Long before the first appointment, patients are scrolling, comparing, questioning and deciding. At this year’s British Orthodontic Conference (BOC), Neil Hillyard will examine the online conversations shaping orthodontic decisions and why every practice needs to understand them.
Before a patient sits in your dental chair, asks you questions or explores your treatment recommendations, something important has already happened. They have been researching, comparing, discussing, scrolling, watching and, in many cases, already deciding about the treatment options which may be right for them. That is the territory Neil Hillyard wants orthodontic teams to understand better.
In Brighton this September, Neil’s session, ‘So, what do you guys think? How patients make treatment decisions before they ever walk through your door’, will look at the online world patients inhabit long before they contact a practice. For Neil, this is not a side issue. It sits right at the heart of every patient consultation. It is all about trust, communication and case acceptance.
Neil is not a clinician, and that is part of what makes his perspective so useful. His route into orthodontics began with his own treatment as an adult, when he became aware of how little accessible information there was for patients trying to make sense of the process. That experience led him to create a patient-focused blog which grew into a respected information resource in the orthodontic space. Over time, that insight turned into something wider. He found himself in a position to translate what patients were feeling and thinking for the practices trying to find more effective ways to communicate with them.
The consultation is no longer the start
One of the clearest points Neil makes is that practices often misunderstand where the patient journey really begins. By the time someone phones the practice or submits an enquiry form, the decision-making process is often well underway.
‘Far more than most practices realise,’ he says, ‘and the gap is widening. By the time a patient picks up the phone or fills in an enquiry form, they’ve often spent weeks or even months in online communities, watching videos, reading forum threads, and comparing experiences. In many cases the decision of whether to have treatment, what kind of treatment, and even which type of practice to approach has already been substantially shaped. The first consultation isn’t the beginning of the decision. It’s often closer to the end of it.’
What Neil describes is a changing decision-making landscape. And understanding that shift matters because many of those influences are not coming from professional sources. Some are thoughtful and reassuring, some are emotionally supportive, and some are inaccurate. Some are highly persuasive and completely misleading.
Where the conversations are really happening
One of the strengths of this BOC session is that Neil is not talking vaguely about social media. He is talking about how different platforms shape different kinds of belief.
The online world he describes is not one large patient forum. It is a collection of very different spaces, each shaping expectations in its own way. Facebook groups are where emotional sharing happens most openly. Patients compare fees, warn each other about poor experiences, and look for reassurance from people who have already been through treatment. TikTok and Instagram are where orthodontics becomes normalised, but also where misinformation spreads fastest because it is packaged so convincingly.
Reddit tends to attract a more analytical and sceptical patient, often someone who wants detail and is willing to challenge what they are told. YouTube works differently again, giving patients the chance to build trust with people documenting their treatment over months or years. ‘As for awareness,’ Neil says, ‘some clinicians are very switched on, but many have little idea these conversations are happening at the scale they are, let alone what’s being said.’
What patients are actually discussing
The content of those conversations is just as revealing. Cost and value come up repeatedly. Patients share fee quotes, compare what is included, and make judgements about whether a practice is worth it based on what other patients say, not necessarily on clinical quality. There is also a great deal of second guessing. People post photographs, ask whether treatment looks right, wonder if they should be concerned, and invite strangers to comment on decisions made by their orthodontist.
But the part Neil finds most striking is not the practical detail. It is the emotional depth of what patients were sharing. ‘These aren’t conversations most patients are having with their clinical team,’ he says. ‘They’re having them with strangers online, and those strangers are becoming enormously influential in the process.’
That line gets to the heart of why this matters. Many patients are having the most honest conversations about their orthodontic journey somewhere else entirely. They are talking about confidence, embarrassment, age, regret, anxiety and the uncertainty that can set in when treatment feels worse before it feels better. By the time they arrive at the practice, those conversations may already have shaped what they expect, what they fear and what they are prepared to believe.
Not just for the orthodontist
Neil does not frame this as something only the lead clinician needs to understand. He is particularly passionate about the wider team. Nurses, therapists and practice managers are often the first people a patient speaks to, and often the people they feel most comfortable being honest with. If those team members understand the world the patient has already been living in, the quality of those conversations changes.
‘Case acceptance often fails not because the treatment plan is wrong, but because an unspoken concern, something the patient read online at midnight, was never addressed,’ he says. ‘The whole team benefits from understanding the world the patient has been living in before they walked through the door.’
This shifts the issue away from marketing and back towards the importance of communications and patient care. It also explains why this session is likely to resonate across the conference, not just with orthodontists, but with the wider teams who shape the patient experience every day.
Practical, not preachy
Part of what makes Neil credible on this subject is that his suggestions are straightforward. He is not suggesting practices to become content creators overnight or to spend hours chasing online trends. He is advising them to become more aware of the spaces their patients already inhabit.
Spending a small amount of time in the Facebook groups patients use, or looking at the hashtags they follow, can tell a team far more about the patient mindset than a formal survey ever will. In the consultation itself, asking what patients have read, what they have watched and what they are worried about can address assumptions before they harden into mistrust. It also removes the awkwardness around research. Patients have looked things up. Most practices know that. The smarter response is to make that part of the conversation.
For teams who do want to communicate more openly online, Neil also makes a valuable point about voice. Patients often respond best not to polished corporate messaging, but to something human and approachable from people they can imagine actually treating them. He is not criticising the profession here. He is inviting it to see patients more clearly.
The decision to attend
What Neil wants delegates to leave with is not a set of tactics, but a different mental model of who the patient is by the time that first appointment begins. Not simply someone waiting to be informed, but someone who has already been influenced, reassured, frightened or persuaded before the practice has said a single word.
That makes this one of the more quietly important sessions in Brighton. It is not a clinical lecture, and it does not pretend to be. What it offers instead is something many practices need just as much: a sharper understanding of the modern patient, and a more realistic picture of where trust is now built or lost.
BOC 2026 takes place at the Brighton Centre from 24 to 26 September. For any orthodontic team that wants to communicate better, understand its patients more fully, and stop assuming the consultation is where the real decision begins, Neil Hillyard’s session looks set to be well worth attending.
Book your place and see the full programme here.
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