Saturday, March 18, 2023

Direct-To-Consumer Dentistry

Direct-to-consumer (DTC) medical care is rapidly gaining momentum, appealing to everyone who values convenience, accessibility, and affordability when it comes to their health and wellness. 

One area of DTC care is telemedicine - the use of technology to deliver medical care remotely. 5 years ago, radiology, psychiatry, cardiology, emergency medicine, and dermatology were among the top specialties of telemedicine. In recent years, teledentistry has experienced a surge in popularity as a new form of delivering dental care. According to the American Dental Association, 42% of people don't go to the dentist frequently enough. This could lead to poor oral health, more invasive and expensive emergency treatments, and wider health implications. Teledentistry could help to improve the general oral health of the public. 

Another area of DTC healthcare is the direct sale of healthcare products to consumers without the involvement of healthcare providers. This can include the sale of over-the-counter medications, at-home testing kits, and other health-related products. While some dental products, such as toothbrushes, toothpaste, dental floss, and mouthwash, have always been easily accessible over the counter without a prescription, there have been other products that were exclusively available through licensed dental professionals and too expensive for most people to afford.

It wasn't until the mid-2010s that new DTC companies such as SmileDirectClub  and Candid started offering teeth aligners directly to consumers online. These companies use a combination of telemedicine, at-home impression kits, and 3D printing technology to create customized clear aligners that are shipped directly to the patient's home. The list of DTC orthodontics companies keeps growing - including ByteAlignerCoNewSmileSmileLove and SnapCorrect

According to analysis of data collected in 2019, while many respondents would have preferred traditional treatment from a dentist or orthodontist, they chose direct-to-consumer aligners instead due to the lower cost and greater convenience. More than half did consult with a dentist before purchasing aligners and most respondents (87.5%) were satisfied with DTC treatment, although 6.6% had to visit their dentist due to the severity of adverse effects. Most recent analysis of 1,362 surveys identified a significant inverse association between the complexity of an orthodontic case and the likelihood of choosing DTC treatment over an orthodontist. Laypeople seemed to understand how complex their case was. Participants were 3.53 times more likely to choose DTC treatment for a mild case (DI score, 0-10) compared with a complex case (DI score, > 20), although the likelihood of choosing DTC treatment for a moderate case (DI score, 11-20) was only 1.79 times higher than for a complex case. (DI score, measured by professionals, evaluates severity of malocclusion, or misalignment of teeth, based on position of teeth in the jaws, the size and shape of teeth, the relationship between the upper and lower jaws, etc). 

In recent years, more DTC companies have emerged offering dental laboratory services, where patients are instructed in how to independently take their own impressions and order products such as mouth guards, snoring appliances, teeth whitening trays and bleaching products, partial dentures, veneers, fake teeth and even temporary implants. DIYDenture, for example, offers supplies for those who need a quick solution for missing teeth. Temptooth and Brige sell tooth replacement kits on Amazon. Resetsmile offers an at-home tooth replacement option. New-York-based Dental Lab Direct is an online provider of custom-made dental products, including partial dentures, nightguards, retainers, and more. DentKits is a less known online provider of custom-made full dentures, partial dentures, and other dental appliances. TruSmile veneers offer Snap-On teeth veneers as a cheaper alternative to dentures. 

The American Dental Association (ADA) and the American Association of Orthodontists (AAO) have raised concerns about this trend, referring to it as DIY dentistry. They are concerned that patients may be self-delivering unsupervised dental treatments, which can potentially cause damage and irreversible complications. However virtual dental care is much more than a cheap digital knockoff of in-person care. Besides, in-person care is not free of flaws, including a significant disparity among licensed dentists when it comes to evaluating radiographs, performing procedures, and making decisions that may be driven by profits rather than the patient's well-being. The human sensitivity can vary from 19% to 94%, and there is only a moderate level of agreement among clinicians, with less than 63% of the data considered reliable.

New computer-guided technologies allow the dentist to utilize AI and bioengineering to improve their interventions. These technologies can also provide patients with more information about their dental health, guide their less-complicated DIY solutions, help them make more informed decisions about their treatment options and manage their wellbeing throughout the course of care.

Acknowledgements: Special thanks to the Stork app, OpenAI's Assistant, Perplexity (and other products based on the OpenAI API) for their help with illustrating this article and diligent research.


Tabbaa S, Nguyen T, Toubouti Y, Saltaji H. Direct-to-consumer orthodontics: Exploring laypeople's perception of orthodontic treatment complexity. J Am Dent Assoc. 2023 Feb;154(2):130-140.e2. doi: 10.1016/j.adaj.2022.10.017. Epub 2022 Dec 31. Erratum in: J Am Dent Assoc. 2023 Feb 3;: PMID: 36593134.

Wexler A, Nagappan A, Beswerchij A, Choi R. Direct-to-consumer orthodontics: surveying the user experience. J Am Dent Assoc. 2020 Aug;151(8):625-636.e4. doi: 10.1016/j.adaj.2020.02.025. PMID: 32718492; PMCID: PMC7391059.

Bader JD, Shugars DA, Bonito AJ. Systematic reviews of selected dental caries diagnostic and management methods. J Dent Educ. 2001 Oct;65(10):960-8. PMID: 11699997.

Valachovic RW, Douglass CW, Berkey CS, McNeil BJ, Chauncey HH. Examiner reliability in dental radiography. Journal of Dental Research. 1986 Mar;65(3):432-6.

Alqutaibi, A.Y.; Aboalrejal, A.N. Artificial intelligence (AI) as an aid in restorative dentistry is promising, but still a work in progress. J Evid Based Dent Pract. 2023 Mar;23(1):101837. doi: 10.1016/j.jebdp.2023.101837. Epub 2023 Feb 8. PMID: 36914305.

Kane CK, Gillis K. The use of telemedicine by physicians: still the exception rather than the rule. Health Affairs. 2018 Dec 1;37(12):1923-30.

Monday, January 2, 2023

Quantified Self: From Sousveillance to Personal Science and Phenotyping

The quantified-self movement which involves using technology to track various aspects of one's daily life and behaviors, could be traced back to the sousveillance-like monitoring described in 1970. One of the first platforms for these activities - Nike+ website publicly launched in 2006 - was helping runners to track and share their workouts. 

The term "quantified self" was coined in 2007 by Wired magazine editors Gary Wolf and Kevin Kelly who co-founded the Quantified Self Institute and "Quantified Self Meetups." The movement experienced a period of rapid growth in popularity in the 2010s. Forbes has even called 2013 "The Year of the Quantified Self". 

As the technology for self-tracking has become more advanced and widespread, it has attracted the attention of commercial hardware developers. Fitbit founded in 2007 as Healthy Metrics Research, released their first tracker in 2009. In the 2010s, a number of major tech companies, including Apple, Google, and Samsung, began to develop and market wearable devices and self-tracking apps.

Quantified Self movement has not become a mainstream trend due to a combination of cost, technical barriers, and privacy concerns. Many people resented self-tracking being pushed by their employers, health and life insurers in order to monitor them. And despite many attempts to develop analysis tools, most people are still lacking the skills to process their data in order to make better decisions in everyday life.

"Personal science" (the use of scientific methods and principles to analyze personal lifelogging) and N-of-1 studies (when individual is studied in isolation, rather than as part of a larger group in a clinical study) are related to the quantified-self movement in that they both involve the use of technology and data to track and understand one's own health and behavior. These approaches, however, are not yet widely used or understood by the general public. 

The use of self-tracking data has the potential to inform the study of various medical conditions through the process of phenotyping, as several papers have demonstrated (eg, for vaccine-triggered anorexia and endometriosis). However, the understanding of how to effectively use this type of data for this purpose is still in the early stages, and it has not yet been widely adopted by traditional medical science. In contrast to what was expected 20 years ago, phenotyping has taken a back seat in human genetics research. It was thought that having a precise or well-measured phenotype was far less relevant than having a huge sample. However, now that the field of genetics has a working strategy for gene discovery, and AI is getting more sophisticated, the importance of phenotype is re-emerging, and this will likely lead to a renewed interest in the quantified self.


McClusky M. The Nike experiment: how the shoe giant unleashed the power of personal metrics. Wired. 2009 Jun 22;17(07).

Gabashvili IS. Why Red Beans and Rice Are Good ... But Not with Coffee, Forbes 2012, April 30. DOI: 10.6084/m9.figshare.13600517

Osozawa S. Case report: anorexia as a new type of adverse reaction caused by the COVID-19 vaccination: a case report applying detailed personal care records. F1000Res 2022 Jan 4;11:4

Urteaga I, McKillop M, Elhadad N. Learning endometriosis phenotypes from patient-generated data. NPJ digital medicine. 2020 Jun 24;3(1):1-4.

Dick DM. The Promise and Peril of Genetics. Curr Dir Psychol Sci. 2022 Dec;31(6):480-485. doi: 10.1177/09637214221112041. Epub 2022 Sep 16. PMID: 36591341; PMCID: PMC9802013.


Special thanks to OpenAI's Assistant for their help with illustrating and writing this article.

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