Perceptions and experiences of direct-to-consumer orthodontics: insights from a Reddit-based analysis

Direct-to-consumer orthodontics (DTCO) has emerged as an alternative model of orthodontic treatment, allowing patients to undergo care without routine in-person clinical supervision. Despite increasing popularity, concerns remain regarding patient safety, adequacy of clinical oversight, treatment outcomes, and corporate practices. This study aimed to explore public perceptions of DTCO through qualitative analysis of Reddit posts, focusing on user experiences, associated risks, and decision-making processes.

Publicly available Reddit posts were collected using Python's Reddit API Wrapper (PRAW) from selected subreddits. Qualitative thematic analysis was conducted following Braun and Clarke's six-phase framework. Themes were identified and quantified based on frequency of occurrence. Sentiment analysis was also performed, classifying posts as positive, negative, mixed, or neutral.

A total of 721 posts were retrieved, and 165 included after screening. Seven themes were identified: dissatisfaction with treatment outcomes; communication challenges and limited customer support; billing issues and financial frustration; physical discomfort and self-management; uncertainty in treatment progress; use of visual evidence for peer validation; and cost-driven decision-making with perceived limitations in care. Discussions frequently reflected uncertainty, reliance on peer-generated content, and difficulties accessing professional guidance. Negative sentiment predominated across posts and brands.

DTCO is commonly discussed in the context of dissatisfaction, uncertainty, and limited support. Reliance on self-monitoring and peer advice may delay recognition of complications and increase risks. While affordability and convenience are perceived benefits, DTCO may expose patients to clinical and informational risks, underscoring the need for improved patient education, clearer communication, and greater awareness of its limitations and dangers.