In a research brief published in October 2014, the American Dental Association identified finances as the biggest barrier to dental care.

Tech startups have entered the orthodontic field to provide cheaper teeth alignment options for consumers. Let’s look at how a few of them deliver treatment, as well as the pitfalls to this treatment method.

There’s an App for That

Want straighter teeth? A tech startup that launched in January 2018 offers an app for administering orthodontic treatment. Users download the app to start their remote evaluation, which involves answering several questions and taking selfies of their teeth.

Orthodontists affiliated with the company evaluate the information and make a determination on whether the user is a good candidate for this particular treatment. Then an appointment is scheduled to take a scan of the teeth and create a prescription for a series of aligners, which are similar in appearance to Invisalign aligners. This in-person appointment takes place at an orthodontist’s office in San Francisco, California. Those who use this treatment method must be able to travel to San Francisco for the initial appointment and one to two follow-up appointments. The follow-up visits happen at the end of treatment to evaluate and scan the teeth one last time for a retainer, which is mailed to you.

The app sends reminders of when to change aligners and submit updated selfies of the teeth.

Direct-to-Consumer Aligners

Another startup offers a path to teeth alignment that costs “up to 65 percent less” than competitors. It is designed for minor to moderate alignment correction. It begins with a “modeling kit” where patients take their own impressions of their teeth, as well as some selfies.

Once that diagnostic information is received, the company schedules a remote evaluation with a participating orthodontist to determine whether the treatment will address the patient’s needs.

A prescription is created and aligners are mailed directly to the patient for treatment.


A startup that began in 2014 has drawn some consternation from the American Association of Orthodontists for the way it markets itself, and other violations, according to TechCrunch. This business model uses “teledentistry to virtually connect licensed dentists and orthodontists with people who want to straighten their teeth.”

Patients take their own impressions of their teeth before beginning treatment, or they go to a location where the impressions are taken. A 3D image of the teeth is created from the impression and is reviewed by a dental professional.

Patients are sent a preview of what their smile will look like at the end of treatment, as well as their aligners. Once treatment is complete, the patient may choose to purchase a set of retainers.

The Benefits of In-Person Treatment

What do all of these startups have in common? An in-person visit is involved at some point.

In light of the oral health benefits that are associated with orthodontic treatment, it’s great that there are companies willing to step up and attempt to make it attainable for more people. But as I mentioned on this blog in a previous post about mail-order braces, there are some key differences between these options and an in-office orthodontic consultation. It’s time to revisit that.

In addition to requiring a financial investment, high quality orthodontic treatment requires an investment of your time. An in-person orthodontic evaluation is the best way for an orthodontist to comprehensively evaluate your teeth to create a treatment plan.

Do you want to leave the quality of your orthodontic treatment to your own ability to take good selfies and to make a usable impression of your teeth, or would you rather entrust those important tasks to trained professionals who do that dozens of times a day?

Some of these startups’ websites are unclear about X-rays, but these are important diagnostic tools when planning orthodontic treatment. When you undergo an orthodontic evaluation at our office, our team takes a full set of digital panoramic X-rays. You are given an opportunity to have those X-rays reviewed by a radiologist to determine if you have any issues that might call for a change in our treatment approach.

We also evaluate the relationship between your upper and lower jaws, and the way your teeth fit together. In my opinion, it is far better to see that in real life instead of in a photo taken with a camera phone.

Retainers are for Life

Another area of concern with at least one of these companies is that they make retainers appear to be an option for patients to take or leave. If they want them at the end of treatment, they pay extra for them.

The retention phase is as important to your orthodontic treatment as brackets and arch wires or plastic aligners. Teeth are able to be moved into ideal alignment, but their natural tendency often is to return to their old positions once active treatment ends. Retainers help maintain the ideal alignment we created during treatment.

Retainers need to be a part of your life for the rest of your life to prevent relapse. We instruct our patients to wear their retainers all the time initially, and slowly allow them to taper back. We tell patients that once their retention phase is complete, they should continue to wear the retainers nightly, or at least several nights a week.

If you ever pop in your retainers and you feel pressure on your teeth, that is a sign that your teeth have shifted slightly. We recommend that you wear your retainers nightly again until you no longer feel pressure when placing them over your teeth.

Professional Dental and Orthodontic Organizations Oppose DIY Treatment

You might be thinking that of course I oppose mail-order orthodontic treatment, but two important dental organizations also have voiced their concerns with these methods. The American Dental Association House of Delegates passed a policy in November 2017 that said it discourages “the practice of do-it-yourself orthodontics because of the potential for harm to patients.”

The policy voices support of keeping dentists and orthodontists in charge of diagnosing and treating patients to ensure that orthodontic care is safe and appropriate for each patient.

The resolution states that the Association “believes that supervision by a licensed dentist is necessary for all phases of orthodontic treatment including oral examinations, periodontal examinations, radiographic examinations, study models of scans of the mouth, treatment planning and prescriptions, periodic progress assessments and final assessments with stabilizing measures.”

Kevin Dillard, general counsel for the AAO, said the AAO has filed complaints with dental boards and attorneys general in numerous states that allege some of these mail-order orthodontic treatment companies are violating laws designed to protect the public because they are performing medical work that many state laws reserve for licensed professionals. That includes taking impressions and delivering dental appliances to patients.

Ways to Pay

I get that orthodontic treatment can be costly for some. We want to make treatment available to all who need it, and we work with our patients to develop payment plans that fit their budget. We also offer interest-free financing through CareCredit. Our staff is happy to file paperwork on your behalf to help you make the most of your dental insurance benefits.

Please call our office today if you would like to learn more.

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