What You Should Tell Your Patients About Mail-Order Orthodontics

Emilia Taneva, DDS, MS, ABO


Many patients have come to my office for retreatment after having mail-order dental aligners placed in their mouths. These patients weren’t properly diagnosed, underlying conditions and pathologies weren’t identified, and the necessary type of treatment wasn’t provided. 

People often are lured in by the low price, which can be around $2,000. By comparison, traditional metal braces or full clear aligner treatments typically run from $5,000 to $8,000, although both have options for mild alignment issues that are less costly. In general, mail-order aligners are for very simple issues. 

In my own practice, I have seen a sharp increase in adults seeking orthodontic care, with 30% of my patients being adults. They either never had the chance to improve their smile as a child or they are seeking retreatment due to poor retainer wear. 

Because the motivating factor with adults in many situations is cosmetic, I can see how the lure of mail-order aligners would be attractive to adults who are on a budget or who simply think it is more convenient to use them for their teeth. Clear aligners appear invisible, and many adults opt for them over metal braces. 

However, there is a fundamental misunderstanding in the market. Many consumers are led to believe that mail-order clear aligners are no different from the clear aligners you would get from an orthodontist.

The biggest and most concerning difference is that these mail-order aligner companies often miss or do not diagnose dental pathologies at all prior to treatment. More importantly, the treatment is not cleared, and, once initiated, it is not regularly supervised by a dentist or an orthodontist. With an undiagnosed disease or issue, these aligners could worsen the situation, costing the patient more in the long run.

Moving teeth when there is an active dental disease (tooth decay, tooth sensitivity, broken teeth, extra or missing teeth, teeth stuck inside the bone, oral lesions, painful chewing or cancer) or in periodontally compromised patients (unhealthy supporting gum tissues and bones; red, swollen, tender, or bleeding gums) has led to many patients losing their teeth when undergoing mail-order aligner treatment.

According to the American Association of Orthodontics, nearly 13% of its member orthodontists are even seeing patients who have tried do-it-yourself (DIY) teeth straightening—using rubber bands, dental floss, and homemade retainers instead of seeing an orthodontist—with some of those attempts causing irreparable damage.

In the end, mail-order and DIY patients may need to go through additional, extensive dental work at a much greater expense to fix a bigger problem than a few crooked front teeth. Once the damage is done, the involvement of a dentist and several other dental specialists is required.

Teeth may need to be taken out and replaced with implants. Periodontal surgery may be indicated. Most commonly, full retreatment with clear aligners or upper and lower braces is initiated because the teeth were not straightened, and the bite issue was not properly addressed, or it was made worse.

An orthodontist is a dentist who chooses to go through additional training, a full-time residency program for two to three years, focusing his or her knowledge on the safe movement of teeth and the development of the jaw, face, and profile.

Orthodontists limit their practice to providing only orthodontic treatment, including the prevention, diagnosis, and treatment of facial and dental irregularities. No mail-order dental aligner companies of DIY efforts could substitute those rigorous 10 to 11 years of education and training.

Even most dentists who offer orthodontic procedures simply don’t have as much experience or knowledge as an orthodontist. Although orthodontics can be cost prohibitive, there are a lot of financing options. Patients can be quoted as little as $1,500 with mild alignment issues. The more severe the case and the longer the treatment time, the higher the cost might be. 

Dr. Taneva was a clinical assistant professor with the University of Illinois at Chicago Department of Orthodontics between 2014 and 2018. She is a Board Certified Orthodontist, also known as a Diplomate of the American Board of Orthodontics. She completed her postdoctoral specialty training in orthodontics at the University of Illinois at Chicago and works as an orthodontist in several locations in Chicagoland. In her spare time, she travels the globe, documenting her adventures on her lifestyle blog, BubblyMoments.com, and at her Instagram handle @Bubbly.Moments.

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