The risks and rewards of mail-order braces


While mail-order aligners continue to grow in popularity, several organizations are speaking up about the risks associated with this treatment.

It’s no secret that most people desire pearly white, straight teeth. Perhaps it’s our obsession with Hollywood or our irrational need to capture the perfect selfie to post on Instagram. Regardless of the reason, one thing is certain: The demand for cosmetic dentistry is skyrocketing.

Most adults don’t want their mouths filled with wires and brackets, but unfortunately not everyone has the financial resources to afford inconspicuous clear aligners. That’s where mail-order orthodontic businesses like SmileDirectClub entered the picture.

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SmileDirectClub was founded in 2013 as the first digital brand for straightening consumers’ smiles. The process is broken down into a few simple steps. First, the patient has a 3D image created of his or her teeth either by using an at-home impression kit or stopping by a local SmileShop for a scan. Next, a SmileDirectClub affiliated licensed dental professional reviews the case and determines whether the patient is a candidate for the invisible aligners. If the patient is deemed a candidate, SmileDirectClub sends a preview of what the patient’s new smile will look like and begins production of the invisible aligners. Once the aligners are delivered, the patient is instructed to wear them for a prescribed number of months. Invisible retainers are also available for purchase after treatment is complete.

The treatment is designed for minor to moderate tooth correction such as spaces between teeth, crowding and rotations. Patients who have missing teeth, implants or wisdom teeth have their cases evaluated to determine if they are a candidate for the treatment, according to the manufacturer’s website.

One of the reasons mail-order aligners like those from SmileDirectClub are so appealing to consumers is the price. SmileDirectClub aligners can be created for a one-time payment of $1,850 or 24 monthly payments totaling $2,170. Compare that to Invisalign, which can range from $3,000 to $8,000, according to the manufacturer.

But is the low cost worth it? Maybe not, according to several organizations.

The American Association of Orthodontists, which represents 19,000 orthodontist members, has cautioned consumers from using do-it-yourself orthodontic treatments. According to its website, nearly 13 percent of orthodontists who are members of the AAO are seeing patients who have tried DIY teeth straightening treatments, with some attempts causing irreparable damage.

“Moving teeth is a medical procedure and needs personal supervision by an orthodontist,” the AAO says on its website. “Moving teeth without a thorough examination of the overall health of the teeth and gums could result in the permanent loss of teeth, which may result in expensive and lifelong dental problems.”

The American Dental Association also “strongly discourages” the use of DIY orthodontic treatments, according to a new policy passed by the 2017 ADA House of Delegates.

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“Patients are being inundated with direct marketing campaigns encouraging them to initiate and manage their own orthodontic treatment,” says Dr. Craig Ratner, chair of the ADA Council on Dental Practice. “This year’s ADA House of Delegates recognized the need for the ADA, as America’s leading advocate for oral health, to take steps to educate patients about the potential pitfalls of self-managed orthodontic treatment. This new policy supports the importance of dentists being in charge of diagnosing and treating patients to ensure the safe delivery of appropriate care.”

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Adrian LaTrace, CEO of Boyd Industries, says he has conducted market research and seen some poor outcomes experienced by SmileDirectClub customers. Take, for instance, Charlene Burnham, a 60-year-old SmileDirectClub customer who told BuzzFeed News that the aligners she received were too tight, which ended up cutting her gums and exposing part of her tooth near the root. Burnham claims she spent a week trying to speak with a SmileDirectClub dentist on the phone to no avail.

According to the Better Business Bureau, 205 consumer complaints have been lodged against SmileDirectClub in the last three years. Most of the complaints are about the product itself, while others deal with shipping or billing issues.

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“Although there will be people that SmileDirectClub gets right, there will be many they don’t. What is the acceptable number of patients that are harmed by this method? This will have to be answered by the regulators and marketplace,” LaTrace says.

According to a blog post on SmileDirectClub’s website, the clear aligners are offered through a network of more than 225 Endorsed Local Providers (ELPs) throughout the country. The network is reportedly comprised of state-licensed, board-certified orthodontists and general dentists who assess each individual case.

“An individual who is requesting treatment by using SmileDirectClub’s aligners is receiving the same level of care from a treating ELP as an individual visiting a traditional orthodontist or dentist for treatment,” says Jeffrey Sulitzer, DMD, chief clinical office at SmileDirectClub. “The teledentistry platform allows for more convenient access and flexibility for individuals who may not have access to local care.”

However, most patients don’t visit a dental office or orthodontist during their invisible aligner treatment, which is an area of concern for the Michigan Dental Association. The MDA created a resolution stating that “supervision by a licensed dentist is necessary for all phase of orthodontic treatment.”

From a commercial perspective, LaTrace says, SmileDirectClub is another outside threat to the orthodontic profession.

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“Orthodontists have faced stiff competition from general dentists who prescribe orthodontic procedures or aligners, and more recently from the ‘do-it-yourself’ tooth realignment crowd,” he says. “SmileDirect, unlike the teenager who ties their teeth with elastic, does provide a level of screening before producing and supplying the clear aligners to correct a person’s malocclusion. From publicly posted results, it is apparent that at times the end results do not meet the customers’ expectations. In contrast, an orthodontist provides a continuum of care to make the necessary adjustments to assure good patient outcomes.”

SmileDirectClub, however, stands by its product and treatment process.

“The medical industry has been here before,” says co-founder Jordan Katzman in a release. “Products like hearing aids, contact lenses and dialysis supplies faced resistance at first too. We are confident in our product as well as our process and independent providers and will not let the opposition keep us from providing more accessible and affordable services.”

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