Mail-Ordered Orthodontics? 🤨

We recently came across an ad promoting clear aligners that you can order online to straighten your teeth by yourself. We are cringing just from the thought - but alongside 'Cavity Filling Kits' at the store and 'DIY Dentistry Tutorials' on YouTube, we're really not quite sure which is worse.

It is not a question of whether or not plastic aligners work - because they do! We have helped many of our smiling stars using Invisalign® Technology and we've seen firsthand how effective they can be. The question is this: If it takes about 8 years of post secondary education to become a general dentist in Canada and 4 additional years to specialize in orthodontics - can braces really be something you could do at home?

The Claims:

Straight teeth with either one dental visit - or none at all (you get a choice)
Less expensive option compared to seeing a dentist who does orthodontics or a specialized orthodontist
Corrects gaps, crowding and bite issues
May be covered by your (and/or your spouse's) insurance dental plan
Easy process:

Take a quick questionnaire to see if you make a good candidate
Get an impression made
Have aligners mailed to you (all you have to do is wear them regularly)
Have regular check-ins with a remote dentist
Then once you've achieved your straight smile, you can purchase retainers to keep your teeth from moving back or shifting in other ways

We can see how this might appeal to the general public but if it sounds too good to be true, it often is. And, while we usually applaud improved technology to make it easier for individuals to access dentistry, here are some of our concerns:

Having a 30-second, self-report questionnaire that is 7 questions long to determine whether you're 'right' for an orthodontic treatment doesn't seem very reliable. We tried answering the questions differently several times to test it out. Regardless of whether we reported our teeth as "mildly crowded" to "severely crowded with bite problems", we still received an analysis of, "You're a great candidate"! Sounds a bit fishy to us.
The potential complications of wearing orthodontic appliances include issues like root resorption, temporomandibular joint dysfunction (TMJD), gum disease, etc - whether you're using traditional braces or clear aligners. You can check out the study here. If you don't have an actual dentist examining your teeth every couple of weeks and end up experiencing one of these issues, you can lose your tooth (or teeth) in both root resorption and periodontal disease cases and you can experience lifelong jaw pain from TMJD. If a dentist was seeing you regularly, the problems could be identified early and prognosis would be good. In the mail-ordered aligners - sure, you have 'remote dental check-ins' - but how much detail can a dentist really glean from online video communications? And would you know what early signs to look for and what to report to these remote dentists if you ultimately had one of these complications? Didn't think so.
Yes, upfront, their product isn't as costly as seeing a dentist or orthodontist - but you're also getting way less (see above point on identifying potential problems and the lack of one-on-one assistance!) You may end up with a straight smile - but, as an example, the cost could be a lifelong subscription to TMJD pain. Alternatively, if you experience these complications, you may have to pay out to have these orthodontic issues resolved. Had you been seeing an actual dentist all along, the corrective measures would have been addressed when it was a smaller problem - likely using less invasive procedures and less expensive resolutions.
Many insurance companies who would cover dental-office braces may not actually cover mail-order aligners. While the reimbursed amount would be based on an agreement between the company issuing your benefits (usually an employer) and you, 'miscellaneous dental expenses' almost always leads to questions asked by insurance companies and even providing legitimate answers like 'medicated fluoride rinse' may not be paid out when its sold from the dental office. Layer on the part about 'receiving dental alignment trays without having had a one-on-one with a dental professional and it's likely insurance will not cover these mail-order products unless you have something like a health spending account.
In-person orthodontics also address bite issues, gaps and crowding teeth - and resolve these issues better than a remote dentist ever could. Consider the case where your dental anatomy prevents a specific type of movement - no matter how many trays you wear, you're not going to achieve it. It may require shaping your tooth - which can be done by an experienced dentist while you're under their care and when they see you for regular ortho review appointments.
In some of these DIY braces, the patient is asked to take their own dental impression. Our office uses 3D digital scanning technology (iTero®) that achieves a tighter fitting set of trays (and therefore, more accurate, fine-tuned movement of your teeth) than even the physical impressions our team use to make. With digital scanning, we're going tooth by tooth, recording their shapes and sizes. When we used to take physical impressions, we would put the impression material in your mouth, ask you to bite down - and in the removal process, the spaces would widen slightly, because we'd have to nudge it off your teeth and out. And when an impression wasn't good enough? It had to be retaken. If we are responsible for that, we eat the costs. With the mail-order ones, we've read reviews that they bill their clients for retakes.
By the end of the estimated treatment period, if your desired smile has not been achieved, we usually either keep the braces on for longer or we request more trays to help your teeth align even more. You have that option - to choose to continue or get your braces off. With online braces, it's probably not going to be an option (especially if they're touting 'super low prices').

Obviously, these are worst case scenarios and these programs *could* work for simple cases. But, if you don't have that background in dentistry, how would you even know if your case was 'simple'? Leave it to your dentist and/or orthodontist. Seriously (and if you won't take our word for it, you can always do quick internet searches to see what normal people have to say about the company you're looking into).

To book your Orthodontic Consultation with us (real people, face-to-face, in-your-actual-mouth-dentists), please feel free to use our online form or give us a call at (416) 226-6688. We offer traditional brackets and wires, Invisalign® and vPro5 Propel Orthodontics acceleration devices.

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