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DTC Customers Seeking Retreatment in Orthodontic Offices


The survey of AAO member orthodontists found that majority of respondents reported patients seeking retreatment in their orthodontic offices when DTC treatment didn’t include an in-person exam before starting. 

Mail-order orthodontic treatment that is promoted as “easy” and “affordable” is leading to many patients seeking help in-office by trained specialists for retreatment after attempting to move teeth and bone using clear aligners at home, according to findings released by the American Association of Orthodontists (AAO). In a survey of its member orthodontists, 77% of respondents said they have seen patients come into their offices for retreatment after mail-order or “DTC” treatment that did not include an in-person examination prior to starting.

“It sounds almost too good to be true: the convenience of orthodontic treatment without ever having to leave your home or see an orthodontist or dentist in person,” said Ken Dillehay, DDS, MS, president of the AAO. “Far too many patients are finding out what the scientific evidence makes clear: that undergoing orthodontic treatment without first being examined in-person by an orthodontist or dentist can lead to irreversible harm.”

Many mail-order orthodontic companies portray treatment (especially straightening only the front teeth) as only “cosmetic.” But the research, according to the AAO, clearly shows that moving teeth is a medical procedure that involves complex biological processes and should be monitored in-person by a trained dental professional. Yet with some companies offering orthodontic treatment through clear aligners mailed directly to the patient, the patient is never examined in-person by the supervising dentist or orthodontist.

The AAO released the findings as World Orthodontic Health Day approaches, May 15, to highlight the health and financial risks causing concern among members of the profession. The survey—conducted Nov. 24, 2021, through Jan. 10, 2022—also showed 61% of respondents see new retreatment patients at least quarterly. A total of 260 AAO members responded with a margin of error of +/- 6 points.

The AAO survey also showed the vast majority of member orthodontists allow patients to pay for treatment through interest-free monthly payments. Results showed 97% of AAO member respondents offer payment plans, with 90% of those offering plans not including financing fees or charging interest. By contrast, mail-order companies advertising payment plans often charge interest on monthly payments up to 18% as part of their business model.

As the AAO points out, the cost of mail-order orthodontic treatment can include paying high interest rates on treatment fees for years. This is something patients may not be aware of. Interest-free payments make treatment more affordable for those who prefer to spread the cost out over time, and this is offered by the overwhelming majority of orthodontists caring for patients in person. While aspects of mail-order orthodontics might sound tempting, patients need to know the true range of expenses before making a treatment decision, says the AAO.

Health equity and access to care remain a priority for the AAO, which advocates for making orthodontic treatment accessible—including use of teledentistry when combined with necessary in-person treatment– while maintaining the highest standard of care to protect patients. The AAO also says it advocates for policies that break through geographic, financial, and convenience barriers while maintaining the standard of care.

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