Undercover Exposes Problems with Mail-Order Ortho

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Hidden Camera Investigation finds Misleading Information with Smile Direct

Four Testers with various orthodontic conditions went undercover

The undercover test subjects visiting the Smile Direct outlets  had a range of typical concerns  from minor spaces, moderate crowding to serious bite/skeletal issues. The same conditions could be seen in typical consultations in a dental office where a general dentist with moderate training in orthodontics would usually refer about half to an orthodontic specialist.  

Advertising Claims

The company has an interest in encouraging the public to bypass  the  typical alternatives between a general dentist and an orthodontist. Other dental specialists -including pediatric dentists sometimes also provide orthodontic services as well. Smile Direct suggests patients teeth may be straighter in 4-6 months- which if they are implying the treatment will be complete it would mean the cases are very uncomplicated. Treatment time is a consideration for patients but claims of cost saving would be the main reason people choose to try Smile Direct. 


Smile Direct claims to provide treatment for half the price of an orthodontist. The company offers mail order service or scans in their stores (currently closed due to the coronavirus epidemic). 

Complainants afraid to speak out

According to the story- " Marketplace has spoken with several SmileDirectClub customers who said they weren't happy with their treatment. Complaints ranged from three viewers who said their aligners did not arrive on time and/or did not fit correctly to more serious consequences, including two customers whose bites were misaligned, one who had a broken crown, and two who said they needed gum grafts following treatment."


Complications related to orthodontic treatment are not rare. Dental professionals use a detailed consent form that discusses a wide range of troubles that can arise from proceeding with treatment. 

Difficult Cases NOT properly screened out

It was extremely concerning to read that some patients have been told it was unnecessary to have routine dental treatment up to date (one said she had not seen a dentist for four years). No x-rays are taken and a clinical exam is not provided by a trained professional. Their online consultants only see the patient through photos and digital images of the teeth. This would fail to qualify as adequate records for the Standard of Care. 


The biggest concern is if they treat 95% of people that request the service this would suggest the program fails to refer away the moderate to severe cases that require at least a general dentist and probably an orthodontist, possibly even a combination of specialists to provide ideal results. Smile Direct may use consent forms that recommend seeing a dental professional before starting their program but the investigation found many people were instead encouraged to start right away. 


"SmileDirectClub says it has 250 licensed orthodontists or dentists affiliated worldwide." It appears to attempt to solicit working relationships with local dental professionals but this would be a concern to local dental authorities who have posted warnings about this mode of care. 


Bottom line:

If cost of care is your primary concern and your situation is mild you should be able to find a dentist who offers orthodontic treatment at a price between Smile Direct and an orthodontist. Continuing education for general dentists can range from weekend courses (6 Month Braces/Six Month Smiles) to extended programs that recommend referring about half the cases to a specialist (even after the training is complete). 


Teeth are usually crowded for a reason. If forced into alignment the roots may be pushed out of the bone leading to recession of the gums. When the jaw is too small to fit the teeth in decent alignment sometimes teeth are slenderized (reshaped) and some may be extracted. Mail order treatment would obviously not include these measures or be able to coordinate additional procedures that could lead to an improved result. 


Orthodontic options include clear aligners, other removable appliances (Inman aligner), braces on the outside and inside of the teeth. If your budget is tight it may be better to delay treatment than choose a mail order product. Most times orthodontics is not required for anything more than vanity. You may learn to accept your smile as it is and skip the treatment entirely. 


 If your situation is moderate to severe an orthodontic specialist is recommended. Do not begin any orthodontic treatment without first getting a routine care completed by a trusted dental professional. Even if your family dentist provides orthodontics it may be wise to seek a second opinion from an orthodontist to compare approaches. There are turf wars in the dental profession- this new competitor seems to have united general dentists and orthodontists to be on the same side.