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 Byte, AlignerCo, NewSmile, SmileLove 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. Dentek store, for example, provides temporary filling kits (other options are zinc-oxide-based Safe-and-Sound kit, and Refilit material). DIYDenture 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. 3D printing offers a faster, cheaper way to create dental products. New biotechnologies will allow to engineer tooth enamel that is harder and more durable than the real thing, including its elasticity and ability to absorb vibrations. Virtual/augmented reality headsets being developed could provide instructions or media for better patient-dentist interactions.  These technologies can 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.

REFERENCES

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.

The Rapid Expansion of DTC Healthcare

Preventive care is recognized as the most effective strategy for health care cost reduction. Screening for early signs of heart disease, cancer, maintenance of diabetes and allergies and prevention of infectious diseases can be done without a supervising physician. Direct-to-consumer (DTC) laboratory testing allows individuals to order tests directly from a laboratory without going through their healthcare provider, and often at lower cost. The number of companies providing direct-to-consumer diagnostic testing is rapidly growing, along with the range of health information provided by these tests. Ancestry (genealogy) testing is an example. And so are new devices for cardiac monitoring. 

Experts anticipate a near-term explosion in the DTC marketplace. DTC healthcare already was a US$700 billion industry in 2020, including over-the-counter drugs. The Mark Cuban Cost Plus Drug Company, PBC (MCCPDC) is nearing one million customers. An analysis of 2011-1019 records from Rock Health Digital Database, showed that 252 (21%) of 1214 digital health companies pursued a direct-to-consumer strategy. The pandemic has accelerated this growth. According to research by Deloitte, the number of people using virtual healthcare rose from 15% to 19% from 2019 to early 2020, then jumped to 28% in April 2020. On average, 80% were likely to have another virtual visit, even post COVID-19 and said they will use this type of care again. Latest data showed that consumers’ appetite for virtual health and digital health tools continued to steadily increased, although there was significant variation in physician adoption. 

Human touch remains central to care delivery. In the 2022 Deloitte Survey of US Health Care Consumers, 70% of respondents who had a virtual visit in 2022 (vs. 67% in 2020) thought that the quality of virtual care was as good as in person, but only 73% (vs. 82% in 2020) thought they were able to connect with the clinician the same way they would in-person. Integration of data from patients' wearables and their self-reported outcomes into health records also experienced a setback. 

The global market for Direct-to-Consumer (DTC) testing was predicted to grow from $1.4 billion in 2020 to $2.6 billion by 2025. There were cautionary cases of uBiome and Theranos, there are quackery labs, but as the industry matures and moves toward utilization of clear clinical metrics, and as the capabilities of technology advance, DTC testing will me more and more impactful. There are DTC companies that offer the tests and biometric screenings that a physician would typically order as part of a routine annual physical, such as a complete blood count, comprehensive metabolic panel, urinalysis, and cardiovascular and diabetes risk assessment. Ultalabs, JasonHealth, discounted labs, drsays and privatemdlabs all allow to self-order laboratory tests and Quest and Labcorps locations. 

No more uncomfortable questions for a blood test prescription. No doctor visit needed to gettest results - they will be emailed instead. Consumers pay up front and know exactly what they are paying for. Unfortunately, the same cannot be said for many other healthcare services.

Genetic counseling for patients who are pursuing genetic testing in the absence of a medical indication, referred to as elective genomic testing (EGT), is becoming relatively common. More people are using technology to monitor their health, measure fitness, and order prescription refills. Before COVID-19, there was a slight decline in people who were willing to share their health data—but during the pandemic, new data showed that people are more comfortable sharing data during a crisis

REFERENCES

Cohen AB, Mathews SC, Dorsey ER, Bates DW, Safavi K. Direct-to-consumer digital health. The Lancet Digital Health. 2020 Apr 1;2(4):e163-5.

Stoffel M, Greene DN, Beal SG, Foley P, Killeen AA, Shafi H, Terrazas E. Direct-to-Consumer Testing for Routine Purposes. Clinical Chemistry. 2022 Sep;68(9):1121-7.

2022 Global health care sector outlook | Deloitte

deloitte-nl-healthcare-consumer-centered-future-of-health.pdf

https://www.beckershospitalreview.com/lab/lab-test-market-shifting-from-provider-driven-to-consumer-driven.html