Here’s What You Should Know About Those Mail-In Braces Programs

If you follow any wellness influencers, trainers, or former Bachelor contestants on Instagram, chances are you've seen some of them touting invisible braces or retainers with some sort of promotional code. It's surprising that this orthodontic accessory has become trendy, but people seem to be into the concept, and it's almost impossible to ignore the ads.

The business model is more or less what would happen if Warby Parker and Invisalign had a baby. Here's how one popular company, Smile Direct Club, works: First, you're sent a kit to make a 3-D mold of your teeth, which is then passed to a dental professional who creates your retainer plan. They'll even show you a preview photo of what they say your new smile will look like. You pop into a dentist to get a quick checkup, and voilà — you get your set of aligners in the mail to start wearing.

Why not just go to an orthodontist and get traditional invisible aligners? Well, these are way cheaper (60% cheaper than traditional invisible aligners, according to the site) and you don't have to pay for regular checkups.

It's kind of obvious why some orthodontists would be wary about these services. But if they're half the price, does that mean they're only half as safe and effective as the traditional braces you'd get from a doctor? We asked a few orthodontists what they really think about these new mail-in services.

Do they work?
Scroll through any of the before and after photos on social media, and it certainly looks like mail-in aligners work. There are hundreds of glowing reviews on Smile Direct's website, with patients saying that they're "ridiculously affordable" and "efficient." One Instagram user posted a photo of her results, and said that she was able to close a gap between her front teeth in just four months of her six-month treatment. Another Smile Direct reviewer said that the "improvement was almost immediate." But other people left reviews saying that the aligners didn't straighten their teeth as much as they would have liked. One wrote, "I am not sure if saving the money was worth not being able to have access to a dentist to ask questions to."

Invisible aligners aren't always as effective as standard braces, though they generally produce positive results to patients using them under medical supervision, says Sunil Wadhwa, DDS, PhD, associate professor of dental medicine and director in the division of orthodontics at the Columbia University Medical Center. Orthodontists often make numerous refinements to make sure that the aligners are absolutely perfect, and in about 30% of cases, they have their patients also wear traditional braces to ensure the best alignment, he says — and that's an important difference from what you'll get in the at-home sets.

"We'll continue treatment until it's done appropriately, which will take as long as it takes," Dr. Wadhwa says. Most mail-in companies will give you between three and 10 months for treatment. "That's a huge thing: We're going to do it until it gets done, and they'll just give you a set amount, and whatever it looks like is what it looks like," he says.

Are they safe?
The American Association of Orthodontists takes a strict stance against DIY braces (using a rubber band to fix a gap, 3-D printing a retainer, or MacGuyvering metal braces from a clothes hanger, for example) — but that seems pretty obviously unadvisable.

And ordering aligners online isn't doing it yourself. Smile Direct Club products, for example, come from a "licensed dental professional in your state who reviews your case," according to its site. It adds that "top dentists and orthodontists" create and prescribe treatments for its patients — but the company also makes it pretty clear that it's not practicing medicine. Still, "There are very few things that could harm your dental or general health," Dr. Wadhwa says.

There are some risks associated with having crooked or incorrectly straightened teeth, which is why Dr. Wadhwa says it's important to see an orthodontist for the safest fix. With mail-in retainers, "it's just a computer doing the [straightening], so it assumes that the bone will grow with the teeth, but that's not necessarily happening," says Jing Chen, DDS, PhD, assistant professor of dental medicine at the Columbia University Medical Center. Braces are technically a medical appliance, and should be used under the supervision of a professional, she adds.

How much will it cost?
"The biggest negative effect would be money, and I think it could be a waste of your money," Dr. Wadhwa says. For some perspective, metal braces can cost between $3,000 and $7,000, and invisible aligners from an orthodontist typically cost between $3,000 and $6,000, according to the Consumer Guide to Dentistry. This price can vary a lot, depending on the type of insurance you have, but if you use insurance and a flexible spending account with Smile Direct Club, you could only pay $750 for the mail-in version. Ultimately, you have to decide whether you're willing to pay that much money for a potentially imperfect job, or just shell out your money and time to go to an orthodontist.

Should you try them?
Mail-in aligners might seem like a good option for a slight fix. But keep in mind you're not the expert on how minimal a fix your teeth need. "It's difficult to go from something that's 90% good to make it 100% perfect; in my experience, I find that these are the harder cases," Dr. Wadhwa says. The results of using invisible aligners can be extremely unpredictable, because some people respond well to them and others won't. "It's very hard to monitor this by yourself, because — like everything in medicine — not everybody responds the same," he says. The real difficulty comes with figuring out how to correct your smile if you're not responding correctly to the retainers, he says.

The bottom line: You get what you pay for, Dr. Wadhwa says. "If you're okay with it not being perfect or not lasting, that's fantastic," he says. That said, treatment from traditional metal braces doesn't necessarily last forever, either. Unless you wear a retainer, your teeth will naturally relapse and move toward the middle of your mouth, Christine Hong, DMD, MS, assistant professor of orthodontics at UCLA School of Dentistry told Refinery29 in April. Be an informed customer, and ask your dentist or orthodontist if they think this at-home version would be a good idea for you.

And as with any #sponcon, just because a celebrity claims that something worked for them, does not necessarily mean that it will work for you — especially when that "something" is a medical device.

UPDATE: SmileDirect reached out to Refinery29 with the following clarifying statement.