Internet and social media have become integral parts of our modern lives, revolutionizing the way we access information. This has transformed the way we learn, stay informed, and make decisions in our daily lives. With the onset of the COVID-19 pandemic, a drastic increase in information-seeking practices has been observed worldwide, bringing a wealth of knowledge to our fingertips. With a population that increasingly relies on the Internet for quick fixes to their problems including dental care, DIY Dentistry has gained significant momentum.
Dentistry still struggles against a negative image painted by the media and movies, where the dentist is often portrayed to inflict pain while an anxious patient sits in the dental chair. The subconscious impact of this image has been a prominent factor for patients to delay and often avoid seeking dental care. As a result of dental services being disrupted during the pandemic, the pre-existing challenges became even more pronounced, leading many individuals to turn to over-the-counter (OTC) products, ‘at-home’ hacks and DIY (Do it yourself) methods as a substitute for professional care.
The primary problem with over-the-counter products and DIY hacks is that many of them are unregulated and potentially unsafe, being promoted by unlicensed individuals. This poses significant concerns for patient safety. The markets are flooded with a plethora of DIY kits addressing a variety of oral needs like, at-home veneer kits, DIY filling kits, DIY tooth straightening kits, super glue tricks to fix crowns and broken teeth, etc. As we have already explored various at-home teeth whitening products and techniques in the previous article, this segment will focus on other DIY dental practices and products.
DIY – Tooth Fillings:
A filling is technically called a ‘restoration’ as it is aimed at re-establishing the form, function, and esthetics of the tooth. As dentists, we frequently encounter various attempts at restoring teeth, particularly when it comes to dislodged fillings. In my personal clinical experience, I once encountered a patient who had replaced a dislodged restoration with M-Seal! In another, a patient used an at-home kit to re-fill a dislodged filling in their tooth using a material obtained from a motor garage! The at-home kit consisted of a disposable mirror, probe, and forceps along with a round-head electric toothbrush. The patient debrided the cavity, applied the material and trimmed the bristles of the electric toothbrush to aid adaptation of the material.
Upon the patient's arrival at the clinic, it was determined that he was experiencing excruciating pain, which was later diagnosed as irreversible pulpitis. Other complications of DIY fillings are:
a. Further progression of caries due to incomplete caries removal.
b. Unesthetic appearance due to poor shade matching or contrast color
c. Damage to pulp (nerve of tooth) due to incomplete setting and release of byproducts resulting in mild to severe pain or extra-oral swelling
d. Raised bites causing headaches and jaw pain
DIY – Tooth Extractions:
Among various unsuccessful attempts documented in research papers, the most amusing is where someone tried a cartoon-inspired extraction by tying a string to the tooth, attaching it to the door, and slamming it hard expecting the jerk to expel the tooth out of the oral cavity. Another patient attempted the procedure by consuming a good amount of alcohol as a substitute for local anesthesia; followed by the use of crude pliers to extract the tooth.
As a specialist, I find the potential harm caused by some dental products and practices to be quite alarming. Some patients have lost completely healthy teeth in their pursuit of a flawless smile using unmonitored and cheaper methods that appear to be more comfortable, and it often requires us to place dental implants to rehabilitate their missing teeth! Often the neglect of impacted teeth results in occlusal problems, the teeth whitening agents induce caustic effects on soft tissues, and self-extraction enthusiasts often land up with severe infections. Restoring the damage caused by such products/practices requires extensive intervention from dentists and surgeons, which greatly compromises the patient's quality of life.
Dr. Malvika Hasrajani Taneja (Oral and Maxillofacial Surgeon)
There is a significant amount of online content that depicts individuals attempting to remove their own wisdom teeth at home. Unfortunately, this content is grossly misleading and may encourage people to try and perform this procedure on themselves, which can be very dangerous. Tooth extraction is a surgical procedure that requires specialized training and equipment to perform safely and effectively; which can only be done by registered dentists and oral surgeons. In addition to being illegal, attempting extraction at home can also lead to severe infection, excessive bleeding, nerve damage, and damage to adjacent teeth or prostheses; thereby putting the patient’s health in jeopardy.
DIY Teeth Straightening:
The popularity of at-home teeth alignment services can be attributed to companies claiming excellent customer service and policies, fast results, remote treatment facilities, and affordable payment plans. While these products are typically only suggested for minor teeth problems like small spacing or mild crowding of teeth; the scientific evidence supporting this claim is insufficient.
The process begins with an at-home impression kit that patients use to record impressions of their own teeth. However, this can be challenging, as patients lack experience and may not be able to record their impressions accurately leading to inefficient treatment plans and ill-fitting appliances, causing further harm.
Dental aligners, commonly known as "contact lenses for teeth," are widely used in orthodontic treatments. However, it's important to note that orthodontic treatment is best carried out by a specialist, and the Indian Orthodontic Society (IOS) strongly discourages the over-the-counter purchase and use of aligners. In fact, IOS has completely banned these services and recommends that treatments should only be carried out at clinics run by registered practitioners.
Dr. Twinkle Bajaj (Orthodontist and Dentofacial Orthopedist)
There are several factors that may make an individual ineligible for at-home teeth alignments, such as severely malaligned teeth, untreated skeletal jaw discrepancies that require in-office orthodontic treatment or surgery, periodontal disease, decayed teeth, or existing dental restorations, implants, and prostheses. Additionally, without in-office visits, treatment may be less predictable, and there is insufficient scientific evidence to guarantee the safety of these commercial aligners or rapid tooth movement. As extensive monitoring is not feasible in remote situations, the results and outcomes may be grossly unpredictable.
At-home veneers:
Dental veneers and laminates are conservative treatment options with minimal or no tooth preparation in order to modify the position, colour and sometimes the shape of the teeth. These procedures can significantly enhance the aesthetic appeal of a patient's smile, resulting in a more attractive appearance. OTC options provide various reversible options which are affordable, removable and convenient. They are usually applied in a snap-on form which makes them a temporary alternative and are not durable.
Another type where the application of pliable re-lining material yields instant veneers has become widely available online. It consists of pre-formed plastic trays containing resin-based material in mouldable consistency. The material is immersed in hot water, and placed in the patient's mouth where they bite down to shape it as it hardens. This allows the pliable material to set and conform to the patient's teeth.
A 60-year-old male patient approached me with an OTC dental product that he ordered online from one of the most popular online shopping platforms. It was a thermoplastic material that was supposed to be molded using hot water to be stuck onto your existing teeth. Honestly, it took me a while to register the kind of product he had just brought to me. According to what I have learned in my last 10 years in dentistry, that material is not going to stay there even for a day. It will also cause a large amount of food lodgment & bad breath. The poor man just fell into the trap of a marketing gimmick!
Dr. Javeria Khan (MDS, PERIODONT Dental Clinic and Implant Centre, Amravati)
In a recent case report, a patient had a veneer locked onto their teeth, resulting in a visit to a dentist for removal. Unfortunately, upon removal of the veneer, ulceration of the soft mucosa was observed. This highlights the risk of trauma and mishaps when procedures are performed without seeking professional advice and a thorough examination. Additionally, substandard material with unspecified composition used for such veneers can lead to further adverse reactions and complications.
Using reversible, removable, and temporary at-home DIY kits for dental needs may seem like a fun, attractive and cost-effective option for some people. However, it is crucial for individuals to fully understand the product and the potential risks associated with it before making a decision regarding their oral health needs. Many companies market their DIY kits with clickbait headlines, which can mislead patients into believing that these products are safe and effective. However, DIY Cosmetic-Dentistry often centers firmly on patients' desire to cut corners and find quick fixes for their dental issues, which can lead to serious complications. It is important for patients to consult with licensed dental professionals for any dental concerns or needs.
As the saying goes, "half knowledge is dangerous" holds true, especially with the emergence of unqualified social media influencers endorsing over-the-counter dental products like aligners, teeth whitening kits, and dentures. Unfortunately, instead of seeking professional dental care, patients are opting for these cheaper alternatives, which can result in detrimental outcomes. In turn, the botched experiences may require patients to spend more money to repair the damage caused by these products. On the other hand, affordable over-the-counter products like electric toothbrushes and HA-rich (Hydroxyapatite) toothpastes have had a positive impact on consumers' oral health by encouraging them to brush and floss more frequently and for longer durations. As a result, these products have helped reduce oral issues such as calculus and halitosis.
Dr. Devika Shrivastava (Oral and Maxillofacial Surgeon)
References:
McColl, E., Witton, R. & Mathews, A. Vodka-assisted extraction. Br Dent J 233, 441 (2022).
Westgarth, D. The alarming rise of DIY dentistry. BDJ In Pract 34, 10–14 (2021).
Sedgwick MJ, Krishnapillai D. Dentistry, the press and a pandemic. Br Dent J. 2021 Dec 14:1–4.
Jadun, S., Monaghan, L. & Darcey, J. DIY dentistry: Clip-on veneer. Br Dent J 224, 557 (2018).
Behrents RG. Do-it-yourself impressions and clear retainers: A fairy tale. Am J Orthod Dentofacial Orthop. 2016 Aug;150(2):205-7.
