Direct-to-consumer companies are everywhere these days, promising to disrupt fill-in-the-blank industry by cutting out the middleman and selling you mattresses! knives! suitcases! toothbrushes! at a fraction of the cost. Most of the time, this is a good thing. It allows you to buy a well-designed product at an affordable price, without ever having to put on pants (our kind of shopping).

But are DTC companies always good for consumers? Dentists don’t seem to think so. 

Yep, dentists. Orthodontics is one of the industries being “disrupted” by DTC startups, and doctors aren’t too happy about it.

For a long time, you could only straighten your teeth by going to an orthodontist and getting braces or Invisalign. But then Invisalign’s patents started running out and 3D printing became more advanced, allowing clear aligner newcomers like SmileDirectClub, Byte, and Candid to come on the scene. 

It makes sense, right? Straightening your teeth is pricey, costing upwards of $4,000. And it’s a hassle, requiring multiple visits to the dentist. Like most DTC companies, these startups save you time and money by eliminating the middleman and shipping aligners to you directly. Only in this case, the middleman is the doctor. 

The Big Problem With DTC Aligners

Here’s how at-home aligner companies work: They send you a DIY kit, and you use putty-like molds to take impressions of your teeth. Or, if the company has brick-and-mortar locations, you may be able to go in for a digital scan instead. Then, a remote dentist, orthodontist, or dental technician uses those impressions to create your treatment, and the company ships all of your aligners to your home.

Convenient, right? At $1,900, it’s also a whole lot cheaper than braces or Invisalign. But dentists say you might be paying a different kind of price for that convenience.

Orthodontics is a complicated, individual medical treatment, not a consumer product like sneakers or razors. Teeth are not exactly easy to move around—they’re made up of nerves and blood vessels and are connected to your jaw and head. If you have underlying issues like cavities or gum disease, wearing aligners can exacerbate those issues or cause even bigger ones like tooth loss or jaw pain.

That’s why dentists say in-person, pre-treatment evaluations are necessary before beginning any sort of orthodontic procedure. They need to look at your full mouth—your tissue, your gums, your bones—in order to make sure you’re a candidate for aligners. But most DTC companies skip that all-important step and instead just take the patients’ word for it that their mouth is healthy.

Woman inserting teeth-straightening clear aligner into her mouth

Not only that, but dentists say putty molds are outdated and can easily result in ineffective or poorly fitting aligners, especially when untrained patients are the ones taking the impressions. In fact, many customers say they had to adjust their aligners themselves using nail files. While more companies are offering in-person digital scans, which are much more accurate, they’re usually operated by an assistant or technician, not a trained doctor.

Because patients don’t get face time with a dentist, most DTC aligners can only treat mild cases—usually people who had braces but forgot to wear their retainer and need to make a few small adjustments. But that’s not always the way they’re marketed. In a petition against SmileDirectClub, the American Dental Association accused the company of using before-and-after photos to imply that it can fix more severe situations.

The American Association of Orthodontics also warns against superficial treatments, saying “there is more to creating a healthy, beautiful smile than moving the visible portions of your teeth.” In fact, just fixing your front six teeth, which is what a lot of DTC aligners do, can throw off your bite and cause even bigger issues.

How Dentists Are Fighting Back

But not all is lost. Some companies are helping dentists fight back against DTC aligners by putting the doctor back in the picture. Dandy, for example, offers aligners at a similar price ($1,900 for simple cases, $2,600 for more complex ones), combining the professional supervision you get with braces or Invisalign with the convenience and affordability of DTC aligners.

Dandy partners with top-tier local dentists to do in-person checkups, 3D digital scans, and X-rays before every treatment. This, in turn, allows Dandy to treat cases other aligner companies can’t. Dentists can take care of fillings, IPR, or other necessary dental work, plus apply the small, tooth-colored attachments necessary for more complicated mouths.

But unlike traditional orthodontics, Dandy cuts down on the hassle of having to see a dentist every couple weeks. Instead, it ships your aligners to your home and monitors your progress virtually, making it a win-win for dentists and patients alike.

Want to give Dandy a try? See if you’re a candidate.