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Orthodontists and Invisalign Take a Bite Out of Your Bank Account

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My teeth mean a lot to me. I’ve been blessed with strong, mostly white, mostly straight teeth. I’ve always had a small gap in between my two front teeth, but it never really bothered me. I have only one small filling. Going to the dentist is not a traumatizing experience for me emotionally, however, it has come to be financially traumatizing.

My kids did not inherit my “I don’t need braces or fillings” teeth. My oldest sucked her thumb until she received her driver’s license (just as her father did). If you’ve never seen a thumb-sucking mouth before, I caution you – it is not pretty. Ever hear the expression, “she could eat a corn cob through a knot-hole”? Well, she could have.

When someone sucks her thumb that much, the roof of the mouth is pushed upwards, the front teeth protrude, and the jaw can be misaligned. I knew this was going to be an expensive mouth to fix. My youngest inherited teeth that looked like tombstones in the moonlight. Where he got all the room in his mouth for all the spaces, I’ll never know. I have a small, sweet mouth.

I needed to find an orthodontist. Lucky for me, there’s one on every street corner these days – and now I know why. What a racket!

The first step is to go to the orthodontist. While there, you will have pictures of your child’s mouth taken, and then they put it on a computer where you get to see the teeth visibly move until the last frame when your child’s smile is complete. Very clever, because how can you take your child away from that beautiful, computer-enhanced smile and say, “No thanks, we’ll keep looking”? Well, it’s hard.

I tried to shop around. My habit is to get three estimates before I agree to purchase anything. My child permitted me two before she said, “It’s my mouth and those bitewings hurt and I’m not going anywhere else.” I couldn’t really argue since both estimates were the exact same price. How they managed to quote the same thing, I’ll never know, but my conspiracy theory voice whispers that there are some underhanded shenanigans in orthodontia.

Both offices (I secretly went to a third without her and got the same spiel) so really, all three offices were eerily similar. All three had an arcade section, a TV area, cookies (Yes, junk food – it is a conspiracy!) and beautiful “after” pictures on the wall.

Now to the price: two years of braces cost $6,700 for each kid. The first time I heard the price I almost passed out from the force of the air entering my lungs in an enormous gasp. The second time I was steadier, but the voice in my head screaming, “What the f—?” did not stop for days. My insurance only paid $2,000 per kid. At the risk of sounding incredibly old, do you know how much I paid for my first car? Nine hundred dollars. My current car is only worth half of the cost of one set of braces.

The cost is explained as orthodontists needing to pay for “a lot of specialized, expensive equipment and to pay their staff and their rent. The Orthodontists need to pay for all of their materials and the operation of their sterilizers. Then there is the cost of malpractice insurance. Most of an orthodontist’s fee goes to paying their fixed cost.”

If they just added in a sentence here about also paying for their three homes and the yacht, I’d feel less violated. My kids’ orthodontist takes almost every Friday off to go sailing, or so I’ve heard. Nice work if you can get it.

We take out a home equity loan and get the braces. The orthodontist put on the brackets and the assistant placed the rubber bands and, voilà, the children are braced. Every six weeks for the next two years, they had a 15-minute appointment to get the rubber bands changed and the wire tightened. I wonder why I couldn’t have done some of it myself. One time, when a bracket popped (on a Friday of course), I took my needle-nosed pliers out of my tackle box (just kidding, sort of) and fixed the loose wire. It wasn’t all that difficult.

When I asked my dentist pal why it was so expensive, in solidarity with his brethren, he said, “Knowing where to glue on the brackets takes education and expertise.” Yeah – and $7,000 per kid. Could this explain the cookies in the orthodontists’ waiting rooms? The orthodontist-dentist connection?

To this day, I don’t understand how they can justify the cost. Every time we went, all 10 chairs were filled every 15 minutes. The assistants handle all the banding and the orthodontist “visits” each child for five minutes. I used to try to calculate what his income was via having roughly 40 children every hour, five hours per day (to account for some longer appointments and lunch), four days per week (to account for sailing time), which is 800 kids.

The kids seen in one week don’t generally have to return for six weeks, so theoretically this orthodontist could have up to 4,000 clients a year. Using a conservative 3,000 clients per year, at an average cost of $5,000 per child (since my kids’ mouths were probably not “average”), my estimate is $15,000,000. I’d go sailing, too.

So, if the cost of braces is due to “overhead,” then Invisalign should be cheaper, right? The creation of the retainers is done at a lab somewhere else, so there should be only minimal overhead and cost, right? Wrong.

I started grinding my beautiful teeth at night when my kids became teenagers. I’m sure there is no connection. I could tell my teeth were shifting and I began to have jaw pain. I ignored all that until one day I chipped a front tooth while grinding as I listened to yet another reason why my teenager didn’t do what she was supposed to do.

I knew I was going to have to get a night guard. My dentist asked me to consider Invisalign to fix the problems inherent in constant grinding. It was also his mission to close my gap.

The steps seemed easy enough.

“Step 1: See a certified Invisalign provider.” I did. He told me that, due to my “medical condition” of grinding and jaw issues, my insurance would pay for up to $1,000 for Invisalign. He also told me I would qualify for an “express case,” which is half the cost of the full treatment. Great!

An express case only cost about $2,100, and with my insurance paying $1,000, I thought this was much more reasonable than braces. Plus, you can take them out to brush and floss which is very important and (almost) ritualistic to me. I assumed an express case was a year-long procedure because he told me the full case takes approximately two years. This is important later.

“Step 2: Map out a treatment plan. You and your doctor develop a treatment plan specifically for you. Then the doctor takes bite impressions of your teeth, which Invisalign will use to custom-mold a series of clear, removable aligners that will gradually move your teeth into an incredible new smile.” Great, again!

Hold up! They forget to mention that at some point you might be told your “express case” really can’t be fixed as an express case and, sorry, but you need the full case. What will that cost? Oh, about $6,000.

I have a great relationship with my dentist and he was only reporting what Invisalign told him. He did not understand why they couldn’t fix my newly-messed-up bite (and close my gap) in an express case, but he shrugged and said there was nothing he could do. I walked away.

I chipped another tooth a few weeks later while diving into a really cold swimming pool. When I went back to my dentist to have it fixed, I told him it was his and Invisalign’s fault. If they hadn’t done the “bait and switch” of telling me it was going to be $1,200 (my cost) then changing to $5,000 (my cost), I would have been wearing my retainers and not chipped a tooth. So my dentist pursued getting me an “express case” despite the recommendations from Invisalign.

“Step 3: Your aligners are created. The advancements in technology that led to clear aligners were developed by Invisalign. Your aligners are created via precision computer mapping and design, then are shipped to your doctor.”

My Invisalign were numbered sets (1 of 7, 2 of 7, etc.) and my dentist gave me the first three sets. He instructed me to change to the next set every two weeks. They hurt really, really badly that first day, but the next sets didn’t hurt at all. I did not have to return for six weeks when I picked up sets 4, 5 and 6. When I went back to pick up set 7, I asked when I’d get the next set. He says 7 is the last one. I say,

“What?” The brochure says, “Each case is a little different, but on average, treatment lasts about a year. Then you can show the real you with an amazing new smile.” I did not have an amazing new smile. How could I in 12 weeks? I was able to stop grinding because I always have my teeth covered with plastic unless I’m eating or brushing. My little gap is still present. My teeth are infinitesimally straighter, but they were pretty straight going in.

My dentist was also not happy about how little my teeth had moved. He wanted my gap closed. He tells me you can get three more sets for “refinement” on an express case. Of course, there’s an additional charge. I tell him, “No way.” I have my very expensive bite guard now and I don’t care about my gap.

Somehow, he sees my gap as mocking him and he wants it gone. I think because he told me Invisalign could easily fix it, he pursues getting my “refinement” and he pays the penalty fee. He won’t tell me how much it costs because he’s a great man who takes responsibility for promising something that Invisalign couldn’t or wouldn’t fulfill.

I have seen how little my teeth moved in the past 14 weeks and I don’t hold any hope that three more sets (six weeks) will refine my teeth enough to close the gap or make any noticeable change. So far, no one has noticed any change in my smile. Including me.

I originally saw Invisalign as a cheaper way of fixing my bite so I would stop grinding and possibly close my gap. I wish now that I had just gotten a bite guard and not been seduced by wanting “a perfect smile” because, after two sets of braces and my own Invisalign cost, I find it harder to eke out a smile these days.

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About Alexandria Jackson

  • SLP

    A couple of comments / thoughts. Not to be overly critical but, 1) Some of the “overhead” of becoming an orthodontist is also the opportuntiy cost and expense of 11 years of college to become a specialist. 2) Invisalign is usually more expensive because there is a large lab bill added to the overall overhead cost. 3) Your estimates of the patients being see by an orthodontist is overestimated. The average orthodontist “starts” ~ 200-250 new patients per year citing the Journal of Clinical Orthodontics. 3000 a year is just not accurate or realistic for an orthodontist to manage.

  • http://alexandria-jackson.blogspot.com/ alexandria jackson

    Well, I was wondering when an orthodontist would weigh in. 1)I understand education costs because I also earned my doctorate. But I don’t describe that as “overhead.” Once you pay off your student loans, then do you drop the price? 2) I still would be very interested in an acutal cost breakdown of both orthodonture and invisalign because I have trouble making the figures work out. 3) You may be right, I forgot to figure that those 3000 clients are in braces for a 2 year average so my figure of $15 million was inadvertently doubled. Still, for the service received and the time spent in the orthodontist’s office, the cost is difficult to justify. If any orthodontist reading this wants to itemize the cost of an “average” set of braces, I’d love to read it with an open mind.

  • paul b

    I don’t think anyone should be held accountable of their fees because of how they spend their money. When my plumber or electrician are in my house for an hour or less and charge me a fee, i don’t ask them to justify what they charge. As far as a conspiracy, we have to fill out forms to insurance companies with our fees. I agree that their are some orthodontists that charge a lot, but sometimes you get what you pay for. By the way, I am not an orthodontist. Please respond. I would like to continue this further.

  • http://alexandria-jackson.blogspot.com/ Alexandria

    I guess I do think that there should be some justification in the cost of health related items. I one time got quoted $120 for a breathing apparatus, but when I got there, said I had insurance and filled out my insurance forms, the machine ended up costing (my insurance company) $340. I never pursued this because one of my kids was suffering at the time, but it still seems a bit sneaky to me. I DO want to know why orthodontia is so expensive and I AM frustrated by the rising health care costs in this country. But you could also plug in any health care item like “mammograms” or “sonagrams” or even “lab work” and I’d still want to know the cost breakdown and why. One time, when I went for a mammogram, I was asked if I wanted the “comfort pad.” I said, “what is that?” and they said, “It’s a cushion so it doesn’t hurt so much.” I said, “Yes please!” and they told me the cost was $5. I was outraged! What about the people who can’t afford that? Why would the little piece of cotton cost so much? why wouldn’t they just make that standard? So it isn’t just orthodontia that I’m frustrated with, that just happened to be my current frustration.

  • JoAnne

    My son lost his lower retainer. A small piece of wire… which my son calls “a piece of paper clip”, which is what really looks like. It costs $250 to replace it, which I cannot afford. I want to know how this outrageous price can be justified. Also, I was told that if he had the retainer and needed to be fixed, it costs $150 (still outrageously high). Any suggestions?
    Thanks.

  • JoAnne

    I am very concerned about the metal used for retainers. I believe it is Nickel. My concern is having it in the mouth 24/7 for the rest of your life and how this metal leaks into the body. Does anyone know how toxic it is? Thanks.

  • Geoffrey

    I have never met anyone who felt they were paid too much and the “other guy” is paid too little.

    It is easy to diminish the work of others whether it is being paid to “say the right words” in counseling (words are free right?) or just “throwing a ball” in professional baseball. What about the CEO of an insurance company that gets $100,000,000 as a “golden parachute upon retirement?

    It is really all about the hoops necessary to get into particular line of work and the screening that takes place along the way that naturally limits the number and type of people in a particular profession. Not to knock plumbers or dish washers but how many of them would you want operating on your of your child’s brain?

  • http://alexandria-jackson.blogspot.com/ Alexandria

    JoAnne, I wish I could help you but I just don’t know the answer to your questions. Perhaps an orthodontist can answer you?
    Geoffrey – while I do understand about hoops, skills and abilities, you have to admit that in some specialty areas, there seems to be little oversight. Professional sports is certainly one of those areas, too…. The bottom line is the lack of oversight/keeping things in perspective. The cost of orthodontia seems outrageous for what you get. Just one gal’s opinion.

  • candy

    i agree completely, Alexandria!

  • george

    if the insurance company paid for it all would you still think it is too much money? ….I did not think so. What you are doing is letting a third party whose only motivation is profit influence your rational thinking, you have been brainwashed.

  • tomy2tone

    my ex wife works for an orthodontist, i can tell you if you new the cost of the invisaline to the doctor, you for sure would have a heart attack, it is in my opinion outragious to have a mark up so extreme, i run a retail store selling recreational power sports vehicles, we struggle to make 10% on our sales of vehicles, i wont reveal what i know exactly about the profit in this product, but it sickens me.

  • JoeP

    The costs of orthodontia are purely sickening. I am convinced that these docs work together to establish something akin to fair market value, which translates loosely into “that’s what everyone’s charging for this.” I’d love to see an orthodontist come along who will charge something far more aligned (pun intended) with the actual service provided. I’m not against someone trying to make a living, but when they conspire to set high prices for moving a few teeth a few millimeters, I get a little cranky.

  • Amy

    No offence, but you shouldnt complain about your children’s orthodontic cost. I have a ‘thumb suckers smile’, and I know first hand how terrible it feels. You shouldnt put a price on confidence!

  • Meg

    Yes, there is a particular cost in doing things and yes Orthodontics will charge more that that. There is reasoning behind prices, just like anything.
    My apologies you haven’t looked into the prices of dental materials and equipment. Also why not look up the price of University to get into a dental graduate course, followed by the price of dental college, followed by the price of the additional 3 years or so of Orthodontic practice. Also, take into account those assistants that are placing the bands and elastics have taken their education programs and been trained to fulfil those duties in an orthodontic office, and yes, the Orthodontist also has to pay them.
    It’s nice to think the Orthodontist is just stoppping by the visit your child, they are actually checking and approving the job of the assistant.
    Changing your child’s face is not just moving teeth a few mm. Try reading up on human embryology and anatomy, aswell as biomechanics. Maybe then you will have a greater understanding of how your body works.
    Clearly you do not know much about Orthodontics, or even dentistry as a whole. Gerneral dentists can also help you with orthodontic treatment, if your child’s condition isn’t terrible. The job is just done better and with more concern when done with someone who has specialized in that field.

  • DJ

    The orthodontist’s cost for Invisalign is 300%+ greater than that of the materials used for braces. Of course the cost of materials is only one portion of an orthodontist’s overhead.

    Most orthodontists are small business people and incur the same frustrations of many small business people in today’s climate. Trying to support his family as well as the families of the 10 people he employs is a huge concern for my boss. Have you seen the cost of health insurance these days?

    Our fees, while not at all as high as you have experienced, are well justified. A confident smile will last a lifetime and reap its own rewards far beyond that of the price tag to straighten teeth.

    And, no, we are not in cahoots with other orthodontists!

  • Dan

    My wife came back from the Orthodontist yesterday in shock. My kid has beautiful teeth–straight, teeth come together well, and no spaces, with a slight crowding/turning of his lower front teeth. Same result: $5,500 after insurance and “discounts.” The Ortho used scare-tactics, stating that if left “untreated,” he could develop an “underbite” (due to the growth of his jaw–!! will the rest of his face stop growing??!!)

    Neither his mother nor I ever had braces and we share his lower front tooth “abnormality.” Neither one of us turned into a werewolf. One word: Racket. It’s an economic model. Period. They are pulling kids in earlier and earlier–prior to 12 year molar entry or wisdom teeth–he had an answer for that too–it won’t change his other teeth after braces (but look out for the growing lower jaw, though!!)

  • Joe

    My brother’s friend is an orthodontist and I have spoke with him quite a bit. Just a few comments that I would like to make:

    1) Braces are a lifelong investment. Alexandria mentioned that braces cost more than her first car. It’s not like you are buying a $7000 computer that will be obsolete in 12 months. That same confident and attractive smile is as good when you are 60 as when you are 15.

    2) Appearance is everything (well, almost everything). We live in a society where you are judged by your appearance. Every time you interact with another human, that person is judging you by the way you look. Straight teeth and a confident smile increase one’s attractiveness tremendously. A potential mate will find you less attractive if you have an unesthetic smile. What happens when your child goes to that first job interview after graduating from college and doesn’t get hired because the employer was thinking to himself, “I can’t have that snaggle-tooth interacting with clients”? Is it fair? No way! Is it reality? Yes sir. Amy said it best. You can’t put a price on confidence. Braces have a psychological benefit that can’t be measured monetarily.

    3) It is a very long, and expensive process to become an orthodontist. It takes 11 or 12 years beyond high school to become one. 4 years of college, 4 years of dental school, many do an intern year, and then 3 years of ortho residency. Not only do you spend 11 years paying tuition (at a cost of approx. $100k college, $150K dental school, $60k ortho school), but you are out of the work force for 11 or 12 years making exactly $0. All the while accumulating debt near $300k.

    4) It is very competitive, requires a lot of hard work, dedication and intelligence to become an orthodontist. I could tell you of at least 10 people who said the first day of college that they wanted to be orthodontists. You know what? Those same people dropped biology 101 three weeks in because they were failing. People going to med/dental school have to take advanced science courses such as organic chemistry, biochemistry, calculus based physics to name a few. Your average college student couldn’t even pass those courses, let alone get the A or A- needed to get into dental school. Once you get to dental school it is even more demanding. If you don’t graduate in the top 5% of your class, you pretty much have no shot at getting into ortho school. About 4,400 people graduate from dental school every year and there are only 250 or so spots every year for incoming ortho residents. After you get your degree, you must take licensing exams that run in the thousands of dollars to prove that you are competent.

    5) It requires a tremendous amount of money to run a practice. Just the x-ray machine alone costs close to $150K, and each ortho chair is $8,000. Not to mention rent, materials/supplies and the hundreds of thousands of dollars you have to pay your assistants and front desk staff every year.

    6) Ortho is not easy. Granted, they’re not splitting the atom, but it’s much more difficult than it looks. If it were so easy, you’d be able to buy a kit from an infomercial and do it in your garage. Trust me

    7) They start patients younger these days not to get more of your money, but to try to take advantage of the child’s growth and hopefully prevent the need for surgical intervention down the road. Your jaw growth is pretty much complete by the time you are 15 or 16.

    8) I wouldn’t price shop for braces. You price shop for a DVD player, not things related to your health. It is good to get several opinions, but don’t pick an orthodontist based on price alone.

    Peace

  • Lance

    Alexandria,

    Joe summed up our business very well. 200-250 starts is an average as someone else mentioned. Your math, unfortunately, was way off base. I would venture to say that there is no single orthodontist in the world grossing $15,000,000 per year. In fact, I would be extremely surprised if you could find one that even does $5 million. There is only so much one can do.
    $7,000 is a lot of money, but worth every penny paid and then some. How many people are dropping $3-4,000 on plasma tv’s right now? Kinda puts it in perspective.
    Most orthodontists graduate with $150,000 or more in debt, spent 12 years of their life training, just to have the title. Then they drop another $500,000 minimum to start up their practice(building not included). It takes years to build up a practice and a lot of us make well below 6 figures for several years as we fight to build our practices.
    The bottomline is I know it costs a lot to get ortho care, but it is easily justified based on the costs of getting the degree and the ongoing costs of running the business.
    Hope this helps. Nice writing by the way.

  • Dave

    Thanks for the article and to everyone for their comments. My dentist is telling us that both our kids look like they will need braces. My daughter may need some help. She was born premature and her teeth did not form properly. She is 8. My son is just 5, and they’re telling me his teeth are too close to each other.

    I’m sorry, but I don’t buy plasma TVs or other outrageous luxury items, and we’re trying to just get by like everyone else. The cost of braces for one of my children will put us back greatly. But, a second child’s braces will put us in a huge hole.

    I want to ask this, and somebody please answer honestly. Do dentists get kickbacks or fees from an orthodontist for referrals? Because I’m assuming when a child’s teeth look normal to a layperson, it’s going to take a dentist to refer to you to an orthodontist. Really, truly, I have no problem with these professionals making money for necessary treatment — at the same time, orthodontics is extremely expensive and hard to swallow for most people.

  • Bobby

    No kick-backs. I believe that is illegal and I’ve never heard of anyone doing it–at least in the world of dentistry. Avg orthodontist makes 300K. I bet the orthodontist who is the subject of this blogger’s fuzzy math doesn’t make much more if any more than that. Yes, that is good money, but about the same as other medical/dental professionals with the same kind of training and background. Lastly, orthodontic treatment is not easy. Any orthodontist who says otherwise is probably not a good orthodontist. There are so many factors that go into one specific treatment. If you think orthodontists have the best job in the world then get your kids to follow that career path and maybe they will buy you a BMW someday.

  • Feeling Sore

    I was recently presented with a “estimate” of “initial treatment” by my son’s orthodontist. We live in a city with many orthodontists…ie. a market that ought to be perfectly competitive. My son is 10…arguably too young to have this treatment started and provides clues to why the words “initial” treatment was used.

    When I shop I always ask pertinent discount seeking questions like “Why should I buy this here?” I intend to ask the orthodontist why his miracle teeth moving system that changes things for the low price of $5000 per mm is better than his competitors during the next opportunity I get. I am curious to know the answer he will provide.

    Everything I’ve purchased during my adult life that has price tags like these “miracle workers” are charging for paper clips has come with a guarantee or warranty or other promise of performance. No such luck with the omnipotent smile fixers.

  • jen

    Maybe you should go glue some paperclips to your children’s teeth and see what happens

  • http://alexandria-jackson.blogspot.com/ Alexandria Jackson

    #23, I followed your link with hope but was met with just your website. I didn’t see the breakdown in costs I thought you were going to give. A simple cut and paste to this site would be wonderful, thanks!
    Jen – really?
    Obviously I stepped on some orthodontist toes, but geez, my opinion. You’re entitled to yours. I’m glad the teeth professionals are weighing in. Those who did with candor and honesty, justifying their costs are appreciated. It makes a struggling single mom happier to believe that there aren’t kickbacks and cahoots everywhere.

  • chris

    I loved your blog Alexandria. Thank you for writing from a consumer perspective. My 9 year old daughter is on this relentless cycle and I have to watch in almost amusement of the excessive office opulance the T W TH office hours, the 30 kids an hour and the constant trickle of luxury cars in the parking lot, and I wonder more and more, “Did my daughter REALLY NEED these braces after all??”

  • Richard

    Those luxury cars belong to the patients… not the doctor!! I work as an orthodontist. Some of these “price bargaining” patients drive way better cars than I do. I don’t charge much for treatment. Around $3000 mark for an average two year treatment. But these patients have every gadget that you could imagine. IPhone 4, Ipads, Louis Vuitton bags, Coach bags… and drives a shiny new Lexus, sometimes even carries a gold credit card!

  • Jane

    Regarding orthodontia. I’m running into the issue of adults with TMJ who’ve had orthodontic work done as kids. Research it before you get anything done.

  • Just a thought

    I suggest try moving a tooth to an incorrect location and then correcting it. Its a measure once cut once profession. That’s what your paying for. Spend more time researching your practitioner and not his or her fees.

  • Make it happen

    If a dentist/orthodontist was only going to get paid the same, or a little bit more than a house cleaner, social worker or mcdonalds server, why would they bother with the years of education, the constant training and the costs and risks associated with that? I’m sure they’d rather work in mcdonalds too.

    If you’re happy to live a normal life like ‘everyone else’, aren’t financially motivated, or were ‘too cool’ in school and now regret not passing year 12, then you’re not in a position to criticize high income earners. Orthodontist earning $300,000 a year? $6000 per week? – Great for him. You should look up to people who have what it takes to rise to the top of the income ladder, and not sit back and criticize costs because you’re content with driving a taxi or living off the government. If I spent 10+ years in tertiary education, countless hours studying/training and years building up a practice to finally cut even, – and I wasn’t making fantastic money, it wouldn’t have been worth it. And then it comes down to supply and demand, if every tom dick and harry was a dentist, prices would be cheaper. But when there’s only a select few that make it to the job, there’s going to be more demand to fulfill the supply, so of course you up your prices until you find a spot that levels out, called an equilibrium. – although I only really expect an orthodontist on this forum to understand that concept.

  • Consider This

    Most people don’t view the big picture; they only see the average 45+ year old dentist reaping the fruits of their labor, not the work or time they put in. Consider the fact that most dentist sacrifice getting married and having children during dental school and specialty training so that they can focus in school 100% and pursue their aspirations, cutting the biological clock very close. Those that are in school with children miss pivotal years of their children’s development because they are in school or studying. In addition, the other opportunity cost such as school loan debt, specialty loan debt, starting a practice debt, time spent building a practice. Very few people would be willing to make those types of sacrifices or desire to enter that profession.

  • rene

    I am an orthodontist, nobody asked you to get a consult, you went, for sure there are cheaper prices than 6700$, you decided to stay with that dr.
    If you think its nor worth it…leave.
    Explain the cost does not make any sense….

  • iva

    being an orthodontist its really hard, go became one, then you tell me.

  • Alexandria Jackson

    Again, the ortho’s weigh in with justification. Perhaps you missed that I myself am a doctor and went to graduate school? Perhaps in your haste to justify yourselves, you overlooked the reality. You charge too much for too little. There is no oversight agency for your exorbitant fees.

  • Andrea

    You are completely ignorant. Research what goes into an ortho practice…becoming one, running one, hiring and training staff, maintaining CE credits, maintaining equipment, OSHA… before you spout off on what a racket it is.

  • J.D.

    Hi Alexandria…it seems you struck a nerve with us orthodontists :) (I am an orthodontist as well…I think like any healthcare profession there some practitioners who might charge a hefty fee and not give a result worth that charge. I am sure there are these types of unethical people in your field as well. But who should be our oversight agency… the government? If money was the only thing that I or anyone else in orthodontics was after we would have gone into something else right out of high school or college. I was in the educational system for 12 years and amassed a student debt of over $500,000. Think about the opportunity cost of that amount. Essentially there is a limit to the supply of orthodontists because it is such a competitive and expensive education, and this increases the price of the product. The good thing about orthodontics is that it is elective in most cases… so if you don’t think the price is worth it, don’t get it.

  • Barbara

    I enjoyed reading this blog – Glad I am not the only one out there that feels like I am being overcharged. Hats off to the Ortho charging an average of $3k – both my kids were in the region of 7k – I find this outrageous.

  • Em

    I sit her not complaining about cost, I know its a luxury item. I however have severe migraine and misaligned jaw- both are painful. I have crowded teeth that overlap each other which id not only ugly but hard to floss between. My teeth even cause me neck pain from all the stress. I understand the cost, orthos have nice cars and houses and school loans they have to pay for. I get it. I however can not get the treatment. My parents never had the money- my father has never even drove a car with AC and we live in Florida for crying out loud! Its not for lack of need, desire or a matter of disrespect. Its a genuine inability to afford something. Unfortunately this is considered “cosmetic” I would settle for just fixed enough to stop the pain, i don’t need to look like Julia Roberts!

  • kd

    My daughter is facing this and you feel hopeless. With this economy, you think it would be a little less expensive. It seems the price is the same where ever you go. My daughter needed something before the braces so that basicaly ate up the insurance money as it only allows $2,000 for braces per kid. What other choice do you have? It is so frustrating.

  • Toothfairy- Not a dentist

    You (or your children) will not die from a malocclusion (bad bite). I see a slew of issues with this article, beginning with your daughters and husbands thumb sucking issue- to the obsene gesture that orthodontists make “millions” a year. Albeit- I would welcome anyone today who actually earns 7.5MM a year- that would be over 3MM in Federal Income Taxes to support those who are not contributing to society. The fees collected go to overhead, continuing education (so you can have the option of invislign), insurance (Professional/Malpractice, Liability, Wokers Compensation), materials, supplies, rent and employees. Also, many businesses, because this is a business after all, pay for medical insurance, contribute to a 401K Plan and contribute thier time and money to charity. This narrow minded view only clouds professionals like dentists, doctors and attorneys (who by the way only file papaers and talk for their 30-40%). We somehow never look at supermarkets charging us 8.99 a pound for chicken or a retail store charging 12.99 for laundry soap. Just because you pay 12.99 for a product does not mean you are not being overcharged. Who do you think pays for those million dollar Ad’s during superbowl?? Orthodontists? Come on now– I challenge you to THINK before you post.

  • Mark

    When I was a kid, I had very gnarly looking teeth. Not only was I the first kid in kindergarten to get bug-eyed glasses, but I also had a nice pair of “buck teeth” that would have landed me a great role in a Chiclets commercial. Thankfully, my parents had the foresight to know that fixing my smile would be an investment that would pay off with extremely high returns. They sacrificed a lot and worked long hours to afford my orthodontic treatment. We never went hungry for the sake of my treatment, but meals became simple, holidays had little celebration, and old cars were sent to the mechanic rather than to the junk yard. My case was so advanced that it required two phases of treatment. The first, to ensure I had enough space for my permanent teeth, and the second, to align my permanent teeth correctly. After my treatment was completed four years later, my teeth weren’t the only part of me that had changed. I found more confidence and found I was treated differently by others. I was perceived more intelligent by my peers. I was able to clean my teeth much more effectively leading to a healthier smile (fewer cavities = $$$ saved!). I didn’t cover my mouth anymore when laughing to hide my ugly teeth.

    I realize that orthodontics is an elective, and therefore expensive procedure, but my parent’s investment of $5000 (back in 1992) has helped me become more financially successful in the workplace. I doubt I would have had very successful job interviews if the interviewer only remembered my Chiclet teeth. I doubt I would be a very good sales person if clients viewed me as less intelligent. My orthodontist may have a comfortable lifestyle, and I’m sure he’s worked very hard to get to where he is. But I have him to thank for the lifestyle I now enjoy today with a confident and healthy smile. I cannot thank my parents enough for the investment that they made, it has had far more returns than any other place $5000 could have gone. Ms. Jackson, I hope you too will bite the bullet and do the same for your children. Maybe in a few years, they too will right a similar comment in response to your blog.

    This June I’m proud to announce I’ll be starting my residency in Orthodontics.

  • Alexandria Jackson

    Congratulations, Mark. I agree that this elective procedure can change a lot about a person. I do believe that my kid’s smile and self-confidence is certainly worth any price. However, when insurance only pays $2000 and the going rate is $6000, it seems like there is a lot of padding.

    As for all the orthos who wrote in, I am a licensed practitioner and I pay insurance and overhead, too. Only, my field is protected by oversight commissions that limit how much we can charge. I wish yours were too.

  • Spencer

    Hi Alexandria,
    I really enjoyed your writing and I congratulate you for giving a voice to many parents around the world. I am neither an orthodontist nor a patient of orthodontistry, but I do teach economics.

    So here are my 2 cents:

    as you are a doctor yourself you are undoubtably familiar with the high cost of student loans. These costs along with the “scarcity” of doctors, and the value of healthiness form the basis for the size of the fees doctors can charge.

    I always wondered why my cardiologist doesn’t charge more than she does but the oversight commissions you mentioned explain that nicely.

    I would guess, as you have, that the reason orthodondists make as much as anesthesiologists (a far riskier profession insurancewise) is the abscence of these commissions.

    The free market and political reasoning behind this abscense all rests on insurance companies.

    Compulsory seat belt wearing was signed into law after Ralph Nader indirectly told insurance companies how much money they could save. These companies then emptied their coffers to lobbiests in a proseatbelt wearing campaign and in 1984 the law was passed.

    As Orthodontics are not medically required procedures (though for some they arguably should be) insurance companies have very little stake in them. This means the amount the Government would hear of them from insurance lobbiests would be minimal. Only a charitable lobby would really let the government know of a want for orthodontic oversight commissions. Unfortunately Last I checked there aren’t any Fix our teeth lobbies. Maybe you should form one.

    Anyway that’s my opinion: full of guesses and extrapolations. ha but that’s economics for you.

  • http://blogcritics.org/writers/alexandria-jackson/ Alexandria Jackson

    Spencer, thanks for writing in with the economic perspective. Your “guess” is as good as mine. I wish I had the energy to form a tooth lobby – because it would be fun to come up with a clever name for it!

  • Benda

    Does anyone know if you can get partial braces? The ortho I saw was full mouth or nothing even though my 15 yr. old’s only problem is lower crowding.

  • Orthodontist

    I am currently in an orthodontic program. By the time I graduate I will owe around 600k. I will have spent 13 years in school without income by the time I complete my education. The average for a 1st year graduate is around 200k. That being so, I will be in about the 35% tax bracket which means I will take home around 130k. My student loan payment will be around 5500/month. Which means when it is all said and done I will be living on about 60k/year. If you calculate how much I would have had in retirement in 30 years had I just worked and invested in a normal 401k (and not became and orthodontist) I promise you that the math works out not so much in my favor. So, for those of you complaining about how much you have to pay for treatment, perhaps you should consider just exactly what myself and others have given up in order provide you or your child with a beautiful smile.

  • Brandi

    If any of the orthodontists are still hanging around and weighing in, can you please tell me why our family has to pay twice for our daughter’s braces because we moved? My husband is in the military and we started our daughter’s orthodontic treatment while stationed in one state. She’s had them on for 18 months and we were very close to paying them off. Husband gets orders from the navy and we have to move clear across the country. Orthodontist says, “We’ll just transfer her records, and a new doc can take over…happens all the time.” Yeah right. I’m completely flabbergasted that all the orthos here are telling me that she has to have her braces taken off and completely redone with a different system and I get to pay $5000 again! Are you serious?! The insurance money is pretty much gone used to pay the ortho in the other state. I feel like crying. We already sacrifice so much being a military family and all, and I feel like this is just a huge slap in the face. I’m still not sure what to do.

  • William

    Hey Brandi,

    Unfortunately, transferring during treatment will almost always cost more than the one fee that you were originally quoted, but I am surprised that you are being charged in full again. I can’t speak for all orthodontists, but I typically look at the percentage of treatment completed (my estimate vs the starting orthodontist’s estimate – there’s a transfer form we exchange). From there, I look at what percentage was paid to the first orthodontist. If the percentages match up, I usually just charge whatever the patient/parent was expecting to pay to complete treatment and hope that you have a younger child or two. In your case, I’m guessing that your daughter was in treatment with the first orthodontist for 18-24 months and that you paid the first orthodontist’s full fee during that time. If that is the case, I would suggest that you contact the first orthodontist and request a partial refund as you likely paid for initial bonding, 18-24 months of adjustments, the debond appointment, a set of retainers, and 1-3 retainer checks. At the very least, the first doctor should refund whatever he/she charges for debonding and retention as neither of those services were performed. That may only amount to 5-15% of what you paid, but it’s a start. You may also want to check your initial contract as I have heard that some doctors specify that they won’t refund anything for transfers – but I have only come across that once in my personal experience.

    As for why the new orthodontist(s) want to charge you for a full case, I’m not sure. It could be that your daughter’s case still looks like a 2 year case. If so, they likely would prefer to use the type of bracket to which their staff is accustomed to using – all brackets aren’t the same. There are .018″ and .022″ slots…there are numerous bracket prescriptions often named after the self-important orthodontist who slightly modified the degrees of tip or torque “invented” by another orthodontist…there are self-ligating brackets with proprietary tools needed to open the clips…and so on. On transfer cases that I accept, I remove Begg brackets, most self-ligating brackets, and cases that I think were just bonded poorly. It’s probably cheaper for me to replace all of the brackets than to mess around with a bracket system with which I’m unfamiliar. Even so, I don’t think that I’ve ever charged a full fee on a transfer case. Maybe I should start though, so I can upgrade my Honda to something more in line with the comments above regarding what I should be driving.

    I doubt many people are still following this old thread, but I can echo what some of the other orthodontists wrote above…yes, student loans (215K+ for me), practice purchase/startup (600K), health insurance for staff (50K/year), new building eventually (1-1.4M), dental equipment and supplies, etc are all costly. I did spend 11 years in school which means I lost some retirement investment years. I did hold off on starting a family until the end of dental school so I could concentrate on my studies and be in that top 5%. But in the end it’s a very nice career/lifestyle – albeit far from extravagant for most of us. Most of us work 4 days a week, make a nice salary, have time to spend with our families, etc. I’d do it all again which is not what I hear from many of my friends in the medical field and about half of the attorneys I know – actually, I’d probably have kids earlier. If the financial rewards are not there for a career that carries a huge time and debt commitment, you will see fewer people opting for it (which may drive the cost back up). As it stands now, more orthodontists are being pumped out of graduate programs than ever before (I think), Invisalign is marketing their appliances to general dentists, and many older orthodontists are delaying retirement…so you may see a decrease in fees as more providers are available. As noted above though, the vast majority of orthodontic cases are elective. As parents we all want to give our kids the best opportunity to succeed in life, and at least in this country, appearance matters a lot. College admissions and job interviews are competitive – having “bucked out” or “thumb sucker” teeth is certainly a disadvantage. It’s often not medically necessary, but it is something we want (just like HDTVs, nice cars, and, of course, cable tv and wireless phones for all – I hope you are also complaining about the ridiculous rates for the latter two items)…I think you should expect a bit of a premium for luxury items.

    And yes Benda, you can do partial braces. We do it all the time. I charge based on number of teeth bonded and estimated treatment time. You just need to agree on the treatment goals ahead of time for partial cases. In defense of the full or nothing guy, many times you can’t align just the lower teeth, they still have to fit inside the upper arch.

    Looks easy, is easy, not as easy as it looks.

  • George

    There are alot of fixed costs associated with running an office and it’s nice to be able to supply well paying jobs for people too. However, the price of braces comes down to what people are willing to pay. Supply meets demand. There is a limited number of dental professionals due to the cost, length, and rigor of training. Patients do not need to buy an orthodontic treatment plan – if it’s too expensive they can forego it as it was not worth it to them.

    lol. Tell us; What other products and services do you want at whole-sale cost?

    Welcome to America.

  • Nick

    I must agree with the above poster. You seem to be advocating for “oversight” of orthodontists which is really odd. Why is it you believe that another persons services should be provided at a cost determined by the government? Are you really that selfish & controlling?

    Nick

  • Alexandria Jackson

    George, I appreciate your candor. I don’t believe that I have to pay higher prices because orthos are paying off dental school. That was your choice. I have student loans too. I do understand your point though. We are willing to pay it so you can charge it. No oversight. No cap. We’re stuck with it if we want great smiles for our kids. And thank you for saying this is America – where we force the government to get into every last aspect of our lives because with no rules, some professions/people will try to milk the masses for everything they’ve got.

  • George

    Alexandria,

    You’re correct in that you do not need to pay for my education; however, I do not need to discount my services such that I’m paying for yours either. The reason I mentioned education in my previous post was because that is where the value is being added that makes up the differences between the fixed costs of running a dental practice the market price point. Rest assured that you’re not paying a higher price for ortho treatment because of your dentists’ student loans. They charge what they do because of their expertise and the value of the result to the patient.

    To your second point; most dental professionals I know are honest people and don’t want to “milk” anyone for money. It’s simply a good/service that has high value on the market. I see patients everyday that enjoy high standards of livings in sales, IT, engineering, university research, plumbing, electricians, physicians etc. etc. They all compete in the market place to get paid for providing important services. Would you expect them to take a pay cut too because a service or good they provide is perceived to have a “high price”? Some make more than I do; yet, at the end of the day I have a choice weather I want their service or not. In aggregate that will make an impact on their wages.

    To be honest I think your perspective is a little myopic. Would you say that everyone should take a pay cut in order to make everything less expensive? Perhaps the government could start setting price ceilings in all industries rather than just enforcing anti-trust & monopoly laws? I don’t think those are fair things to desire because you don’t value someone’s goods, services, or employment enough to feel comfortable with the purchase. The adult thing to do is just let your dollars do the talking by realizing your consumer index is lower than their price point.

    I encourage you to do some economic readings and look beyond your own interests. Providing high quality care at a fair price is important to me. My patients love the end result and are happy with their smile for years and years to come in their life. My employees enjoy solid employment and contribute to the local economy. Don’t rely on big brother to force other people to subsidize your living or pad your bank account by price fixing. Instead, save, invest, and only buy what you feel has value.

    George

  • Brandon

    It’s unfortunate, but most of our medical bills are inflated due to the need for malpractice insurance. I have a small gap as well, but I’m fine with it. It doesn’t bother me and it certainly isn’t worth it to me to spend several thousand dollars to get rid of it.

  • Hans

    George,

    Well said. Having a masters in economics I like to see any conversation digress to more lofty economic theories. I am about to invest in my child’s teeth. As an economist I am always looking at the margins.

    But the question is, how much does it cost not to have braces?

    Regards

    Hans
    Brisbane.

    P.S. Any orthodontist in Brisbane that would like to look at my Daughter please add a comment.

  • Ap

    Have any of the people critical of orthodontics considered that no one is forcing you to purchase anything. Discussions regarding the benefits of treatment are meant to inform / educate you. Othodontic treatment is a “quality of life” decision. If it’s not for you or your child , that’s fine but please don’t make derogatory and ill informed comments about an extremely well respected profession. I happen to love my smile and am deeply thankful to my orthodontist for his expertise.

  • Shapnal

    Cost of Invisalign aligners are slightly higher than traditional braces. Although a portion of this can be shouldered by your health insurance provider.

  • http://www.clearbracesdublin.com Cresta

    Invisalign has been always a very best choice for obtaining the perfect smile in a very short time. Because, these Invisalign braces are invisible as it never shows pain or irritation of your mouth like traditional metal braces.