Would you do your own plastic surgery? If you broke your leg, would you try to set the bone yourself?  How about your own cardiac surgery? Why would you think that you could be your own dentist or orthodontist?

Sounds crazy, but thousands of people in this country are spending millions of dollars so they can perform their own tooth alignment. That’s right, they are paying companies hundreds and even thousands of dollars so they can be their very own dentist. Why? Sure, it seems convenient to have your clear aligners shipped to your home and to do-it-yourself, but the prevailing reason why most people choose direct-to-consumer, or do-it-yourself dentistry, is cost.  They are lured in by great television and online advertising, often by a celebrity endorsement, and buy into the theory that it is so simple and easy that they can be their very own dentist/orthodontist.

As a dentist for the last three decades, I have ALWAYS chosen quality dental products and laboratories to provide the very best to my patients. As an Invisalign Global Faculty member and Platinum Plus Provider who has started over 1,500 cases, I do the same when choosing which tooth alignment system to provide to my patients. I know this might sound like a commercial and I promise it is not, but why wouldn’t you provide the very best quality for your patients?

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Invisalign is just that with over 7 million cases started worldwide. While some of the leading direct to consumer tooth aligner companies are spending millions of dollars on advertising, Invisalign has spent millions on technology to set itself apart from every other aligner company in the world. The Smartforce technology used in Invisalign’s aligners set it apart from all other aligner companies in the world.  Smartforce moves teeth in ways very similar to orthodontic wires and brackets. Teeth can be rotated, uprighted or even moved from position A to position B. The technology used in every other aligner company is equivalent to that of Invisalign’s original aligner material that was used over 20 years ago. The movements from this aligner material are limited and essentially involve a tipping of the tooth and thus many consider it outdated. 

Although aligner material is critical, the biggest downside of direct-to-consumer tooth alignment is the lack of professional supervision throughout treatment by a licensed dentist.  Some direct to consumer tooth alignment companies attempt to circumvent the lack of supervision by having patients sign consent forms that state they have been seen by a licensed dentist in the last six months. They claim that their case is “designed” by a licensed dentist and supervised when a patient sends in photos from their cell phone (if the patient chooses to do this). If that does not sound a bit strange, you would think that a patient would get wary of the process at the onset of treatment.

You see, depending on which do-it-yourself company that a patient chooses, treatment can get started one of two ways. Patients can go to a scanning center (where there is never a dentist present) to get scanned for their aligners that can get shipped to their homes or patients can take their very own impressions with no training whatsoever.  Imagine that. Dentists attend four years of college and four years of dental school to learn these procedures, and dental assistants are also trained and work under the watchful eye of a dentist, yet patients get a kit in the mail, watch a video, and they are just as “qualified” as a dentist or dental assistant in the eyes of the direct to consumer aligner companies. 

Now let’s talk about actual treatment. If a patient is not confirmed to be periodontally sound prior to the onset of orthodontic tooth movement, teeth can be lost prematurely. Direct-to-consumer tooth alignment companies can not verify periodontal health, and this has resulted in numerous cases reported where patients’ undiagnosed periodontal disease combined with do-it-yourself tooth alignment have resulted in tooth loss and an acceleration of undiagnosed periodontal disease.  Premature tooth loss is just one problem that can result from direct-to-consumer tooth alignment.  Other problems include occlusion issues and tempomandibular joint (TMJ) problems. Bottom line, tooth movement is a very serious issue and should be left in the hands of a trained professional. It should not be treated like a do-it-yourself home repair. 

When patients undergo orthodontic tooth movement with a dentist or orthodontist, supervision is routine and constant, and progress is monitored on a regular basis (on the average every four to six weeks). Aligner fit, tooth movement and patient compliance are evaluated on every visit.  If any unforeseen problems occur, a dental professional can intervene early and rapidly address any issue.  With direct-to-consumer tooth alignment, patient compliance, which is critical to a positive outcome, is NEVER monitored and problems when they arise are often well into treatment and may not be correctable with direct to consumer dentistry. 

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Now here is the best part, when one sees a dentist, we do everything in our power to ensure patient satisfaction. If a patient is not satisfied, a patient has multiple courses of action to achieve a positive outcome. With direct to consumer clear aligners, you never see a dentist, so to resolve issues, especially major issues, resources are limited at best.  And when things go south and patients are totally unhappy with their results and a direct to consumer company offers to refund a patient’s money, it comes with some serious strings attached. Patients who receive refunds, as a condition of their refund, must sign a release and agree not to post or remove any existing negative reviews about the direct-to-consumer tooth alignment company to ensure word does not get out about the poor results patients might experience when using their product. The State of California recently ruled that this practice was illegal.

In a recent news report, one of the largest direct-to-consumer clear aligner companies described itself as an “industry disruptor.” With over eighteen hundred Better Business Bureau complaints in the last few years (compared to Invisalign that has only a handful of complaints over the last 20+ years) and the unidentified, unsatisfied patients that have received refunds, it can indeed be concluded that they are an “industry disruptor.” They may claim many satisfied patients, but they are unable to claim their aligners deliver the same results of dentist supervised, quality aligner companies such as Invisalign.  Both the dangers and downside of direct to consumer clear aligners need to be brought to patient’s attention, so they can make educated decisions.    

Dr. Rick Mars, DDS is a general dentist and the author of “The Big Smile: The Principles of Modern Dentistry – for Dentists and Patients.” Mars has practiced patient-centered dentistry in the Miami area for over 25 years. Mars is an Invisalign Elite Provider and has lectured internationally on Invisalign for over a decade.

Published on Feb 19, 2020