Direct selling is nothing new, and I remember door-to-door sales as a young child for household brushes and cleaning products, doorstep cosmetic sales, and of course, Tupperware. This isn’t a blog about the reasons why we all have drawers and cupboards full of these products, but the world has, of course, changed since the days of doorstep selling and the internet offers a new shop window, marketplace and, crucially, the ability to demonstrate the ‘need’ for products and services with multimedia productions.
Healthcare continually changes and since the COVID pandemic, there has been an upshift in the desire for health and wellness in many, if not most, countries around the globe. Dentistry is no different, with patients being keen to ensure their teeth and oral cavity is as healthy as possible. Healthcare companies are ready to satisfy consumer demand with products and services that patients and consumers want.
The internet will undoubtedly continue to make significant waves in dentistry, as patients are effectively shoppers and the key for the seller is to convert them to a buyer. Consumer-friendly models are everywhere around us for so many aspects of modern life with everyday items, work essentials as well as luxuries being available via our computers, tablets and smartphones.
In an ideal world, patients should be able to undertake a degree of self-care from the comfort of their home in the same way as they monitor and manage other conditions such as asthma, diabetes and hypertension among others. Dentistry can be supplemented by technology and AI-driven oral healthcare solutions to improve oral health. The ongoing digital revolution in dentistry will be a subject for a future blog so as the saying goes, keep tuned.
Everyday oral healthcare products remain the backbone of the Direct-to-Consumer (DTC) part of the dental industry with companies having sold toothbrushes, dental floss, mouthwashes and a variety of oral health products for many years both directly and more recently through third party sellers such as Amazon and eBay. Some companies now market these on a subscription basis which is innovative. It strikes me that the unique selling point and advertising of many of these items is that of the consumer look and feel rather than the outcomes and impact of their use.
We all recognise that anything that can be done to assist the delivery of and access to oral healthcare is a positive step. Geographical areas of dental under-provision and the lack of access to dental care continues to be an ongoing concern for the Faculty of Dental Surgery and it is no surprise that patients sometimes have no alternative but to look on the internet for methods of solving their immediate and longer-term problems. However, all might not be as good as you thought for DTC dental products as direct selling has slowly crept into other areas of dental care which require accurate diagnosis for appropriate treatment. This part of the industry is based on the principles of affordability, convenience and accessibility.
Affordability is always identified as a reason for direct selling. The opportunity to offer products and services direct to patients is attractive for the industry suppliers as the traditional dental system of marketing via in-office staff is bypassed. This theoretically reduces overhead costs as the staffing model for direct to patient businesses are considerably reduced, potentially offering a cost reduction for patients.
Convenience is king and anything that improves accessibility is always of interest to patients who are keen to manage their dental care as and when it suits. Patients neither want to be left on long waiting lists for dental treatment, nor do they want to have to make substantial journeys to purchase products and services. I am a fan of remote dental consultations to triage, diagnose and signpost patients as this reduces travel and improves accessibility, and whilst not appropriate for all dental appointments, remote assessment has a valuable place. I don’t think the traditional waiting room with dog-eared copies of outdated magazines will be lost completely though.
The key DTC products are now at-home tooth whitening kits, orthodontics, and custom night guards. At-home tooth whitening kits are nothing new but there is a surprising amount consumerism in this part of the dental market now, with custom-fit trays, professional-grade whitening gel, supposedly offering similar results to ‘in-office’ treatments at reduced cost. Have a look on the internet and you will be amazed at what products are on the market these days as well as some other general suggestions including brushing with baking soda, oil pulling (from Ayurvedic medicine), and using hydrogen peroxide.
Similarly, mail-order custom-fit night guards are sold direct to the comfort of patients’ homes with direct selling by several companies for conditions including bruxism and clenching, snoring and sleep apnoea as well as orthodontic retainers. Some websites even boast that they “cut out the middleman.” All that is needed is an impression of the teeth to be sent to a dental laboratory who then return the night guard in the mail.
So called ‘at home’ orthodontic aligner companies are booming on the internet with many websites offering to mail the equipment, providing simple step by step instructions and making these seem surprisingly cheap with some even indicating there is a dentist in the background who is part of the overall treatment process. However, many of these companies pop-up and disappear, are not always forthright in which country they are located and with no real oversight, some are known to be dubious. The use of non-disclosure agreements and settlements with unhappy customers are one thing, but the lifetime impact of inadequate diagnosis, inappropriate treatment planning and poor-quality treatment are more substantial issues. Failure to diagnose dental pathology such as caries, periodontal disease is effectively supervised neglect, but what about bone or oral mucosal disease, and even pre- or malignant lesions when no formal dental examination is undertaken? To my mind, this is reprehensible and not surprisingly, the NHS makes no mention of DTC orthodontics.
The Royal College of Surgeons of Edinburgh view is that whilst DTC dental healthcare has a role to play in improving overall global oral health, a duty of care is an essential aspect of dentistry and patients should not be converted to consumerism in relation to treatment. It is important that the overall system is led by dental health professionals with dentists diagnosing disease and undertaking the majority of treatment planning. Patients should not be viewed as an opportunity for all aspects of dentistry to be monetised and above all, patients’ dental health needs should always be prioritised over patients’ wants.
My suggestion for the future is that companies interested in this aspect of oral care partner with the traditional dentist-led market to provide a hybrid model, which combines the best of both worlds for our patients and eliminates the disadvantages of both. Patients need to be led by experts. Whilst telehealth will continue to expand and assist in the prevention and signposting when to seek in-person care and treatment delivery along with provision of oral health aids via mail order, treatment should be under the direction of a registered dental health professional who is able to care for patients on a longer-term basis.
The Royal College of Surgeons of Edinburgh stance is that whilst affordability, convenience and accessibility are appealing, the limited scope, quality and safety concerns and regulation or oversight are more important, and more needs to be done by those regulating the profession around the world to ensure patient protection is never compromised by direct selling in dentistry. Time will tell whether households will have drawers filled with discarded tooth whitening kits, night-guards and at-home orthodontic aligners among other direct sales items.
As ever, please feel free to contact me on any matter at dental@rcsed.ac.uk.