Clear aligners for teenagers: what parents should ask

Aligner treatment for a teenager works the way it works for an adult, with one difference that dominates everything: it depends on a teenager choosing to wear a removable appliance for most of every day, for months.

Align Technology is unusually direct about this in its own material for parents. "Consistent wear is the single most important factor in achieving treatment goals on schedule."

What the manufacturer publishes about teen treatment

Align's instruction is the same one it gives adults: "Teens should wear their Invisalign clear aligners 20 to 22 hours per day, removing them only to eat, drink anything other than water, and brush and floss."

On scale, the company says that since 2001 "over 6,500,000 teen patients age 19 or younger have been treated with the Invisalign system", and its material refers to cases in the 11-to-19 range. That is the manufacturer counting its own treatments, and it tells you the product is established rather than that it is right for a particular child.

On lost trays, the advice is practical: "if your teen loses an aligner, contact your orthodontist promptly", keeping the previous set as a backup while you get advice.

Why removable is the whole question

A fixed appliance works whether or not the wearer is enthusiastic. A removable one does not, and the failure is invisible until a check-up finds that teeth are behind the plan.

That is not an argument for or against either. It is the thing to be honest about at the consultation — including with the teenager, who should be part of the conversation rather than the subject of it. A child who does not want the treatment is not going to wear it for 20 hours a day, and a plan that assumes otherwise is going to cost more than it was quoted.

Worth asking the practice directly: what does it do when wear has slipped? Practices vary, and the answer tells you something about how the case will actually be managed.

Money, and the temptation of the cheap option

Teen orthodontics is expensive enough that a mail-order price is genuinely tempting, and it would be dishonest to pretend otherwise. A course listed at a few hundred dollars against a private quote several times larger is not a small difference to a household budget.

Two things are worth weighing against it. The first is that a benefit may exist: orthodontic cover for dependants is more common than for adults, though almost always capped as a lifetime maximum. Ask the insurer for a pre-treatment estimate in writing before ruling the practice route out on price.

The second is that a course that has to be redone is the most expensive course there is. That is not a prediction about any particular seller — it is the reason the questions below are about supervision rather than about brands.

Things that are different at that age

Teenage mouths are still changing, and a few points follow from that.

• Teeth still coming through. A plan for a mouth with teeth still erupting is a different plan, and some aligner systems include features for it. What your practice uses, and why, is a fair question.
• Sport. A mouthguard and an aligner are different appliances with different jobs. Ask what the child should wear for contact sport, and when.
• Losing things. Trays go missing in school bags and canteens. The case habit is not optional, and a replacement takes time whoever makes it.
• Cleaning. A tray seals whatever is on the teeth against them for hours. Brushing after meals matters more during treatment than it did before — the practicalities are in how to clean aligners without wrecking them.

Mail-order and minors

The two mail-order sellers this site names sell to consumers, and their material describes review by licensed clinicians remotely rather than an in-person examination.

For a growing mouth, that gap is larger rather than smaller. The US Food and Drug Administration's consumer advice is to get an evaluation "preferably in-person to determine whether clear aligners are appropriate for you", and in the UK the General Dental Council's position is that there is "no effective substitute for a physical, clinical examination as the foundation for that assessment".

There is also the ordinary matter of who is responsible. Treating a minor involves consent from a parent or guardian and a clinician who can be identified and held to a standard — which the GDC describes by saying that where a dentist relies on information from another source, "the responsibility for that judgement rests wholly with the prescribing dentist". You should be able to name that person.

Whose decision it is

A teenager old enough to be responsible for wearing an appliance is old enough to be in the conversation about it. Practices differ in how much they involve the young person directly, and it is reasonable to ask for the plan to be explained to them as well as to you.

That is partly about consent and partly about outcomes. The instruction that decides this treatment — trays in for most of every day, out only to eat, drink anything but water, and brush — is not one a parent can carry out on somebody else's behalf.

It also means the honest answer is sometimes "not yet". A case that is not urgent, in a mouth still changing, with a teenager who does not want it, is a case where waiting is a real option to put on the table.

What to ask before anyone pays

1. Who is the treating clinician, and where are they registered?
2. Has my child been examined in person, with X-rays, and what did that show?
3. What is the plan if wear time slips — and what does that cost?
4. What is included: every tray, refinements, retainers at the end?
5. What happens at each appointment, how often, and with whom?
6. Is a fixed appliance a reasonable alternative for this case, and what would change if we chose it?

Ask the last one even if the answer is no. A practice that will not compare the options it offers is telling you something.

After the last tray

Retention applies to teenagers as much as anyone, and the cost of it is the part nobody quotes — see retainers after clear aligners. What a course costs before that, according to the sellers themselves, is on what clear aligners cost, read at source.