This story is a part of Show Your Teeth, a package in which Allure examines dental care (or lack thereof) in the U.S. and what we can do at home to better care for our teeth.
I spent most of my childhood at the dentist's office and, thanks to my cleft palate, wore braces on and off for about 10 years of my life. Although I've never experienced wearing braces as an adult (I finally got mine off my junior year of high school), I know that it's a big step toward achieving a straighter smile. The problem is, most teeth-straightening options, including in-office braces and at-home treatment plans, are extensive, expensive, and might not be covered by dental insurance.
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As a pre-teen, when my parents and I were deciding which kind of braces to get, there really weren't many options to choose from, so I went with the classic metal braces. Today, the options for in-office and at-home teeth-straightening plans are vast, making it a really exciting time for orthodontia.
"Traditionally, orthodontic treatments with braces or clear aligners were only available in the dental office, designed and supervised closely by a dentist throughout the treatment," says Sharon Huang, a dentist and founder of Les Belles NYC in New York City. "In recent years, many direct-to-consumer aligner companies have created mail-order aligners available to consumers without the supervision of a dentist — they're faster, cheaper, and more convenient. There's a rise in direct-to-consumer marketing promising a straight smile from home for less money without seeing a dentist."
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However, Huang isn't a big fan of at-home braces without the supervision of dentists because they go through years of training to master the skills to predictably move teeth, to ensure proper resulting biting force, alignment, and aesthetics. Plus, she doesn't love that patients, who have no prior dental training, are required to take mold and photos of their own teeth (for most at-home treatment plans).
Some other at-home treatment plans will take a scan of patients' teeth, and most at-home orthodontic treatment programs do not see patients in person — the full treatment is designed remotely. "It is very difficult to make a proper diagnosis by looking at pictures of a patient," says Huang. "It's important for patients starting orthodontic treatment to have a proper exam by a dentist to detect cavities, gum disease, signs of resorption, or shortened roots prior to orthodontic treatment or these may deteriorate throughout orthodontic treatment."
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Another important thing to note is that there are currently no regulations for at-home orthodontic treatments, as stated on the American Dental Association's (ADA) website. "For the health and well-being of the public, the ADA believes that supervision by a licensed dentist is necessary for all phases of orthodontic treatment…," according to a policy passed by the ADA House of Delegates in 2017. "The ADA 'strongly discourages' the practice of do-it-yourself orthodontics because of the potential for harm to patients."
Although at-home teeth-straightening treatment plans might be less expensive compared to in-office options, that doesn't mean they won’t make a significant dent in your bank account. While yes, some in-office braces may be covered by dental insurance, without insurance, the average cost of braces for adults is between $4,800 and $7,135, according to a 2018 survey by the ADA. On the flip side, at-home teeth straightening plans can cost between $1,800 to almost $3,000, depending on which plan you choose and how long you'll need treatment.
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Whether you choose pricey in-office braces or are willing to risk a less expensive at-home treatment plan, there are a plethora of options, including metal braces, clear aligners, lingual braces, and more. And while we can't change the cost of the treatment, we can, however, provide you with all of the information you'll need when choosing braces.
Below, we've outlined a comprehensive guide to getting braces as an adult, if you so choose to straighten your smile.
In-office teeth straightening treatments
Traditional braces have been around for a long time, and they're probably the most recognizable symbol of orthodontics. Fixed appliances, like braces, are attached to your teeth and aren't taken off until you complete your treatment. "These orthodontic workhorses have a long history of successful treatment and are great at correcting many oral issues," explains Jordan Cogan, a Philadelphia-based orthodontist. "That's why metal braces continue to be the top orthodontic treatment for patients of all ages."
An ideal candidate for traditional braces would be someone who has more moderately to severely crooked or overlapped teeth or someone with small gaps. If you have a misaligned bite, you might be a good candidate for traditional braces, and you also need to have relatively healthy teeth, as metal braces use a lot of force to move your teeth around.
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Bracket technology is always advancing, creating the smallest, lowest profile mix of stainless steel, nickel, and other metals to create braces that are durable and significantly less noticeable, according to Cogan. "The wire is a thin piece of metal that runs from one bracket to another, and the orthodontist has advanced training and knowledge to change the shape and curvature of the wire to move your teeth in the right direction," he says. "Bends in the wire will provide different types of pressure on different teeth." A bend in the wire is how most orthodontists cause specific and precise movements.
The price of traditional wire braces will vary depending on the complexity of your orthodontic needs. That being said, metal braces are cost-effective because they don't require some of the more complex technology or expensive equipment that newer treatments do, according to Cogan. Additionally, "[some] insurance plans offer orthodontic benefits and most orthodontic offices will work with you to maximize your benefits," says Cogan. Some offices will offer flexible financing options at zero percent interest to make orthodontic treatment more accessible. Traditional braces, without insurance, can cost anywhere between $3,000 to $7,000.
Additionally, the time you spend wearing traditional braces will really depend on your teeth's needs. "The average time spent in metal braces is around 18 to 24 months, but could be shorter or longer, depending on the individual treatment plan," explains Cogan.
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The history of clear aligners goes back to 1945, when tooth positioners were introduced to refine the final stages of orthodontic treatment after appliance removal, according to a 2014 article in the New York State Dental Journal. In 1997, two Stanford students founded Align Technology — Invisalign (one of the most recognized clear aligner companies) was created in 1999.
"Clear aligners, are customized appliances created by the aid of sophisticated 3D imaging and animation tools that enable virtual simulation of tooth movements," says Cogan. "Tooth movements resemble a filmstrip, and each frame or stage corresponds to a set of clear plastic aligner trays. As the trays are worn by the patient, every tray pushes the teeth slowly to their proper positions."
Unlike traditional braces that are visible with metal, clear aligners are made with smooth plastic and don't have metal components that can irritate your mouth — however, you will need to switch out the plastic retainers every two weeks. "Because they're removed when you eat, you won't have to watch what you eat like you would when wearing braces." Before you sign up for these, you must be willing to remove the clear aligners for eating and drinking (other than water) every single time — eating with Invisalign could cause damage to the aligner, and drinking with them could cause staining.
The cost of clear aligners will vary depending on the complexity of your orthodontic needs, but a typical treatment plan can range from $3,00 to $7,000. "[It] typically costs slightly more due to the more complex technology or expensive equipment that it requires," says Cogan. "However, insurance companies offer many benefits to help make orthodontic treatment with Invisalign more affordable than ever." Treatment can be as short as six months, or go up to 12 to 18 months, depending on your teeths' needs.
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Unlike traditional braces, which are fixed to the front of your teeth, lingual braces are placed on the back of your teeth, toward your tongue. Lingual braces work in the same way that traditional metal braces work. "They apply a gentle, continuous pressure to your teeth to slowly shift them into their new, straighter positions," explains Cogan. "This treatment can take anywhere from six to 30 months, depending on how severe your bite or overcrowding is."
Unlike traditional braces, lingual braces may cost more (anywhere from $5,000 to $7,000), depending on your teeths' needs. "Similar to Invisalign and other treatment options that require more complex technology and expensive equipment, [lingual braces] will typically cost more than traditional braces."
Although lingual braces may look less noticeable, you might find them a bit more uncomfortable than traditional braces within the first few weeks. It takes time for your tongue to adjust to the new space in your mouth, causing a slight speech impediment temporarily. Additionally, you might find that your tongue develops canker sores as it rubs against the lingual braces frequently — your tongue should be able to adjust to the new braces, but you should utilize wax if discomfort continues.
Once you've completed your teeth straightening treatment plan, your orthodontist might want to insert a permanent retainer on the inside of your teeth to prevent them from moving around. "To help combat unwanted tooth movements, permanent retainers are bonded to the lingual (inside surfaces) of the front teeth," explains Cogan. "That being said, nothing comes without sacrifice — these metal permanent retainers make flossing and routine oral hygiene more challenging and periodically require maintenance." If used properly, specifically when paired with a removable retainer that your orthodontist might give you post-treatment, permanent retainers are a great solution to maintaining a perfect smile.
As much as we'd love retainers to last forever, a permanent retainer won't last a lifetime, and you might find that you'll need to get your retainer replaced or repaired periodically. It's important to note that permanent retainers won't actually change the position of your teeth, but are a maintenance appliance that will keep your teeth in the same position that they were in after your teeth-straightening treatment was completed.
At-Home Teeth-Straightening Plans
According to Huang, at-home aligners may seem like an inexpensive and easy way to straighten teeth, but they may cause more costly problems to fix in the future. "With at-home kits, patients are left in charge of their own teeth movements, and so much can go wrong during the treatment: ill-fitting aligners, inadequate or too much force or torque on teeth, chronic inflammation, improper biting force, recession, bone loss, long-term joint discomfort or pain, and even tooth loss," she says.
That being said, if your teeth require more supervised care, it might be a smarter option to head to a dentist, rather than rely on at-home treatment plans to do the work for you. "The FDA encourages patients to speak with their healthcare provider about all appropriate treatment options for their condition," a spokesperson for the Food and Drug Administration (FDA) tells Allure.
However, if you think your smile needs just a slight adjustment, at-home teeth straightening might be a more cost-effective, time-efficient option for you — but, of course, it's best to check with your dentist first.
SmileDirectClub is a popular at-home teeth-straightening treatment plan that uses 3D scanning to create clear aligners to gradually straighten your teeth over time. When signing up for Smile Direct Club, you have three options to get started: you can visit a SmileShop for a 3D scan, order a doctor-prescribed, remote impression kit, or obtain a 3D scan or impression from a dentist's chair via its Partner Network.
Whichever method you choose, each customized treatment plan is reviewed, finalized, prescribed, and monitored by one of SmileDirectClub's state-licensed dentists and orthodontists. SmileDirectClub will then manufacture the aligners in its 3D printing facility and then ship your aligners to your door. "Depending on the treatment plan their doctor prescribes, customers either wear their SmileDirectClub aligners for 22 hours per day or the Nighttime Aligners for 10 continuous hours of nighttime wear," explains Jeffrey Sulitzer the chief clinical officer with SmileDirectClub. "Customers can complete their treatment plans in as little as four months."
Although you aren't going into a dental office for a routine check-up and braces adjustment, SmileDirectClub offers a telehealth platform to allow patients to have face-to-face conversations with their dental team. "Every SmileDirectClub patient's entire treatment is doctor-prescribed and doctor-directed, from the safety and comfort of home," explains Sulitzer. "In addition, SmileDirectClub's aligners are made of a smooth, comfortable plastic that does not irritate cheeks and gums like traditional metal braces tend to do."
While it may seem more convenient, Huang has many concerns with at-home orthodontic treatments. "Most at-home treatments will send patients an orthodontic kit to take molds and photos of their teeth, but how accurate a mold is will dictate the fit of the aligners/braces, which in turn will dictate the success of treatments," she says. "How could a layperson take a proper mold they've never been trained to take, and then have months of treatment designed based on the mold?"
In response to these concerns, Sulitzers says, "SmileDirectClub patients are not in charge of their own treatment, nor are the outcomes of its treatment any different from other clear aligner option." "...Treatment is prescribed by state-licensed dentists or orthodontists who use information such as patient X-rays, dental history, a visual exam of the patient's mouth and gums using either photographs or when needed, video calls, and the 3D scans taken in-shop or modeled using an impression kit to prescribe the clear aligner treatment program."
Some products will take a scan of patients' teeth, while most at-home orthodontic treatment programs do not see patients in person, and the full treatment is designed remotely. "It is very difficult to make a proper diagnosis by looking at pictures of a patient, and it's important for patients starting orthodontic treatment to have a proper exam by a dentist to detect cavities, gum disease, signs of resorption, or shortened roots prior to orthodontic treatment or these may deteriorate throughout orthodontic treatment," explains Huang.
In response, Sulitzer says that regular check-ins with a professional dental team at SmileDirectClub, as well as the treating provider using the telehealth platform, can ensure more monitoring and possible points of contact than a brick-and-mortar dental office. Like other at-home teeth-straightening plans, SmileDirectClub is about three times less than clear aligners and up to 60 percent less than traditional braces.
Patients can pay in two ways: Single Pay or SmilePay. Single Pay includes a one-time payment of $1,950, and SmilePay includes a down payment of $250 and then $89 per month for 24 monthly payments. Additionally, SmileDirectClub charges an initial $59 for scans and impression kits, and they encourage patients to wear SmileDirectClub’s retainers after treatment to maintain their new smile, which costs $99 per set.
Similar to Invisalign and SmileDirectClub, Byte is another aligner company that lets you straighten and whiten your teeth from the comfort of your home. To get started, customers will complete an Impression Kit at home and send molds of their teeth in for review. "If we determine that you are a candidate for Byte, we create a treatment plan based on your unique smile," explains Jay Khorsandi, Byte's in-house dentist. "Every treatment plan is overseen and prescribed by a licensed dentist or orthodontist, and in just a couple of weeks, you'll receive an aligner kit to begin your smile transformation."
Once you've been approved for Byte, you'll receive a kit that includes your invisible aligners (made from BPA-free highly transparent, medical-grade, polymer material), BrightByte teeth whitener, and its HyperByte device, which "uses high-frequency vibration to help seat your aligners, decrease discomfort, and shorten treatment times," explains Khorsandi. "Our goal is to help you gain confidence and find a smile that you're proud of."
Byte's aligner treatments start at $1,895 with financing options at $83 per month. "We have a treatment that allows you to only wear your aligners at night so you can straighten while you sleep," says Khorsandi. "Treatment times vary with averages of four to six months, depending on the type of plan you choose."
The Byte team did not respond for Allure's request for comment regarding the ADA's, FDA's, and Huang's stance on at-home teeth-straightening treatments.
Candid is another at-home clear aligner treatment plan that allows you to straighten your teeth remotely. Once you sign up for Candid, you can choose one of two options: either book a complimentary appointment at a Candid Studio location, during which a Candid Care Specialist will take photos, X-rays, and 360-degree inter-oral scan of the patient's teeth or, you can purchase a Candid Starter Kit, where you can take your own photos and impression at home.
Next, you'll be assessed by one of their state-licensed Candid Orthodontists, who will design a customized treatment plan to align your teeth holistically and address your individual chief complaint. "The same orthodontist will be on the patient's case throughout, tracking their progress and monitoring the speed of their treatment," explains Cathrin Bowtell, president of Candid. "Patients will receive their aligners about two to three weeks after accepting their custom treatment plan, along with Candid's premium Gentle Whitening Foam, and the CandidMonitoring technology to conduct bi-weekly scans for check-ins, which patients will share with the orthodontist assigned to their case via the CandidApp."
In addressing concerns cited earlier by Huang, Nick Greenfield, the cofounder and chief executive officer of Candid, explains that all Candid patients are required to see a dentist within the 12 months leading up to their treatment start date. "About 20 percent of patients report they haven't been to the dentist within 12 months, and our orthodontists require them to complete a robust oral health evaluation with their general dentist before starting treatment," says Greenfield. "Candid does far more pre-treatment and mid-treatment to identify core issues and is able to diagnose and track patients remotely with the Candid App. Without the Candid App, we wouldn't feel comfortable doing doctor-directed at-home clear aligners."
The Candid treatment takes an average of six months to complete, but it could also take anywhere from three to 12 months, depending on an individual patient's needs. Once your treatment is completed, the final aligner can serve as a nighttime retainer to ensure your teeth stay in place forever.
Unlike other at-home clear aligner treatments, Candid is able to cut out many of the additional costs associated with in-person orthodontist visits with the at-home CandidMonitoring system. The Candid Starter Kit costs $95, while the Clear Aligner Treatment itself costs $2,400 total. If you have insurance, you might be able to save up to $1,300 from the out-of-pocket expense, and Candid also offers custom financing plans to help you make smaller payments over a longer period of time.
When asked to comment on the ADA's stance on at-home teeth-straightening treatments, Greenfield says, "we agree that a licensed orthodontist should be involved throughout treatment for all clear aligner therapy. We believe that care can be administered using telehealth. We are strongly opposed to DIY orthodontics."
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