Orthodontic practices are getting more calls. How many prospects actually become patients?

Orthodontists in the United States are treating more patients than at any point since the American Association of Orthodontists began tracking the number nearly four decades ago. In its 2025 Economics of Orthodontics and Patient Census Survey, the AAO reported an average of 696 active patients per member in 2024, up from 574 in 2022. It was the highest level recorded since the survey began in 1987.

That is the encouraging part of the story. The more complicated part begins earlier in the patient journey.

Separate data from Gaidge, published by the AAO, shows that new-patient calls have been growing faster than completed exams and treatment starts at many practices. During the second quarter of 2025, new-patient calls at single-doctor orthodontic practices increased 3.5% from a year earlier. Completed exams at those practices rose only 0.2%, while treatment starts increased 2.4%. Among multi-doctor practices, calls were up 6.6%, exams increased 4.3%, and treatment starts rose 3.3%.

The figures do not suggest that something is inherently wrong with orthodontic practices. Nor does every caller who fails to start treatment represent a lost patient. Some people contact several offices. Some children are properly placed under observation. Some prospective patients are not yet ready for treatment, clinically or financially. Others simply decide that another practice is a better fit.

What the numbers do show is that there is a meaningful difference between generating patient interest and converting that interest into treatment. For a practice owner trying to understand growth, that distinction matters.

There Is No Single Orthodontic Conversion Rate

The phrase “conversion rate” is often used as though it describes one number. In an orthodontic practice, it does not.

A new patient usually moves through several separate stages: an inquiry, a scheduled exam, a completed exam, a clinical recommendation and, where treatment is appropriate, a treatment start. A practice can perform very well at one stage and poorly at another.

A strong marketing program, for example, may produce a healthy number of new-patient calls while a scheduling problem prevents enough of those callers from reaching an examination. Another practice may schedule most prospects successfully but lose too many of them to cancellations or no-shows. A third may complete a large number of exams, yet see a relatively high share of treatment-ready patients leave without starting.

Treating all three situations as the same “conversion problem” makes it harder to identify what is actually happening.

That is why orthodontic conversion is better understood as a series of transitions:

New-patient inquiry → scheduled exam → completed exam → treatment recommendation → treatment start.

Each transition answers a different question about the practice.

The Gap Between a Call and an Exam

Historical Gaidge data provides some context for one of the earliest points of attrition. In a published analysis, Gaidge used 90% as a benchmark for converting new-patient calls into completed exams. The same analysis described an example practice that recorded 793 new patients in its system but only 625 completed exams, a conversion rate of approximately 79%.

That difference may appear modest until it is translated into volume. Against the 90% benchmark, the practice was effectively short 89 completed exams.

Gaidge then modeled the financial implications using several assumptions: 20% of new-patient exams entering observation, a 63.52% case-acceptance rate, and an average orthodontic contract value of $5,089. Under those assumptions, the analysis estimated more than $230,000 in potential additional production associated with closing that particular call-to-exam gap.

That number should be interpreted carefully. It was a practice-specific illustration, not a national average, and the result depended on the assumptions used in the model. It would be misleading to say that the average orthodontic practice is losing $230,000 a year because of poor conversion.

The more useful lesson is mathematical rather than sensational: when a small percentage of prospective patients disappears at each stage of a repeated process, the cumulative effect can become substantial.

An Exam Is Not the Same as a Treatment Start

Even after a patient completes an exam, the funnel remains more complicated than it first appears.

Orthodontics differs from many other elective services because not every consultation should result in immediate treatment. A younger patient may appropriately enter observation. Treatment may not be indicated. The orthodontist may decide that intervention should be delayed. A patient may need additional dental work before beginning. Some adults may explore treatment without being ready to make a decision.

This is one reason a theoretical 100% exam-to-start conversion rate would be a poor objective. Good clinical judgment requires that some patients do not start immediately.

The more meaningful question is whether appropriate, treatment-ready patients who understand the recommendation are moving forward at a healthy rate.

That is a narrower and more useful measure than simply dividing all exams by all starts.

It also changes how a practice should think about improvement. A lower-than-expected start rate does not necessarily mean the treatment coordinator needs to “sell harder.” It may point to financial barriers, unclear communication, weak follow-up, scheduling friction, competitive pressure or even a mismatch between the patients the practice is attracting and the services it most wants to provide.

Demand for Orthodontic Care Is Strong

The discussion about conversion is especially relevant because the broader orthodontic market has been growing.

The AAO's 2025 Economics of Orthodontics and Patient Census Survey collected usable responses from 635 members in the United States and Canada, including 570 U.S. respondents. The association reported that average active patients per member increased from 574 in 2022 to 696 in 2024, the highest figure in the history of the survey.

The AAO estimated approximately 6.66 million patients in active treatment among its members in the United States and Canada. Adult orthodontics also continued to represent a significant part of the market, with the association estimating approximately 1.91 million adults in active treatment in the United States, up from 1.64 million in 2022.

Those figures suggest a market with substantial underlying demand. But strong demand does not make conversion unimportant. If anything, it makes the quality of the patient-acquisition process more valuable because more prospective patients are moving through it.

A practice receiving 30 new inquiries a month has fewer opportunities for small operational inefficiencies to compound than a practice receiving 150. At scale, modest differences in scheduling, show rates or treatment starts can produce meaningful differences in annual production.

The Way Patients Choose an Orthodontist Is Also Changing

The AAO's 2024 Orthodontic Landscape Consumer Study provides another reason to pay attention to the beginning of the patient journey.

A dentist's recommendation remained the largest single reason consumers said they chose an orthodontist. But its share declined markedly. In 2021, 43% of respondents cited a dentist recommendation as their primary selection driver. By 2024, that figure had fallen to 28%.

It would be a mistake to conclude that referrals are becoming unimportant. They are not. A dentist recommendation remains one of the strongest trust signals available to an orthodontic practice.

What appears to be changing is the degree to which one referral alone determines the decision.

Patients now have more information available before they ever contact the office. They can search for nearby orthodontists, compare websites, read reviews, look at social media, investigate treatment options and often form a preliminary impression of several practices before speaking with anyone.

A parent may receive a referral from a dentist and still compare three orthodontists online. An adult patient may discover a practice through search, read reviews, visit the website twice and only then make a call. A family may know the practice by reputation but still investigate competitors before scheduling.

That makes the first direct interaction with the practice increasingly important, because the caller may already be comparing alternatives.

Where Prospective Patients Are Most Likely to Disappear

For practice owners, the useful question is not simply how many prospects fail to convert, but where they leave the process.

The first obvious point is the initial inquiry. Was the call answered? Was an online form followed up promptly? Did the conversation create confidence? Could the patient get an appointment within a reasonable period? If a prospective patient contacted three practices, did the experience give them a reason to choose this one?

The next point is between scheduling and attendance. A practice may have a strong booking rate but still underperform because too many patients cancel or fail to appear. The cause may be long wait times for appointments, weak confirmation systems or simple changes in patient intent between the day an appointment is made and the day it takes place.

Then comes the consultation itself. Here, the patient is making sense of a clinical recommendation that may involve a substantial financial commitment and a treatment relationship lasting many months or years. Clear communication matters. So does whether the patient understands the diagnosis, the available options, the expected timeline and the cost.

Finally, there is the group that leaves without making a decision.

“I need to think about it” is not necessarily a rejection. Yet in many practices, it effectively becomes one because there is no consistent process for what happens afterward. A treatment coordinator may intend to call. Someone may send a text a week later. The prospect may be entered into a follow-up list that is rarely reviewed.

For a practice that has already invested time and money to generate the inquiry and complete the consultation, that final stage deserves as much attention as the original lead.

Single-Doctor and Multi-Doctor Practices Should Not Be Treated as Identical

The Gaidge data is useful partly because it distinguishes between single-doctor and multi-doctor practices.

In Q2 2025, the two groups behaved differently:

All figures compare Q2 2025 with Q2 2024. They represent year-over-year changes, not absolute conversion rates.

The distinction in the final row is important. A 0.7% increase in exam-to-start conversion does not mean the practice converts only 0.7% of exams. It means the conversion metric improved by 0.7% relative to the comparable period a year earlier.

That may sound obvious, but benchmark reports are frequently misread when growth rates and absolute rates appear alongside each other.

There are also practical reasons to separate practice sizes. For a single-doctor orthodontist, a relatively small number of additional treatment starts each month can make a noticeable difference to annual production. In a larger multi-doctor or multi-location organization, even a modest percentage improvement may be applied across hundreds or thousands of inquiries.

The principle is the same. The economics are not.

What a Practice Should Actually Measure

A useful new-patient dashboard does not need to be complicated. In fact, excessive measurement can make the important signals harder to see.

A practice should at minimum know how many qualified new-patient inquiries it receives, how many of those prospects schedule an exam, how many complete the exam, how many appropriately enter observation, how many are treatment-ready and how many ultimately start treatment.

The practice should also know how long it takes to move from the first inquiry to a start.

Those numbers become considerably more useful when they are broken down by referral source. Dentist referrals may behave differently from Google Ads. Existing-patient referrals may have a different show rate from social-media inquiries. Adults may convert differently from parents seeking treatment for children.

Once that information is visible, the discussion about growth becomes much more precise.

A practice with weak inquiry volume probably does need more demand.

A practice with plenty of inquiries but weak scheduling may have an intake problem.

A practice with strong scheduling but poor attendance may need to examine its confirmation process or appointment availability.

A practice with strong exam volume but weak starts may need to look more closely at treatment presentation, financial options, competitive positioning or follow-up.

Without those distinctions, the easiest conclusion is often simply: “We need more leads.”

Sometimes that is true.

Sometimes it is the most expensive possible answer.

The Most Valuable Prospect May Already Be in the Practice's Funnel

Orthodontic practices understandably devote considerable attention to attracting new patients. Referrals, reputation, search, advertising and community visibility all matter. A practice cannot convert demand that does not exist.

But acquiring more prospects is only one side of growth.

The other is understanding what happens to the people who already raise their hand.

A prospective patient who has called, scheduled or completed an exam is no longer an abstract marketing metric. The practice has already earned some degree of attention and trust. It has often spent money, staff time or referral capital to reach that point.

Losing an appropriate patient late in the process can therefore be considerably more expensive than it appears.

The best question for an orthodontist may not be, “How many leads did we generate this month?”

It may be much simpler:

Of the people who were interested enough to contact us, what happened next?

The answer tells the practice whether it truly needs more demand, or whether some of its most valuable growth opportunities are already sitting inside the funnel it has.

Data and Methodology

This article draws on multiple orthodontic industry datasets because no single national database reports every stage of the U.S. orthodontic new-patient journey.

AAO/Gaidge Q2 2025 data: The quarterly analysis includes more than 300 single-doctor practices with less than $1 million in quarterly production and more than 200 multi-doctor practices with as many as 10 locations. The Q2 2025 figures are year-over-year comparisons with Q2 2024.

AAO 2025 Economics of Orthodontics and Patient Census Survey: The survey received 635 usable responses from the United States and Canada, including 570 U.S. respondents. The AAO reports that practice figures largely reflect calendar year 2024 and that reported differences were statistically significant at the 95% confidence level, although precision varies by question.

Historical Gaidge conversion analysis: The 90% call-to-exam benchmark and the example involving 793 new patients, 625 completed exams, a 63.52% case-acceptance assumption and $5,089 average contract fee come from a historical Gaidge conversion analysis. They are included as an illustration of funnel economics and are not presented as current national averages.

Important limitation: There is no single universal U.S. “orthodontic conversion rate.” Call-to-exam conversion, exam-to-start conversion and case acceptance among treatment-ready patients measure different stages and should not be used interchangeably.

Primary Sources

American Association of Orthodontists — Gaidge 2025 Q2 Report: Metrics Show Positive Indicators for Growthhttps://www2.aaoinfo.org/gaidge-2025-q2-report-metrics-show-positive-indicators-for-growth/

American Association of Orthodontists — 2025 Economics of Orthodontics and Patient Census Surveyhttps://www2.aaoinfo.org/member-survey-indicates-orthodontic-patient-numbers-at-all-time-high/

American Association of Orthodontists — 2024 Orthodontic Landscape Consumer Studyhttps://www2.aaoinfo.org/orthodontic-landscape-consumer-study-examines-patient-marketplace/

Gaidge / Planet DDS — Conversion Waterfall Analysishttps://www.planetdds.com/resources/using-gaidge-analytics-to-find-leaks-in-the-practice-bucket/

Last updated

August 2026