Families are still spending. Their confidence is falling fast.
The Conference Board’s consumer confidence index fell 6.7 points in September to 81.9. Its measure of what families expect over the next six months fell for a third straight month, to 63.6, and 68% of consumers now expect interest rates to rise. The University of Michigan’s sentiment index came in at 48.1, with only 8% of consumers expecting their income to grow faster than prices.
Spending tells a different story, for now. Americans spent 0.9% more in August than in July, according to the Bureau of Economic Analysis, while after-tax income rose only 0.3% and the savings rate sat at 4.1%. Prices were up 3.4% from a year earlier. These are national consumer measures, not orthodontic data.
Potential orthodontic impact
Households are spending more than their income is growing, and they are nervous about the months ahead. For a family weighing a treatment plan that costs several thousand dollars, that combination tends to show up as “let us think about it” rather than a flat no. Adults, whose treatment is the most optional, are usually the first to wait.
What to do next
For the next 30 days, have your treatment coordinator record why each family that doesn’t start on the day of the exam says it is waiting: cost, timing, a spouse or parent to consult, or something else. Review the list with your office manager every Friday.
If cost is the most common answer, test a lower down payment or a longer plan before you consider discounting your fee. Keep following up with families who said “not yet”: a large share of starts come from patients who return later.
The Conference Board · September 29 consumer confidence release ↗ · Bureau of Economic Analysis · August income and spending, released September 30 ↗ · University of Michigan sentiment, final September reading (news report) ↗
Align is telling adults their teeth keep moving. Expect some of them to call.
On September 28, Align Technology launched “SHIFT Happens,” a U.S. social media campaign that explains to adults that teeth shift throughout life. Align says earlier local pilots in the San Francisco Bay Area and Tampa drew consumer response when doctors localized the campaign. Invisalign-trained doctors can download customizable local ads and co-marketing materials through the Invisalign Practice Marketing Hub.
Align says about 200 million U.S. adults could benefit from orthodontic treatment but only about 1% are in treatment. That is the company’s own estimate, and a campaign announcement is not evidence that adult starts will rise.
Potential orthodontic impact
Adult awareness may rise at the same time adults are the most price-sensitive patients. An adult who sees the campaign may call two or three practices, including general dentists who offer aligners. The practice that answers quickly and explains the value of an orthodontist’s care has the advantage.
What to do next
Have your marketing lead check that your Invisalign doctor locator profile is complete and accurate, and review the local campaign materials in the Marketing Hub before deciding whether to run them. Make sure your adult treatment page explains, in plain language, why teeth shift with age. Ask your front desk to note new adult callers who mention an ad or “teeth shifting,” so you can tell whether the campaign is reaching your market.
Align Technology · September 28 campaign announcement; company-reported ↗
An “AI info” label on a before-and-after photo can cost you trust.
A September 29 AAO article explains how new AI disclosure rules could reach orthodontic marketing. Under the EU AI Act and California’s AI Transparency Act, both in effect since August 2, large AI companies must mark content their tools create. Facebook, Instagram and TikTok already add “AI info” labels to images that carry those markings.
The article’s point for practices is narrow and practical: the risk is not AI-drafted website copy. It is before-and-after photos edited with AI tools, which may be labeled automatically, and AI-written testimonials or reviews, which the Federal Trade Commission’s rule on consumer reviews has prohibited since October 2024.
Potential orthodontic impact
Before-and-after photos are among the most persuasive things a practice can show. If a family sees an “AI info” label on your results, they may assume the result isn’t real, even if the only edit was lighting. A fabricated review is a legal problem, not just a reputational one.
What to do next
Ask whoever manages your social media and website to list every before-and-after photo that was touched up with an AI editing tool, and replace those with unedited images. Put a simple rule in writing: clinical photos are never edited with AI, and no one on the team or at your agency writes reviews or testimonials for patients. If you use AI to draft other content, have a team member review and personalize it before it goes out.
AAO · September 29 article on AI watermarking and practice marketing ↗
Dental offices have stopped hiring. The rest of health care hasn’t.
Jobs at dentists’ offices fell by about 2,900 in July and 4,600 in August, according to the Bureau of Labor Statistics, leaving employment only 0.3% higher than a year earlier. Over the same year, physicians’ offices added 1.5% and outpatient health care overall added 2.4%. August figures are preliminary and will be revised.
The government does not count orthodontic offices separately, so this is general dental data. It lines up with what practices have been saying: in the ADA Health Policy Institute’s second-quarter survey, 26% of dentists said they were not busy enough.
Potential orthodontic impact
A pause in dental hiring can make it easier to find good assistants and front-desk staff. But your candidates are not choosing only between dental offices. Physicians’ offices and clinics are still hiring and often compete for the same people, so pay pressure has not gone away.
What to do next
If you have an opening, or a team member you would like to upgrade, this is a reasonable time to recruit. Have your office manager compare your pay for assistants and front-desk roles with local physicians’ offices and urgent-care clinics, not just other dental practices. Before adding a new position, check that your plan works with flat patient volume.
Bureau of Labor Statistics · Employment by industry (table B-1), released September 4 ↗ · ADA Health Policy Institute · State of the U.S. dental economy, Q2 2026 ↗
Earn the “yes” from nervous families.
Our demand forecast expects patient volume to stay flat over the next 6 to 12 months, with adults the most likely to delay. This issue points the same way. Families are spending but worried, adults are about to hear more about treatment than usual, and trust is being tested by AI labels. The practices that do well will answer quickly, explain value clearly, show real results, make the payment easy to say yes to and keep a team that can do all of that.
- Record why each family that doesn’t start is waiting, and review the list weekly.
- Test payment flexibility before discounting.
- Check your Invisalign locator profile and your adult treatment page.
- Replace any AI-edited before-and-after photos with unedited images.
- Benchmark your team’s pay against local physicians’ offices, not just dental practices.
Keep looking ahead.
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