SmileDirectClub’s Legacy and the Importance of a Local Orthodontist
By Dr. Emily Watson
People love to choose cost savings and convenience whenever they can.
But doing so is not always a good idea, as in the case of those companies that offer in-home aligners that allow people to try to straighten their teeth without the direct care of an orthodontist.
A case in point is what recently happened with one of those companies, SmileDirectClub, and its customers.
SmileDirectClub, which had filed for Chapter 11 bankruptcy protection in September, ceased operations in December, leaving many customers abandoned in mid-treatment and, in some cases, still making payments on services they can never hope to receive.
Now all of those people will need to find someone else to finish the treatment that SmileDirect started.
One frustrated SmileDirectClub customer, Ashli Noelle Evans of Knoxville, TN, told CBS News that she had hoped to perfect her smile, but now is stuck with finance payments for another year, but no treatment.
“The ‘lifetime smile guarantee’ is obviously gone, and I will not receive my aligners that I put in for last month,” she was quoted as saying. “So now I’m going to have to go to an orthodontist anyway. So it was kind of pointless to go that route to try to save some money since my treatment was so small.”
This is an unfortunate turn of events for all the people who signed on as customers, but, sadly, I’m not surprised at how things ended up and that the company ultimately folded.
It was only a matter of time because the quality of care was not there, and patients were having too many issues. That is one of the concerns with any sort of do-it-yourself or mail-order effort to accomplish orthodontic work. It’s important to have a local orthodontist in your corner; someone you see in person, who has examined you to get a good understanding of your needs, is monitoring your progress, and is there if you have questions or concerns as your treatment moves forward.
Mail-Order Versus In-Person
That personal care is not what happens with the mail-order companies and I wrote about their operations in more detail in a previous blog.
Here’s how it typically works with these orthodontics-by-mail arrangements compared to what a patient experiences when they visit an orthodontist.
For all of my patients, we will have an initial exam before we get started on any treatment. This way I can evaluate what needs to be done. Then we will do X-rays, take an impression of their teeth, and as a result have a thorough idea of how we need to proceed. At that point, we will come up with a treatment plan. Depending on the situation, there are different approaches we may need to take. In some cases, we may use clear aligners. In other cases, I might recommend traditional braces. Sometimes we might even postpone the braces until a later date.
The procedure is much different when it comes to the long-distance approach. The customer orders a kit that arrives in the mail. Using that kit, the customer takes impressions of their own teeth and mails the impressions back to the company. The company then creates aligners and a treatment plan and mails those to the customer.
In some cases, instead of taking their own impression, the patient might go to a center where someone with the company scans their mouth and the impression is accomplished that way. Perhaps later a doctor will look at that scan, but if so, the patient never sees the doctor.
Essentially, in the mail-order approach, the patient does not have X-rays taken. They never have an office visit. A doctor never actually examines their mouth in person, possibly discovering things that the scan doesn’t pick up. In short, many of the necessary things that happen when you are under the care of an orthodontist are skipped. The trade-off from the customer’s standpoint is that the mail-order method is less expensive than the personal care an orthodontist gives and they can avoid office visits. But that trade-off can be more than they bargained for.
When Things Go Awry
As you might guess, the American Dental Association and other professional medical groups never cared for SmileDirectClub or similar companies.
After SmileDirectClub announced it was shutting down, the ADA issued a statement reaffirming its opposition to direct-to-consumer dentistry “because of the potential for irreversible harm to individuals, who are treated as ‘customers’ rather than as patients.”
The American Association of Orthodontics has expressed similar concerns in the past. The organization notes that when orthodontics is done incorrectly, the patient faces “potentially irreversible and expensive damage, such as tooth and gum loss, changed bites, and other issues.”
Sadly, as I have previously written, I have witnessed the problems caused when someone chooses mail-order aligners instead of putting themselves under the in-person care of an orthodontist. One patient, a teenager who was using a mail-order company’s aligners, had a cyst growing in his jaw the whole time he was going through the teeth-straightening process. With no one to regularly monitor the young man and take action, the cyst grew and grew. With an orthodontist involved, and the patient showing up for regular checkups, it is almost certain that the cyst would have been detected much earlier than it was.
By the time the cyst was discovered, surgery was needed to remove it and the young man’s jaw bone had been badly damaged. He was a high school athlete but had to sit out of sports for a year because of concerns that a blow to his mouth could have easily broken his weakened jaw.
On another occasion, a patient using aligners from a mail-order company ran into a problem with an impacted tooth. A canine tooth was trapped, and the patient needed to have room made for the canine and then needed to see an oral surgeon to have the tooth uncovered so it could be brought into position. This definitely was not something a company working with the patient long distance was going to be able to remedy. But by the time the patient saw me, and then the oral surgeon, the mail-order company had already been paid a few thousand dollars.
Yes, those mail-order companies that tout the benefits of at-home aligners are less expensive, and you avoid the slight inconvenience of office visits. But the tradeoff is that you don’t have a medical professional monitoring your progress in person and, if things go awry, serious problems can develop.
And, as the SmileDirectClub customers learned, you may end up under the care of a local orthodontist anyway.
