It’s been a long time since I have written a blog post. No excuses. Life is busy with family and other concerns, and I’ve not been inspired… until now.
Many of you may have already heard about online companies offering do-it-yourself orthodontic clear aligners. For many of us, the instinctive reaction is to scoff or laugh at such a silly notion. Some will dismiss the news and suggest that P.T. Barnum had it right about a “sucker being born every minute.” I suppose the consensus might initially be summed up with the single-worded vernacular, “WhatevAR!” What’s next? Do your own crown preps? Tele-crowns?
No worries, right? If you visit this consumer review webpage and see their clients’ “before & afters,” you’ll likely be quite amused at the “results.” Or, just keep reading.
Of course, we have many well-founded clinical concerns and objections to the concept of self-diagnosis and self-treatment. No need to review them. As dentists, we know what they are. Smile Direct Club (SDC) claims that each case is “reviewed” by a licensed dentist. The clients send in cell phone selfies of their smiles and self-administered impressions from the kit sent by SDC. That’s it. Consider the standard of care here. How many of us would recommend orthodontic appliances for patients without a comprehensive examination prior to treatment? These “hired guns” are approving cases based solely on selfies and models (of dubious quality)? No x-rays? No perio evaluation? Caries or defective restorations identified? Fixed bridges or splinted crowns? Can you imagine what might happen to a practicing dentist who did that with patients of record?
Best Frenemies Forever?
Recently, Align Technologies (Invisalign) purchased part of SDC and is making their aligners for them. The folks at Align tried to assuage the concerns of dentists by claiming they just want to be “ahead” of the trend (of self-treatment or “tele-dentistry”) and that the aligners they make for SDC are not the same technology as Invisalign brand aligners. Furthermore, in the merger announcement, Align said, “30% of Smile Direct Club’s interested customers do not qualify using the Smile Direct Club protocols.” Yeah… Remember that 68% of all statistics are made up 93% of the time. 😉 Looking at the RealSelf.com SDC page, I’m hard-pressed to find a SINGLE CASE that was turned away by SDC. Below you’ll see one I expect you’ll agree should have been.
SDC claims that every case is “reviewed” by a licensed dentist. Word on the street (DentalTown) is that they hire dentists in each state to look at the selfies and impressions (remotely, I assume) for $50 a pop. Fifty bucks. Wow. I wonder if there is an incentive to “approve?” Do the dentists get paid the same measly $50 if they reject a case? Who takes on the liability if / when the case goes south and the “patient” is looking for compensation?
It’s the same thing!
The problem with that is that SDC will certainly market this as “made by Invisalign,” and consumers will perceive it to be the same.
To wit… I got the email below from a patient this week. He had come to see me for a Six Month Smiles (SMS) evaluation. He told me he was considering doing it himself with Smile Direct Club. I felt he was not a candidate for SMS, and it was a case beyond my comfort zone for Invisalign in my general practice. So, I referred him to an orthodontist.
I turned down the “opportunity” to help him with impressions. Perhaps I should have offered to do it for only $4,990? 😉 I joke, of course. I do understand the issue of affordability with patients who simply don’t have $5,000++ to spend. But, I take issue with the notion that they’re getting the same thing for $1,500 online.
Ah… but, SDC / Align have figured out how to get around the impression issue. They’re apparently setting up “SmileShop Centers” across the country, where “techs” will do intraoral scans.
“We’re getting Invisalign wholesale!”
As I predicted, consumers are going to understandably assume that do-it-yourself ortho with SDC is the “same thing” as Invisalign. It perpetuates the mistaken assumption that dentists are simply retailers or “middlemen” for the aligner device. I’ve already seen consumers on SDC social media sites claim that SDC is “wholesaling” aligners to the public. They don’t recognize that orthodontic treatment is a SERVICE, not a device.
I suspect the brainiacs at Align knew this, as well. What is insulting is that they expected us to believe their bullshit about it being a different product, and that it wouldn’t compete with our services. It IS a different product. But, the consumers don’t know that, and won’t believe it. Their perception of it being the same will compete with professionally-administered aligner therapy. Though I expect there will be a wave of dissatisfied customers.
So “simple” any aligner can do it!
There is a website called “RealSelf.com.” It’s about all sorts of cosmetic procedures, and there is a page dedicated to SDC clients. Members of the webpage can post their cases, reviews, and experiences with SDC. According to Align, SDC accepts only the “simple” or “mild” cases. You mean like this one?
Or this one (from the FB page)?
What could possibly go wrong?
Posted on the SDC Facebook page:
So, do you think there is some conflict of interest with Align trying to serve two masters? Where do you think tele-dentistry will lead? Will it harm patients? Will there be a tsunami of lawsuits from dissatisfied clients? Who will be liable? Will the concept be defended by the political forces on the basis of the “access to care” narrative? Will we all (eventually) be busier fixing all the inevitable problems? Why is the ADA silent? Chime in below!