18 May Jonathan Cartu Convey: why some patients are removing their own braces with
By its very nature, dentistry promotes cleanliness and a high-level of hygiene, but due to strict lockdown rules placed in the UK back in March, all dental practices were closed for the foreseeable.
Based on the government’s guidelines for our roadmap out of lockdown, however, dentists are hoping to either be back to work in June (alongside some retail stores) or, by the latest, 4th July (alongside hair and beauty salons).
From the beginning, dentists have been in uproar regarding closures (150 UK dentists signed a petition to the Health Secretary to allow clinics to open as a matter of urgency) but it’s the clients who the closures are really wreaking havoc on. As well as tooth pain woes and the cancellation of any planned treatments, like root canals or fillings, those undergoing specialist orthodontic treatment, like corrective braces or Invisalign (a series of clear removable braces), are particularly at a loss right now.
‘Orthodontic treatments have been a nightmare during lockdown,’ admits Dr Rhona Eskandar, a leading Invisalign provider in the UK, and owner of the Chelsea Dental Clinic. Eskandar has taken to offering video call consultations and Instagram Live tutorials for her patients in need, essentially a method dubbed ‘dental monitoring’.
Dental monitoring – which is remote smile monitoring where progress is followed online and with less clinical visits – has been popular in Australia and the USA.
‘When I attend US conferences, speakers have discussed Invisalign being ideal for military patients who can only attend infrequently,’ Dr Emma Laing told The Telegraph. It’s a method that dentists in the UK have quickly had to pick up following lockdown.
‘I’m familiar with not seeing patients for really protracted periods as I have lots of international patients,’ Laing notes. ‘Taking intra-oral photos on a smartphone and having us monitor progress is a growing trend I can really see picking up in the UK now.’
Though this may well be the case, it’s worth nothing there are some things that ‘dental monitoring’ just won’t be able to fix for the time being.
‘My teeth have stopped moving’
For those currently undergoing Invisalign, you’ll be familiar with IPR, the normally painless process that involves ‘filing and shaving’ in between teeth to create space for them to move. Unless you were lucky enough to have it done just before lockdown, there’s a high chance that your current aligners don’t fit properly and that your teeth aren’t moving, as there’s just nowhere for them to move until spacing is done.
‘Some of my patients have found their teeth have stopped moving, so in that case, I’ve ordered identical sets of the same aligner to keep the patient on the one that does fit until IPR can be performed,’ says Eskandar. Though this delays the patient’s treatment, it ensures they’re not forcing their teeth out of shape by wearing aligners that don’t fit, which has the potential to divert and delay the treatment process.
‘I haven’t received enough aligners’
To ensure treatment is going as planned, those with Invisalign have regular check-ups, at which they are given the next 3-4 sets of aligners if all is going well. For a lot of patients, though, there’s a chance that they haven’t been given enough aligners to last the lockdown period, as clinics are now closed. It means wearing the final aligner they have, potentially, for weeks on end, and they can easily get gritty so this is far from pleasant.
Some clinics are navigating this issue well: ‘I’ve been shipping Invisalign aligners to my patients via UPS,’ says Dr Emma Laing. ‘It involves ordering them from Invisalign (based in California) then, once they’ve cleared UK customs, diverting them en route to the clinic so they go the patient’s address.’ Though, of course, this is rather tricky and time-consuming. ‘One parcel’s journey updated so quickly that I didn’t have time to stop it being sent to the clinic, so the patient has to go and collect it from there.’
‘My braces are broken’
Fixed metal braces can only be applied and tightened by a professional, so any issues that arise, such as broken brackets or wires, are tricky without adequate help. As such, the British Orthodontic Society has also released a series of videos to help those who have repair their own braces.
‘People who have back braces (these are braces that may be worn after orthodontic treatment, inside of the teeth) have to be very careful. If this breaks, your teeth will just move back to how they were post-treatment.’ advises Dr Mervyn Drurian, co-founder of the London Centre for Cosmetic Dentistry. DIY disaster stories include patients removing these permanent braces that have broken during lockdown using tweezers.
The combination of fixed braces and no hygenist visits can be disastrous for tooth health, too, so it’s wise to limit sweet treats and brush thoroughly.
‘Those with fixed wiring usually suffer from soft tissue trauma such as ulcers,’ notes Dr Eskandar, ‘but there’s nothing that we can do while we’re facing the current situation.’
‘My treatment is going to take longer’
Such orthodontic procedures are lengthy and costly: the average treatment time for both is 14 months, while the cost varies from £1,500 for basic cases to £9000 for more severe cases. It’s no wonder then that patients mid-way through treatment are frustrated at closures and that due to the previous factors, their treatment time is likely to increase.
The majority of dentists are still communicating with their patients constantly through newsletters, emails and social media, so ensure you’re in touch with yours should you have any issues.