Perceptions of general public on direct-to-customers (DTC) orthodontics

Abstract

Background. Direct-to-customer (DTC) orthodontics has been a new trend in Hong Kong. There is an increased number of advertisements, with the aid of social media, emphasizing reduced cost and increased flexibility. However, little is known about the perception of DTC orthodontics regarding the general public in Hong Kong. Aims. To better understand the general public’s experience and perception on DTC orthodontics as well as the treatment provided by DTC orthodontics companies in Hong Kong. Methods. A cross-sectional anonymous online questionnaire was conducted during 26 February – 17 March 2021. Target participants were residents in Hong Kong that could be reached via social media and online forums. Data on socio-demographic information, experience of orthodontic treatment, perception of DTC orthodontics were collected. Sting operation up to the consultation stage as a potential customer was performed to compare and contrast the differences among 3 DTC companies in Hong Kong, including Zenyum, SmileDirectClub, WonderSmile. Results. Total of 944 responses were received, with 672 valid responses (71.2%). More than half (63.5%) of respondents had heard of DTC. Most common sources were advertisement and social media. About one thirds (36.6%) of respondents had considered DTC, the main factors being better aesthetics and lower price. About two thirds (63.4%) of respondents had not considered DTC, the main factors being lack of dentist supervision and doubted effectiveness. Younger respondents (P<0.001), female respondents (P<0.001), student and full time worker (P<0.001) showed higher tendency to have heard of DTC. Younger respondents (P=0.002), female respondents (P=0.007), respondents with higher education level (P=0.002), respondents who have heard of DTC (P<0.001), respondents who have undergone orthodontic treatment (P<0.001) exhibited higher tendency to have negative opinion on reliability of DTC. Female respondents (P=0.001), respondents who have heard of DTC (P<0.001), respondents who have undergone orthodontic treatment (P=0.001) had a higher tendency to think that the treatment process of DTC is not the same as traditional orthodontic treatment. Older respondents (P=0.002), respondents who have heard of DTC (P<0.001) showed higher tendency to think that the channels of complaint for DTC is the same as those for traditional orthodontic treatment. Only 11 DTC users were found, which was too small to represent the users’ experience. Sting operation revealed differences in requirement for on-site visit, location of dentist and treatment process offered by the three DTC companies. All companies claimed there was little to no side effect, no failed cases, and only accepted mild and moderate orthodontic cases after screening. Conclusion. Majority of respondents had heard of DTC orthodontics. As for the general perception of DTC orthodontics, most of the respondents were skeptical of the reliability of DTC orthodontic treatment, and disagreed that DTC orthodontics shared the same treatment process with in-office orthodontic treatment. Knowledge of channels of complaint was inadequate. The DTC companies screened for suitable cases and minimal dentist involvement was noted.