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