Still cosmetic patients love how easy and attractive the aligners are. Either way, more and more dentists are offering Invisalign.

Said one dentist, “All the work for the most part on simple cases is done by the Invisalign computer.”

But an orthodontist complained, “I use Invisalign rarely, as it doesn’t move teeth as efficiently as fixed brackets.”

The Wealthy Dentist conducted a survey asking dentists if they use Invisalign. To hear what they had to say, Click Play on the following dental video–

With Align announcing this week that they are launching Invisalign in Russia and the Midddle East, have you been happy offering Invisalign to your dental patients?

OrthoAccel Technologies has announced the FDA clearance of their AcceleDent device, a removable gadget that an orthodontia patient wears in their mouth for 20 minutes a day.

The device works by accelerating teeth movement through vibration when used in conjunction with conventional braces.

In the clinical trial, the appliance exhibited an acceleration of teeth movement of 106% during the initial alignment phase and 38% – 50% during closure of extraction space.

In a statement released by Dr. Dubravko Pavlin, professor of orthodontics at the University of Texas Health Science Center at San Antonio, he exclaimed, “With an increase in rate of tooth movement observed in our study the orthodontic treatment time could be shortened by at least 5 months during the first two stages of orthodontic treatment.”

Here is the video promo for the AcceleDent device –

What do you think about this new dental science technology?

For more on the AcceleDental device see: Brace Yourself: AcceleDent Device Could Cut Orthodontic Treatment Time in Half

In Texas, Medicaid pays dentists for orthodontics per procedure, instead of a lump sum for the “finished mouth” of straight teeth.

This has made Medicaid orthodontia a lucrative dental business in Texas.

WFAA-TV of Texas has been investigating this story for the last six months and has uncovered hundreds of millions of dollars of questionable Medicaid spending on dental braces for children in Texas. Their news reports prompted federal investigators to now audit the Texas Health and Human Services Commission, which controls the Medicaid funds.

According to the WFAA website -

In a letter to the state, the Inspector General says it will examine the “authorization process for orthodontic treatment” under Texas Medicaid. “The objective of our audit,” the letter continues, “is to review the State’s controls to ensure that only medically necessary orthodontic cases are paid.” The time period covered by the audit is September 1, 2008 through May 28, 2011.

The new station’s investigation revealed that during that period, Texas taxpayers spent $424 million on orthodontic braces for children under Medicaid. Taxpayers spent $100 million in 2008, $140 million in 2009, and $184 million in 2010, state records show.

Texas dentist, Dr. Christine Ellis, who teaches at UT Southwestern Medical Center, has twice traveled to Washington in an attempt to convince lawmakers to scale back Texas Medicaid orthodontics payments and divert funds for more pressing dental needs.

Her attempts fell on deaf ears. According to the WFAA-TV article, Ellis said, “There’s no response. No one is putting the brakes on this thing.”

Billy Millwee of the Texas Health and Human Services Commission is now telling WFAA-TV that if taxpayers money has been lost, the Attorney General might take action to get it back. He went on to say that Texas will have a new managed care Medicaid dental program beginning next spring.

For more on this story see: Feds Investigate Texas Dental Medicaid Program and Taxpayers Footing the Bill for Braces in Texas.

No longer do patients fear having a “mouth full of metal.”

We conducted a survey that asked dentists what type of orthodontic options they now offer at their practice.

This was their response -

• Conventional braces — 22%
• Ceramic braces — 19%
• Lingual braces — 6%
• Invisalign® — 22%
• Inspice ICE® — 4%
• ClearCorrect® — 10%
• Simpli 5® — 6%
• Smart Moves® — 4%
• RW II® — 3%
• Red White & Blue® — 4%

“I have done orthodontics as a GP for 24 years.” (General dentist)

“Patients value the option of avoiding bands and brackets.” (Urban dentist)

“I prefer fixed orthodontia, as it is easier to keep the patient compliant.” (North Carolina dentist)

“Pre-treating arch discrepancies including posterior cross bites with removable orthopedic appliances allow you to finalize many cases with Invisalign®.” (California dentist)

As part of The Wealthy Dentist dialogue on dental practice management and marketing, we offer weekly surveys and invite your participation.

In order to understand different perspectives on the dental industry, we have developed surveys to canvas a diverse group of dental practices on their view of the dental industry, what constitutes current good practice in dental marketing and quality care.

The information collected will be used to prepare articles for The Wealthy Dentist readership.

The survey should take no more than 90 seconds to complete -

We found that general dentists charge an average of $4350 for orthodontia work, while orthodontists charge $5141.

Some orthodontists felt that braces should cost more.

“The average price should be $7500-8500 based on inflation. Unfortunately, managed care practices and #$&!@!! general dentists are screwing up pricing. In turn, this ‘trickle down effect’ will only hurt dentists who should be getting $1800 for a crown!” expressed a Colorado orthodontist.

Location is factor that can influence the cost of braces. California is known for being one of the most expensive states for dental treatments in general, and braces are no different.

Suburban dentists’ braces fees have increased to match their urban counterparts, which is a change in the last two years.

Here a few comments from doctors:

“We do Invisalign at a lower cost but only if it is minor movement with treatment taking only a couple of months.” (Pennsylvania dentist)

“My cases are treated with better and more individualized diagnosis, and finish with better facial aesthetics, better occlusion, a better smile line and better function.” (Illinois orthodontist)

“The cost of braces depends on the type and length of treatment.” (New Jersey orthodontist)

“Well-trained GP’s are fully capable of providing orthodontic services!” (Ohio dentist)

“We only do Invisalign.” (General dentist)

The Journal of Clinical Orthodontics conducted an orthodontic practice study in 2007 on the average cost of braces in the United States. The study found that for comprehensive treatment of orthodontics the costs averaged $5,354 for adults and $4,914 for children.

Has the cost of braces remained flat or increased in your area over the last four years?

For more on this survey see: Braces Cost an Average of $4,350 at General Dentist

The Wealthy Dentist conducted a survey to determine what dentists and orthodontists are charging for Invisalign.

The results from the survey revealed that Invisalign treatment costs an average of $4,622 when provided by a dentist and $6.945 when treated by a specialist.

“We adjust our cost according to how long treatment takes. Times can range from 5 – 18 months (rarely more). We are willing to “deal” on Invisalign because the actual Dr. time is so minimal,” reported a Minnesota dentist.

The cost of Invisalign treatment is on average $500 higher than the cost for regular braces treatment. The dentists who responded to this survey noted that the higher cost reflects the lab fee that they pay for the Invisalign trays.

Here’s a sample of what dentists had to say about the cost of Invisalign treatment:

“I take into consideration material cost of impressions for both initial and refinement, the lab cost and shipping. We charge $5,000 for a full treatment.” (Georgia dentist)

“I have wrestled with the most appropriate fee levels for Invisalign for a long time. We have historically kept the cost of a ‘full’ treatment a bit higher than traditional orthodontia. Although the ‘full’ treatment cost is $5800 — I charge $3200 for express.” (Washington orthodontist)

“Specialists usually get ‘tougher’ cases, so they charge more. We have three fee structures for simple, medium, and complex.” (California dentist)

“My Invisalign rep suggests that I should lower my fees or offer financing that takes a bite out of my profit due to the economy, but I don’t see them lowering their lab fees to me!” (Illinois dentist)

“I hate how high the lab fee is!” (General dentist)

“Invisalign pre-treatment of prosthetic cases greatly reduces the complexity and cost of many restorative challenges. Talk about a revenue enhancer! Invisalign is the best thing this GP has added to the bag of tricks in the last 4 years!” (Florida dentist)

“I am thinking of lowering my fees to compete with the general dentists in the area …” (Oregon orthodontist)

“Clear Choice is much lower in cost to the dentist (and the cost savings can be passed along to the patient). Clear Choice appears to be just as good, if not better than Invisalign. I’m so fed up with Invisalign and our local rep is not very helpful either.” (Ohio prosthodontist)

“Our cost includes whitening and first set of retainers, which we make in house.” (Connecticut dentist)

“There is no free lunch!” (Ohio dentist)

For more on this survey see: Fees for Invisalign Treatment Average $4,622 – $6.945

The cost of braces tends to be higher that what patients want to pay and lower than what dentists want to receive.

A Washington orthodontist wrote, “Over the past thirty years, the cost of braces has kept pace with cost of living increases. Thankfully, technology has allowed greater efficiency and consequently, reasonable profitability for the orthodontist and a good price for the consumer.”

Click on play to watch the video -

• Do different orthodontic treatments cost different amounts?

Yes, but less than you might think. Adult braces and Invisalign costs were about equal in this survey. Teen braces (on average) cost a few hundred dollars more.

• Are prices the same across the US?

You will find the most affordable braces in the American west. Dental braces cost the most in the Northeast, the Pacific and Canada. The reason is simply regional price differences.

For more on this survey see: Braces Cost More from an Orthodontist

The average dentist often refers out braces, sedation dentistry, and root canals, while keeping cosmetic dentistry, and denture patients.

Related Story: Specialists Usually Refer Patients Back, Report Dentists

When it comes to pediatric dentistry and gum disease, dentists refer some patients out and treat others in house. 

Related Story: How Dentists Refer Wisdom Teeth Cases to Oral Surgeons

Overall, the average dentist refers out less than 20% of patients.

Related Story: Root Canal Referrals: Dentists vs. Endodontists

Here are some dentist comments on referring patients:

• “Impacted wisdom teeth and molar endodontics are referred out 100%. Everything else is decided case by case.” (North Carolina dentist)
• “Some patients have such poor dental insurance for certain procedures, I’d rather let a specialist do the treatment.” (Nevada dentist)
• “I think most dental implants should be placed by either oral surgeons or periodontists because in my community, a lot of the dental implants placed by general dentists fail.” (Alabama dentist)
• “I refer out general anesthesia, but most anxious patients do well in office with oral sedation.” (New York dentist)

Read more: Dentist Specialist Referrals: What Dental Treatment Dentists Refer Out

The newspaper has recently covered a mother’s plight to have her son’s braces removed.

According to the woman, the orthodontist refused to remove the teen’s braces until the family settled a mysterious $300 bill for missed visits. Her two daughters had seen the same doctor, and the family had paid the orthodontic practice a total of about $12,000 over the years.

The dispute occurred in January, and involved the office filing a police report against the mother (for charges she denies). She contacted the newspaper in July. Now that it’s been featured in the paper, the boy’s dental braces are off.

The orthodontist expressed bewilderment over the whole thing. According to the practice, there is no $300 balance due, and the boy would have been welcome in at any time.

It’s not clear what really happened – but it is clear that the orthodontist doesn’t come out looking so good in the local paper!

Read more: Mom not smiling over dental dispute