Though Anna Rosemond, now 33, had braces when she was young, a couple of years ago she noticed her teeth were again starting to crowd. So when she saw a Groupon deal for SmileDirectClub, she jumped on it.

“I thought, ‘This looks like a really cool way to do braces,’” said Rosemond, who made her own teeth impressions with putty and used a “smile stretcher” – a device that pulls apart the lips and cheeks – to take pictures of her mouth. A few weeks after she submitted the items, plastic aligners arrived in the mail, beginning what the company describes as Rosemond’s “smile journey.”

On that trip, there would be no time-consuming visits to a dental office, as her treatment would be overseen online through a SmileDirectClub-affiliated dentist or orthodontist – at a current cost of only $85 a month and a $250 down payment, according to the firm’s website.

Initially, she said, the aligners sent in 2017 seemed to be working. But over time, Rosemond said, she grew concerned: “My teeth were literally moving at an angle.”

Rosemond is part of a wave of patients who have embraced this do-it-yourself approach to orthodontia, hoping to attain a perfect smile without the high out-of-pocket cost and potential inconvenience of traditional braces or tooth aligners.

To be sure, technology enables consumers to do more at home, and dental care – with its limited insurance coverage – offers a large potential market. Home teeth-whitening kits have largely displaced in-office treatments, for example.

Now, teeth straightening is the newest dental frontier, with startups like SmileDirectClub, Candid, Smilelove and SnapCorrect advertising their services aggressively on billboards and social media.

When results are good, the DIY approach can yield thousands of dollars in savings. But when the treatment plan doesn’t produce results or goes wrong, consumer-patients like Rosemond voice their frustrations in Facebook groups and complain to the Better Business Bureau or the Federal Trade Commission that they have nowhere to turn for help.

The companies do not make information public about success rates or problems — although SmileDirectClub says it has achieved a rating of 4.9 stars out of 5 on nearly 58,000 Google reviews — and there are few scientific studies of outcomes for direct-to-consumer orthodontics.

To get a simple refund after an initial 30-day period, patients are often asked to sign what SmileDirectClub calls a “release,” stating the consumer won’t complain publicly — which it says is fairly standard in business. A shareholder lawsuit against the firm says those releases suppress consumer complaints, leaving investors in the dark.

Consumer complaints to advocacy groups and regulators, including the FTC, the Food and Drug Administration and state attorneys general, as well as lawsuits, are accumulating.

Yet, SmileDirectClub, the company with the largest market share of direct-to-consumer orthodontics, says it’s achieving its aim of disrupting the entrenched orthodontia industry.

“We have provided consumers for the first time with an affordable option that is also far more convenient for those who cannot afford to miss school or work or are disabled and cannot get to multiple office visits,” said Susan Greenspon Rammelt, general counsel for SmileDirectClub.

Tiffanie Leatham, who worked as a dental assistant for SmileDirectClub for a year, felt the company pressured her to sign up patients whose teeth she thought were not suitable for aligners. “It was mostly sales with a small hint of dentistry,” she said.

Recent SEC filings show SmileDirectClub spent more than half its revenue on marketing.

The direct-to-consumer teeth-alignment industry was enabled by the arrival two decades ago of Invisalign, clear plastic aligners that offered an alternative to the hated “metal mouth” look of braces so familiar to a generation of children. Invisalign, however, is dispensed by dentists or orthodontists during in-office visits, so it’s more costly for consumers.

While Invisalign sales remain high — its manufacturer, Align Technology, reported a record $2 billion in worldwide total revenue in 2018 — patents on the product began expiring in 2017.

SmileDirectClub saw the opportunity early and launched in 2014, with backing from Camelot Venture Group, a private investment group that also backed Quicken Loans and 1-800 Contacts. Initially, the startup’s aligners were made by Align Technology; now, SmileDirectClub does its own manufacturing.

Nashville-based SmileDi-rectClub, which says it has served more than 750,000 customers worldwide and represents 95 percent of the at-home clear-aligner industry, went public on Wall Street in September 2019. Its customers almost tripled – from 90,000 to 258,000 – from 2017 to 2018, according to SEC filings. But the company has yet to post a profit, also according to its SEC filings.

SmileDirectClub said customers initially used impression kits at home. Now, the company said, most customers visit one of more than 360 “SmileShop” locations, some inside CVS or Walgreens pharmacies, where technicians take a 3D scan of their mouths. The total cost starts at $1,895, although financing or additional items, such as retainers, can add to the price, according to the firm’s website.

Those impressions, photos and scans are sent to the firm’s facility in Costa Rica, where technicians develop treatment plans and one of 85 dentists employed there reviews it. For U.S. customers, treatment plans are also reviewed by a dentist or orthodontist licensed in the state where the customer lives, says SmileDirectClub.

Customers then receive an image of what their teeth might look like after treatment and can decide whether to proceed. If they do, the facility sends off the plastic aligners, which are worn sequentially over a few months for 22 hours a day.

If there is a question or problem with the aligners, billing or other issues during the months-long treatment process, customer service agents are the first stop. They can route concerns to the affiliated dentists, said company executives. Sometimes, according to a written statement, “the treating doctor will ask to see the patient in person, or work with the patient’s regular dentist.”

In the same statement, SmileDirectClub said it could not comment directly on specific patients’ experiences.

The Louisiana Weekly newspaper.

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