Traditionally, pharmaceutical companies would market their drugs to medical doctors.  At first, it was just form letters, brochures, and office visits from sales representatives.  As the marketplace became more competitive, this grew to free gifts, free lunches, and even free vacations.  New regulations and guidelines curtailed these practices, and for good reason: it was giving the medical profession the appearance of being "bought off" by big pharma.  Without the ability to wine and dine doctors like before, pharmaceutical companies took to magazine ads, radio, television and the internet to promote their products.  Only United States and New Zealand even allow direct to consumer marketing of prescription drugs.  (source) 

Where doctors were typically marketed with objective clinical findings and charts, consumer advertisements use much more subjective images of attractive people living happy lives free of problems.  Of course, there are the obligatory disclosures of side effects and interactions.  It's indisputable that it works: the top selling drugs in the US are dominated by drugs that are marketed direct to consumers.

Pros and Cons

 The main advantage to direct to consumer (D2C) marketing is that the general public is made more aware of health issues.  It makes people take charge of their health care.  After seeing a drug ad, people may do their own research, though many will start at the pharmaceutical company's product website and stop there.  D2C has also forced doctors to keep up to date on new drugs.  Promoting health is a great service to society.

The main disadvantage to D2C is that the general public may not know all the facts, and may not have the training to evaluate the pros and cons of a specific drug for their own body.  Everyday folks may not always be able to discern claims from facts.  D2C ads almost never mention other alternatives to their products, while medical professionals are legally required to give you all the reasonable options for treatment.  Sometimes good ads support bad products.  If a doctor doesn't agree with a product's advertised claims, it can unfairly make the doctor seem backward or ignorant.  Because there are a lot more people in the general public than doctors, direct to consumer marketing is considerably more expensive, which ends up being factored into the cost of the product.

The Push into Dentistry

Now we're starting to see large dental corporations promote their prescription products to consumers.  While the majority of dental products are still marketing to dentists, an increasing number of brands are competing for attention among the public.  We take a brief look at four popularly marketed dental brands, their prescription products, their claims and their competition.

 Zoom! by Discus Dental

The product: Discus Dental aggressively promotes its Zoom whitening system to dentists and consumers.  They've had their products placed on prominent reality shows like Extreme Makeover and the Swan.   Zoom! has instant name recognition: dentists often use Zoom! in their advertisements to draw new customers.

You don't think of tooth whitening as a prescription product, but it is: Zoom whitening may only be dispensed by a licensed dental professional.  The active ingredient, hydrogen peroxide, is in a much higher strength than over the counter whitening strips.  It's safe to use as directed.  But without following Discus Dental's instructions, you would suffer painful gum burns from the gel, and possible blindness from the light.  That's why it needs professional supervision.  Fortunately, Discus Dental regularly updates both their light and their product; it's a lot better than it was a few years ago.

Their claims: Zoom claims to whiten teeth substantially in just 45 minutes, with very little sensitivity.  The secret is the exclusive Zoom whitening light.

The facts:  Most of Zoom's whitening effect comes from the drying out the teeth.  Leave your mouth open and breathe for just a few minutes, and they'll start to appear whiter, no money necessary.  As the teeth rehydrate, however, the whitening effect diminishes.  Zoom's own charts show that the light is responsible for just 18% of the whitening effect, most of which is temporary.  Independent studies show that 1 hour whitening without any further whitening treatment is ineffective.  As a result, Discus and most Zoom using dentists dispense a home whitening kit to maintain the whitening effect.

The alternatives: Over the counter whitening strips are, used as directed, safe and affordable for most people with fairly straight teeth.  Sure, it takes longer, but the slower the whitening process, the longer the result will generally last.  Best results are still achieved when you use a custom tray made by a dentist for a period of one to two weeks, with moderate strength peroxide gels.

Verdict: Slower is better.  No one wants to hear that slower is better, but in the case of whitening, it's indisputably true.  You'll get a longer lasting result, less sensitivity, and a lower price than one hour whitening systems.  If you've got a wedding or something immediate, then one hour treatments may be your only choice.  Otherwise, stick to a home whitener, either over the counter, or from a dental professional.  Read our Whitening FAQ .

 Invisalign by Align Technologies

A popular orthodontic brand is Align Technologies' Invisalign.  It's a compelling, asthetic form of orthodontics. 

The product: Instead of brackets and wires, clear aligners are used to straighten teeth.  A computer creates a series of progressively straighter aligners that literally push and pull your teeth into alignment.  Like Zoom, it is a prescription product that can only be dispensed by a dentist or orthodontist.

Their claims:  Invisalign can give you a straighter, more attractive smile without ugly, uncomfortable braces

The facts: With proper patient selection, Invisalign works great (disclosure: the author previously received Invisalign treatment at a professional discount).    Since our offices does not carry Invisalign, we've asked several local orthodontists for their feedback:

1. Esthetic: it truly does look better than braces.  Even tooth colored braces leave lumps.  (though you can get "lingual" braces on the back sides of the teeth)
2. Quicker visits: intermediate visits are quicker, as there are no bands or ties to change.
3. More Expensive: Even though the inventory cost is lower, it ends up costing several times more for the orthodontist to treat you, which ends up being passed on to you in the form of a higher fee.  (because of market conditions, some dentists and orthodontists end up doing the cases at little or no profit)
4. Compliance driven: you must faithfully wear the aligners 24/7, except when eating.  If you do not wear them continuously, results are severely compromised.
5. Lack of fine control: the aligners are pre-made for the entire sequence of treatment.  If a tooth doesn't move as predicted, or a new type of movement is desired, all the subsequent aligners must be remade.  In many cases, braces must be worn for a few months to finetune tooth alignment.

The alternatives: Orthoclear had a compelling product, but was brought to court by Invisalign for patent infringement.  Orthoclear settled the litigation by agreeing to be purchased by Invisalign.  Align Technologies graciously paid for all "in progress" cases to be completed.  For now, Invisalign has a monopoly on full arch clear aligner treatment, and they will sue you out of business if you dare to compete with them.  (Disclaimer: Dr. Le was once Orthoclear certified, and refuses to carry Invisalign because of their anti-competitive legal practices and their arrogant sales representative)

Raintree Essix is a product that uses clear appliances for minor tooth alignment.  It's less expensive for dentists to become certified than Invisalign, in part because it's a simpler, less ambitious system.  It's also less expensive for you, the patient.  If you have a crooked front tooth or two, it may work for you.  Because of limited marketing funds relative to Align, it's marketed mostly to dentists.

"Old fashioned" braces still offer the best balance of cost, control and compliance. 

The verdict: Invisalign is a solid technology, with limitations that make it best for minor to moderate orthodontic cases.  Be prepared for the chance of a short round of braces (less than 6 months) for fine tuning at the end of your Invisalign treatment.

Damon Braces

The Product: Damon braces belong to a class of products known professionally as "self-ligating brackets."  (SLB's) Remember all those bright colored ties that go around each bracket?  SLB's, like the Damon system, do not need them.  Wires are secured with a clip, rather than rubber ties.

Their claims:  Damon braces straighten teeth faster than conventional braces, because there's less friction without the rubber ties.

The facts: SLB's, according to the orthodontists I've spoken to, do indeed move teeth faster.  This is especially a boon for adults, whose teeth are generally harder to move than teenagers.  There is a slight loss in lateral control, but that is easily dealt with in most cases.  SLB's do cost slightly more than rubber tied square brackets, but the shorter treatment times often offset the upfront expense.  Also, young children and teens may like the rainbow colored selection of rubber ties, and may not SLB's because they can't be decorated with multi-color ties.  Certain types of tooth movement may still require traditional square brackets.

Alternatives:  Besides Damon, there are other brands of SLB's, such as 3m Uniclip, that would yield comparable results, because they use comparable technology.

The verdict: SLB's are a welcome evolutionary improvement in braces which should speed up treatment times, and lower your costs.  Ask your orthodontist is self ligating brackets would be helpful in your case; do not second guess your doctor if he or she says they aren't--they have twelve years of higher education, and years of clinical experience.  Reading one or two articles on the internet does not make you smarter than an orthodontist.  (Believe me, I've tried)

Cerinate by Denmat

The product: Reinforced porcelain veneers, also called "no prep veneers" in our profession.

The claims: Beautiful, esthetic porcelain veneers without drilling or shots.  Completely reversible.

The facts: Cerinate can produce very good results, especially on people with small, narrow, or gappy teeth.  It can't correct grossly crowded teeth, or teeth that are too large.  You don't have to shave any enamel initially, but a small amount of finishing and polishing is required, so you will still hear the drill.  Like conventional veneers, if you don't create a smooth finish line, you'll have permanent gingivitis.  Most conventional veneers are fairly conservative, also don't require shots anyway.  No-prep veneers like Cerinate are reversible, but they require a highly, highly skilled dentist to remove them without damaging the enamel underneath.  Cerinate veneers are more expensive than average for veneers, but they also require less chair time, and no temporaries.  High end custom veneer labs can cost even more.

Alternatives: Conventional porcelain veneers can produces comparable results, often with very minor tooth reduction: we're talking 1/2 a milimeter off the front, a 1 milimeter off the top.  Other, lesser known dental labs (at least to the public) and dental manufacturers produce excellent porcelain products.  For example IPS's Empress and Glidewell's Vivaneers are two very successful veneer products that aren't heavily promoted to the public.  While not as strong, conventional, hand stacked (foil technique) porcelain is still reputed to give the best translucency...though not all cases require it.   In fact, too much translucency can create grey, dead looking teeth.  Everything in moderation...

The verdict: A very good product, which enables truly conservative dentistry (no removal of precious enamel at all), to be used in carefully selected cases by a conscientious dentist.  A good dentist will select the best restorative system for your specific case.

 Conclusion: Do Your Homework

You owe it to yourself to thoroughly research things, and talk them over with your dentist after doing your homework.  Visit lots of accredited sites, not just the manufacturer sponsored ones.  Make sure you make the right decisions.

Acknowledgements: We would like to thank (in alphabetical order) the following orthodontists for their knowledgable help:

• Chris Carter, Carter Orthodontics, Rancho Santa Margarita 
• John Eli, Eli Orthodontics, Lake Forest
• Richard Ting, Ting Orthodontics, Santa Margarita

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