Orthodontists treat more patients than ever. So why is winning them harder?

Two orthodontic practices appear in the same Google search results. Both have strong reviews, modern websites and competitive treatment options. Both receive inquiries from prospective patients.

But what happens next may be very different.

At one practice, the patient receives a brief explanation and a price estimate. At the other, the team takes time to understand the patient’s concerns, explains the available options and offers a realistic preview of what treatment could achieve. The patient leaves with information to review and discuss at home.

Both practices succeeded in attracting attention. Whether they earned the patient’s confidence is another question.

That distinction matters in an orthodontic market where traditional referral relationships, competing providers and digital discovery are all evolving. Yet despite the growing complexity, the evidence suggests that specialist orthodontic treatment remains strong.

More competition, but more patients

According to the American Association of Orthodontists’ 2024 Orthodontic Landscape Consumer Study, orthodontists accounted for an estimated 70% of patients undergoing orthodontic treatment, up from 65% in 2022. General and pediatric dentists accounted for 20%, while mail-order providers represented 10%.

A separate AAO Economics of Orthodontics and Patient Census Survey reported that the average number of active patients per responding member rose from 574 in 2022 to 696 in 2024, a record for the survey. The figures came from a survey of AAO members in the United States and Canada, not a census of every orthodontic practice.

The adult market also expanded. The AAO estimated approximately 1.91 million adults receiving orthodontic treatment in the United States from AAO members in 2024, compared with 1.64 million in 2022.

These findings challenge the assumption that greater competition necessarily means fewer patients for specialists.

The competitive landscape itself has changed in unexpected ways. SmileDirectClub, once a prominent direct-to-consumer clear aligner company, ceased operations in December 2023 after filing for bankruptcy. Its disappearance removed a well-known alternative to office-based treatment, although there is insufficient evidence to establish how much it contributed to orthodontists’ subsequent market-share gains.

General dentists, meanwhile, continue providing orthodontic care. A 2022 study published in the American Journal of Orthodontics and Dentofacial Orthopedics found that 42% of 373 surveyed general dentists provided orthodontic treatment. The respondents also reported continuing to refer complex cases and growing patients to orthodontic specialists.

The study’s low response rate limits how broadly its findings can be generalized. Nevertheless, it illustrates how competition and professional collaboration can coexist.

Are dentist referrals becoming less important?

One of the most revealing findings concerns the traditional referral relationship.

The AAO’s consumer research found that a dentist’s recommendation was the primary reason for selecting an orthodontist for 28% of respondents in 2024, down from 43% in 2021.

That is a substantial change in reported decision-making influence. But it does not necessarily mean that dentists are referring fewer patients.

The 2025 Orthodontic Products practice survey, reported in April 2026, identified general dentists as the largest referral source among participating orthodontic practices. Its analysis described referral sources as broadly stable over four years, although dentist referrals declined relative to 2024.

The distinction is important. A general dentist may recommend an orthodontic consultation, but the patient may subsequently research several specialists, compare reviews, consider financing options and make an independent decision.

Referrals can still generate opportunities without determining the final choice.

The growing adult treatment market raises further questions. Adults deciding on treatment for themselves may have different priorities from parents choosing care for a teenager. Convenience, cost, appearance, treatment duration and existing relationships with dental providers may all influence their decisions.

Whether those considerations are becoming more important remains a question for further research. But orthodontists are competing for patients whose choices may involve more information and more alternatives than in the past.

The changing value of being discovered

Digital discovery adds another layer of uncertainty.

In 2025, Pew Research Center found that users clicked a traditional Google search result in 8% of visits when an AI-generated summary appeared, compared with 15% when no summary was present.

These figures do not prove that orthodontic advertising is becoming less effective or that practices are receiving fewer inquiries. They do demonstrate that the relationship between searching for information and visiting a website is changing.

At the same time, patients can encounter orthodontic information through YouTube, Instagram, TikTok, reviews, recommendations and AI assistants. Greater access to information may allow prospective patients to compare providers more extensively before contacting a practice.

For orthodontists, this creates both a challenge and an opportunity.

Advertising can help a practice become visible. Specialist expertise, reputation and patient education can help explain why someone might choose it. But neither guarantees that an inquiry will become a treatment start.

That decision is influenced by what happens after the first contact.

What happens after the first inquiry?

The telephone conversation, the welcome at reception and the consultation itself are all part of patient acquisition, even if they rarely appear in a marketing report.

A practice can invest heavily in generating inquiries while overlooking whether patients receive clear answers, feel understood or leave with enough information to make a confident decision.

Visual communication can play a useful role. Photographs, explanations and realistic treatment previews can make possibilities easier to understand. But their purpose should be to support an informed clinical discussion, not promise a particular result.

And not every consultation should lead to treatment. Some patients require monitoring, others may benefit from different care, and some appropriately decide not to proceed. Consultation-to-start rates are useful operational measures, but they must be interpreted in their clinical context.

The question of what happens between an inquiry and a treatment start is explored further in our earlier article, Orthodontic practices are getting more calls. How many prospects actually become patients?

The opportunity to earn trust also continues long after treatment begins.

A patient who completes treatment and is pleased with both the result and the experience may become one of the practice’s most credible advocates. With appropriate consent, photographs documenting the transformation can help tell that story. A recommendation from a satisfied patient or family carries something an advertisement cannot manufacture: a real relationship and a personal experience.

This completes a cycle that acquisition metrics can easily overlook. The patients a practice serves today can influence who chooses it tomorrow.

For orthodontic practices evaluating their future, three questions may be as useful as another discussion about advertising channels:

• How quickly and thoughtfully do we respond to new inquiries?
• What does a patient understand, remember and take home after the consultation?
• Do we know how many consultations become appropriate treatment starts, and why others do not?

Google will continue changing. General dentists will continue offering orthodontic services. Referral relationships and patient preferences may evolve in ways that are difficult to predict.

But practices retain considerable influence over how they communicate, how they care for patients and what people remember about the experience.

Advertising can buy attention. A referral can open the door. But a patient’s confidence still has to be earned.

Sources

American Association of Orthodontists. Orthodontic Landscape Consumer Study Examines Patient Marketplace. March 2025https://www2.aaoinfo.org/orthodontic-landscape-consumer-study-examines-patient-marketplace/

American Association of Orthodontists. Member Survey Indicates Orthodontic Patient Numbers at All-Time High. July 2025https://www2.aaoinfo.org/member-survey-indicates-orthodontic-patient-numbers-at-all-time-high/

Lee, Daniel S., Taylor Sulkowski, Clare Bocklage, et al. Identifying factors that impact general dentists’ referrals to orthodontists. American Journal of Orthodontics and Dentofacial Orthopedics, 161(2), e147–e171. 2022https://pubmed.ncbi.nlm.nih.gov/34538711/

Levin, Roger P. Steady Year, Shifting Landscape: Findings From the 2025 Orthodontic Practice Survey. Orthodontic Products. April 2026https://orthodonticproductsonline.com/practice-management/business-development/steady-year-shifting-landscape-findings-from-the-2025-orthodontic-practice-survey/

Pew Research Center. Google Users Are Less Likely to Click on Links When an AI Summary Appears in the Results. July 2025https://www.pewresearch.org/short-reads/2025/07/22/google-users-are-less-likely-to-click-on-links-when-an-ai-summary-appears-in-the-results/

SmileDirectClub. SmileDirectClub Begins Swift Wind Down of Business to Maximize Value. December 2023https://www.prnewswire.com/news-releases/smiledirectclub-begins-swift-wind-down-of-business-to-maximize-value-302010460.html