“The Rise of At-Home Teeth Aligners: A Study on Patient Perceptions and Safety” in Al-Kharj, Saudi Arabia

ABSTRACT

Background:

The emergence of at-home teeth aligners has transformed orthodontic care by offering affordable, convenient alternatives to traditional braces. However, their growing popularity raises safety concerns due to the absence of direct clinical supervision.

Objective:

To assess the awareness, perceptions, and experiences of adults in Al-Kharj, Saudi Arabia, regarding at-home teeth aligners and evaluate their safety from the patient’s perspective.

Methodology:

A cross-sectional survey was conducted among 400 adult residents of Al-Kharj using a structured bilingual questionnaire. Data were analyzed using descriptive statistics and Chi-square tests to assess associations between demographic factors and participant responses.

Results:

Seventy-five percent of participants had heard of at-home aligners, primarily through social media and advertisements. While cost-effectiveness (30%) and convenience (29.8%) were perceived as advantages, key concerns included lack of professional supervision (32.5%) and improper alignment risks (27.5%). Only 40% considered them a safe alternative to braces. Aligner usage (25%) was limited, with mixed satisfaction levels. No significant associations were found between gender, education, or aligner use and treatment preference.

Conclusion:

While awareness of at-home aligners is high, safety concerns persist. Most participants prefer traditional orthodontic care, highlighting the need for professional guidance and patient education in direct-to-consumer orthodontic models.

INTRODUCTION

The advent of at-home teeth aligners has revolutionized orthodontic treatment, providing an alternative to conventional braces. These aligners promise convenience, cost-effectiveness, and privacy, making them an attractive option for patients with mild-to-moderate malocclusions.[1,2] Companies marketing these aligners often emphasize the ease of use and affordability compared to traditional orthodontic treatments.[3] However, the increasing popularity of these products has raised concerns among dental professionals regarding their safety and efficacy, particularly in the absence of direct supervision by orthodontists.[4]

Studies have highlighted that unsupervised orthodontic treatment may lead to improper alignment, compromised periodontal health, and temporomandibular joint (TMJ) disorders.[5,6] Furthermore, while some patients report satisfactory outcomes, others have faced complications due to the lack of comprehensive diagnostic assessments and follow-ups.[7] Dental professionals emphasize the importance of personalized treatment planning, which may be compromised in at-home systems.[8]

In Saudi Arabia, including regions like Al-Kharj, advancements in tele-dentistry and increasing digital awareness have amplified interest in at-home aligners.[9] However, there is limited research exploring the population’s understanding, perceptions, and concerns regarding these aligners. This study aims to assess the knowledge, attitudes, and opinions of the Al-Kharj population toward the safety and effectiveness of at-home teeth aligners, contributing to the growing body of literature on patient-centered orthodontic care.

METHODOLOGY

Study design

A cross-sectional survey was conducted targeting the adult population of Al-Kharj, Saudi Arabia. The study aimed to evaluate their knowledge, attitudes, and perceptions regarding at-home teeth aligners.

Study population

The study population included individuals aged 18 years and above residing in Al-Kharj. Participants were recruited from dental clinics, public spaces, and online platforms.

Inclusion criteria

• Residents of Al-Kharj aged 18 years or older

• Individuals with prior awareness of or exposure to at-home teeth aligners.

Exclusion criteria

• Non-residents of Al-Kharj

• Individuals with professional orthodontic treatments (other than at-home aligners).

Sample size estimation

The sample size was calculated using the formula for cross-sectional studies:

N = Z² ⋅ p⋅(1 − p)/e²

Where:

• Z = 1.96Z = 1.96Z = 1.96 (for a 95% confidence level)

• P = 0.5 (assumed prevalence of awareness in the absence of prior data)

• e = 0.05 (margin of error)

n = (1.96) ² × 0.5× (1 − 0.5)/(0.05) ² = 384.

To account for a nonresponse rate, the final sample size was adjusted to 400 participants.

Survey tool

The questionnaire was designed in English and Arabic to accommodate the target population. It consisted of four sections:

1. Demographic information

2. Awareness of at-home teeth aligners

3. Perceptions and opinions

4. Experience and feedback.

Data collection

The survey was distributed through physical copies at dental clinics and public spaces and an online link shared via social media platforms. Participants provided informed consent before participation.

Data analysis

The data were analyzed using SPSS Statistics Version 26, Manufactured by IBM, Chicago, IL, USA. Descriptive statistics were used for categorical variables, and Chi-square tests were employed to assess associations between demographic factors and opinions about at-home aligners. A P < 0.05 was considered statistically significant.

RESULTS

A total of 400 participants from Al-Kharj, Saudi Arabia, completed the questionnaire. The findings from the analysis are presented in Tables 1–6.

Table 1.

Demographic distribution of participants (n=400)

Demographic variable	Categories	Frequency, n (%)
Age group	Below 30 years	181 (45.2)
	30–40 years	99 (24.8)
	41–50 years	82 (20.5)
	Above 50 years	38 (9.5)
Gender	Male	179 (44.8)
	Female	221 (55.2)
Education level	High school or below	82 (20.5)
	Undergraduate	195 (48.8)
	Postgraduate	123 (30.8)
Visited a dentist	Yes	340 (85.0)
	No	60 (15.0)

Table 6.

Chi-square association

Comparison	χ 2	P	Interpretation
Gender versus future treatment preference	3.41	0.427	Not statistically significant
Education level versus awareness of aligners	3.96	0.407	Not statistically significant
Aligner usage versus satisfaction level	6.45	0.520	Not statistically significant

Table 1 summarizes the demographic distribution of the study population. The majority of participants were below 30 years (45.2%), followed by those aged 30–40 years (24.8%). Females accounted for 55.2% of the respondents, slightly higher than males (44.8%). In terms of education, nearly 49% had an undergraduate degree, while 30.8% held postgraduate qualifications. A large majority (85%) had previously visited a dentist, suggesting that most participants had prior exposure to dental care and could provide informed responses regarding orthodontic options.

Awareness of At-Home Teeth Aligners [Table 2] shows 75% of participants had heard of at-home teeth aligners. Among these, the most common sources of information were dentist recommendations (23%), social media (22.7%), and friends/family (19.3%). Despite the high awareness, only 60% of participants reported understanding how aligners work. This highlights a discrepancy between awareness and comprehension, possibly due to the influence of advertisements and incomplete public health education.

Table 2.

Awareness of at-home teeth aligners

Variable	Response	Frequency, n (%)
Heard of aligners	Yes	300 (75.0)
	No	100 (25.0)
Source of information	Social media	68 (22.7)
	Advertisements	56 (18.7)
	Friends/family	58 (19.3)
	Dentist recommendation	69 (23.0)
	Other	49 (16.3)
Understands aligners	Yes	240 (60.0)
	No	160 (40.0)

Table 3 illustrates participants’ perceptions of at-home aligners. The most commonly perceived advantages were cost-effectiveness (30%), convenience (29.8%), and reduced dental visits (25.3%). However, significant concerns were also expressed, including lack of professional supervision (32.5%), risk of improper alignment (27.5%), and long-term safety (23.8%). When asked whether they believed these aligners are a safe alternative to traditional braces, only 40% agreed, while the remainder were either unsure or disagreed, reflecting caution among the population.

Table 3.

Perceptions toward at-home teeth aligners

Perception Category	Response Option	Frequency, n (%)
Advantages	Cost-effectiveness	120 (30.0)
	Convenience	119 (29.8)
	No frequent visits	101 (25.3)
	Other	60 (15.0)
Concerns	No professional supervision	130 (32.5)
	Risk of improper alignment	110 (27.5)
	Long-term safety	95 (23.8)
	Other	65 (16.3)
Safety opinion	Yes	160 (40.0)
	No	120 (30.0)
	Not sure	120 (30.0)

Table 4 presents participants’ experiences with at-home aligners. Only 25% reported having used them. Among users, less than 20% were satisfied or very satisfied, while nearly 23% reported dissatisfaction. Interestingly, 50% of all respondents stated they would recommend at-home aligners to others, despite the relatively low satisfaction levels. This may reflect perceptions of affordability or convenience over clinical outcomes.

Table 4.

Experience and satisfaction

Question	Response	Frequency, n (%)
Used At-Home aligners	Yes	100 (25.0)
	No	300 (75.0)
Satisfaction (users)	Very satisfied	32 (8.0)
	Satisfied	36 (9.0)
	Neutral	40 (10.0)
	Dissatisfied	45 (11.3)
	Very dissatisfied	47 (11.8)
Recommend aligners to others	Yes	200 (50.0)
	No	80 (20.0)
	Maybe	120 (30.0)

Table 5 indicates that when given the choice, the majority of respondents (59.8%) preferred traditional braces with professional supervision. Only 30.2% favored at-home aligners, while the remaining 10% chose other alternatives. This reinforces the idea that although at-home aligners are popular, the trust in traditional, supervised orthodontic care remains strong.

Table 5.

Future orthodontic treatment preference

Preference Option	Frequency, n (%)
Traditional braces (with supervision)	239 (59.8)
At-home teeth aligners	121 (30.2)
Other	40 (10.0)

The Chi-square analysis [Table 6] examined associations between demographic variables and key knowledge, attitude, and practice indicators. No statistically significant association was found between gender and treatment preference (P = 0.427), education and aligner awareness (P = 0.407), or usage and satisfaction (P = 0.520). This indicates that perceptions and preferences related to at-home aligners are consistent across demographic groups, suggesting widespread public concerns irrespective of gender or educational background.

DISCUSSION

This study evaluated public knowledge, perceptions, and safety concerns regarding at-home teeth aligners in Al-Kharj, Saudi Arabia. The findings reveal high levels of awareness (75%) and moderate acceptance of these devices, though notable concerns persist about their safety and effectiveness in the absence of professional supervision.

Consistent with global literature, participants identified cost-effectiveness and convenience as primary advantages of at-home aligners. These findings mirror those of Rossini et al., who concluded that patients valued aligners for their aesthetics, comfort, and ease of use compared to traditional braces.[2] Similarly, Keim et al. found that patients increasingly seek orthodontic care that minimizes in-office visits and treatment costs.[3] However, this shift toward direct-to-consumer (DTC) models has also raised significant concerns.

Approximately 32.5% of respondents in our study cited the lack of clinical supervision as a major drawback, followed by risks of improper alignment (27.5%) and long-term safety concerns (23.8%). These apprehensions are not unfounded. Papadimitriou et al. and Phan and Ling have both emphasized that while aligners can produce effective outcomes in select cases, unsupervised treatment may compromise periodontal health, lead to occlusal instability, or even cause TMJ dysfunction.[1,5] Furthermore, as Livas et al. reported, patient dissatisfaction with DTC aligners often stems from unmet expectations, absence of follow-up, and lack of individualized treatment plans.[7]

Interestingly, although 75% of participants had heard of at-home aligners, only 60% stated they understood how they work, revealing a clear gap between exposure and comprehension. This supports the findings by Wexler et al., who documented that most DTC orthodontic users were influenced by marketing and social media rather than dental professionals.[4] In fact, marketing strategies often oversimplify treatment processes and may downplay potential complications.[10]

The relatively low percentage of users (25%) in our study, coupled with mixed satisfaction levels, further illustrates this divide between promise and practice. Less than 20% of users were “very satisfied” or “satisfied,” while a comparable number reported dissatisfaction. These outcomes align with clinical observations by Tepedino et al., who noted that aligners tend to be more effective in anterior tooth movements and less predictable for complex rotations and torque control.[11]

When asked about future orthodontic preferences, a majority (59.8%) of participants chose traditional braces under professional supervision, indicating that trust in clinical expertise remains a crucial factor. This is consistent with studies by Joffe and Amato, who emphasized that the success of orthodontic treatment is often contingent upon personalized diagnosis, regular progress monitoring, and adaptability of treatment plans—elements that are often absent in DTC systems.[6,8]

Our findings also reflect regional trends. With the rise of teledentistry and digital health platforms in the Middle East, particularly post-COVID-19, there is a growing inclination toward remote dental care.[12] However, regulatory frameworks to safeguard quality, standardization, and accountability in these models are still evolving. Research underscores the need for structured patient education and professional consultation, even in hybrid or remote orthodontic models.

CONCLUSION

While at-home teeth aligners offer promise in terms of accessibility and affordability, significant concerns remain regarding their safe use without dental supervision. Public awareness is increasing, but understanding is not yet adequate. There is a clear preference among patients for professional oversight, and dental authorities must focus on regulating and educating around DTC aligner systems to ensure patient safety.