Mail-order orthodontics can harm patients' teeth South Carolina dentists and orthodontists say. A state House panel advance a bill on Tuesday, April 21, 2026, to stop it. (File photo by Getty Images)
COLUMBIA — Wanting straighter teeth, patients come across an online company that promises to fix their smile without ever having to sit in a dentist or orthodontist’s chair.
They’re sent a kit to upload photos and take bite impressions, which they mail back to the company. That company, in turn, mails back clear aligner trays to switch out every few weeks.
But it doesn’t always work out as planned, and in many cases, can do more harm than good, according to the professional associations representing dentists and orthodontists in the state.
“Their teeth might be nice and straight, but their jaws no longer fit together,” said Thomas Edmonds, a retired dentist in Lexington County.
That’s why the associations are pushing a bill at the Statehouse to bar the practice in South Carolina.
A House medical affairs panel voted unanimously Tuesday to advance the bill, sending it to the full committee. The Senate passed the bill unanimously in February.
It requires that any teledentistry appointment to evaluate a person for an orthodontic appliance be followed up by an in-person visit.
Some 77% of the American Association of Orthodontists’ more than 18,000 members nationwide reported treating patients who suffered adverse effects from one of these companies, an Upstate orthodontist, Mark McGinnis, told members of the Senate during a hearing on the bill last year.
“Sometimes these patients had to pay twice,” he said. “And sometimes these outcomes have compromised the overall health care of the patient, with irreversible damage that can’t be corrected.”
“The problem is that, when you’re moving teeth, really what you’re doing is remodeling the bone around the roots of the teeth,” McGinnis added. “If you don’t have healthy bone around the roots of the teeth, you can move teeth out of bone. You can cause more bone damage. You can’t evaluate certain things without X-rays and in-person exams.”
And following the House meeting, Edmonds told the SC Daily Gazette, when a person’s jaws get out of alignment, it can put too much pressure on their rear teeth, causing teeth to crack, jaw pain and muscle spasms than can take years to reverse.
Dentists and orthodontists also were finding these companies were forcing patients to sign agreements to stop them from filing professional complaints or lawsuits. The bill stops this practice as well.
Without it, Edmonds said, the state regulatory boards for dentists and orthodontists had their hands tied.
No one spoke in opposition to the bill and House members raised no questions.
Similar laws have passed in eight other states, McGinnis told senators last year: Florida, Georgia, West Virginia, Nevada, Illinois, Utah, Oklahoma and Texas.
Edmonds also told the Gazette a good number of these mail-order companies have already gone out of business across the country, but the industry wants to prevent others from emerging.
Teledentistry is largely covered through the state’s larger telehealth law, according to the state’s dental association, but the new bill also adds rules specific to dental practice.
“This typically involves a patient who has a dental emergency and can’t get to a dental office,” Edmonds said.
In emergency situations, dentists can use video calling to do an initial analysis and refer a patient directly to an oral surgeon, essentially allowing the patient to skip that first in-person visit and go directly to a specialist. Dentists can also prescribe medication or tell patients when a problem doesn’t require immediate treatment, preventing unnecessary trips to the emergency room.
Gov. Henry McMaster actually allowed the practice during the COVID-19 pandemic. Under that emergency order, dentists could receive Medicaid reimbursement for teledentistry visits.
“It was a huge success,” Edmonds said.
Patients booked 60,000 virtual appointments at a time when most dental offices shuttered to prevent the spread of the highly contagious disease. Of those, less than 1% required a trip to the emergency room.
Courtesy of South Carolina Daily Gazette
