In June 2025, Texas became the 8th state to require an in-person exam by a licensed Texas dentist or orthodontist before starting orthodontic treatment. Thanks to the multi-year efforts of advocacy groups including TAO and the American Association of Orthodontists (AAO), Texas joins Nevada, Florida, Illinois, Utah, Georgia, West Virginia, and Oklahoma as part of the movement to ensure teledentistry patient health and safety.

“This is a big win for the state of Texas and I’m proud to have worked alongside so many hardworking advocates on the state and national level to get this bill passed,” said Dr. Ralph Brock II, current president of TAO. “We recognized the risks of Direct-To-Consumer (DTC) orthodontic treatment years ago and knew we had to do something. It’s a relief to know that Texas patients are now protected by law.”

The law goes into effect on September 1st, 2025.

Why Did We Need New Teledentistry Regulations?

New technology and the rise of DTC companies made it possible for customers to completely bypass traditional, in-person orthodontic treatment. This low-cost, low-hassle clear aligner service seemed like a great option for people looking to straighten their teeth, but over the course of a decade the business model would prove too good to be true…

One of the major problems with these types of services is that they didn’t require an in-person exam or x-rays. At best, you could have a digital scan at one of their customer service centers, but the exam wasn’t performed by a professional orthodontist. The scans were sent to dentists who worked for the company, and they used those scans to create treatment plans.

Starting orthodontic treatment without an in-person exam is risky for several reasons:

• Undiagnosed gum disease complicates treatment
  • Healthy gums are crucial for successful treatment. Attempting clear aligners with undiagnosed gingivitis or periodontitis could cause loose teeth or, in some cases, could even make your teeth fall out.

• Treating only the front teeth could cause new problems
  • Direct-to-consumer companies often focus on aligning only the straight teeth, or “the smile zone.”
  • Moving only those teeth and not looking at the whole picture could alter the way the teeth fit together and increase wear and tear or make malocclusion worse.

• Repairing damage is costly and time-consuming
  • Without a comprehensive exam and follow-up from a professional orthodontist, these types of treatments could cause real damage that is difficult to fix.
  • Remember, the reason teeth move is because the bone that holds them in place dissolves and reforms. This complex biological process requires expert care and guidance. Just because it’s common doesn’t mean it’s easy.

For most orthodontists, the idea of a patient undergoing these types of treatments without in-person care set off alarm bells from the very beginning. 

Then we started to see patients in our chairs who were seeking help AFTER unsuccessful treatment with direct-to-consumer clear aligners. At best, these patients complained that their treatment had no real effect. At worst, they were dealing with some of the problems we mentioned before (loose or missing teeth, worse bite problems, etc.)

And it wasn’t just a few patients. In fact, in a survey of AAO members, 77% reported that they had seen patients for retreatment who had previously tried direct-to-consumer treatment without a prior in-person exam.

Orthodontists all over the country were worried about patients getting substandard care, and decided to take action. 

Five Years of Advocacy Work to Protect Texas Patients

From 2020 to 2025, TAO and the AAO collaborated with key stakeholders in Texas to strengthen teledentistry regulations. The first step was to legalize teledentistry in 2021 which had become more popular after the COVID pandemic.

In 2022, the Texas State Board of Dental Examiners enacted new legislation to regulate teledentistry and protect patients, but the team from TAO and AAO didn’t stop there. They would advocate for another three years to make an in-person exam a requirement for teledentistry. Finally on June 22nd, HB4070 was filed in Governor Abott’s office. 

Higher Standards Lead to Healthier and Happier Patients

At TAO, we’re committed to maintaining the highest standards of care in Texas, and that includes advocating for laws and regulations that protect our patients. 

Orthodontic treatment is more affordable and faster than ever when you choose a qualified professional with the training and experience to help you get a healthy, brilliant smile.

It’s not worth cutting corners when it comes to the health of your smile and your bite. When you trust your smile to one of our members, you can rest assured that your well-being and safety is their top priority. 

Find a TAO Orthodontist Near You

To find a member orthodontist near you, visit our searchable, online directory. 

Many of our members offer an initial consultation at no cost to you, so you can get an examination and understand your options before making a decision. 

Why wait? Schedule an appointment today!