18 May 2021

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COVID and orthodontic products directly to the consumer: an American Journal survey

Davide Elsido

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In the era of COVID, the use of remote work practices and therefore also remote medical consultation had a very strong impulse, due to the need to minimize the opportunities for contact.

Even in orthodontics this is leading to a change in the setting of treatments and controls. It is natural to imagine how clear aligners - which generally require less chair time and potentially less frequent check-ups - may be preferred by some patients over traditional fixed braces for this reason.

And what about the so-called orthodontic products directly to the consumer "DTCO" (direct to consumer orthodontic products)? An interesting study published in AJODO asked this question.

DTCOs is a concept that promotes delivering orthodontic treatment at a lowered cost and increased patient convenience. There are multiple companies that currently offer DTCO appliances in the United States, such as SmileDirectClub (Nashville, Tenn), Candid (New York, NY), Byte (Los Angeles, Calif), and others. DTCO companies ask customers to take impressions of their teeth at home or to get an intraoral scan by a technician at one of the company's stores. The digital models are then reviewed by technicians and/or dentists from a remote location, and clear aligners are then created and mailed along with instructions to the consumer. The customer then wears the aligners, typically without visiting an orthodontist or a dentist and without receiving direct supervision. DTCO appliances were introduced in the United States in the last decade. Since then, they have been rising in popularity among patients seeking a cost-effective, convenient method to address their malocclusions. For instance, SmileDirectClub, one of the most popular DTCO companies, was founded in 2014, and as of the current year, they reported treating upwards of 1 million patients. However, orthodontic organizations and dental boards have raised some concerns about pursuing treatment with DTCO products compared with trained orthodontists. Some of the proposed concerns were whether radiographs would be acquired for diagnostic purposes; whether a dentist or orthodontist would be involved in designing treatment, monitoring progress; and many others.

Traditionally, orthodontic treatment was only provided by trained dentists, but a recent shift in the market has allowed companies to promote and sell orthodontic aligners directly to the consumer. The robust marketing campaigns by DTCO companies have attracted many consumers seeking orthodontic treatment, despite concerns from dental organizations and dental boards. A similar trend has been observed in the medical field over the last 2 decades, with researchers voicing their concerns about the potential misleading or incomplete information provided to the consumer and its influence on patients’ decision making. The purpose of this population-based study was to try and understand how the general population of the United States may perceive DTCOs. Despite the alarming orthodontic market trends, there is a paucity of studies investigating the population's perceptions of DTCOs. Understanding how the market is reacting to DTCOs may be crucial to help organized dentistry understand the needs of the patients and identify aspects that may need to be addressed through awareness campaigns.

The majority of participants seemed to perceive DTCOs as a viable alternative for seeking orthodontic care. Convenience was perceived as the highest benefit for choosing DTCOs, whereas cost seemed to be the most salient concern with choosing a trained orthodontist.

Although participants had concerns about the COVID-19 pandemic, results showed that the pandemic might not significantly affect the preferences. Finally, orthodontists and their constituent organizations may consider more robust awareness and advocacy campaigns to educate the population about orthodontic treatment, the availability of payment plans and convenient approaches to treatment, and the benefits of pursuing treatment with a trained orthodontist.

For additional information: When convenience trumps quality of care: A population-based survey on direct to consumer orthodontics.