A new study shows that 77% of orthodontists who are members of the American Association of Orthodontists (AAO) have retreated patients who are dissatisfied with their mail-order clear aligners or experienced an adverse event as a result.
“This mail order business is not a small business and it's potentially a lucrative market,” said Trey Lawrence, vice president and general counsel at AAO. “These companies say it’s all about finance and trying to protect their client’s financial interests but it's really not, because our orthodontists are seeing an uptick in adult patients who wouldn't have thought about getting brackets or wire braces if they hadn’t seen their marketing online.”
Procedures such as straightening two front teeth is often packaged as cosmetic by many mail-order orthodontic companies but moving teeth has historically been a procedure that involves medical attention, according to Lawrence.
“If you start moving the teeth without roots that are healthy like they should be, then there's a chance you're going to end up with loose teeth and then moving teeth itself contributes to root resorption,” he said. “So, obviously if you're in that state already, then you don't want to add to that or contribute to root resorption.”
Other contraindications include gum health and impacted teeth.
"What we have heard from patients is that people who treat with these online mail order companies, they're not seeing the dentist," Lawrence told the St. Louis Record. "These companies say they have a dentist or an orthodontist supervising treatment, but it's very clearly not somebody that's seen the patient in person themselves before they start treatment."
The study also found that mail-order companies, such as Smile Direct Club and BYTE, that advertise payment plans often charge interest on monthly payments of up to 22.92 percent as part of their business model.
“Because we hear the reports of patients who've had adverse outcomes from this, we certainly believe it's an essential component of the basic standard of care that a patient receives an in-person physical examination and x-rays before they start orthodontic treatment,” Lawrence said in an interview.
The AAO is headquartered in St. Louis however the Missouri legislature has yet to regulate the mail-order orthodontics industry.
“The St. Louis University orthodontic program is the oldest orthodontic program in the nation,” Lawrence added. “The AAO arose back in the early 1900s in connection with the St. Louis University orthodontic program but these mail order clear aligners are a relatively new phenomena, which sprung onto the market in about 2018 or so.”