The Risks of Online Clear Aligners

The introduction of Invisalign® clear aligners in 1999 gave many teenagers and adults wanting to straighten their teeth a highly desirable alternative to traditional metal braces. Since that time, some companies – most prominently SmileDirectClub —developed a business model in which those wanting fast results at a discounted cost could bypass being treated by an orthodontist and order aligners online. Despite warnings from the American Dental Association (ADA), the American Association of Orthodontists (AAO) and countless orthodontic practices about the safety of aligners purchased from direct-to-consumer companies, their popularity grew, thanks mainly to extensive advertising and social media influencers.

The cautions from orthodontic and other dental care providers proved well-founded. In September 2023, SmileDirectClub filed for Chapter 11 bankruptcy protection, then soon after shut down operations without notice — leaving its customers with no support for treatment already underway, yet legally obligated to continue paying the amount they still owe. At the time of this writing, it has not been determined what type of compensation - if any - customers can expect after the assets of SmileDirectClub have been liquidated.

Although any company can go out of business, SmileDirectClub’s situation brought to public attention the issues that the orthodontic community had long been vocal about - mostly regarding the risks to your teeth and overall health by skipping care and supervision by an orthodontist. Our blog post - “Are Online Teeth Aligners Safe?” - published in 2021, covers this situation in detail. As it’s unfortunately now more relevant than ever, we look again at the major reasons to avoid ordering clear aligners online.

The Inability to Determine if You’re a Good Candidate for Treatment

Not everyone is a good candidate for clear aligners. Some issues — such as severely rotated or severely tipped teeth - can only be corrected by metal braces. But you wouldn’t know that if you opted for ordering aligners online.

The typical procedure is for direct-to-consumer companies to send you an at-home impression kit to take impressions of your teeth. Once mailed back to the company, they are - according to the company (claims of each such company are similar) - reviewed by its “network” of state-licensed doctors and orthodontists. However, the person doing the reviewing could also be an unlicensed technician with no formal training.

A set of aligners are then made and sent to the patient, with instructions to wear them for a specific amount of time to begin correcting teeth. Patients may have online video consultations with “their” doctor during the course of treatment.

The big problem is that an online video chat doesn’t allow for a true in-person evaluation that would reveal such issues as tooth decay, root resorption or gum disease - all of which would need to be treated before you could be fitted for aligners. In addition, an orthodontist must evaluate your bones, which are affected by orthodontic treatment. This requires X-rays (which obviously can’t be taken via video conference call), specialized equipment and a specialist with years of training who can plan how teeth and bones will be moved during treatment, reviewing the process consistently.

In addition, some teeth may need to be extracted to make room for the other teeth to move and align properly according to the treatment plan. Only an in-person, in-office examination can determine this. In the words of the AAO, “Remember that orthodontic treatment is not a product or device - orthodontic treatment is a professional, medical service.”

Lack of In-person Supervision of Your Treatment by a Licensed Orthodontist

The lack of supervision by an orthodontist during treatment is another danger of ordering online aligners. According to Laster Orthodontics, “When you are treated with clear aligner therapy in an orthodontist’s office, they require routine appointments to make sure your teeth are moving at the safest, most efficient rate. An orthodontist will adjust your treatment plan as needed along the way, but you won’t get this when you go with DIY, home aligners. With mail order aligners, teeth may move slower or faster than anticipated. You may develop gum disease or cavities during your treatment, with no orthodontist or dentist being able to treat you because they can’t see your teeth.”

Because teeth and bone are living, organic tissues, they may not necessarily move or adjust as an online company’s computer model of your mouth projects. Only in-person visits to a licensed orthodontist can make sure that the teeth are being repositioned as planned, and fine-tune treatment as needed.

Moreover, as Dr. Charles Gemmi points out in his blog post for Orthodontics Limited, the trays you receive from an online company may move your teeth in the wrong directions - or the trays themselves could be slightly misaligned and therefore cause problems. “It will be up to you to know what is normal or abnormal and to raise any concerns you may have.” Of course, as one who has no education or training in orthodontics, you can’t be expected to know what is normal or abnormal during the course of “treatment.” It should not be the patient’s responsibility to recognize if something has gone wrong, or needs adjustment before the situation becomes irreversible.

Bad outcomes are common. Orthodontists report treating patients who come to them complaining of poorly fitting aligners that resulted in their teeth falling out, serious bite problems, cuts to the gums, an inability to close their mouth or chew properly, and that their teeth were overall worse off after going through treatment with the online aligners.

So why haven’t these devastating results been widely reported to the public? In the case of SmileDirectClub, the District of Columbia's attorney general's office filed a lawsuit against the company in December 2022. According to an article by Vaidehi Mehta, Esq., for FindLaw, the lawsuit alleged that SmileDirectClub engaged in deceptive and unfair business practices. The allegations included using non-disclosure agreements (NDAs) to silence consumers, manipulate online reviews and hide information. These NDAs prevented customers from publicly sharing their experiences with SmileDirectClub, including posting reviews or filing complaints with regulators. In June 2023, the company agreed to release over 17,000 customers from NDAs that they had signed as part of receiving a prorated refund after the 30-day trial period.

Lack of Accountability to Patients

Although SmileDirectClub is now getting all the negative publicity, it isn’t the only company of its kind. Just because the others haven’t yet collapsed doesn’t necessarily mean they’re any more ethical or conscientious about the ultimate outcome of the patient’s treatment. In the end, SmileDirectClub’s “Lifetime Smile Guarantee” warranty was meaningless, as its customers/patients are unlikely to receive refunds, or compensation for finding an orthodontist on their own to complete their treatment. Ironically, those who expected convenience and economy by ordering clear aligners online got neither.

The following paragraphs of our original blog post on this topic are worth repeating - and reading, if this is the first time you’re visiting our blog.

“Online teeth aligner companies want people to think of the orthodontist as a ‘middleman’ who can be cut out of the process as an unnecessary expense. But keep in mind that orthodontic treatment is medical treatment that needs to be performed by a licensed professional who has the required training and credentials, and who follows ethical practices. Otherwise, patients cannot expect a good outcome or even safety.

“Contrary to what these companies imply or say outright, conventional orthodontic practices are not trying to profit as much as possible from patients. Our commitment is always to provide the highest level of care, giving each patient the benefit of our specialized education, professional training and experience. We are accountable to you for the quality of services we provide. Online companies are not.

“Online services are tech platforms, not health providers. Such companies deny any responsibility by claiming they function as a marketing company for dentists, connecting them to customers - although part of their marketing is that people can skip going to the dentist. It’s also common practice to require patients to sign a form before treatment agreeing that any problems or complications that occur are the patient’s responsibility. Their lack of accountability and responsibility to patient health should negate any perceived convenience in ordering orthodontic treatment with a few clicks. For treatment in any branch of medicine to truly be successful, a doctor-patient relationship based on trust, accountability, mutual respect and transparency is essential.”

The Take-Home Message

Although today’s consumers feel comfortable bypassing traditional providers to deal directly with online companies, dental and medical services still require in-office visits for in-person evaluations and treatment - as well as that all-important doctor-patient relationship.

At NK Family Dental, we understand the desire for straight teeth and the appeal of a clear alternative to braces. We are proud to represent Invisalign as our clear aligner brand. It is the most advanced aligner in the industry, and has produced outstanding results for millions of patients. Our blog post - “10 Things You Need to Know Before You Start Invisalign” - is a good introduction to what to expect during treatment. We also offer traditional braces for teenagers and adults.

We know that the main concern you may have is cost, which is why we accept all major PPO plans for dental insurance and also offer our in-house dental plan. Please visit our financing page for more information.

At NK Family Dental, it is our mission to provide the highest quality and most compassionate oral care to our Chicago patients, including dental, orthodontic and periodontal services. Our dental specialists include our general dentist, Dr. Nilofer Khan, our periodontist, Dr. Amir Danesh, and our endodontist, Dr. Sabek.

We serve the neighborhoods of Logan Square, Bucktown, Humboldt Park, and Wicker Park with the dedication that’s earned us the reputation as the Best Dentist in Chicago!

Schedule your visit through ZocDoc, or contact us directly. We look forward to treating you soon!

10 Things You Need to Know Before You Start Invisalign

Invisalign has become one of the most popular treatment options for cosmetic dentistry, especially for teens and adults. The clear aligners are discreet and can offer a more comfortable experience than traditional braces. However, Invisalign requires just as much care and attention as traditional braces in order to achieve the same winning smile. Learn the 10 most important facts about Invisalign treatment so your treatment will be successful and permanent.

Benefits of Invisalign

There are many benefits to Invisalign compared to traditional braces. One of the greatest benefits is that there is no upper age limit for Invisalign, so both teens and adults can opt for it. Of course, the clear aligners make the process of teeth straightening much more subtle. There are also no food restrictions for Invisalign wearers, compared to the lengthy list of taboo foods for those with metal braces. Soreness from teeth shifting may additionally be reduced by opting for Invisalign over traditional braces. Finally, while this is not a guaranteed benefit, Invisalign can potentially help with whitening your teeth, as the whitening agents in toothpaste after brushing will be compressed to your teeth when wearing the clear aligners.

How to Prepare

It’s important to know your options and be fully prepared before starting Invisalign treatment. While Invisalign offers many benefits and is less obvious than braces, not everyone is a candidate. Traditional braces will be required for more complex teeth and straightening concerns. As with any dental treatment, it’s important and necessary to talk with your dentist to decide the best plan of action for your needs. Remember that Invisalign is not an easier option simply because of the clear aligners, so be prepared to put as much effort into taking care of your teeth as traditional braces.

Top 10 Things You Need to Know Before You Start Invisalign

Now that you are more aware of the benefits and preparation steps, let’s look at some of the most important things you need to know about Invisalign before you start:

You’ll be wearing your aligners the majority of every day. Just because they are clear doesn’t mean you can leave them off for long periods of time. Invisalign works best to straighten your smile when the aligners are worn as long as possible—a minimum of 22 hours a day. Keeping them in as much as possible will help you get used to the feel over time, as well.
You may notice a small difference in your speech. While it likely won’t be that noticeable to anyone except yourself, you should expect to experience a slight lisp as you adjust to the aligners. This is likely to improve after the first day or two of wearing a new Invisalign set. The best way to adjust is to simply practice and speak with them on as much as you can.
There is no set length of treatment. Because every person’s teeth are unique, the length of time to straighten them varies even with Invisalign. Adults can expect a year of treatment, on average, but your orthodontist or dentist will be able to provide a more accurate length according to your own needs. The best way to get Invisalign off as quickly as possible, though, is to be vigilant in your routine care and wear them the minimum 22 hours a day.
You’ll frequently be brushing and flossing. After every time you eat, you will need to brush and floss your teeth, no matter what. Food particles getting caught between your teeth and the aligners can lead to irritation, pain, and even cavities. The pH of your mouth will additionally change when wearing Invisalign, so it’s essential to keep your mouth as clean as possible. The few extra minutes a day will be worth it.
The aligners require extra care. It’s not just your teeth that you will need to make sure are clean. Invisalign aligners must be cleaned daily by brushing them just like your teeth. Once in the morning and once in the evening is recommended, but brushing them when you brush your teeth after meals can help keep them clean throughout the day. Soaking the aligners once a day can also help keep them cleaner and whiter.
You can’t eat with the aligners on. Thankfully, there are no restrictions on what you can eat when they are off. The downside to this is the frequent brushing and flossing, as mentioned in #4. Eating with the aligners on can make taking care of them very difficult, so it’s important to always take them out before eating. Drinking water regularly with Invisalign treatment will also help keep your mouth hydrated and clean.
You may need attachments. Invisalign provides a clear, almost unnoticeable experience. However, the straightening needs of your teeth may require a little extra assistance to catch up to speed with the rest of your teeth. Attachments, known as Invisalign buttons or brackets, are tooth-colored and blend right in to your teeth. They will only be attached to individual teeth that require them. With these potential attachments are likely to be clear rubber bands to help the treatment process.
You will need to wear a retainer afterward. Just like with traditional braces, you will still need to wear a retainer every night once your Invisalign treatment is completed. A nightly retainer will help maintain the success of your straightened smile for years to come. Slacking on this step will cause your teeth to slowly start shifting back into misalignment.
Your teeth may need extra work before starting Invisalign. This may depend on the size of your teeth and how well they will fit in with your aligner trays. In some cases, larger teeth may need to be slightly filed down in order to fit evenly. This routine procedure is not painful, and not everyone may need it done.
Invisalign costs are variable. There is no way to give a precise estimate on the cost of Invisalign compared to traditional braces. Every person’s mouth and needs are different, after all. For some people, Invisalign may cost less than traditional braces. For others, the costs may be about the same. Your dental insurance provider may cover Invisalign treatment, as well. Your orthodontist or dental office will be able to provide you a more accurate quote for both Invisalign and braces.

Smile Freely Again

If you’re looking to regain confidence in your smile, look no further than Dr. Khan at NK Family Dental, your top-rated Bucktown dentist in the heart of Chicago. NK Family Dental provides a full range of dental, orthodontic and periodontal services, including both Invisalign and traditional braces. Contact us today to schedule your consultation.

WHAT TO EXPECT WHEN UNDERGOING INVISALIGN TREATMENT

Teenagers and adults alike seek orthodontic treatment to help them obtain a beautiful and healthy smile. Since the introduction of Invisalign, a more aesthetically pleasing alternative to metal braces, the number of people pursuing treatment has increased. Although popular and effective, Invisalign patients will have a different experience compared to those who opt for metal, or traditional braces. Keep reading to learn what to expect when undergoing Invisalign treatment, so that you will be adequately prepared.

Benefits of Invisalign

Most dental patients are initially drawn to Invisalign, as the aligner trays are less noticeable than metal braces. However there are other noteworthy benefits. The thin and clear shells work faster than metal braces, and are relatively pain-free. You will likely experience soreness as your teeth shift, but you will not experience tissue injury. Invisalign trays are also easy to remove and reinsert, meaning you can enjoy the foods that are restricted with metal braces. Finally, as the aligners are removable, cleaning both the trays and your teeth will be less of a hassle. With good oral hygiene habits, your teeth will be less susceptible to discoloration and cavities than with traditional braces.

Things You Should Know

Wear your aligners as much as possible - Invisalign requires patients to wear the aligners for a minimum of 22 hours per day. Resist the temptation to remove your aligners as much as possible, and you will reap the reward of a faster treatment period. The more you wear them, the faster you will forget they are there!

You must take them out to eat - A downside to Invisalign is that you have to remove the trays to eat. That being said, the removable aspect means you can eat more than you could if you had opted for braces. A common mistake Invisalign patients make is wrapping their aligners in napkins at mealtimes, and accidentally tossing them out. Avoid this by using the provided case at all times!

The aligner trays will discolor - You will be issued a new Invisalign aligner every two weeks. You can bet by the end of those two weeks, there will be some significant discoloration to the trays. To prevent this, clean the trays every day with a toothbrush and toothpaste. It's also a good habit to give the trays a quick rinse when you remove them ‒ it will help you feel less icky!

The dentist may adjust your teeth - To assist in aligning your teeth, your dentist may offer to file some teeth down slightly. This quick and painless step will help your teeth have a more uniform shape, and will allow your teeth to fit in the aligner trays more comfortably.

Prepare to brush your teeth a lot - On any given day, you likely get a variety of foods stuck in your teeth. Normally, this is not an issue, as our saliva and the amount of water we drink washes most of it away. When you wear an aligner tray for 22 hours a day however, food can be trapped for an extended period. For this reason it is very important that you brush your teeth more often ‒ each time you eat, in fact.

You will have to floss frequently - The same as brushing, you will have to floss more often. Floss each time your eat a meal, as well as in the morning and evening.

Teeth may feel loose - If your teeth feel loose, don't panic! Before your teeth can shift into the correct position, they must first be slightly loosened. This is natural, and once they are properly aligned, the teeth will again settle in firmly.

You may speak differently - A side effect of wearing the plastic aligners is that you may notice that you are unable to enunciate clearly. Most people have a lisp for a few days following each new set of aligners, but no worries, it won’t last.

You will have a retainer - After successfully achieving the smile of your dreams, you will no longer be issued Invisalign trays. Instead, you will receive a retainer that will help keep your teeth from shifting.

At NK Family Dental, we are proud to offer Invisalign clear aligners for patients who want to experience the benefits of standard braces without metal or wires. Encounter the benefits of exceptional dental treatment and service by contacting us to schedule your appointment today. Our team of highly trained professionals will be glad to assess your unique dental situation in order to provide the best method of treatment possible to help you achieve the smile of your dreams.