Caveat Emptor-The Dilemma of Direct-To-Consumer Aligners

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

In the May 2024 edition of the Journal of the American Dental Association (JADA 155(5)), there is an editorial that caught my attention this month.

The direct-to-consumer aligner industry represents a paradigm shift in orthodontic care delivery. These companies offer clear dental aligners directly to patients, typically bypassing the traditional orthodontist’s office visit model. The allure of DTC aligners stems primarily from such factors as convenience, cost-effectiveness and adept marketing strategies. DTC aligner kits are conveniently shipped directly to users homes and are marketed as a more affordable alternative to traditional orthodontic procedures. Diagnosis often hinges on patient submitted photographs and self-administered impressions with a lack of detailed medical history. The absence of direct oversight by a trained dentist or orthodontist gives rise to concerns of erroneous treatment and misdiagnoses and thus, improper execution of treatment. The DTC industry’s growth is also due to its aggressive marketing campaigns levering influential celebrity endorsements.

The health implications of unsupervised orthodontic treatment can be profound. The risks range from mild discomfort to serious oral health issues, including periodontal disease acceleration (loss of bone supporting the teeth) and tooth mobility and loss as well as temporomandibular joint disorders.

A major player in the DTC aligner market recently went into bankruptcy leaving their clients holding the bag for incomplete treatment and poor outcomes. Economically, direct-to-consumers aligners may appeal to the cost-conscious demographic; however, patients must be educated to recognize the potential pitfall and hidden costs, both financial and healthwise, of the DTC aligner model.  

Spring Lake Dental Group has a board certified orthodontist on staff (Dr. Thorpe Whitehead) who is adept at diagnosing and treating malocclusions. The intricate planning he does with his record appointment allows him to see a reasonable solution to orthodontic challenges. For the problem can sometimes be skeletal and sometimes dental or sometimes both. Treating a growing dentition is different than treating an adult dentition.  Appreciating working in a healthy mouth as opposed to someone with active decay, gingivitis or periodontal disease or with TM disorders and/or symptoms requires his full attention is achieving a healthy, esthetic, functional smile.

Taking your own impressions is not an easy task and is fraught with inherent error. Moving teeth in a diseased periodontium only accelerates the loss of attachment and potentially leads to tooth loss.

I marvel that my established professional association is somewhat powerless to stop this infringement on our ability to protect our patient’s health. But my profession has been under siege from many sides as we try to fight back on the fronts that invade on our ability to keep a strong relationship with our patients. As patients and clinicians navigate this intricate maze of DTC aligner marketing, the age-old adage remains starkly relevant, caveat emptor (buyer beware).