From banking to making major purchases — such as homes and cars — more consumers than ever feel comfortable bypassing traditional providers to deal directly with online services. Unfortunately, this trend includes medical treatments that should require a doctor-patient relationship.

Case in point:  online teeth aligners . Also known as mail-order teeth aligners, these products are based on the popular  Invisalign® clear aligners that straighten and reposition teeth in place of traditional metal braces. Clear plastic aligners are favored among adults and teenagers because they typically achieve results faster, and allow a smile unobstructed by metal and rubber bands during the course of treatment.

But while Invisalign and similar brands require a visit to a participating licensed orthodontist for in-office treatment, direct-to-consumer companies take a different approach — and not a good one. The  American Dental Association (ADA) and The  American Association of Orthodontists (AAO) caution against using online companies, issuing statements that realigning teeth is a medical procedure and needs to be directly supervised by a trained medical professional — emphasizing that improper treatment can result in the loss of teeth and costly dental complications. 

Direct-to-consumer companies supply the patient with an at-home impression kit to take impressions of their teeth. Once mailed back to the company, they are — according to the company (claims of each such company are similar) — reviewed by its “network” of state-licensed doctors and orthodontists. A set of aligners are then made and sent to the patient, with instructions to wear them for a specific amount of time to begin correcting teeth. Patients may have online video consultations with “their” doctor during the course of treatment.

If you haven’t read between the lines as to all the  possibilities for such treatment to go wrong , we’ll walk you through them.

The first is the lack of a comprehensive examination prior to your fitting that would determine if your teeth and gums are healthy enough for orthodontic treatment. An online video chat doesn’t allow for a true in-person evaluation that would reveal such issues as tooth decay, root resorption or gum disease — all of which would need to be treated before you could be fitted for aligners. In addition, an orthodontist must evaluate your bones, which are affected by orthodontic treatment. This requires X-rays (which obviously can’t be taken via video conference call), specialized equipment and a specialist with years of training who can plan how teeth and bones will be moved during treatment, reviewing the process consistently.

In addition, some teeth may need to be extracted to make room for the other teeth to move and align properly according to the treatment plan. Only an in-person, in-office examination can determine this.

In fact, upon an in-person examination, an orthodontist may determine that clear aligners are not the right treatment for your particular case. Some issues can only be corrected by metal braces — but you wouldn’t know that if you signed up with an online company.

Now, let’s talk about those DIY impressions. Even dentists and experienced dental technicians often need to retake impressions. Whether taken for aligners or restorations such as bridges and crowns, making dental impressions is a skill for a professional, and needs to be performed in a dental office — not by the patient at home.

Another problem is that your  treatment can’t be adjusted properly along the way . Teeth move and realign at varying rates, and an orthodontist is the only one able to monitor progress and make the appropriate adjustments to ensure your teeth and surrounding structures are aligning according to the treatment plan — as well as to head off any complications that may be occuring. Again, a video call with the online company’s dentist isn’t adequate to make an accurate evaluation.

 24/7 Local Dentist isn’t the only practice to post articles about the risks of online aligners. Many other practices are issuing warnings, including Laster Orthodontics of Rolesville, NC.  Its blog post on this important topic is worth quoting at length.

“Another danger of mail order aligners is the lack of supervision during treatment. When you are treated with clear aligner therapy in an orthodontist’s office, they require routine appointments to make sure your teeth are moving at the safest, most efficient rate. An orthodontist will adjust your treatment plan as needed along the way, but you won’t get this when you go with DIY, home aligners. 

“With mail order aligners, teeth may move slower or faster than anticipated. You may develop gum disease or cavities during your treatment, with no orthodontist or dentist being able to treat you because they can’t see your teeth. These are both real concerns that a lack of supervision during orthodontic treatment brings to light. I see daily pictures of patients’ teeth that were damaged, and bite ruined by poorly designed mail order aligners that were done at home with no supervision. I would suggest to anyone that no treatment is much safer than unsupervised treatment. ” [emphasis ours]

Online companies heavily market themselves on social media and hire an army of influencers to amp up the hype. But what the Instagram posts of smiling, seemingly satisfied customers don’t reveal are the numerous complaints of botched outcomes and the additional pain and expense of correcting them — that is, if the damage isn’t permanent. Orthodontists report treating patients who come to them complaining of poorly fitting aligners that resulted in their teeth falling out, cuts to the gums, an inability to close their mouth or chew properly, and that their teeth were overall worse off after going through treatment with the online aligners.

Ironically, although many patients choose online aligners because they’re less expensive than conventional orthodontic treatment with Invisalign, the ultimate cost can be far greater.

Online teeth aligner companies want people to think of the orthodontist as a “middleman” who can be cut out of the process as an unnecessary expense. But keep in mind that orthodontic treatment is medical treatment that needs to be performed by a licensed professional who has the required training and credentials, and who follows ethical practices. Otherwise, patients cannot expect a good outcome or even safety. 

Contrary to what these companies imply or say outright, conventional orthodontic practices are not trying to profit as much as possible from patients. Our commitment is always to provide the highest level of care, giving each patient the benefit of our specialized education, professional training and experience. We are accountable to you for the quality of services we provide. Online companies are not.

Online services are tech platforms, not health providers. Such companies deny any responsibility by  claiming they function as a marketing company for dentists , connecting them to customers — although part of their marketing is that people can skip going to the dentist. It’s also common practice to require patients to sign a form before treatment agreeing that any problems or complications that occur are the patient’s responsibility. Their lack of accountability and responsibility to patient health should negate any perceived convenience in ordering orthodontic treatment with a few clicks. For treatment in any branch of medicine to truly be successful, a doctor-patient relationship based on trust, accountability, mutual respect and transparency is essential.