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Just the facts.

Protecting the health and well-being of orthodontic patients is of paramount importance to the American Association of Orthodontists (AAO). The AAO has particular concerns about some common practices and policies within the mail-order orthodontic field. These concerns are based on reliable, peer-reviewed scientific evidence, unlike information from some who advocate for DTC companies. The AAO provides the following resources to support laws and regulations that best protect patients.

For more information or questions, you can contact the AAO Advocacy team at advocacy@aaortho.org.

Click Here to Meet the Legal & Advocacy Team!

AAO Position Paper on DTC Orthodontics:

The AAO has significant concerns about certain components that are common to direct-to-consumer orthodontic treatment, such as the patient never being seen in-person and the absence of x-rays prior to beginning treatment. These concerns are based on reliable, peer-reviewed scientific evidence, and are focused on protecting the health and well-being of the patient, and are set out in a comprehensive AAO position paper.

Handout on importance of in-person examinations:

An in-person examination by a dentist or orthodontist prior to beginning orthodontic treatment is essential. The AAO advocates for laws that require an in-person examination prior to orthodontic treatment, based on reliable scientific evidence. A new summary from the AAO lays out the need for laws requiring an in-person examination.

Handout on importance of radiographic imaging:

Radiographic imaging (x-rays and other types) is an essential component of the evaluation and diagnosis that must occur prior to beginning orthodontic treatment. The AAO advocates for laws that require radiographic imaging prior to orthodontic treatment, based on reliable scientific evidence. A new summary from the AAO lays out the need for laws requiring radiographic imaging.

Many direct-to-consumer orthodontic providers treat patients solely through asynchronous teledentistry—meaning there is no live, face-to-face communication between doctor and patient. Authorities throughout the medical, legal and ethics fields raise serious concerns about whether a patient can give informed consent to be treated without live interaction with the doctor. These concerns are set out in an AAO position paper.

Testimony by Former DTC Doctor:

In a class action lawsuit involving a direct-to-consumer orthodontic company, testimony by a dentist who formerly worked for the company was recently made public. His testimony raises serious concerns about the standard of care provided to many DTC patients.

AAO Teledentistry Parameters:

The AAO strongly supports the incorporation of teledentistry elements into orthodontic treatment, so long as the proper parameters are incorporated to best protect patient health and well-being. The AAO advocates in legislative and regulatory settings throughout the United States for laws that require these protections.

In 2021, the AAO’s House of Delegates approved revisions to the AAO’s Clinical Practice Guidelines. Among other changes, these revisions make clear that the AAO intends that the guidelines apply to any orthodontic treatment, whether provided by an orthodontist, a general practitioner dentist, or otherwise. In addition, the revisions clarify that certain patient protections including in-person examinations and x-rays should be incorporated when teledentistry is used in treatment.

Access to Care

Making Orthodontic Treatment Accessible while Maintaining the Highest Standard of Care to Protect Patients – Access to care doesn’t need to come at the cost of patient safety. The AAO supports policy that breaks through all three categories of barriers while maintaining the highest standard of care.

Teledentistry Catch-22
Dental boards and state legislatures throughout the United States have expressed concern that patients who elect to receive orthodontic treatment through mail-order are not being adequately protected. The scientific evidence overwhelmingly demonstrates that an in-person examination and x-rays prior to orthodontic treatment are essential to the standard of care for safe and effective treatment.
myths vs facts

It sounds almost too good to be true: the convenience of orthodontic treatment without ever having to leave your home or seeing an orthodontist or dentist in person (meaning no office visits); and, it sounds considerably cheaper than in-person orthodontic treatment. What’s not to like?

Self-service Healthcare

Mail-order orthodontic providers claim to offer “doctor directed” orthodontic treatment. A statement by one of their own allies in advocacy efforts, TechNet, reveals the truth about their vision for orthodontic care—“self-service healthcare.”

Many clear aligner companies offer “partner programs” or “partner networks” for dentists and orthodontists. Promises of company-generated leads and increased income for your practice may make these programs sound tempting.
But, there may be risks and other complications that are not obvious when first considering these options.

You probably have serious concerns about mail-order orthodontic treatment and want to protect your patients and the public by providing them information on the topic. But the stories of orthodontists and dentists getting sued or encountering other problems when they speak out on the topic understandably cause concern.

Mail-order orthodontic treatment that is promoted as “easy” and “affordable” is leading to many patients seeking help in-office by trained specialists for retreatment 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 retreatment after mail-order or “DTC” treatment that did not include an in-person examination prior to starting: a total of 77 percent.

AAO Concerns about the American Teledentistry Association and its Positions:

The American Teledentistry Association has been active advocating throughout the United States against regulations on teledentistry. Specifically, the ATDA argues that in-person examinations and x-rays should not be required prior to beginning orthodontic treatment. The AAO has serious concerns about the lack of evidence-based support for the ATDA’s positions, as well as concerns about whose interests the ATDA represents.

AAO Analysis of ATDA White Paper on In-person Examinations

The AAO believes that the ATDA’s arguments against requiring in-person examinations prior to beginning orthodontic treatment are not supported by credible scientific evidence. An examination of the ATDA’s argument against requiring in-person examinations, and the lack of credible scientific evidence in support, can be found below.

AAO Analysis of ATDA White Paper on Radiography

The AAO believes that the ATDA’s arguments against requiring x-rays prior to beginning orthodontic treatment are not supported by credible scientific evidence. An examination of the ATDA’s argument against requiring x-rays, and the lack of credible scientific evidence in support, can be found below.

Who is the ATDA?

The AAO has serious concerns about the ATDA’s close affiliation with certain direct-to-consumer orthodontic companies, as well as contradictions in the ATDA’s current advocacy messages. Its executive director makes arguments today that directly conflict with statements he made in his academic publications prior to forming the ATDA. A summary can be found below.