The rise of direct-to-consumer orthodontics has exposed a gap in how practices and DTC companies address generational habits, and patient concerns such as pricing, convenience, and practice visits. Now’s the time to close it.

By Roger P. Levin, DDS

Orthodontic practices are distinct and unique businesses. They are not like other businesses outside of dentistry and they are far different than general practice or other specialties within dentistry. The uniqueness of orthodontics has been a benefit to practice performance, production and profitability but is about to undergo transition. The supply and demand economics of orthodontics allowed practices to perform well. Very few orthodontic practices struggle and most create excellent, enjoyable and fun careers and financial stability.

The Disruption Factor

Today we are seeing disruption in the orthodontic specialty. Disruption is a term coined by the late Dr Clayton Christensen, a world-renowned professor on innovation in business at the Harvard Business School. His landmark book, The Innovator’s Dilemma, explained how disruptive forces can go unnoticed in an industry for long periods of time until they become a new standard. I am not suggesting that orthodontics has a new standard. However, there is data from the Levin Group Data Center that clearly indicates orthodontic practices have a higher level of competition for patients, that new patient numbers nationally due to the COVID-19 pandemic are flat and may begin to decline for some period and the emergence of direct-to-consumer orthodontics (which now includes relationships with DSO’s and insurance companies) may be a disruptive factor for the orthodontic specialty.

How does an orthodontic practice protect itself?

Viewing Value Through a Different Lens

Up until now building value in orthodontics focused on the “how’s.” Wonderful articles, books and seminars presented various ways on how practices could build value around orthodontic treatment in the minds of new patients. However, with the emergence of direct-to-consumer orthodontic products, building value needs to be viewed through a different lens. It’s no longer only about how to build value, but what value really means. Direct-to-consumer orthodontics has given patients a less expensive option for orthodontic treatment which has made it more difficult for traditional practices to justify their fees. Now, practices must re-determine what is most important to their patients. They will no longer invest in treatment simply because a practice is the best in the area, has been there for 30 years, or can treat all family members.

The Gap

The difference between traditional orthodontics and direct-to-consumer orthodontics is something I’ll refer to in this article as the “gap.”  In this case the gap represents the difference between how practices and direct-to-consumer companies address generational habits, and patient concerns such as pricing, convenience, practice visits, and parents taking time off from work. These are the things that are important to parents and patients.

In preparing to fill the gap between your practice and direct-to-consumer companies, your Treatment Coordinator (TC) must be ready to answer some important questions including:

  • Why is there such a significant difference in price between your practice and direct-to-consumer orthodontics?
  • How well does direct-to-consumer orthodontics actually work? (Don’t be insulted, it’s a legitimate question for a parent or patient to ask an expert.)
  • How frequently must parents take off work to get their child to the orthodontist?
  • Do you offer convenient appointments?

Time for a Strategy Session

I strongly recommend that every orthodontic practice hold a strategy session in the very near future and start by making a list of these types of questions. You may be a parent and certainly many your staff members have children. Rely on your own perspectives and think about what you would ask an orthodontic practice about you or your child’s treatment if you didn’t already know the answers or have a bias toward your practice. Develop scripted answers to these questions and then practice them on each other because it won’t always be the Treatment Coordinator who is asked these questions. They will be asked of the front desk staff, the assistants and the orthodontist. It’s not about who is asked but what can be said to build value.

Keep in mind that many direct-to-consumer companies are engaged in robust advertising campaigns. Advertising can shape people’s belief systems and, eventually influence them to think differently. And even though direct-to-consumer companies will inevitably face regulatory and legal hurdles, there is every indication that they will survive, thrive, and become part of the orthodontic landscape.

You must do what you can now to build value in your practice and close the gap before it gets too large. OP

Roger P. Levin, DDS, is the CEO and founder of Levin Group, a leading practice management consulting firm that has worked with over 30,000 practices to increase production. A recognized expert on ortho practice management and marketing, he has written 67 books and over 4,000 articles and regularly presents seminars in the U.S. and around the world. To contact Levin or to join the 40,000 dental professionals who receive his Ortho Practice Production Tip of the Day, visit or email [email protected].