Increased demand for orthodontic treatments during the COVID-19 pandemic: a commentary

Omran, R., Dowie, A. Increased demand for orthodontic treatments during the COVID-19 pandemic: a commentary. Br Dent J 234, 84–87 (2023).


The COVID-19 pandemic, which originated in late 2019 in Wuhan, China, has rapidly overwhelmed the delivery of dental health services worldwide. Despite that, there was a positive, unanticipated upsurge in the need for orthodontic treatments. This type of treatment often aims to correct malignment of the teeth when the jaws are closed, known as malocclusion, which can affect one’s appearance, function, facial harmony, and psychological well-being. Malocclusion carries a high prevalence among children and adolescents worldwide, being most prevalent in Africa and least prevalent in Asia (81% versus 48%).

Factors underlying the rise in demand:

There are several contributing factors underpinning seek for orthodontic treatments. Firstly, due to working from home during the pandemic, there was an upsurge in use of video conferencing platforms. These have made people to be more self-aware about their on-screen appearance, creating the ‘Zoom boom’ phenomenon. This has encouraged patients with misaligned teeth to seek smile enhancement treatments. The British Orthodontic Society (BOS) surveyed orthodontists in April 2021. It was found around 84% of orthodontists (n=271) reported an increase in the number of orthodontic treatment seekers, mostly being female patients, compared to the past five years. This was further supported by the positive attitudes towards aesthetic surgery amidst the pandemic. These are also likely to be a result of video conferencing for long hours. Secondly, due to the nature of dental care provision (i.e. being in close proximity to patients), a few mitigation strategies, including enhanced periodontal protective equipment , procedural and environmental strategies were put in place to reduce the viral transmission. Associated with this, dental clinicians in many regions were disallowed to perform elective and non-emergency treatments. In fact, only clinics running treatments requiring less chair time, less production of droplets and aerosols and fewer treatments needing use of high-speed turbine preparations were likely to take place. This has shifted treatment modalities in orthodontics to be more compatible with the current situation, which has led to the reinforcement of 4–6-week appointment protocol and realising that orthodontic treatments are less invasive and better probability of infection control. Thirdly, COVID-19 restrictions were associated with holiday-making and leisure activities cancellation which resulted in extra disposable funds. This has led some people to consider pursuing orthodontic treatments since invasive elective dental treatments were unavailable.

Do-it-yourself aligners:

Since COVID-19 appointment has led to limited availability of face-to-face appointments, there was a great shift to clear aligner treatments (CAT), specifically the do-it-yourself (DIY), which reflects a self-directed low-cost intervention to correct malocclusion without an orthodontist supervision. Around 25% of potential DIY users do not consider risks associated with it and the large majority believe that their own dentist should detect issues during their treatment. While this may suggest that some individuals are exploring alternative treatment options to CAT, this raises concerns about patient understanding of potential risks with self-directed treatments without professional supervision. With regards to this context, the General Dental Council (GDC) issues a statement on professional standards and that providers who are not on the Dental register may get prosecuted for unlawful practice of dentistry.

Aligners versus fixed conventional appliances:

COVID-19 pandemic has reignited the debate of whether conventional fixed appliances are superior to CAT or not. Recent report suggested that patients who use CAT often have increased improved oral hygiene, increased intra-oral accuracy and fewer treatment-related issues. patients with malocclusion were also found to have better periodontal health when treated with CAT. Hence CAT should be the treatment of choice when malocclusion is associated with potential risk of developing gingival inflammation. Among the adult population, treatment outcomes with fixed orthodontic appliances were better than CAT. However, it is unclear if this is due to their use or slow improvement in CAT research.


Overall, COVID-19 has led to an increase in the demand for orthodontic treatments. Factors including: a) unavailability of invasive elective treatments; b) increase in the use of extra funds from leisure activity cancellation; c) increase in on-screen self-awareness associated with video conferencing for long hours; and d) the better chance of infection control, have all contributed to the rise in orthodontic treatment demand. Longitudinal studies should investigate the safety and long-term effectiveness of DIY.

Research Summary Written By: Mohammad Khalfan, BSc Dental sciences, BDS3 – University of Glasgow

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