
Straighter Teeth by Mail - scarmig
http://well.blogs.nytimes.com/2015/02/01/a-trip-to-the-mail-box-not-the-orthodontist/
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natosaichek
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.

~~~
Sir_Substance
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.

~~~
reubenbond
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?

~~~
Sir_Substance
Contractor.

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ChrisNorstrom
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.

~~~
jcomis
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.

~~~
j_matthews
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.

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adrianhoward
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.

~~~
hessenwolf
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 :).

~~~
adrianhoward
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.

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Magi604
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.

~~~
wldcordeiro
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.

~~~
to3m
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.

~~~
TheSpiceIsLife
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.

~~~
greedo
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.

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merckx
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.

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robotcookies
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).

~~~
aaron695
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.

~~~
robotcookies
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.

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

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

~~~
mreiland
In context of people it means sexual attraction.

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phreeza
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.

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grantlmiller
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.

~~~
hatty
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](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.

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

~~~
mattlutze
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.

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robodale
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.

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patejam
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.

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bruceb
What is needed is more orthodontists, increase supply.

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sethkontny
sleepmedx inc

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jostmey
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.

~~~
nilkn
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.

