Health Times reporter Xu Shiyu Qiu Yue
Inside the dental clinic, patients receive treatment. Photo by Xinhua News Agency reporter Wang Fei
Patients in many places reflect that the orthodontic market is mixed
"Before orthodontics, my face was a little crooked, my teeth were not aligned, and two small tiger teeth protruded. After orthodontics, I developed periodontitis and had a neat mouth full of discarded teeth. Xiao Xu told the Health Times reporter.
Ms. Sun of Shenzhen, Guangdong Province, chose a Chinese medicine hospital in Shenzhen for orthodontics because of the uneven midline of her teeth. "Three years later, the hospital changed three dentists for me, and when I went to other hospitals for face-to-face treatment, I found that the brackets were all crooked, and the doctor asked me why I chose an irregular orthodontologist. I failed orthodontics, and many hospitals were afraid to take over and continue to treat me. ”
"I want to correct beauty." The small one in Guiyang, Guizhou, began orthodontics from the age of 19, and within four years of correction, four or five orthodontic doctors were replaced, the alveolar bone was moderately absorbed, and the temporomandibular joint was worn.
According to the statistics of China Insight Consulting, the number of orthodontic cases in mainland China has increased from 1.6 million in 2015 to 3.1 million in 2020, and it is expected to reach 9.5 million cases in 2030.
From March 28 to April 12, Health Times reporters visited a number of dental clinics in Beijing and found that invisible appliances such as Invisalign and Angelalign have become products promoted by dental clinics. The reporter's experience found that shooting dental CT, oral scans, and dentist consultations are all free services. The doctor's consultation lasted only ten minutes, but the conversation with the operations staff lasted more than an hour. The reporter found in the offline investigation that the price of a pair of invisible appliances ranged from 5,000 to 100,000. Some dental clinics attract consumers with low prices, promotions, and complimentary tooth extraction and filling services.
A number of orthodontic experts revealed that the orthodontic industry has now become a capital-driven market, on the one hand, the charge is rising; on the other hand, a large number of orthodontic doctors have not undergone professional training, general practitioners have turned to orthodontics, and even invisible correction with higher technical requirements, resulting in a mixture of fish in the orthodontic market.
Professor Xu Tianmin, deputy secretary-general of the Chinese Stomatological Association and doctoral supervisor of the Department of Orthodontics of peking University School of Stomatology, said that after the emergence of the invisible appliance without brackets, because it greatly reduced the technical difficulty of the doctor's clinical operation, the traditional fixed orthosis was regularly changed by the doctor for the patient to be forced by the patient to wear braces by the patient himself and replace a new pair of braces every two weeks or so, so that many non-orthodontic doctors, after short-term operation training, dare to engage in orthodontic work. However, the contribution of manual operation is only a small part of a successful orthodontic treatment, invisible orthodontics can not replace the diagnosis of orthodontists, etiology analysis, tooth extraction and non-extraction judgment, mechanical design of moving teeth, adjustment of the program in treatment, etc., without systematic orthodontic knowledge it is impossible to carry out successful orthodontic treatment. This is one of the reasons why the orthodontic complaint rate has remained high in recent years.
"At present, there are three problems in the orthodontic market, first, some doctors who have not received education in the orthodontic system, and even those who do not have the qualification certificate of oral practitioners are carrying out unreasonable and irregular orthodontic treatment; second, online shopping platforms sell 'DIY braces' to the masses for self-orthodontic treatment; third, there is a phenomenon of excessive medical treatment in the field of early correction." Zhao Zhihe, director of the Professorial Committee of the West China School of Stomatology of Sichuan University, introduced that these problems may lead to an increased risk of orthodontic failure in patients.
Less than 0.7 orthodontists per 100,000 people
According to the Fourth National Oral Health Epidemiological Survey Report released by the National Health Commission in 2017, the prevalence of malocclusion in China is 74%. According to this estimate, the number of people corresponding to malocclusion deformity exceeds 1 billion people. However, the number of orthodontic cases in China in 2020 was only 3.1 million, and the penetration rate was less than 0.3%. This means that the future development potential of China's orthodontic market is very huge.
In stark contrast to the huge demand, there is a serious shortage of orthodontic specialists. Professor Jin Zuolin, chairman of the Orthodontic Professional Committee of the Chinese Stomatological Association and director of the Department of Orthodontics of the School of Stomatology of the Air Force Military Medical University, told the Health Times reporter, "The professional orthodontic doctors recognized by the Orthodontics Committee are either graduates of orthodontic graduate students of stomatological colleges, or have been trained in large-scale tertiary hospitals for more than one year and worked for more than three years, and there are only nearly 10,000 orthodontic doctors who meet these basic conditions." ”
However, in the view of Professor Zhou Yanheng, executive member of the World Orthodontic Union (WFO) and doctoral supervisor of Peking University Stomatological Hospital, this number is even lower, and there may be only three to five thousand qualified orthodontic doctors in the mainland. Taking Peking University as an example, there are less than 20 graduates of orthodontics every year, which is far from enough to meet the market's demand for orthodontics.
According to the data provided to reporters by the Orthodontic Professional Committee of the Chinese Stomatological Association, there are less than 10,000 professional orthodontists in the mainland, which is equivalent to less than 0.7 orthodontic doctors per 100,000 people. According to the 2018 statistics of the American Dental Association (ADA), there are 10,658 orthodontists in the United States, which is equivalent to 3.27 orthodontists per 100,000 people, which is 4.67 times that of the mainland.
"Orthodontics is a very special sub-discipline in stomatology, and the vast majority of stomatology students do not require mastery of orthodontics at the undergraduate level." Xu Tianmin introduced that professional orthodontists can become orthodontic specialists after completing the undergraduate degree in stomatology, and then studying for 3 years of orthodontic master's degree students, or 6 years of orthodontic doctoral students. In each class of undergraduates, only about 10% of graduates will choose to study orthodontics, "you can imagine how big the demand gap is." ”
The reporter's inquiry found that at present, there is no provision for the development of orthodontic clinical work to require additional qualification certificates, and there is no strict entry threshold, and doctors holding dental practitioner qualification certificates can carry out orthodontic treatment. Zhao Zhihe said that at present, most orthodontists are after graduating from college, through the further training of orthodontics, participating in the training of orthodontics series of courses, and gradually reaching the level of orthodontic specialists.
Zhang Wenbo, a senior partner at Beijing Jundu Shanghai Law Firm and director of the Legal Department of Life Sciences and Health Care, told the Health Times reporter that the orthodontic doctors in some clinics are not from orthodontics, have not undergone professional orthodontic training, do not have oral medicine education background, and choose certain ways to "package" their qualifications and academic qualifications. In this regard, consumers need to be careful to distinguish between some "expert names" and "overseas education".
Zhou Yanheng said that invisible orthodontics is a new type of orthodontic technology and an important "technological revolution" in the orthodontic industry. At the same time, invisible appliances are only a tool, and professional orthodontists with rich clinical experience are the key to the success of orthodontic treatment.
Orthodontics is a medical act, not a cosmetic act
Many of the above experts have called for the establishment of a specialist system as soon as possible, the implementation of orthodontic doctor access certification system, so that the people can find professional orthodontic doctors on professional websites, to protect the medical rights and interests of patients. At the same time, we will further promote the training of orthodontic doctors and let professional doctors dominate the orthodontic industry and market.
"Orthodontic treatment is not as simple as taking pictures of the teeth, lining the teeth on the computer, and then using software to automatically generate dozens of molds." Xu Tianmin introduced to the Health Times reporter that orthodontics is a very professional process, from the initial acquisition of patient teeth model, X-ray, taking facial and maxillofacial photos, to the doctor to make a complete treatment plan for the patient, including whether to extract teeth, what teeth to extract, the order of moving teeth, the amount of tooth movement, what technology is more appropriate, etc., all need to go through a series of professional evaluation and design, after the patient wears the orthosis, it also needs to be continuously adjusted according to the actual situation.
"Because the invisible orthosis is a series of braces that are prefabricated for about two years at a time, although it seems to reduce the difficulty of operation of orthodontists, it actually puts forward higher requirements for the expertise and experience of orthodontists in the design stage, and the patient's cooperation requirements are also higher." We must anticipate in advance when designing the plan for various situations that may occur in these 2 to 3 years, even professional orthodontists are difficult to be thorough, so in the follow-up follow-up diagnosis, we must also monitor the movement effect of the patient's teeth at any time, once the braces and the tooth surface do not fit, we must try to take various remedial measures, if necessary, restart treatment. At this point, the fixed orthosis has a stronger ability to control the tooth position, and it is correcting the deviation during the monthly follow-up, and there is basically no problem of restart, so it is more efficient for difficult and complex cases. Xu Tianmin said.
Jin Zuolin told the Health Times reporter that orthodontic doctors pay more attention to function, and patients pay more attention to beauty. Qualified, standardized orthodontic doctors will fully inform the risks of orthodontics, emphasizing that orthodontics is a medical act, not a simple cosmetic act.
"The pursuit of beauty is beyond reproach, and the public's pursuit of beauty can promote orthodontists to continuously improve their skills and self-improvement." However, orthodontics must be done by professional doctors in order to have a good corrective effect. Zhou Yanheng said.
