Why should I see my dentist if I can order clear braces online?

Treatments for straightening teeth have traditionally been carried out by specialist orthodontists and dentists, however it is now possible to straighten your teeth from home, with no dental visits required. Is this safe?

      Teeth straightening

      If you’ve heard “come on everyone, big smiles! Show us your teeth!” while posing for a photo, there’s a chance that you might have felt anxious or uncomfortable at the prospect of smiling with your teeth on show. A 2019 survey found that half of Britons do not like their teeth and feel that they shouldn’t show them at work and in their personal lives. It also emerged that 61% of the 2,000 adults surveyed have been regarded by others as ‘miserable’ because they don’t smile very often.

      Showing our teeth is a way of communicating across boundaries and languages – animals sometimes show their teeth as a way of asserting dominance, or demonstrating aggression. Equally some animals are able to ‘smile’ with their teeth to show happiness and contentment. 

      Smiling Dog
      There are many reasons why people might feel conscious of their teeth, most of which are treatable by a dentist or orthodontist. If your teeth are crooked (misaligned) or have large gaps between them, there are lots of options out there for teeth straightening. Traditional metal fixed braces have been used for hundreds of years, with dental books written in the 18th century making reference to using metal and ‘bandeau’ devices for tooth alignment.
      Teeth straightening has come a long way since then, and an increasingly popular choice are clear aligners. These are an ‘almost invisible’ plastic form of braces that fit over your teeth and are changed over (usually every 2 weeks or so) to slowly move your teeth to a straighter position. They can feel more convenient than traditional fixed braces because they are removed for eating, drinking and cleaning teeth.

        Clear aligners

        Aligners are very thin and clear ‘mouthguards’ that fit closely over the teeth. They are ideally suited to adult patients who would prefer a less obvious way of straightening their teeth, perhaps because their work or personal life would be impacted by a visible conventional fixed brace. As with any form of orthodontics, a proper assessment, diagnosis and treatment plan is essential to achieving successful treatment, and an accurate impression or scan of the teeth is imperative. Each appliance moves the teeth a small distance towards the intended position before moving on to the next aligner until the final alignment (usually straight, uncrowded teeth) is achieved. They need to be worn both day and night for optimum results, only being removed for eating meals, drinking anything other than water and for cleaning teeth and the aligner(s).

        Clear Aligner Person Smiling Ed

        Aligners from your orthodontist or dentist

        Traditionally it was only possible to receive orthodontic treatment by visiting your orthodontist or specialist dentist. Fixed metal braces can only be attached, tightened and maintained by a trained professional, whereas the market for clear aligners includes the option to buy online. So why bother still seeing the dentist for aligners?

        Firstly, the person treating you will be able to assess in person the level of severity of your tooth position issues and accurately create a tailored treatment plan, clearly outlining how long they expect you to require aligners for and estimating how many different sets you will need throughout your treatment. They will also be able to check the health of your teeth and gums, esnruing that any issues are rectified before starting tooth alignment if necessary.

            A dental care professional will then take a mould (or ‘impression’) of your teeth, the process of which is much more accurate when completed by a professional than with a home DIY kit. An increasingly new way of taking impressions of a patient’s teeth is to use a digital scanner. This is a small handheld device that uses laser and optical scanning for taking teeth impressions without the discomfort of traditionally used putty impressions. When taking a putty impression, mistakes are sometimes made (even by professionals, and definitely when taken by an individual with no training), which will impact the aligners themselves, whereas a digital scanner is extremely accurate and any mistakes or missed sections can be easily rectified. Some scanners also offer the ability to predict how the teeth will look inside your mouth once treatment has been completed.

            Your dentist or orthodontist will then send your impressions off to a laboratory to plan your treatment, ready to have your set of aligners made. You will usually have a short appointment to look at the predicted end result and once you are happy, the aligners are manufactured. These will be given to you at your next appointment (usually within a few short weeks), and the person treating you will go through the process of explaining how to insert and remove them, how to maintain them and discuss how to achieve the best results. It’s important that aligners are worn for majority of the day or night (the recommended amount is 22 hours a day), and should only be removed for eating, drinking and brushing your teeth (as well as brushing your aligners).

            You will see your dentist, orthodontist or dental care professional fairly regularly throughout your treatment, which is likely to be between 6 – 18 months, so that they can keep a close eye on how your teeth are progressing and answer any questions that you may have along the way. Sometimes these appointments can be carried out remotely with a remote dental monitoring device using Artificial Intelligence. Once your treatment is complete, you will be given retainers to continue using (increasingly less frequently) in the months and years following. Your dentist or orthodontist will always be available to see you again if any problems arise, or if your retainers need replacing (usually at an additional cost).

            Aligners ordered online

            The ability to order nearly anything on the internet and have it delivered to the comfort of your own home has changed the way that we live, and the dental industry has not been immune. Ordering aligners online has been possible for the last 12 years, with the ease of managing your dental care from your computer or phone an increasingly popular choice. So is it really ‘better’ to order online rather than see your dentist?

            In terms of ease – yes it is easier to order online rather than attend appointments in person. The price of online aligners is usually cheaper too, as there is less (if any) interaction with a professional in person, and this cheaper price is often a key point that these companies use to try and encourage people to use their service.

                When you invest in online aligners, you are likely to be asked to fill in a survey with some patient photos to compare your own teeth to, so that the specialist that reviews your application can decide the severity of your case. In some instances you will be asked to send several photos, showing your teeth and the inside of your mouth. The risk with this is if your photos don’t show specific anomalies or may not clearly demonstrate misalignment. When you visit a dentist or orthodontist in person, they check for gum issues or disease and that roots are healthy, whereas this can’t be done from photos or video calls alone.

                You will then be sent a kit to create moulds of your teeth yourself at home. These kits come with clear instructions, but there is no professional in the room to oversee how you take the impressions of your teeth, which means that there is a risk for mistakes to be made, which will impact the accuracy of the aligners that are sent to you. One large brand offers the option for patients to visit their nearest ‘shop’ to have a digital scan taken (for an additional cost), which removes the ‘ease’ element of ordering aligners online, and isn’t so different from seeing a regular dentist or orthodontist.

                You may be sent all of your aligners for the whole treatment at the same time, clearly numbered so that you can change them every 2 – 3 weeks, or you may be sent your next aligner one at a time throughout your treatment. Most brands offer a few online appointments with your specialist throughout the process, although some online reviews by past patients of big direct-to-consumer brands have stated that they were either never offered these, or that their specialist often wouldn’t turn up and might fail to rebook their appointment.

                At the end of treatment, you check-in with your online dentist and purchase your retainers (at additional cost). Then you are off into the world with your ‘new smile’.

                A risk of online aligners is that the ‘professionals’ providing the treatment may not be GDC (General Dental Council) registered or regulated. In 2021 the GDC acknowledged the following principles in the guidelines that they released:
                • Orthodontic patients need to be fully assessed by a dentist
                • Direct dentist-to-patient interaction – the basis for informed consent – is essential
                • Patients must know the name and registration number of the dentist responsible for their care
                This does not mean that online aligners are ‘bad’, as many will use GDC registered and regulated professionals, however very few include dentist-to-patient interaction, and it is difficult for the GDC to regulate. It’s important that anyone considering online aligners is aware of the risks and that direct-to-patient orthodontics is no substitute for meaningful regulation.

                  Online vs. in-person aligner

                  There’s no right or wrong answer as to which is the best choice for you, and both options have pros and cons. Being able to do everything from home might suit some people for a variety of reasons. The difference in price may also impact some people’s decisions – and this is definitely an important aspect to keep in mind. In some online reviews of online aligners, there appear to be a percentage of people who have had to invest in online aligners several times, making their cost the same or higher than if they had visited a dentist or orthodontist in person in the first place. There have also been patients that we’ve met in our practices who have used online aligners, but had to come to us for more orthodontic treatment as their online aligners have caused more problems rather than fixing misaligned teeth. Depending on the severity of the misalignment, many people cannot be treated without seeing an orthodontist or dentist as they may need some adjustment or improvements to their teeth ahead of tooth alignment.

                  Many of our dental practices offer orthodontic treatments, including aligner solutions, and we also have many Portman orthodontic practices. If you’re considering your options and would like to know more, we’re always happy to discuss the process with patients. You can find your nearest Portman practice here.


                  Find out more...

                  At Portman Dental Care, we provide a range of solutions to ensure your teeth remain healthy and well. We have a number of care and advice articles to help you whilst you are not in the dentists chair. Find out more below.