Text: Stéphanie de Roguin

The mirage of the perfect smile, at a low cost

The low-cost model has spread to orthodontic treatment. Various companies offer teeth straightening for attractive rates. But is quality always up to standard?

In Switzerland, posters advertising offering orthodontic services are not uncommon. Companies offering unbeatable prices now have a strong foothold in the country. They specialise in teeth straightening using clear aligners. These aligners could even replace traditional metal brackets, or braces, with a lightweight, invisible device. Some also offer super-thin ceramic veneers that give damaged teeth a smooth, white appearance. “If the patient has a few crooked teeth, this type of solution can work very well,” says Martin Broome, physician in chief of the Centre for Dental and Oral Medicine at Lausanne University Hospital (CHUV). But in many situations, these miracle solutions are not as effective as advertised.

An automated, standardised system

Low-cost orthodontic treatment companies work like this: people interested in the services go to a clinic where a camera is used to take a set of digital dental impressions. This is usually done by a dental assistant. An orthodontist should theoretically always be involved, “but that’s not always the case,” Martin Broome says. The data is analysed, and an algorithm determines which dental impression is optimal. Another software program creates a set of teeth aligners. They all have a small, deliberate defect, which causes the dental crown to move slightly. Once made, the aligners are sent by post. Most of these companies provide little or no follow-up, or only through a digital application.

“The computer cannot identify a problem located at the base of the bone, such as a jaw that is too far back or too far forward,” the CHUV specialist says. “These low-cost solutions only provide dental corrections, but do not at all perform any orthopaedic action, whereas the teeth sometimes have to be forced into an unnatural position, and mouth guards cannot do that.” And even in this case, the company will often recommend wearing a mouth guard, which will end up being totally ineffective.

Making informed choices

Although presented as easy to use, clear aligners are actually restrictive, as they must be worn 20 hours a day. They must also be also have to be changed every week. For simple cases, the treatment lasts 10 to 15 weeks, but for more complicated situations, up to almost a year. This is not easy to manage, especially for teens. Although metal braces also make for a cumbersome treatment, patients should be able to make an informed choice between the two methods.

The advantage of going to an independent orthodontist is that, at the first appointment, the orthodontist will perform a complete oral health exam and assessment of the condition of the patient’s teeth. This is a way of identifying potential complications that a computer system is unable to detect. “Low-cost services completely disregard the human aspect, which protects against inappropriate treatment,” the expert says.

Lack of follow-up

With a system where people are left to their own devices, once they have received the trays, it is difficult to know who to turn to in case of a problem. “These companies focus on having a nice smile. We regularly get people who come back dissatisfied and have not been proposed anything to correct the problem if the desired results are not achieved,” Martin Broome says.

Much less enthusiastic reviews can also be found online: final result not in line with what was announced (morphology problem not detected at the outset); severe lack of communication; healthy teeth damaged following a given treatment; consultations claimed to be free when any diagnosis requires at least an X-ray for 100 francs.

“Generally speaking, it is complicated to gain recognition of a medical error,” says Yannis Papadaniel, health manager at the Swiss consumer association (Fédération romande des consommateurs or FRC). “The burden of proof lies with the patient. And the procedure is not free.” Depending on the case, legal proceedings can be avoided: in the case of dental care, each cantonal branch of the Swiss Dental Association (SSO) has a mediation commission.

Call charges and hidden costs

One of the major advantages these companies offer is their attractive prices: 1,990 Swiss francs all inclusive for teeth straightening with aligners or a complete treatment starting at 40 Swiss francs per month. For example, a closer look shows that the price for straightening teeth from the jaw is available starting at 2,490 Swiss francs. A subscription starting at 80 Swiss francs per month for application of thin ceramic dental veneers conceals an amount of 8,900 francs for 12 shells.

According to the physician in chief at the CHUV’s Centre for Dental and Oral Medicine, Martin Broome, a traditional orthodontist may charge up to twice as much for the same services as these companies. Less staff, less follow-up, and therefore less cost to the company. And even then, low prices are relative. At the slightest problem, if another treatment is needed because the initial offer does not meet the expected result, the final cost can be much higher than what was advertised.

However, charging variable rates is still legal, as dental fees are not covered by reference tariffs, as with Switzerland’s TarMed tariff system. This means that the maximum prices can be set, but a practitioner is entitled to charge less than the reference tariff. “Dental care is therefore a competitive industry,” says Yannis Papadaniel, health manager at the FRC. “This can be an advantage, but the problem remains that users often do not understand how the price is calculated or the reasons for price variations.”

Another explanation for the low costs is that these companies are well established in all big cities in French- and German-speaking Switzerland. There are therefore investors behind each of them. These companies can afford economies of scale.

But they focus on delivering a nice smile in a somewhat standardised way. Each individual must make their choice based on their dental problem. A few misaligned or damaged teeth can be repaired with cheap solutions. In case of doubt or a more serious problem, a comprehensive dental health exam is essential. /



Failed attempt

Lured by advertisements, Lauren wanted to try it out. “Orthodontic treatments are very expensive, so I was got drawn in by these companies offering free consultations. The offices were not like a regular dental practice, and they took photos of my teeth with a smartphone, the 39-year-old Geneva resident recalls. And contrary to their advertising, you had to pay. When I refused, they got angry. I’ll go and see a real orthodontist instead. Now we know why we pay the price of a service.”

What to do about a medical error?

“To avoid medical ‘errors’, the best strategy is to take action early. Get informed and ask questions to fully understand what the practitioner was offering, or ask for several opinions. These are the first steps to avoid nasty surprises later on,” says Yannis Papadaniel, health manager at the FRC. “Once performed, if the treatment does not match what was announced, you must send your doctor a complaint by registered letter, explaining exactly what points you are dissatisfied with.” Mediation, sometimes available directly through the hospital, can also help. If these steps are not enough, you should have your case assessed by an independent patient advocacy organisation, for example the Swiss Patient Organisation or the Swiss Patients Federation. You can also look into legal protection from insurance companies.

Understanding your rights

In Switzerland, organisations exist to support people who need help or information in the case of medical error.
For example, the Swiss Patient Organisation deals with both patients, their relatives, as well as professionals who may have made a treatment error. The Swiss Patients Federation is also active in this area. It aims to promote transparency in public health. It can also inform individuals about their healthcare rights. To encourage people to learn about their rights on these issues, the French- and Italian-speaking cantons have produced the brochure “Essentials on patients’ rights”, available online.