The role of the orthodontist: Healthcare provider or salesperson?

Dr Mary Zafiropoulou

Dr Anna Hajati

Fri. 3 June 2022

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The demand for gorgeous, perfect smiles has exploded in recent years. During the COVID-19 pandemic, the amount of time spent behind the screen, whether in Zoom meetings or FaceTime chatting with friends and loved ones, has given rise to a greater demand for whiter, straighter, perfect-looking teeth. Direct-to-consumer social media marketing is challenging the role of the orthodontist as a legitimate source of healthcare-related information for patients. In addition, advancements in technology have given the impression that orthodontic treatment is now very discrete, easy, fast and affordable for individuals looking for the perfect smile. These are the clear promises given to consumers. But is it that easy? And most importantly, is it true?

Patient or consumer?

Increased social media marketing involving messages aimed at attracting potential consumers to buy tooth straightening appliances and services has turned patients interested in cosmetic procedures into consumers. The most influential companies in the dental industry have been extremely successful in reaching out to their end consumers, patients, and consciously deliver messages aimed at attracting more customers for their products. To reach out, they use influencers to create healthcare loyalty. Some practitioners, presented as key opinion leaders or another type of expert, have become a part of this ecosystem of a certain product or method. Prof. Kevin O’Brien assesses this practice on his orthodontic blog.¹ A key opinion leader is by definition a trusted, well-respected influencer with proven experience and expertise in a particular field. In healthcare, these leaders could be physicians, hospital executives, health system directors, researchers, patient advocacy group members, and more.

Some key opinion leaders gain benefits from promoting specific products that have little evidence-based support, turning them into profitable salespeople instead of healthcare providers. They go from serving a patient as a doctor to selling a product or method. Being part of such an ecosystem in turn efficiently increases the need for consumption of these marketed tools. Companies also market their brand through clinics, dentists and patients. Many clinics adapt to this without even realising it. People find the messages attractive, as they desire a happier life the invisible, easy and affordable way. Are the messages we send out ethical or even true? A study recently published in The Angle Orthodontist assessed claims mainly concerning treatment duration within Instagram posts on six popular marketed orthodontic products and found that only 2% of the 472 claims assessed were true.² This seems to imply that we need to ask ourselves whether our messages on our websites and social media posts are accurate.

Doctor-driven or artificial intelligence-driven orthodontics?

New integrations between medical imaging, planning, manufacturing, performance and communications have created many new opportunities for both dentists and patients. An orthodontist can capture records in one part of the world, and the patient can receive his or her appliances in another. A patient can start treatment in one part of the world and continue treatment in another part of the world more easily than before. The course of treatment can even be tracked and monitored by the orthodontist from a distance.

Recently, even artificial intelligence (AI) has been implemented by companies for automation of treatment goals and monitoring. We should remember that AI in this sense is nothing more than algorithms implemented in a system by a human, based on calculations from reference material and predictions. These new technologies enable improved precision, save time and allow more flexibility. Many tend to believe that tooth movements can be planned and performed in digitally supported environments without having a dentist examine the mouth. The patient-turned-consumer can order the appliances online or go to a beauty salon or a store to have records taken and appliances ordered. The treatment will start without anyone checking the teeth, gingiva or function or discussing preferences. It is an advancement of technology and it opens the door for even greater flexibility and automation. It is, however, a consumer-driven approach based on 3D renderings and does not take into consideration biology and other aspects, like function. In the future, could AI alone be enough to drive the orthodontic planning and treatment process, without input from an orthodontist?

If orthodontists want to keep up, time and effort need to be put into learning these new technologies, always being mindful of using them to improve patient care.

The challenge

When a patient is turned into a consumer and a medically advanced procedure is marketed as a branded product, the information provided to the patient is skewed. We make it difficult for patients to make well-informed decisions when important information regarding their treatment is not communicated to them. When companies value a healthcare provider based on products purchased, he or she is turned into a salesperson, which has very little to do with his or her professional competence. Soft skills are difficult to measure and sell, so doctors stick to marketing and selling products. But if we, who have a duty to serve our society and our patients, do not provide ethical and accurate information, there is a riskthat patients will suffer. Orthodontic care involves advanced medical procedures, requiring medical and dental history taking and consideration of a number of biological factors, like function and dental health status, as well as dental, functional and skeletal diagnosis. In the long run, there is the risk that communication by orthodontists who have the competence to provide good and safe care will be drowned out and important competence will be lost.

Conclusion

With the advancements of technology, a new reality of endless possibilities is upon us. If orthodontists want to keep up, time and effort need to be put into learning these new technologies, always being mindful of using them to improve patient care. The appliance and approach best suited to each patient need to be figured out, as there is no one-size-fits-all approach.

A doctor spends his or her time educating patients and listening to their needs, is compassionate and honest, and builds trust and reliability. Information needs to come from the expert’s mouth in an honest, unbiased way. We should all ask ourselves: who am I and who do I want to be? And how do I stand up for the ethical values that come with my duties as a medically trained specialist? How do we make patients aware so that they can make informed decisions about their short-term and long-term dental health? We all need to think about the consequences of what we communicate via our various channels. Although the profession may seem like it is entering a new era, the reality is that it might not be very different from the past. Its core values and belief systems are the same: patients’ best interests are and should always be at the centre. Practitioners need to see patients as people and not consumers. There is a place for technology, but technology alone does not offer much if there is no skilled human behind to drive it.

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