Direct-to-consumer orthodontics: surveying the user experience

J Am Dent Assoc. 2020 Aug;151(8):625-636.e4. doi: 10.1016/j.adaj.2020.02.025.


Background: The rise of direct-to-consumer (DTC) orthodontics has caused significant controversy among dentists and orthodontists. However, little is known about the actual harms or benefits experienced by users of at-home teeth aligners.

Methods: The authors designed a 24-item online survey to assess users' experiences with at-home aligners. The authors recruited users for 6 months (March-August 2019) on social media platforms (Instagram, Twitter) and online forums related to DTC orthodontics. A total of 470 responses were analyzed.

Results: The typical respondent was a white, female millennial (23-38 years old in 2019) who purchased aligners to correct crowding. More than one-half of respondents consulted with a dentist before purchasing aligners. In those interactions, the dentist most often recommended an in-office treatment. Although most respondents (87.5%) were satisfied with DTC treatment, 6.6% had to visit their dentist due to the severity of adverse effects.

Conclusions: Although many respondents would have preferred traditional treatment from a dentist or orthodontist, they opted for DTC aligners because of cost and convenience.

Practical implications: Rather than warning patients wholesale against at-home aligners, it might be more productive for dentists to have frank discussions with them about the risks and benefits. In parallel to pushing for increased accountability, it might be prudent to consider new ways of coexisting in this altered landscape, such as offering professional oversight of DTC treatments.

Keywords: Dental devices; dental industry; health policy; home care; oral health; orthodontic appliances; patient education; professional role; public policy; teledentistry.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Dental Care
  • Female
  • Humans
  • Malocclusion*
  • Orthodontics*
  • Surveys and Questionnaires
  • Young Adult