Peer-reviewed article
Determinants of public preference for orthodontic appliances and treatment providers: a scoping review.
Jiang L, Chan AS, Meade MJ, Freer E, Mohammed H ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This scoping review examines public preferences for orthodontic treatment providers and appliances across 56 studies involving over 16,000 people in 17 countries. The review finds that specialist orthodontists are preferred over direct-to-consumer providers, and that adults prefer aesthetic appliances while children prefer metal braces. The study identifies public misunderstandings about orthodontic safety and effectiveness, and recommends better education to improve decision-making.
Key points
- Specialist orthodontists were consistently the most preferred treatment providers, associated with perceived higher quality and expertise
- Adults preferred and were willing to pay more for aesthetic appliances, whereas children and adolescents perceived metallic braces as more aesthetic
- Direct-to-consumer treatment appealed to a minority and was associated with lower cost and convenience
- Common public misperceptions included confusion between general dentists and orthodontists, and overestimation of DTC safety and effectiveness
- Pragmatic appliance features such as effectiveness, comfort, and treatment outcomes often outweighed appearance among informed patients
Limitations
This review concerns adult and adolescent orthodontic preferences rather than child health outcomes or well-being. It does not evaluate the actual effectiveness of treatments or their impact on children's development, health, or quality of life.
Abstract
Background Laypeople can choose from a variety of orthodontic care pathways. It is in the clinician's best interest to understand their preferences in order to tailor consumer engagement. This scoping review maps the evidence concerning laypeople's preferences for orthodontic providers and appliances. Methods The review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Two reviewers conducted a systematic search and an independent screening process across five electronic databases until December 2025. Results A total of 56 studies (48 cross-sectional questionnaires; seven qualitative; one mixed methods) comprising 16,271 laypeople across 17 countries were included. Forty-two studies examined perspectives for orthodontic appliances, and 20 studies investigated providers. Specialist orthodontists were consistently the most preferred treatment providers, primarily associated with perceived higher quality and expertise. Direct-to-consumer (DTC) treatment appealed to a minority and was associated with lower cost, self-perceived easier-to-treat malocclusion and convenience. Adults preferred and were willing to pay more for aesthetic appliances, whereas children and adolescents perceived metallic braces as more aesthetic. Pragmatic appliance features such as effectiveness, comfort, and treatment outcomes often outweighed appearance, especially among informed or experienced patients. Common public misperceptions included confusion between general dentists and orthodontists, and overestimation of DTC safety and effectiveness. Conclusion While DTC and aligners appeal to the public demand for aesthetics and convenience, preference for orthodontists and fixed appliances remains strong, driven by perceived quality and the social acceptability of metal braces in children and adolescents. Better public and in-chair education is recommended to address misperceptions and guide better-informed decision-making.