Everything we do on the internet and on social media leaves a “footprint” behind. Footprints can link people to marketing material that may interest them based on their search history and interests. Social media influences people to try products, make lifestyle changes, and attend events based on their footprints. Consumers are easily influenced by what they see and read on social media, which could have potentially harmful effects.
There are some popular influencers across social media channels who are not dental professionals, yet they are marketing dental products that can lead to the dissemination of wrong information to consumers. The footprints we leave behind lead to advertisements popping up on social media that often contain subpar products and erroneous information. A lot of misrepresentation occurs on social media, YouTube, and the internet about whitening products, orthodontic home aligners, and charcoal toothpastes. As dental professionals, we are faced with the daily challenge of helping our patients debunk the incorrect information media outlets provide. When discussing these topics in the operatory with our patients, it is important to give them the correct information without disrespecting their beliefs, so that they can make educated decisions about their oral-systemic health.
The popularity of companies such as SmileDirectClub and Candid is increasing due to their presence on social media and the fact that their fees are lower than those of orthodontists. Pop-up locations in pharmacies and shopping malls around the country make their products even more accessible than, for example, just ordering a home impression kit from a website. We all know the issues with do-it-yourself aligners. Recently, the American Dental Association (ADA) decided to fight back against these companies due to patient safety concerns.1 Until better rules and regulations are in place, being able to answer our patients’ questions about the benefits of seeing a licensed dental professional versus do-it-yourself aligners is critical.
I often approach this subject by educating patients about the statements from the ADA and the American Association of Orthodontists (AAO) on the topic.1,2 I have their statements printed so I can give patients copies if they are considering SmileDirectClub.3 I inform patients that with orthodontics there is often more to the story than just moving teeth to make their smiles more esthetically pleasing . . . that it is also about function. I let them know that these companies do not take many of the important things into consideration, such as airway health, retrognathia, severe malocclusion, recession, and how much keratinized tissue is present around each tooth. I advise patients that it is important to have a clinical exam to evaluate these issues in order to avoid catastrophic and possible irreversible damage. I also state to patients, “We want to know why your teeth are in the position they are and how they got there before they are moved. We also want to make sure we move teeth through a healthy foundation.” It is important to remind patients that orthodontic treatment is not a product but a medical service that should be supervised by an educated dental professional who understands the process of moving the orthodontia while maintaining the overall health of the bone and tissues.2
I like to give the example of a sinkhole under a house. I tell patients that the homeowner wouldn’t want to do major construction on a house without a stable foundation. I advise patients that it is possible to have straighter teeth more affordably and safely by offering them a consultation with a dentist, an orthodontist, and/or a periodontist if needed. Patients often don’t realize that orthodontic and periodontal work can be financed by third-party companies, such as CareCredit and Wells Fargo Health Advantage Dental Patient Financing. Following up with patients regarding your conversation will also help build trust and rapport.
Teeth whitening is a multimillion- dollar industry and one of the most advertised dental treatments on social media. Many different whitening options are marketed to the consumer—whitening toothpaste, devices, strips, and gels are all options patients can choose from. It is important to educate your patients on the different options available in your own dental office as well, along with the reasons why yours are better than the ones advertised on social media, and in shopping malls, tanning salons, and spas.
There are many issues of concern with over-the-counter (OTC) whitening products. Many OTC whitening toothpastes don’t contain whitening agents. Instead, they use abrasives to remove stains, which can be misleading to consumers. Analyze the ingredients in any toothpaste your patients are using in relation to their goals, as there may be more effective whitening options available.
On the other end of the spectrum, many patients are concerned that their teeth will become too white, so they steer clear of all whitening products. I like to explain that teeth are their own shade value and jumping to “toilet bowl white” is most likely an unrealistic outcome. I discuss how those influencers may have cosmetic restorations that make their teeth appear extra white and potentially it is not their natural teeth that are that shade. I describe how the shade value of teeth is like going to a paint store and picking out a paint value card. That is the patient’s shade. I tell them that you can’t jump from one shade value card to another in a completely different shade value. It is only possible to go from the darkest dark to the lightest light of one shade value card. Everyone’s tooth shade is unique, just like the shade value cards at the paint store.
Other OTC products often contain very low concentrations of whitening ingredients, can be ill fitting, or can cause tooth sensitivity. Advertisements often contain before-and-after pictures showing erosion caused by acid, caries, discolorations that can’t be bleached away, and calculus at the gingival margin. Patients may whiten their teeth and not realize that existing restorations will stand out compared to their natural teeth, due to the inability to whiten restorations. Further, patients often do not realize the ramifications of bleaching an unhealthy dentition. Encouraging them to have a dental exam and their teeth cleaned first can help prevent some of these unfavorable results.
Charcoal toothpaste is a product that has increased in popularity on YouTube and other social media over the last few years, despite there being no evidence to show that it is safe or effective.4 Charcoal toothpastes are often abrasive and can lead to increased yellowing of the teeth due to enamel removal. Patients may report cleaner-feeling teeth after using charcoal toothpaste, but I explain that the clean feeling is due to the high abrasivity of the toothpaste, which is actually damaging the teeth and gums. Another reason why patients’ teeth may feel this “clean” is due to the increase in effective brushing. When patients start using a whitening toothpaste, they will often spend longer brushing and focusing on how they are brushing. I like to ask my patients this question: “Would you use a steel wool scrubbing pad to clean your glass stove top?” I explain that charcoal toothpaste has the same effect on their teeth. I also like to ask patients why they chose to use a charcoal toothpaste in order to determine what they are really looking for in their oral health. Educating patients on the facts about charcoal toothpaste and helping them select a different product that is safe and effective can be most beneficial.
Being prepared to answer questions about the newest social media advertisements and YouTube videos from the biggest influencers can help protect patients from doing harm to their dental and systemic health. It is important to have these discussions with confidence and evidence-based information to help patients make the right decisions for their oral-systemic health.
1. Burger D. New Jersey Dental Association lodges complaint against SmileDirect Club. American Dental Association website. https://www.ada.org/en/publications/ada-news/2019-archive/february/new-jersey-dental-association-lodges-complaint-against-smiledirect-club. Published February 8, 2019. Accessed August 11, 2019.
2. Questions to consider when researching direct-to-consumer orthodontic companies. American Association of Orthodontists website. https://www.aaoinfo.org/_/online-orthodontic-companies. Accessed September 2, 2019.
3. American Association of Orthodontists discusses patient health and safety information regarding direct-to-consumer orthodontics [news release]. St. Louis, MO: American Association of Orthodontists; July 2, 2019. https://www.prnewswire.com/news-releases/american-association-of-orthodontists-discusses-patient-health-and-safety-information-regarding-direct-to-consumer-orthodontics-300878975.html. Accessed September 2, 2019.
4. Natural teeth whitening: fact vs. fiction. American Dental Association’s MouthHealthy website. https://www.mouthhealthy.org/en/az-topics/w/natural-teeth-whitening. Accessed August 11, 2019.