Miami Invisalign AlignersRecently I wrote an article about how orthodontic treatment is not a DIY project. And then lo and behold, Today Show hosts used the DIY term in announcing this segment about companies offering mail-order orthodontic treatment.

Companies have emerged that offer “mail-order braces” with the promise of providing a teeth alignment system that is “designed completely around your schedule, from the comfort of your home.” They claim patients have 24-hour access to support from “affiliated licensed dentists and orthodontists.”

While the Today show story says this isn’t exactly DIY orthodontic treatment, it comes pretty close, in my opinion. Here’s how these programs work:

  1. You take a smile assessment, which appears to involve taking some photos of your teeth with your smart phone.
  2. These photos are reviewed, and if you’re determined to be a candidate, you can purchase a kit so you can take your own impressions of your teeth.
  3. You may need to watch a how-to video before you mix the ingredients to take those impressions.
  4. You mail back your impressions so they can be turned into a three-dimensional model and used to create your aligner trays.
  5. The company sends you a set of sample trays that you must confirm fit properly. Essentially, this tests the quality of your impression.
  6. Once you confirm proper fit, the company sends you your aligners.

The major selling point appears to be cost. The cost of conventional orthodontic treatment overseen by an orthodontist varies depending on each patient’s specific case, but the Journal of Clinical Orthodontics estimated the average cost of braces in 2012 to be $5,200. Invisalign and ClearCorrect are perhaps the most well-known companies that align teeth through a system of clear plastic aligners, and their costs average $4,000 – $6,000, according to a New York Times article. These new mail-order systems advertise prices that range from about $1,000 to $3,000, depending upon the severity of your case.

A representative from one company in the Today segment says its target market is adult patients who may have worn braces previously, but they failed to continue wearing their retainers and they have some orthodontic relapse they wish to correct. However, they go on to say they have patients as young as age 15.

The Benefit of an In-office Orthodontic Consultation

It’s best to describe what happens during an initial orthodontic consultation to explain the difference between seeking treatment under the guidance of a board certified orthodontist in or near your city, as opposed to using a mail-order alignment system.

Your initial visit to my office is free, and it gives you a chance to meet me and learn about my credentials. After graduating from dental school and practicing restorative dentistry for a short time, I went to the University of Connecticut to serve as the chief resident and earn a postdoctoral Certificate in Orthodontics and a Master of Dental Science degree. I’m also certified through the American Board of Orthodontics.

That first visit also enables you to meet our friendly, expert staff who will participate in your treatment. Orthodontic treatment is a commitment, so this first visit is an opportunity to begin building a rapport with the people you’ll see periodically over the course of treatment.

This first appointment takes about 60 minutes, and during your consultation we will:

  • Gather a complete dental history
  • Take a complete set of digital panoramic X-rays, as well as photographs of your face, teeth and smile using technologically advanced, high-quality digital equipment
  • Offer you an opportunity to have your digital X-rays reviewed by a radiologist to determine if any unseen issues exist that might alter the treatment recommendation
  • Complete an oral examination that assesses your bite, and the relationship between the upper and lower jaws
  • Listen to your needs and goals
  • Explain whether treatment is needed, or if a monitoring plan should be implemented so we can determine if/when treatment should begin
  • Answer any questions or concerns that you have about your orthodontic treatment
  • Offer a diagnosis and help you decide on a treatment plan to improve your bite and give you a beautiful smile
  • Discuss treatment costs, insurance and payment plans
  • Take impressions of your teeth if you decide to move forward with braces or Invisalign

Problem Areas for Mail-Order Treatment

While on one hand I can admire the entrepreneurial nature of these companies who are trying to offer a cheaper orthodontic treatment solution, there’s no escaping the fact that there are some potentially significant setbacks to this treatment method.

Your smile isn’t a freestanding feature. I consider so many other factors when creating a treatment plan, including the patient’s facial characteristics and bone structure. I worry about mail-order treatment that only considers the teeth. And there also is the potential that a significant oral health issue that might affect the treatment outcome could be overlooked if the treatment coordinators only use DIY photographs and teeth impressions to develop treatment plans.

If you have a question or concern about your treatment path, one of these companies suggests that you should take photos of your teeth and email them to your consultant. Because this consultant never sees you in person, he or she will always have to rely on your ability to adequately capture your own digital images of your problem areas. That seems risky to me.

The far-removed nature of this treatment in general is bothersome to me. I firmly believe in the value of seeing a patient’s teeth in real life, observing bite function, and physically seeing how the teeth come together.

It’s also important to be seen in person by an orthodontist prior to using an aligner system to determine if you have cavities that need to be filled, or if you have gum infection that might be made worse during orthodontic treatment.

I can’t imagine feeling confident in a treatment plan when I’ve never even seen the patient in person.

Cost Savings

All of the news stories on this new phenomenon seem to place cost savings as the primary reason for using this mail-order treatment option. I would advise to avoid making a decision based solely on cost. There often is a great deal of truth behind the saying, “You get what you pay for.”

At least one of these companies says it doesn’t accept dental insurance. In addition to accepting and filing insurance paperwork on your behalf, we will work with you to figure out a payment plan that fits your budget, and you will not be surprised with any extra fees. Our treatment coordinator will offer you multiple financial arrangements including interest-free financing for qualified applicants through CareCredit. We also offer a discount if you decide to pay for your treatment in full.

I hope this article gives you a broader picture of the options available to you. Please call my office if you would like to schedule an orthodontic consultation.