AAO Consumer Alert

What you may be missing with direct-to-consumer orthodontic treatment

Some online orthodontic companies make their treatment sound as simple as taking a selfie. Some will ask you to include your selfie with an impression of your teeth or get your teeth scanned. Next, you receive aligners in the mail, and after so many months – straight teeth! Right? What else is there to think about? Well, we can name a few.

Is an orthodontic specialist supervising your treatment?

In some instances direct-to-consumer orthodontic companies do not involve the in-person evaluation and/or in-person supervision of your orthodontic treatment by an orthodontist.

Orthodontic treatment involves the movement of biological material, which could lead to potentially irreversible and expensive damage such as tooth and gum loss, changed bites, and other issues if not done correctly.

How customized is your treatment?

There’s no one-size-fits-all approach to orthodontic treatment, which is why a thorough examination of the teeth, their position in the jaws and the relationship of the upper and lower jaws is imperative to developing a custom treatment plan.

Orthodontists closely study dental records such as panoramic x-rays to evaluate any concerns or potential problems that may be hiding below the surface.

Consider this:

What other transforming medical treatment would you undergo without an in-person, pre-treatment evaluation, or ongoing in-person supervision from a medical professional?

Ask questions, get answers.

If you are researching orthodontic treatment, here are a few questions you may want to consider:

As part of your treatment, are comprehensive diagnostic records like x-rays taken before your treatment?

YES – Your teeth and mouth are as unique as you. Examining your mouth with x-rays gives your orthodontist a better road map on how to help you. 

    1. Does the treatment and fee include x-rays of your teeth and jaws?
    2. Does the treatment and fee include a clinical examination of your jaw alignment, teeth, bite, and your teeth’ relationship to the skeletal structures?
    3. Does the treatment and fee include taking photographs of your face, facial profile, mouth, and teeth?
    4. Does the treatment and fee include taking digital scans or other impressions of your teeth?

NO – You have to ask yourself if you are comfortable starting orthodontic treatment without comprehensive diagnostic records. If you would like complete diagnostic records taken, are you comfortable going to another dental professional to take them? If yes, what will that cost?

As part of your treatment fee, do you receive any in-person visits to a dentist’s or orthodontist’s office during your treatment?


  • How many?
  • What occurs during these in-person visits?
  • Is there a licensed dentist or orthodontist in the office to supervise the visits?

NO – are you comfortable with orthodontic treatment that does not involve any in-person visits with a dentist or orthodontist?

Do you know your orthodontist or dentist? Like any treatment, it helps to know who is caring for you. For example, is their name listed on the company's website or elsewhere?


  • What are his or her education and credentials?
  • In what state is he or she licensed?
  • In what state does he or she practice?
  • Can you read any reviews or comments from former patients? What do other patients being treated by him or her have to say?

NO – are you comfortable not being able to research your dentist’s or orthodontist’s background, credentials, patient reviews, etc., before you begin treatment?

Is only one treatment type offered (such as invisible aligners or a certain appliance)?

YES – how do you know that is the best treatment option for you, given your unique situation and oral condition, compared to other treatment models (such as braces)?

NO – how is the decision being made for the best treatment model for you, and who is making that decision?

How do you know if your teeth and gums are healthy enough for orthodontic treatment?
  • Who is making that decision and how is it being determined?
  • If the decision maker is a dentist or orthodontist not associated with your treatment, who pays for that assessment?
What are the possible risks (financial, health, etc.) associated with your orthodontic treatment?
Who can you speak with at the online orthodontic company about your orthodontic treatment?

What is his or her education, background, qualifications and/or experience with orthodontics?

Who is responsible for detecting any issues that may occur during your orthodontic treatment?
  • Is it you?
  • If it is a doctor not associated with your treatment, who pays for those check-ups?
If an issue arises during your treatment, how will it be handled, and who will be responsible for handling it?
If a doctor is involved with your orthodontic treatment, how can you contact him or her over the course of your treatment? How can you contact him or her if an emergency arises?
If you are injured or have another dispute involving your orthodontic treatment, how is it handled (litigation, arbitration, etc.)?

State dental boards have individual complaint processes for patients who have had issues with orthodontic treatment. You can find your state dental board info here: https://aao1consumer.wpengine.com/aao/state-dental-board-info.

If you are injured or have a dispute involving your orthodontic treatment, what rights do you have against the person or company involved with your orthodontic treatment?

Are you asked to sign any forms that seek to release them from liability?

Does the treatment model comply with the dental laws in your state?

Trust an AAO orthodontist.

The AAO is a professional association of orthodontists dedicated to, among other things, “improving the health of the public by promoting quality orthodontic care, the importance of overall oral healthcare, and advocating for the public interest.” Your health and well-being are extremely important.

Remember that orthodontic treatment is not a product or device – orthodontic treatment is a professional, medical service. When your care is personally supervised by an orthodontist who is a member of the American Association of Orthodontists, you are assured that your orthodontist spent years in a post-doctoral residency program focused on providing orthodontic treatment to patients.

Before making any decision about orthodontic treatment, consider doing some research and having an in-person consultation with a member of the American Association of Orthodontists. To find an AAO orthodontist near you, simply click here: aaoinfo.org/locator