questions about your potential treatment and also about what is included. Does that cheap fee include hidden extras like refinements and retainers and how often will you be reviewed? What sort of customer service do you get and do you enjoy your visits?

It's a bit like getting your hair cut. Do you prefer to go to the small salon that has out of date magazines and faded decor, see the junior stylist at a medium salon or pay the extra to see the senior stylist at the best known salon in town? The end result is important but so is the experience you receive.

You should know that Invisalign offers significant discounts to providers who commit to providing a large number of treatments per year, they have to get the numbers in or risk paying large penalties. Even with these discounts some offers I've seen are so low it must be costing the practice money instead of making it. As a small practice and a specialist offering many types of treatment my numbers are relatively low so I can't always take advantage of this, or do "extras" like tooth whitening, hygiene or veneers to gain extra revenue.

I'll finish with a final quote from the article which puts it better than I can; "...isn't the consumer better served by the orthodontic specialist even though having to pay a higher fee? Indeed when the consumer pays more to engage the services of the specialist isn't he receiving more in the way of experience and wisdom that far outweighs the additional fees the consumer may have to pay"

Porcelain Deficiency Disease?

There is an interesting opinion article by dentist Martin Kelleher in the recent Faculty of Dental Surgery journal. He highlights what he terms "porcelain deficiency disease", a made up condition where dentists over-prescribe porcelain crowns and veneers. Unfortunately it has been taken out of context by several tabloid papers with the purpose of shocking the public about "greedy dentists", which is not really what he was trying to say. For a summary of the article click here, for the full article click here..

It's probably not escaped your notice that there is a recent trend for straight white teeth (think Simon Cowell). One way of achieving a very white, very regular smile is to place porcelain crowns or veneers on multiple teeth. A crown is a complete covering of a tooth, whereas a veneer is more like a facing glued to the front. Both are common dental treatments which are widely used for a number of purposes, mainly for restoring teeth that are decayed or broken, but they can also be used for altering the shape, size or colour of teeth. However, in order to accommodate the thickness of the porcelain the tooth is usually reshaped which often involves removing healthy tooth.

Martin Kelleher uses his article to highlight several cases where patients' dental health has suffered following extensive crownwork. The risks of crowns and veneers are well known, and include pulp death leading to root filling, fracture of the tooth underneath and gum disease due to rough edges or poor cleaning. Any responsible dentist will explain the risks to their patient and balance this against the benefits. What happens in a few cases is that the patient is prescribed crowns for EVERY tooth and sooner or later suffer dental health problem because of it. Another dentist then has to try and salvage what they can for the disappointed patient.

So why is this happening? There is certainly a pressure from patients who want to look like their favourite celebrity or their friend who has just had treatment and now looks ten years younger. But there must be a lot of pressure on dentists who perhaps see a colleague down the road doing such treatment and feel they need to keep up to survive, especially in financial terms. Whilst most dentists I know are very ethical and always have the best interests of the patient at heart there are some (like in any profession) who simply want to make money. If a patient appears in your surgery with a fat wallet and requesting complicated expensive treatment then why shouldn't you do what they ask? If you refuse will you lose out when they and all their friends go to a neighbouring dentist?

So, if you want to improve your smile what should you do and who should you believe?

Start by speaking to your dentist about your concerns. A good dentist will take time to find out exactly what your problem is and discuss the options. There will always be more than one possible treatment. Your dentist should discuss the advantages AND disadvantages of all options, but will probably guide you to one preferred option. Any comprehensive treatment should be planned out very carefully, usually with photographs, x-rays and models of your teeth, and sometimes with mockups of the predicted result. Ask to see pictures of previous cases and if you are unsure about anything get a second opinion. If you have irregular teeth has your dentist discussed the possibility of orthodontics? I accept that having treatment with braces is not for everyone, but in most cases it can mean that your natural teeth will be preserved which is much better for your long term dental health. Of course orthodontics itself is not without risks and I always discuss these with my patients before they start treatment.

Sadly there will always be rogue dentists who make headlines and there will always be journalists who will write horror stories about them. This is a very small minority of dentists and the rest are ethical, caring and well trained and would only prescribe veneers or crowns when appropriate. I will certainly be working with my referring dentists to make sure they consider orthodontics as an option.

In Praise of Patients

I treat a really wide range of patients, from about the age of 9 up to 60+. I treat boys and girls, men and women, nervous patients and confident people, housewives, teachers, business men...you get the picture.

One of the lovely things about orthodontics is that because I see my patients every 6-8 weeks over the course of one to two years I get to know them well. I've seen patients through pregnancy and love it when they bring in the babies. I like to hear about exam results, holidays, sporting results (one young girl is a national triathlete) and weddings. Sometimes I need to lend a sympathetic ear in times of bereavement, divorce or job loss. It works both ways, they ask me about my children, my holiday and my dental nurse Carly about how she's getting on with her braces.

I consider all this part of the job and one of the things that makes it interesting. I often hear "I couldn't look at teeth all day" and if as a dentist or orthodontist that's how you perceive your role then no wonder you don't enjoy it. It's the people that make it worthwhile and make no two cases alike.

I know that I make a difference by the smiles and the thank-yous I get when I finish treatment. The best way of thanking me is by recommending me to family and friends, it's not only a great compliment it's one way my practice grows. Some patients choose to show their thanks by gifts, in recent weeks I've been given wine, chocolate, running socks, a plant and some pink champagne (its a tough call as to whether the socks or the champagne are my favourite!). It's not necessary but I am really touched when people take the time to buy a gift or write a card.

So thank you to all my patients, I really couldn't do this without you!