The Impression
STRAIGHT TALK
ON ORAL CARE

Ask An Orthodontist: Wait, I Might Need Dental Work Before Treatment?

Because you can't straighten your teeth without thinking about your oral health, too.

Gretchen Lidicker
Contributing Writer

No matter why you want to straighten your teeth — a gap that’s always bothered you, crowding up front that didn’t used to be there — finding out that you need to see a dentist before you get started can be discouraging. And that’s understandable! After all, a major part of the appeal of clear aligners is convenience, especially for at-home teeth straightening options like Candid. So having to get dental work first can feel like it defeats the purpose.

“It’s disappointing, because [the customer] found a company that can provide affordable teeth straightening, but now they have to spend money on dental work,” Dr. C. Lynn Hurst, co-founder and Chief Dental Officer of Candid, tells The Impression.

But orthodontic treatment planning is incredibly complicated, with tons of different variables to take into account in order to ensure a great outcome. So we asked Dr. Hurst to walk us through the reasons why someone might need to see a dentist before they start treatment with clear aligners.

Gretchen Lidicker: There seems to be a lot of overlap between dentistry and orthodontics — definitely more than I thought. Can you say a little more about the relationship between the two? 

Dr. Hurst: Orthodontics is actually a secondary care specialist in dental medicine, which has nine specialties. The largest one by far is orthodontics, and number two is oral maxillofacial surgery. After that, it drops down to periodontists and endodontists (who do root canals) and pediatric dentistry. The others are academic specialties. 

Because orthodontics is a secondary care specialty, our patients need to go through a funnel where they get their primary oral healthcare needs addressed first. In our direct-to-consumer model at Candid, it’s our responsibility to redirect them if they’re not a candidate for treatment without some prequalifying care.

So it’s not like a test you need to take — it’s more of a collaboration between the two types of care. And sometimes you need one before the other? 

Yes, absolutely. And oftentimes when we're done with what we do, the patient needs to go back to their general dentist to have some post-orthodontic restoration. Or sometimes things are in a condition where you need your teeth in alignment just so the general dentist can then perform the things that they need to do.    

How long have you been an orthodontist? 

I have about 35 years of experience in dental medicine and I’ve been an orthodontist for 33 of them. So...you could say I’ve been in this space for a day or two. I’m the Baby Boomer working in an office of millennials! 

How exactly does the diagnostic process work for clear aligner treatment with Candid? 

Essentially, the process goes like this: A patient orders their at-home starter kit or books an appointment at a Candid Studio near them. They’ll take their own photos and impressions, or a care specialist will take a 3D scan of their teeth at the studio. Then a Candid orthodontist will assess their case. At this point, we’re looking to answer two main questions: 1) Are the patient’s teeth and gums healthy enough for orthodontic tooth movement?, and 2) Is this a case we can treat with the Candid model?

And the answer is sometimes no? 

Unfortunately, not everyone meets these criteria. Some people need to see a dentist first and others don’t qualify at all. We’re completely changing the model for orthodontics to make it more accessible, but there are still some restrictions. In the future, we’ll be able to open up the funnel even more so that everyone is able to straighten their teeth with Candid aligners.

Is it always an orthodontist making these decisions? 

It’s extremely important that we follow the laws of the state, and you have to be a doctor in order to be able to approve that diagnostic information. So yes, 100% of our cases are evaluated by our orthodontists, who have an average of 20 years of experience.

What kind of dental care do most people often need?

It could be as simple as having your teeth cleaned.

Really? That’s easier than I imagined. 

Yes, I’d say that about 75% or more of the patients that our orthodontists refer to a dentist have some oral hygiene issues that don’t have them prepared for clear alignment treatment. It can be more complicated too, though. 

Complicated how? 

They might have a broken filling or a filling that fell out. It’s very seldom someone will actually have a cavity or decay but that will also happen. With clear aligners, we use very low forces compared to braces, so sometimes it makes sense for patients to have their wisdom teeth removed so there’s more space to gently move the teeth. 

Do you have to have your wisdom teeth out to qualify for Candid aligners? 

No, we don’t have all our patients get their wisdom teeth out. This is a model of care where we've tried to open up the funnel. What we really need to make sure of is that people's primary oral healthcare needs are met first. Then we do what we do.  

You're obviously passionate about giving people beautiful smiles. Is it hard to turn people away?

Yes, most people come to us because they want the process to be simple and cost-effective. And in a perfect world, it would be. It’s very discouraging and I see it firsthand when I do online chats with patients.

I imagine some of this dental work can get expensive as well. Is that true? 

Depending on what you need, it can be expensive. A teeth cleaning can range from free (if you have dental insurance) to as much as $200 dollars. More complex procedures could cost you more. 

Speaking of money, by referring people to a dentist, you might never end up treating them, correct?

Referring them to a dentist for oral healthcare means we may never actually treat the patient. They may spend their money on dental work or decide to get their teeth fixed by that dentist instead of with Candid. As long as that dentist knows what they’re doing, well, God bless them — that’s okay with us! Just by referring them, we’ve done the patient some good. 

Because it's not about Candid generating revenue, it's about patients getting the high-quality oral healthcare they deserve. Even if we don’t treat the patient, we’ll still follow our principles and values to do what’s best for the individual. 

If you’ve been seeing your dentist regularly, for cleanings and to fix any issues, is it more likely that you’re a candidate for treatment with Candid?

Yes, if you’ve been seeing a dentist regularly you’re more likely to be a candidate because your dentist would have addressed most issues keeping you from qualifying for clear aligner treatment.  

I imagine some people are more concerned with the length of time this process will take than with the added costs. How long does the teeth straightening process take? 

Our longest treatment plans are about 10 months. It’s not very long compared to braces and most people are happy to hear that!  

That’s quick. I had braces for two full years and it was terrible! Okay, two more questions. First, deciding to spend the money on dental work to qualify for aligners can be a tough decision. What do you want people who are debating whether to take the leap to know? 

What I want them to know is that, if they can afford to make the investment, there’s a lot of value in fixing your teeth. Other than keeping your teeth clean, there’s nothing better for your oral health than having your alignment and bite improved.

So there’s long-term oral health value and also the psychological advantages. Once you fix your teeth, you’ll want to take better care of them. We as orthodontists provide a beautiful result that can help motivate patients to protect their investment in the long-term. And, at the end of the day, we know it’s a big investment.

Finally, what excites you the most about what Candid is doing? 

The number one motivator for me — and it’s why I helped found Candid in the first place — is accessible, affordable, safe, high-quality oral healthcare. It wasn’t until the early 2000s when I realized that as an orthodontist, I was providing a boutique service that left out so many people. At Candid, we’re proving that there are things we can do to change the model and create a different price point and therefore, open up the gates for pretty much everyone to have the opportunity to have a beautiful smile. That’s really my passion and what drives me every day. ✧


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Chisari, Justin R, et al. "Variables affecting orthodontic tooth movement with clear aligners." American Journal of Orthodontics and Dentofacial Orthopedics, vol. 145, issue 4, 2014, S82-S91.
Peter H. Buschang, Steven G. Shaw, Mike Ross, Doug Crosby, and Phillip M. Campbell. “Comparative time efficiency of aligner therapy and conventional edgewise braces,” The Angle Orthodontist: May 2014, https://www.angle.org/doi/full/10.2319/062113-466, Date accessed: April 29, 2019.

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