CENTENNIAL SPECIAL ARTICLE

Attracting orthodontic patients via the Internet:

A 20-year evolution
Greg Jorgensen
Rio Rancho, NM

A generation ago, attracting new patients to an orthodontic practice was often done simply by cultivating a few
good referral sources. General dentists, including some who might have provided orthodontic treatment out of
necessity, were generally glad to have a trusted specialist they could recommend to their patients. Although gen-
eral dentists remain an important source of new patients today, many consumers now turn to the Internet for help
selecting their own specialists. As orthodontists face more competition from various sources, successful clini-
cians will make it easy for search engines—and patients—to find their Web sites on the Internet. (Am J
Orthod Dentofacial Orthop 2015;148:939-42)

W
hen I graduated from my orthodontic pro-
gram at the University of Iowa over 20 years
ago, attracting new patients to my practice
was as simple as developing good relationships with
the general dentists in my community. This usually
involved face-to-face visits to their practices, taking
them to lunch, and giving them referral pads or business
cards. Although some general dentists provided ortho-
dontic services in their practices at that time, they repre-
sented less than 10% of the offices in my area. In fact, 3
general dentists who were providing orthodontic ser-
vices to their patients expressed relief that I was opening
a full-time orthodontic practice so that they wouldn't
have to continue doing orthodontics any more. In those
early days of my practice, referrals from general dentists
represented over 80% of my starts. The other 20% came
from my listing in the phone book, drive-by traffic, and
referrals from my own patients. As my practice matured,
the percentage of referrals from my patients began to
grow.
In 2015, a significant percentage of patients are still
referred by general dentists. This source of patients,
however, has been declining for more than a decade.
Private practice, Rio Rancho, NM.
Address correspondence to: Greg Jorgensen, 1401 Barbara Loop SE, Rio Rancho,
NM 87124; e-mail, drj@gregjorgensen.com.
Submitted, September 2015; revised and accepted, October 2015.
0889-5406/$36.00
Copyright Ó 2015 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2015.10.001
Aggressive marketing campaigns directed at both con-
sumers and general dentists have resulted in more pa-
tients receiving orthodontic treatment from
nonspecialists than ever before. Clear plastic aligners
have great appeal to patients who want straight teeth
but do not want to wear braces. Advertising by the com-
panies that fabricate these aligners has led patients to
believe that most malocclusions can be corrected
without braces in less time than ever before. Their
massive marketing campaigns have been successful in
promoting aligners as an alternative to braces, and the
advertising does not differentiate between specialists
and general dentists. Orthodontics, especially aligner
treatment, has been commoditized, and many con-
sumers assume that the results produced by aligners or
brand-name bracket systems will be identical regardless
of the doctors using them.
Aligner companies have also been aggressive in pro-
moting their products to general dentists. Their market-
ing encourages general practitioners to keep their
orthodontic patients “in-house” by becoming providers
of clear aligners. “Certification” involves attending one
continuing education course where the system is ex-
plained and the protocol for submitting cases is pre-
sented. General dentists can begin providing
orthodontic treatment in their own practices immedi-
ately. It is estimated that over 80,000 general dentists
in the United States have been certified as of 2015. There
are currently fewer than 10,000 orthodontists in this
country.
939
940
Although some general dentists offered comprehen-
sive orthodontics in their practices 20 years ago, the past
decade has seen that number increase substantially
because of the proliferation of products promoted as
“short-term orthodontics.” Whereas the creators of these
techniques are up-front about the limitations of their
systems with the general dentists who take their courses,
they are not as forthcoming in their advertising to con-
sumers. Instead, their marketing strategically empha-
sizes that their results will be faster and less expensive
than treatment provided by a specialist. The promise of
shorter treatment times for less money has resulted in
even fewer orthodontic patients referred from general
dentistry practices.
Another practice that seems to have become more
prevalent over the past 20 years is the referring of pa-
tients by the general dentist to multiple orthodontic of-
fices for second and third opinions. The most common
explanation for doing this is the perceived reduction in
liability for the dentist. True or not, general dentists
have come to believe that if they refer a patient to
only one specialist, they are then responsible for the
treatment provided by that doctor. The theory is that if
they give a patient several business cards, it transfers
the responsibility for selecting the specialist to the
patient. The result is that orthodontic patients now visit
several orthodontists, and this ultimately makes it more
difficult to be chosen as the treatment provider.
With more orthodontists practicing than ever before
(and more being trained than ever before), more second
and third opinions being sought, and more general den-
tists providing orthodontic services in their own offices,
how do patients ever find their way to the offices of or-
thodontic specialists in 2015? Even though the percent-
age of patients referred by general dentists has declined,
professional referrals are still an important source of new
patients. Established practices garner new patients from
the families of former patients and the recommenda-
tions of friends who were former patients. Although
some patients found their orthodontist in the phone
book back in the 1990s, almost no one uses a phone
book in 2015. The Internet has become the new phone
book. Additionally, whether they get our name from
their dentist, their friends, or the Internet, today's pa-
tients go online to investigate us and our practices
well before they walk through our doors. For this reason,
an appropriate online presence is essential for attracting
new patients in 2015.
I discovered the World Wide Web (the Internet) in the
early 1990s. Software disks from a pay-based Web ser-
vice company called America Online (now called simply
“AOL”) started appearing as enclosures in magazines,
in the regular mail, and as giveaways at retail stores
December 2015  Vol 148  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Jorgensen
that sold computers or technology products. These
disks offered free software and complimentary starter
hours on their Web service to encourage recipients to
buy monthly subscriptions. Their marketing reach was
so ubiquitous that at one time it was rumored that
more than half of all computer disks on the planet
bore the AOL logo. America Online offered services
such as e-mail, games, news, and pictures. At first, the
AOL environment was much like a gated community.
You logged onto their servers, and they fed you their
content within their “walls.” For those who explored
the services they offered more thoroughly, however,
AOL included a portal to the World Wide Web. At that
time, the Internet was mainly a network linking college
and university computers. It would be a few more years
before stand-alone Internet “browsers” would appear
that allowed users to bypass fee-for-service Web service
providers such as AOL, Prodigy, Genie, and CompuServe,
and directly access information on the Web. The avail-
ability of browsers caused a shift from Web service pro-
viders to Internet service providers who provided direct
access to the Web without limiting the information
available to a controlled environment.
A critical component of these new Internet browsers
was a search engine. No matter how vast the amount of
information available on the Internet, it was of no use
unless users had some way to search for and find the in-
formation they wanted. In the early days of the World
Wide Web, there were many competitors in the search
engine arena. The mid-1990s saw the rise of search en-
gines such as AltaVista, Yahoo!, and Lycos. In 1997,
Larry Page and Sergey Brin registered Google, which
quickly became recognized as the dominant search en-
gine on the Internet. As of 2015, it is estimated that
more than 90% of searches on the Internet are conduct-
ed using Google. Using Google to access online informa-
tion has become so commonplace that “google” is now a
verb in dictionaries. Making information about your
business or product easy for Google (or any other search
engine) to find is known as “search engine optimiza-
tion.” Having a Web site that promotes your practice is
useless if no one can find it.
In its infancy, the Internet was much like the
brochure rack found in the lobby of an old hotel. The
glossy pamphlets in these display racks were created by
the businesses themselves and contained only informa-
tion that portrayed them in their best light. It was com-
mon to be lured to a local attraction (zoo, outlet mall, or
natural “wonder of the world”) only to be disappointed
because the brochure was misleading. Businesses
created Web sites that were the equivalent of the bro-
chures in these racks. The information found on early
Internet Web sites was also carefully crafted self-
Jorgensen
promotion that may or may not have helped consumers
to find the products or services they wanted. At that
point in its history, the Internet was a 1-way conversa-
tion, with businesses doing all of the talking.
By the mid-2000s, the Internet had evolved, and
users began to be able to interact with businesses and
with one another. The 1990s brochure rack was replaced
by an online “water cooler” where consumers gathered
to discuss the products and services that they were using.
This 2-way business-user or user-user conversation
takes place in the form of blogs, comments, and reviews.
Businesses can no longer hide behind flashy Web sites
and glossy pictures. Less than 15% of consumers fully
believe messages delivered directly to them by businesses
in any form of advertising. Surprisingly, over 90% of
consumers believe reviews written by other consumers
they have never met. The structure of today's Internet
has made yesterday's advertising all but obsolete
and empowered the opinions of common, everyday
consumers.
This 2-way conversation on the Web resulted in the
rise of social media. Social media are any Web-based ser-
vices that facilitate collaboration between users of infor-
mation, goods, or services. There are hundreds of social
media sites and services available online. Although they
may incorporate similar forms of media (eg, texts, pic-
tures, videos), the variations in their objectives and
user interfaces make hard and fast categorization of
every social media service impossible. Thus, it is helpful
to identify some of the most common forms of social
media.
Perhaps the most recognizable form of social media
today is the social network. The biggest social network
as of 2015 is Facebook, with over 1.5 billion registered
users. Social networks are online communities of people
who usually have something in common. They may be
members of the same family or graduates from the
same school, or share common hobbies or pastimes.
Users post information about their activities through
texts, pictures, and videos. Social networks may even
provide features that allow chatting, video conferencing,
and private messaging.
Blogging is the online equivalent of an old-fashioned
newspaper column. Authors can write about anything,
and the content may or may not be factual. Blogging
qualifies as social media because readers interact with
each other and with the authors via a comment section
associated with the blog. Although blogging has reduced
the costs and difficulty of getting published, it has also
allowed erroneous and misleading information to be
presented alongside evidence-based research. Today's
patients often show up at initial examinations with a
folder full of printouts from Internet blogs explaining
American Journal of Orthodontics and Dentofacial Orthopedics
941
various orthodontic techniques in which they are inter-
ested or that they wish to avoid.
Microblogs are messaging services that generally
answer the question, “What's happening right now?”
Twitter answers the question with 140-character text
messages. Instagram uses pictures and videos. Snapchat
captures pictures and videos that display for 10 seconds
and then theoretically “self-destruct.” Microblogging
can be thought of as group messaging to family and
friends. Although anyone with an account can view mes-
sages from anyone posting to services such as Twitter or
Instagram, only those who are “following” or are “sub-
scribed” to other users will typically see their messages.
These forms of social media are popular among those
interested in keeping up with celebrities, politicians,
and current events.
Media-sharing sites such as YouTube and Pinterest
qualify as forms of social media because users rate and
recommend the content found there. Additionally, users
can subscribe or follow other users to see new videos or
pictures when they are posted. YouTube and other
video-sharing sites contain how-to videos, music, news
clips, entertainment, and almost anything else imagin-
able. Pinterest is a photo-sharing site that allows users
to “pin” interesting photos to themed electronic bulletin
boards. These bulletin boards can be viewed, followed,
and shared or “repinned” by users with similar interests.
Product and service review sites such as Angie's List
and Yelp give consumers (and patients) a forum in which
to discuss their experiences with a given product, service,
or provider. Although not typically considered social me-
dia by those more familiar with Facebook and Instagram,
product and service reviews collected by these services
are critical because, as previously stated, consumers
value these opinions more than the advertisements and
Web sites produced by businesses. These forms of social
media may have a star-rating system on a site that sells
products (eg, Amazon.com) or may be dedicated to re-
viewing specific types of services. There are directories
that specialize in hotels and restaurants. There are also
professional directories that list doctors, dentists, law-
yers, and so on. These sites usually have some form of
rating system generated by the reviews of former pa-
tients or clients. The Google search engine itself also
has a feature that allows consumers to share their expe-
riences with local businesses using a star-rating system.
These reviews are particularly important because they
are displayed as part of the search results when con-
sumers google the businesses they are researching.
There are 3 pillars of online marketing: (1) a practice
Web site, (2) paid advertising, and (3) social media. Even
with the explosive growth of social media in the past
10 years, the practice Web site remains the most
December 2015  Vol 148  Issue 6
942
important component of an online marketing campaign.
Web sites must be modern, attractive, informative, appro-
priately coded to be accessible from all electronic devices,
and easily found by the predominant search engine
(currently Google). Search engine optimization is a sci-
ence all its own and a critical part of any online strategy.
Paid online advertising comes in many forms,
including Google ads (that appear when patients search
for orthodontic services in your area), Facebook ads, and
premium listings on professional directory sites. Even
practices with excellent Web sites and well-done search
engine optimization may struggle to be found in
competitive markets. Paid advertising, once taboo in
the healthcare arena, has now become a necessity.
Online advertising is essentially paying search engines
and professional directories to promote your online
presence.
The effectiveness of social media in attracting new
patients is difficult to measure. Social media campaigns
are useful in developing and maintaining the loyalty of
your current patients. Patients are already using social
media, and they expect the companies and services
they use to be as up to date and involved as they are. Pa-
tients want to see that a practice is fun and high tech.
Additionally, social media make it easier for potential
patients to learn about your practice through “likes”
and posts shared by your current patients. Although
these uses of social media may not have the same
measurable return on investment as a practice Web
December 2015  Vol 148  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Jorgensen
site or paid advertising, they are an essential piece of
an online marketing strategy.
Online reviews are perhaps the most visible and
crucial form of social media on the Internet for an ortho-
dontic practice. Whereas contests and pictures on popu-
lar social media networking sites are fun for current
patients, prospective patients place much weight on ex-
periences shared by others in the form of online reviews.
Although most of our patients are happy with the ser-
vices and results we provide, it is impossible to make
everyone happy. Unfortunately, happy patients rarely
feel the need to write about their experiences online.
Disgruntled ones, however, always seem to take the
time. Consequently, practices must continually
encourage satisfied patients to write reviews to protect
themselves against the rare upset patient.
How we attract patients to our orthodontic practices
has changed drastically in the past 20 years. Although
developing good relationships with local dentists is still
important, we cannot solely rely on this source of patient
referrals as we have in the past. Today's successful ortho-
dontic practice must cultivate a higher percentage of re-
ferrals from within their own patient pool than ever
before. Additionally, external marketing to potential pa-
tients is an unavoidable reality. Online marketing
including a modern Web site, online advertising, and so-
cial media (especially online reviews) is essential in 2015
if an orthodontist wants new patients to find his or her
practice.