Align technology brought clear aligners to the orthodontic market in 1999 and called them Invisalign. It has forever changed orthodontics. I first heard about Invisalign in 2000. I got training right away regarding this new and innovative technology and have been using it in my office since then. This technology made orthodontic treatment available to people who didn't want braces. It also led more dentists to offer Invisalign because clear aligners look easier at first glance. As a result, many general dentists started offering orthodontic care in their offices, and direct-to-consumer (DTC) companies started sending straightening kits through the mail. 

People who need or would like orthodontic treatment may need clarification on whether to see their dentist, a direct-to-consumer company, or an orthodontist. Both dentists and orthodontists are licensed dental professionals, but they have different areas of expertise and provide various types of treatments. Because of this, it can be hard for patients to figure out which professional is best for their needs.

Dentists are the main people taking care of oral health. They do cleanings, fillings, extractions, and crowns. Dentists are trained to find and treat oral health problems like gum disease, cavities, and tooth decay. They can give patients information on keeping their teeth healthy.

While convenient and often more affordable, direct-to-consumer teeth-straightening options have several potential downsides. One of the main disadvantages is the need for more professional oversight. DTC options may offer a different level of expertise and professional care than traditional orthodontic care done by a licensed orthodontist. So, DTC options can lead to flaws in the treatment plan and less-than-ideal results. I have even seen many cases where a patient went through treatment with a DTC company and their problem was not corrected or worsened. They ended up seeking care in our office, causing the patient to begin treatment all over again, which could result in additional time and expense for these patients. Another potential downside is that DTC companies' aligners might not fit well or be uncomfortable, which could cause irritation or pain. It is only possible to adjust the aligners with in-person check-ups and adjustments, and the teeth might not move the way they should, making the treatment less effective. DTC options also may not be covered by insurance, making them a more expensive way to straighten your teeth. 

On the other hand, orthodontists use their extensive training and education to use braces, clear aligners (like Invisalign), retainers, and other orthodontic devices to fix bad bites and straighten teeth. Orthodontics is the branch of dentistry that focuses specifically on the alignment of teeth and jaws. After dental school, orthodontists get an extra two to three years of specialized training in orthodontics. As a result, they acquire the skills and knowledge to treat more complex orthodontic problems.

When deciding between a dentist and an orthodontist for treatment, it's helpful to consider the specific oral health problem that needs fixing. If patients have issues, such as cavities or need a routine cleaning, they should see a dentist. Orthodontists have the specialized skills and knowledge to give advanced orthodontic treatment, such as braces, Invisalign, or other orthodontic appliances.

In some cases, patients may require both dental and orthodontic care. For example, if a patient has both cavities and crooked teeth, they may need to see a dentist for the fillings and an orthodontist for the braces or clear aligners. In these cases, the dentist and orthodontist need to work together to provide the best possible outcome for the patient.

It is appropriate to consider a patient's needs and lifestyle when determining the type of orthodontic treatment. For example, some patients may prefer traditional metal braces, while others may prefer clear or invisible options like Invisalign or clear braces (also called ceramic braces). Patients should discuss their options with a dentist and an orthodontist to determine which treatment is best for them.

Some dentists and direct-to-consumer providers can use clear aligners or braces to straighten teeth, alleviate crowding of the teeth, and close spaces between teeth. However, when aligning the teeth and bite, the help of an orthodontic specialist is beneficial. Here are a few examples:

Bite Problems

Clear aligners can straighten the teeth and correct certain bites. However, they are not as good at fixing more severe bite problems (how the upper and lower teeth come together) as braces. For example, deep bites (where the front teeth overlap too much in a vertical direction), excessive overjet (where the lower jaw is too far back), underbites (where the lower jaw is too far forward), and crossbites (where the widths of the upper and lower jaws don't match) are some bite problems that are harder to fix with clear aligners. When these problems are caused by misaligned teeth, aligners may help, but they are not as effective as other methods when the jaw size or shape is to blame. Putting the teeth in the right place without fixing a problem with the jaw could make the bite worse. In these types of cases, there are better options than DTC aligners. In nearly every case, orthodontists have the specialized training to deal with these more complex orthodontic problems. 

Eruption Problems

Problems with eruption include teeth that are impacted (they simply don’t come in), don't form where they should (ectopic teeth), or move into places where they don't belong. Just straightening the teeth that you can see can’t fix these problems. Since you can’t see unerupted teeth by looking in the mouth, the only way to get a full diagnosis and figure out the best treatment plan is to look at x-rays and photos. Most direct-to-consumer (DTC) companies don't require x-rays as part of their procedures, so impacted teeth are rarely found or fixed. Orthodontists can solve these problems and work closely with oral surgeons and other dental specialists when needed. These more complex problems are routine for orthodontists since this is what they deal with every day. 

Excessive Crowding and Dental Protrusion

Most cosmetic concerns for patients are from crowded teeth. Ironically, just straightening crowded teeth makes them protrude even more. So orthodontists are trained to use advanced methods, like expanding the jaw, using specialized bite correction appliances, or taking out teeth to fix crowding and teeth that stick out too far.

Developmental Problems

A very important factor for younger kids is considering how the teeth, jaws, and face will grow and change over time. These developmental factors determine the sequence of treatment for each person. In addition, orthodontists detect when something is not developing properly. Some developmental problems include extra teeth, missing teeth, and misshapen teeth.

With close monitoring of growth and development, orthodontists can spot these problems early and take steps to fix them before it's too late. For example, the orthodontist can ask for teeth removal so the other teeth can grow normally. Since baby teeth hold and save space for the permanent teeth that will replace them, it's important to know when to take them out (if necessary). In addition, if baby teeth are lost or removed too soon, the teeth underneath may move to fill in the gaps, which makes treatment down the road much harder and less efficient.

In conclusion, it can be hard for potential patients to decide between a dentist, direct-to-consumer options, and an orthodontist for orthodontic care. It's important to put oral health at the top of your list and choose a professional who can give you the best, most conservative results while maintaining the health of the bone and supporting dental tissues. Most general dentists and direct-to-consumer companies are not set up to handle and treat more complicated orthodontic issues. Getting several opinions, reading reviews, asking your friends or family, and talking to both dentists and orthodontists will help you figure out which professional will best meet your individual needs and help you achieve your goals. Taking great care of your teeth at home and seeing your dentist for regular dental checkups are the best ways to keep your teeth and gums healthy and avoid more complicated and expensive treatments down the road. I'm sure general dentists and DTC companies can provide great orthodontic care. I like the analogy: if I have a significant hand injury, I am not going to a general surgeon to seek care; I am going to see an orthopedic surgeon specializing in hand surgery. If my teeth and jaws were misaligned in a more complicated way, I would go to an orthodontist, who is a specialist in correcting teeth and jaws that are out of place. In the same way, I want to avoid putting my orthodontic care in the hands of a direct-to-consumer company where I cannot receive direct, in-person care. I like the ability to look someone in the face, ask them questions about my orthodontic issues and individualized treatment plan, and receive personal oversight of my treatment. It makes sense that an orthodontist would take care of the orthodontic needs of patients. Whatever path you take, I hope your orthodontic journey is enjoyable and you achieve a smile you love!

If you'd like to find out if braces or clear aligners are right for you, take this quiz, and schedule your FREE consultation with Dr. Brandon Boggan or Dr. Zehra Syed at our Pelham or Calera locations!