Mail Order Aligners

Major questions have erupted over a mail order orthodontics business model that takes dentists out of the equation in providing clear aligners. The process involves the customer making a bite cast at home. The impression is then reviewed online by a dentist and a series of aligners delivered by mail at a fraction of the cost of conventional orthodontic treatment.

Critics say orthodontics is an art and science that requires expert assessment by an orthodontist in person, and that with mail order aligners, there’s no clinical examination or direct contact by an orthodontist. Providers of direct-to-consumer aligners say orthodontists are misleading the public to keep the cost of orthodontic treatment artificially high, and court battles are looming over allegations of libel.

Direct Supervision Needed, Say Dentists

The American Association of Orthodontists (AAO) says people considering getting clear aligners – or conventional braces – should only seek treatment under the direct supervision of an orthodontist.

The organization warns that “do-it-yourself” orthodontic treatment can result in lasting damage, and it says orthodontic treatment is a medical service, not a device or product. The AAO has lodged complaints in multiple states against one mail order orthodontic company, alleging the business is creating medical risks by bypassing the orthodontic office.

It has warned of what it describes as the increased likelihood of harm with mail order aligners, in the absence of an initial examination and ongoing supervision by an orthodontist. The AAO said almost 13 percent of its members were treating patients who had tried “do-it-yourself” teeth straightening and added that some of these attempts had caused irreparable damage.

The country’s biggest dental organization, the American Dental Association (ADA), has issued a formal resolution against “do-it-yourself” orthodontics, warning of the “potential harm” to patients. The policy statement says orthodontists should be in charge of the diagnosis and treatment of patients to ensure safe delivery of appropriate care.

How Mail Order Teeth Aligners Work

  1. You complete a questionnaire about your gums and teeth and upload photos.
  2. You receive an at-home kit to take an impression of your mouth or get a 3D scan.
  3. A state-licensed orthodontist or dentist prescribes your treatment plan, unless your case is complex, in which case you're referred for in-office care.
  4. You start to receive a set of aligners each month over about five months.
  5. At the end of the treatment, you get a retainer to help keep your teeth straight.

Dentists Stick to Their Guns

The American Dental Association says supervision by a licensed orthodontist is necessary for all stages of orthodontic treatment. Dr. Craig Ratner, chair of the ADA Council on Dental Practice, said it was necessary to educate patients about potential pitfalls of self-managed orthodontic treatment and explain the importance of dental professionals being in charge of diagnosing and treating patients. The Food and Drug Administration (FDA) regards aligners as prescription appliances but does not regulate the practice of orthodontics or dentistry, which is governed by states and their dental boards.

“Risk of Permanent Damage”

Writing for HuffPost (formerly The Huffington Post) in 2015, author and orthodontist Richard Schechtman said mail order orthodontics could not address important issues such as bite function problems or the health of the gums and jaw joints. He said bypassing the orthodontist resulted in the patient coming to conclusions based on what they perceived as important, not was medically appropriate. Only a certified orthodontist had the skills to decide what was best for a patient, he said. Schechtman added that “do-it-yourself” orthodontic treatment posed a risk of permanent damage to teeth, including bone loss and root shortening.

Benefits of In-Office Treatment by an Expert

One problem with direct-to-consumer orthodontics is that you might not know whether you’re dealing with an orthodontist or a general dentist. An orthodontist undergoes two or more years of further training after dental school, giving them greater expertise in fixing crooked teeth and misaligned jaws. Invisalign was designed specifically for treatment by orthodontists, but general dentists successfully sued for the right to use the system.

Another issue is that clear aligners aren’t suitable for all orthodontic issues, and a specialist orthodontic practice can offer alternatives such as ceramic or metal braces. Many well-trained general dentists can treat simple orthodontic cases but there are multiple advantages of finding a certified orthodontist, who will provide expert in-practice treatment and aftercare and advise you on oral hygiene at home to ensure your teeth remain straight and healthy. At OMG Smiles, we take your teeth seriously and provide the latest in orthodontic options. Contact us today for more information.