AAO Highlights Health and Financial Risks of Mail-Order Orthodontics. Survey Results Show Self-treatment Often Leads to Retreatment
Mail-order orthodontic treatment that is promoted as “easy” and “affordable” is leading to many patients seeking help in-office by trained specialists for re-treatment 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, the majority of respondents said they have seen patients come into their offices for re-treatment after mail-order or “DTC” treatment that did not include an in-person examination prior to starting: a total of 77 percent.
“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 Dr.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 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 percent of respondents see new re-treatment patients at least quarterly. A total of 260 AAO members responded with a margin of error of +/- 6 points.
Moving teeth has a profound effect on alignment of the bite, and oral functions like chewing, speaking, and movement of the jaw. In one study that reviewed over 5,000 clear aligner cases, clinicians “frequently” reported the unintended consequence of a “posterior open bite,” where the back teeth do not come together. Posterior open bite has been described as “one of the most severe Malocclusions that can impair a patient’s Masticatory [chewing] function.” Improperly monitored movement of teeth can also lead to Temporomandibular disorder (TMD).
If aligners are used to move teeth when the patient is not an appropriate candidate for treatment, irreversible harm like loose teeth, loss of tooth roots and impairment of chewing and other oral function can occur. The AAO states that the only way to effectively evaluate a patient for orthodontic treatment is in-person: through a physical examination, x-rays and periodontal assessment.
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 percent of AAO member respondents offer payment plans, with 90 percent 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 percent as part of their business model.
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.
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 advocates for policies that break through geographic, financial and convenience barriers while maintaining the standard of care.
For more information on these minimum standards of care and the Scientific evidence supporting them, please visit
The American Association of Orthodontists represents 19,000 orthodontist members throughout the United States, Canada, and abroad. Founded in 1900, AAO is the world’s oldest and largest dental specialty organization. AAO is dedicated to ethically advancing the art and science of orthodontics and dentofacial orthopedics worldwide; improving the overall oral healthcare of the public; advocating for the health and safety of the public; educating the public about the benefits of orthodontic treatment provided by an orthodontic specialist. For more information, visit
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Glenda, Charlie and David Cates
