February, 1999

Tooth Cam

Update: Unfortunately, the “Tooth Cam” site is no longer on-line.

Steve Potter, a neurobiologist, accustomed to doing time-lapse photography of growing neurons, decided it would be an interesting twist to do the same with his orthodontic treatment, then, share it with the world. So before his first visit to the orthodontist, he bought a QuickCamTM and constructed a device to orient the camera. His web site features time-lapse “videos” of his treatment. An upclose and personal mouth morphing accompanied by a diary of his experiences, good and bad.

We felt that Steve Potter had something of import to say about his experience with orthodontics that we could all learn from. Here is a satisfied patient, but he is not without some criticisms of the way that care is delivered. We also decided to get his comments on some issues facing the profession such as “recycled brackets”. With the usual caveats of “the opinions expressed in the article are those of the author and do not necessarily represent those of the Orthodontic CYBERjournal or its staff”, read the interview below and then visit his web site, its worth the click!

Why did you seek care at this point of your life?

I grew up poor. No one in our family got braces, because we couldn’t afford them. My teeth were always too crowded, and every dentist I ever visited said I really ought to have braces. After 10 years of college and grad school, and three years as a junior post-doc, two years ago I was promoted to Senior Research Fellow at Caltech, and could finally afford treatment. them.

What did you think braces were like before you had them?

My brother got them at about age 25, and told me all about the process, the pain, and the progress. I was astonished how it transformed him. I also asked everyone I know if they had had them, and got lots of positive advice and encouragement. No one regretted it. So I went into the orthodontic office well informed and knowing pretty much what to expect.

What was as you expected, what wasn’t?

I didn’t expect all the little things to be so expensive, like $400 for a headgear that is just a strap and a couple wires! I also didn’t expect having to get a bite plate (they sprung that one on me after the treatment had already started) and having to learn how to speak again. As I mentioned above, I had been warned about the pain. But it seemed to be a little more than what they had warned me, at times. One thing surprised me: Not a single person has razzed me for being an older person with braces. All the comments have been positive.

What is the most difficult to put up with?

That dreadful bite plate, which I had to wear while eating. You can read all about how annoying it was in my ToothLog. (http://www.caltech.edu/~pinelab/TimeLapse/ToothCam/ToothLog.html) Sleeping with the headgear was also pretty annoying.

How did you chose your orthodontist?

It is the closest to my work, and I had already been going to the dentist there. It is a tooth factory basically, with a giant row of little rooms stretching off to infinity. The treatment there is terribly impersonal, but generally pretty good.

Since you are based in acedemia, what were your impressions of the educational level of orthodontists before seeking care ? after seeking care?

Interesting question. Well I knew they generally have a doctorate, so I assume they have gone through a fair amount of training. Of course, having recently spent 6 years in grad school myself, I felt like I had gone through more, and felt odd when they would say “Hi, I am Doctor So-and-so.” I didn’t have the nerve, but wanted to say “Hi, I am Doctor Potter. If you want me to call you Doctor, then you have to call me Doctor!”

How many years of college do you think the average orthodontist has and how would you compare the educational level of your orthodontist to a family or general dentist?

I would guess three years beyond a standard undergrad college degree. I think that they both have about the same amount of education.

Were you surprised at the analysis methods used etc.?

What surprised me was how casually everything was done. Perhaps that was because I had an older doctor, with years of experience. The helpers spent a lot of efforts making ‘study models’ and taking photos and x-rays, and it was not at all obvious to me that he had studied them at all, to develop his plan of action. It seems like he just gave them the quick once-over in between patients while I am sitting there in the ortho chair. When I got subsequent x-rays for my dental checkups, I assumed he would take great interest in them, and look to see how the roots were moving past each other, but no. I guess he had seen it all before, and my treatment was pretty routine to him.

How do you perceive the use of technology in your treatment planning and care?

It is prehistoric and barbaric. But it does work. Except for the fact that my brackets were glued to my teeth instead of banded, the treatment was identical to that of patients a generation ago. And this is true for the younger orthodontists at the fairly modern tooth factory I go to as well. Over in the dentistry side of the office, they are using sandblasting to drill teeth, and fiber-optic video cameras to allow the patients to see the cavities up close and personal. They have all sorts of new polymers that are light-cured, and new ways of capping chipped teeth. But on the ortho side, I saw not a single modern invention. I think it would be easy for them to do what I did, that is, take a picture of the teeth at every ortho visit, from several angles, to make a time-lapse movie of the progress. (See my ToothMovie Project: http://www.caltech.edu/~pinelab/TimeLapse/ToothCam/toothcam.html) Patients would find this very encouraging, and the doctors might even learn something or be able to give more efective treatment.

Most orthodontists feel that the appliances are “amazingly sophisticated”. Obviously this is not so apparent to the wearer.

Perhaps there are “amazingly sophisticated” appliances out there, but I have never seen them. Let’s talk about my headgear. It was not very adjustable, the tension is controlled by adding extra rubber bands, which age every day and have to be replaced. It was terribly uncomfortable if not impossible for me to sleep on my side, which I prefer. The little pads on this “device” did not weather well, and no replacement of the pads was possible. It should have been continuoulsy adjustable, never need new tensioning devices, preferably springs, which do not dissolve in LA smog like elastics, have replaceable pads, have flat metal instead of round wires so that I could lay on my side etc., etc. The bite plane was equally crude. The doc had to keep grinding it away an my teeth moved, to the point where it was almost ineffective. There has got to be a better way ( and perhaps there is ).

Were you concerned about the social impact of having braces as an adult?

I was, and it turned out not to be an issue at all. I guess this kind of thing is a much bigger deal for teenagers. It only comes up when I brush my teeth in odd places, which I do a lot.

On another level: How would you feel about having “recycled” braces?

I assume you are referring to using brackets over again? I would be shocked and offended for several reasons:

1. I paid a fortune for each one of those, and deserve to keep them. Any orthodontist that would use them over I would view as being chintzy.
2. As a biologist, I know of several pathogens that are resistant to autoclaving (such as prions), and would worry about catching something from the previous owner.
3. It is a huge amount of work re-gluing a broken bracket, and to prepare the surface of a used bracket to make the best bond (grinding old glue off) would certainly be more work than it is worth, and would cause them to do a poor job and have them break off again. I doubt that archwires could be reused, since they are cut and bent to fit an individual’s mouth.

Did you have any interest in tooth colored braces? Lingual (tongue side braces)?

These are more expensive and/or slower treatment, so not worth it to me. If I were an actor or a model, I may have considered it. The standard braces are fine for me, and in fact, I usually even had some colorful ligatures, as seen in the ToothMovie.

What did your treatment cost and what methods of payment were you offered?

I think the total bill came out to about 4K, of which my dental insurance paid $1300. They had a monthly plan, but I decided to pay with my credit card in full for a substantial savings.

How do you feel about the cost? How does it compare to other expenses in your life, such as health care in general, rent, or entertainment?

The cost for treatment was reasonable. Appliances and study models were way overpriced. It is a luxury to have straight teeth, not a right. Thus I look at it like any other luxury. It is a good way to soak up excess income.

Thanks for this opportunity to share my opinions and to allow my ToothMovie Project to be appreciated by orthodontists.
Steve Potter

Steve Potter, Doctor of Philosophy
Senior Research Fellow
156-29 Division of Biology
California Institute of Technology Pasadena, CA 91125