Thursday, October 25, 2018

Cost (Value) of Braces

Costs Comparable to Braces

(Cost v. Value)

Every so often I have a patient that vents their frustration concerning the cost of braces for little Johnny.  Normally I try to explain the value of Orthodontics, the improved self-image and the life-long improvement of function and oral hygiene.  In truth, Orthodontics can be justified ten times over in most cases of malocclusion and will ultimately save money in the long run while the improvement in self-image/esteem and the sheer beautiful smile is incomparable.  In fact even as an adult, a beautiful smile has been shown to improve job opportunities and lead to an increased starting pay. 


But I would also point out that, as far as expenses go, the cost of Orthodontics/Braces is quite reasonable and affordable for almost every family.   To look at the COST of braces, we have to look at the basic economics of a practice.


As a sole practitioner for over 20 years, I routinely evaluate year-end overhead versus collections to determine profit and decide on pricing for the next year.  Sometimes this means there are no price increases, rarely (though it has happened in the past), we may even drop prices due to something affecting overall overhead such as taxes.  In fact, most Orthodontic office run about 65% to 70% overhead (which is a little better than our General Dental colleagues).  I try to stay at the 65% level so that I don’t have to nickel and dime for everything we do (I do not charge for broken brackets or extended treatments from missed time).  In fact, once I set a fee, that fee remains solid for the duration of treatment.  I also allow payment plans for all patients with no interest and minimal down payments.  If overhead is too high, the fees the following year may increase to reflect such.


But I really cannot go into that kind of detail when a parent is staring me down for some kind of discount.  And the initial fee can give sticker shock to those who have never paid for braces before.  So first, let’s consider the history of costs for a full set of adolescent braces (adult braces have always run @$1000 more) going back to the 1990’s:


1995   Adolescent Braces for 18 to 24mo $3800 to $4000
2000   Adolescent Braces for 18 to 24mo $4200 to $4500
2005   Adolescent Braces for 18 to 24mo $4400 to $4800
2010   Adolescent Braces for 18 to 24mo $5200 to $5400
2015   Adolescent Braces for 18 to 24mo $5600 to $5800
2018   Adolescent Braces for 18 to 24mo $6000 to $6500

Orthodontics have increased steadily but reasonably over the last 23 years with a total increase from a low of $3800 to a high of $6500 or 58% total increase, 2.5% per year on average (my medical insurance alone has increased 60% over the last two years!).
Other prices from 1995:
Median Household Income $34,076
Gasoline was @$1.00/gallon
Average Home: $158,700
Cost of base F-150 Truck $17,000
Full porcelain Crown $300
Dow Jones 5200

Compared to same numbers in 2018:

Median Household Income $62,450
Gasoline $2.49
Average Home: $188,900
Cost of base F-150 Truck $27,700
Full Porcelain Crown $1200
Dow Jones 26,000


On a more recent comparative note, I just received two quotes for repairs at my house; bids to replace my 6 year old water heater from a low of $4000 to a high of $6500 and replacement of a timing chain on my 6 year old car for $5500 (plus anything else they see while in there).  In both cases, more than half was for the labor, each for 1 day’s work!  And I don’t believe they have the same education or debt.    


So understanding that an Orthodontist will be correcting all of the teeth into ideal esthetics and function, setting jaw relationships and improving lip support and facial profile for life, it really is a good value for the money.  I would ask anyone questioning their Orthodontist about a $6000 fee what another specialist in medicine would charge you to treat anything else for 2 solid years (and follow up for another 2 years of retention) including any supplies and overhead he/she may spend along the way for your treatment.   And most Orthodontists will allow you to pay over the treatment time with little to no interest at all making the cost of braces no more than a family’s monthly cell phone bill (if not less).

Real Orthodontics is a tremendous value compared to other dentistry and medicine; probably the cheapest comprehensive correction you can make on an otherwise healthy patient.  The changes can affect behavior, self-esteem, self-confidence along with providing a healthy bite to prevent future jaw pain/headaches, excessive wear on teeth or even fracture of teeth requiring significant life-long restorative work.  It is also a very complicated specialty of dentistry and should not be performed by amateurs or weekend-trained dentists looking to increase their collections at your expense.  When you pay for Orthodontics, you are paying for a very specialized dental and sometimes medical treatment that will change the bite and function of the teeth FOREVER. 


What professional does a typical fee for Orthodontics include?  The “Standard reasonable cost” is based on an expert doctor, a specialist in Orthodontics.  Orthodontists have completed dental school at the top of their respective classes and all have pursued another 2 to 3 full years training in an accredited Specialty school for Orthodontics and you are paying for that post-doctorate education and experience.



“The Standard reasonable cost [Orthodontic fee] is based on an expert doctor, a specialist in Orthodontics.”


In Specialty programs, Orthodontic residents (already dentists) may have treated over 100 patients under the tutoring and guidance of other very experienced Board Certified Orthodontists while taking a full load of post-doctorate classes to understand development, bone physiology, physics, anatomy and biochemistry.  Contrary to current marketing and attempts to dumb down Orthodontics as a equivalent to a trip to the local spa, moving teeth is very complex and wrought with risks and long-term effects.

Remember that every Orthodontist started as dentists but they are far more than dentists after specializing (and their education was far more costly).  Good Orthodontists will explain things and simplify things to basic understanding but there is a world of science, art, knowledge and experience they rely on with every case they treat; knowledge and experience deficient from General Dentists and certainly from companies with direct-to-public schemes or fake-orthodontics/aligners. 



“Paying a General Dentist even 50% of the normal Orthodontic fee is akin to paying the hygienist full price for surgical removal of teeth or paying your school janitor full tuition to teach your child math simply because he can add & subtract and has seen it on the chalk board before.”



There is simply no General Dentist with the knowledge of a Board Certified Orthodontist because the knowledge is only available with a two to three year specialty program, programs that are steeped in 100+ years of research and experience.  If you do not understand the complete mechanisms of tooth movement, you are really just a technician relying on the product/lab technicians making the appliances (i.e. Invisalign, general dentist provides of traditional braces, smile club, etc.).  Paying a General Dentist even 50% of the normal Orthodontic fee is akin to paying the hygienist full price for surgical removal of teeth or paying your school janitor full tuition to teach your child math simply because he can add & subtract and has seen it taught before.   And even that is not proper unless they fully inform you they are not educated as an orthodontist.   Paying a non-dental company (smile direct club, etc.) is more akin to straight out malpractice and practicing without a license.  Might as well get your “Orthodontics” at the local swap meet on Saturday.

As a specialty, we as Orthodontists have been complacent in allowing companies and untrained providers to advertise and market directly to the public without providing accurate information and allowing them to compare their services to real Orthodontists, advertising fake-orthodontics as the real thing and even charging the same fees when they have no expertise.  We are finally awaking to this though it is a bit late. 

Unfortunately, Orthodontics has been terribly simplified in the eyes of the public due to a campaign of misinformation, omission of facts and sometimes outright false advertising and false claims.  Costs of Orthodontics may not vary much between untrained providers and real Orthodontists but you certainly are not getting what you are paying for in many cases.


Orthodontics is a huge responsibility for the both your family and the doctor you choose; so choose carefully by selecting a Board Certified Orthodontist who can properly diagnose, treat and retain your family’s teeth for a beautiful smile that lasts a lifetime.  You will find that the cost is no different and the experience will be much smoother.

If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35th street and MoPac.


Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 22 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at 



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