- The field of direct-to-consumer dentistry is taking off.
- In particular, a crop of new companies have taken on the clear aligners market, helping people straighten out their teeth without going into a orthodontists' office.
- Four years in, SmileDirectClub has built up into a large operation with thousands of employees and plans to add more, as well as partnerships to get its first treatment step, an impression kit, into stores.
Alex Fenkell keeps close tabs on one of his early customers.
Fenkell, a co-founder of SmileDirectClub, picked up a customer service call in 2017 when Golden State Warriors forward Draymond Green called in after a championship game against the Cleveland Cavaliers to let the company know he'd broken his aligner.
Fenkell was incredulous — "That's what's on your mind right now?" he remembers thinking.
Green is an early investor in SmileDirectClub, a four-year-old startup that created the direct-to-consumer clear aligners market. It's a business that's been growing rapidly even as traditional orthodontists claim the process could harm patients if they're not seen in-person. The idea behind the company to make straightening teeth more affordable by cutting out the steps of going in-person to a dentist or orthodontist to get braces or other alignments.
That includes selling its impression kits — the first step of the process in which potential patients can make molds of their teeth that they can then ship to a dentist or orthodontist to evaluate — in 100 Macy's stores across the US. The department store's lifestyle and beauty focus was appealing to SmileDirectClub as its first retail partner, the company says.
Four years in, SmileDirectClub is up to 2,500 employees, and says it plans to hire another 1,000 by the end of 2018, the majority of which will be based in its Tennessee headquarters.
In addition to Green, SmileDirectClub is backed by Camelot Ventures, its largest shareholder as well as Align Technologies, the company that makes Invisalign clear aligners and is a supplier for SmileDirectClub.
No need for the dentist's office
SmileDirectClub is far less expensive than getting braces through an orthodontist. While it typically costs anywhere from $3,000 to $7,000 to get traditional braces or Invisalign-brand aligners, SmileDirectClub goes for a fraction of that — you can either pay $1,850 up front, or $250 up front and $80 for 24 months ($2,170 total). Here's how it works.
- You fill out what's called a "smile assessment," which includes questions about your teeth and gums.
- You get an impression of your mouth taken or have it 3-D imaged at one of SmileDirectClub's shops, of which there are 89 around the country, including places like Lubbock, Texas and Madison, Wisconsin. The price of an impression kit is $79.
- One of the 220 state-licensed dentist or orthodontists that work with SmileDirectClub prescribes a treatment plan for you. If your case is too severe, the company may turn you away at this point. "Since we've launched the business until now, there's not one case that hasn't been reviewed, the treatment plan created and remotely monitored from a dentist or orthodontist," Fenkell said.
- You begin receiving a monthly box of dental aligners, which most people receive for about six months, according to SmileDirectClub.
- By the end of your prescribed treatment, you'll receive a retainer from SmileDirectClub — just as you would from a traditional orthodontist — with instructions on how often to wear it to help keep your teeth straight.
Growing pains while expanding the oral healthcare market
More companies have joined SmileDirectClub in the past few years in offering direct-to-consumer orthodontics, especially as the patents around clear aligners start to expire. Among those are Candid Co., a New York-based startup that's raised $15 million in funding, Uniform Teeth, which launched in 2018, and Orthly.
As the market has expanded, it's attracted increased criticism from the American Association of Orthodontists, the organization that represents orthodontists. In a statement to Business Insider, the AAO said it has filed complaints with dental boards and attorneys general against SmileDirectClub in 36 states. The organization also issued a "consumer alert," which mentioned some of the direct-to-consumer clear aligner companies by name.
"Comprehensive orthodontic treatment is a complex medical process, and the AAO has long held the position that it is in the best, and safest, interest of the public to have that treatment conducted under the direct and ongoing supervision of a licensed orthodontist," the organization said.
"Of the 36 state dental boards that have questioned the SmileDirectClub model, one-third (12) affirmatively closed their inquiries with no action taken. The remaining cases have had no action taken for months or even years. It is common in these investigations for the Board to close the investigation without notice to the party," a spokeswoman for SmileDirectClub said in a statement.
The company said that it has offered to meet in-person with state dental boards to explain the process. "Our goal is always to be as collaborative, transparent and upfront as possible in an effort to educate the boards about this new industry (doctor-directed at-home aligner therapy)," the spokeswoman said.
Marc Bernard Ackerman, the director of orthodontics at Boston Children's Hospital and the founder of the American Teledentristry Association, said he disagrees with the notion that a slightly crooked smile is a major health concern.
For most people, Ackerman said, the reason for getting teeth straightened has to do with appearances and the psychological benefit that comes with that. He looks at small adjustments as mainly non-medical and doesn't believe they need as much oversight as some orthodontists might let on.
As Ackerman sees it, teledentistry services like direct-to-consumer clear aligners will ultimately increase access to care which were previously only available through physical office visits.
About 60% of the counties in the US don't have an orthodontist, according to data from the Department of Health and Human Services. SmileDirectClub's had customers in 70% of those counties, as of November 2017.
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