One of the newer fad discounted treatments for orthodontics is direct-to-consumer aligners such as Smile Direct club. You take some photos, submit your information to their website & they send you retainer aligners to wear to straighten your teeth. On their website they claim a set amount of $2700 per case (Smile Direct Club, N.D.). Treatment in office from a certified orthodontist is typically anywhere from $4500-6000.
In theory these companies work the same as the well-known orthodontic brand – Invisalign. However, with smile direct there is no orthodontist monitoring your treatment, evaluating your bone structure with x-rays and diagnostic records, your gingiva, your bite (which can affect many aspects of oral health & overall health), or cavities on your teeth. Some of these direct-to-consumer sites do claim that there is a trained orthodontist approving treatment, however they still do not have proper diagnostic records & treatment monitoring other than photos. This has left many dental professionals wondering what is teledentistry, who are customers VS who are patients and what is medicine and what is cosmetics (Wexler et al. 2020).
Dentists and orthodontists have argued that moving teeth is a medical service that should only be carried out by licensed healthcare professionals who have undergone training (Wexler et al. 2020). The AAO (American Academy of Orthodontists) has released a consumer alert surrounding direct-to-consumer orthodontic treatment surrounding the possibility of irreversible and expensive damage such as tooth and gum loss, changed bite, and other issues (AAO, N.D.).
The study by Wexler et al (2020) reported that someone in the target demographic had noted that she had signed a non-disclosure agreement (NDA) and was unable to complete the survey. They also noted that these direct to consumer companies sometimes require customers to sign a NDA prior to processing a refund, which makes it difficult to assess the more sever outcomes of these aligners.
After working in orthodontics for a short period of time, I saw several patients come in with damaging results of these programs. While these programs do work for patients in very limited simple cases, most patients should and do need an orthodontist prescribing and overseeing their entire treatment with proper diagnostic records, again the point that Wexler et al. (2020) pointed out – who are customers and who are patients? sticks with me.
AAO. (N.D.). Consumer Alert – What you may be messing with direct-to-consumer orthodontic treatment. http://www3.aaoinfo.org/wp-content/uploads/2021/04/AAO-Consumer-Alert-2021.pdf
Smile Direct Club. (N.D.) Smile Direct Club. https://smiledirectclub.ca/en-ca/
Wexler, A., Nagappan, A., Beswerchij, BS. & Choi, R. (2020). Direct-to-Consumer Orthodontics: Surveying the User Experience. Journal of American Dental Association. 151(8):625-636. https://doi.org/10.1016/j.adaj.2020.02.025
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