Tuesday, December 19, 2023

The Bite of Reality: A Dentist's View on SmileDirectClub's Demise


Image Credit: ©Smile Direct Club

A very long post today, but with good reason.  This post deals with, not only the demise of Smile Direct Club, but also the entire idea of DTC (Direct To Consumer) healthcare.

I've been a dentist for quite a few years and have been involved with Dental Products Report or one of its sister publications since the late 1990s.  That has allowed me to see a lot of things over the years.  Some of those have been great things, some have been mediocre, and some I saw as prototypes of ideas that never came to market.  However "back in the day" those products and ideas were marketed directly to the doctor.  The reason some of those didn't make it to the market is because doctors did not think they would be effective.

However, with the explosion of social media, now anyone can have a platform and a voice.  That means that, unfortunately, anyone with an Internet connection can promote themselves and/or their product in a matter of seconds.  There some times in life where eliminating the "middle man" isn't a bad idea.  However, in healthcare when that "middle man" (or middle person) is a doctor, it's really not the best idea.  In the past 10 years or so I've had a lot of patients ask me about products or trends they learned of in social media and I've always appreciate that they trust me enough to ask before buying something or simply joining a trend.  However, when you get some investors behind you and have money to spend on marketing, you are pretty much guaranteed to hit a segment of the population that won't ask a doctor for their opinion.

From its flashy ads promising "straight teeth without the dentist" to its IPO valuation exceeding $8 billion, SmileDirectClub (SDC) had a meteoric rise. But like a patient neglecting their oral hygiene, its fall was swift and brutal. As a dentist, I witnessed firsthand the allure and pitfalls of SDC, and its demise offers valuable lessons for both the dental industry and consumers.

The Allure of the "DIY Smile":

SDC's appeal was undeniable. It tapped into a desire for affordable, convenient teeth straightening, bypassing the perceived hassle and expense of traditional orthodontics. Their at-home aligner model, marketed as a tech-savvy solution, resonated with a generation accustomed to online services and self-diagnosis.

A Dentist's Perspective:

While I recognized the potential benefits of at-home aligners for certain cases, I remained skeptical from the outset. The lack of proper diagnosis and supervision by a dentist was a major concern. SDC's model relied on patients accurately taking their own impressions and monitoring their progress, which, as any dentist knows, is fraught with potential for errors and complications.

The Cracks in the Smile:

As SDC's popularity grew, so did the reports of complications. Misaligned bites, gum recession, and even tooth loss were attributed to the lack of professional oversight. Additionally, the company faced lawsuits and regulatory scrutiny for its marketing practices and claims.

The Bitter Truth:

SDC's bankruptcy in 2023 was the inevitable consequence of prioritizing profit over patient care. Their "one-size-fits-all" approach to orthodontics ignored the complexity of individual oral health needs. Ultimately, the allure of a quick fix couldn't mask the fundamental truth: teeth are not simply cosmetic; they are vital parts of a complex system, and their treatment requires professional expertise.  Dentists not only have an undergraduate degree from a four year university, they then spend four *more* years learning the nuances of the human body from basically the shoulders upward.  I remember well my class in "Head and Neck Anatomy".  After 4 weeks (basically the beginning of February) our professor said, "Congratulations!  You now know as much about the head and neck as a General Physician does when they graduate Medical School."  We then continued to study and learn the subject until the end of May.  The human body is an extremely complicated machine and the head and neck are a complicated subset of that machine.  It is not a DIY environment. 

Lessons Learned:

SDC's demise serves as a stark reminder of the importance of prioritizing patient safety and ethical practices in healthcare, even in the face of technological advancements and consumer demand. For dentists, it underscores the need to embrace innovation while remaining the trusted guardians of oral health. For consumers, it serves as a cautionary tale, emphasizing the importance of seeking professional guidance before embarking on any dental treatment, especially those promising quick fixes without proper supervision.

The Future of Teeth Straightening:

The at-home aligner market is unlikely to disappear, but SDC's downfall should prompt stricter regulations and a shift towards collaboration between dentists and aligner companies. Dentists can leverage aligners as a valuable tool within their practice, while aligner companies can benefit from the expertise and oversight of dental professionals.

In conclusion, SDC's demise is not a victory against technological progress, but a call for ethical and responsible practices within the dental industry. As we move forward, let us learn from the mistakes of the past and build a future where teeth straightening is accessible, affordable, and above all, safe and effective for everyone.

Remember, a beautiful smile is more than just straight teeth; it's a reflection of overall oral health and well-being. Choose wisely, and let your smile be a testament to both technology and the expertise of your trusted dentist.

What the American Dental Association has to Say

On December 13, as the story was breaking, the ADA released a statement dealing with the professional association's stance on DIY dentistry:

Following news reports about the liquidation of a manufacturer and marketer of teeth aligners sold directly to consumers, the ADA has reaffirmed its policy stating its opposition to direct-to-consumer dentistry. 

According to the ADA, direct-to-consumer dentistry has the potential to cause “irreversible harm to individuals, who are treated as ‘customers’ rather than patients.” In a press statement, the Association said that dentists are the only individuals licensed to accept responsibility for patient care.

“Under virtually all states’ laws and as is reflected in ADA policy, the dentist is ultimately responsible for the patient’s care and is the only individual licensed and qualified to accept responsibility,” the press statement said.

“Moving teeth without knowing all aspects of a patient’s oral condition has the potential to cause bone loss, lost teeth, receding gums, bite problems, jaw pain, and other damaging and permanent issues,” the statement continued. “Without the involvement of a licensed dentist, patients lose an essential quality control checkpoint — their dentist — to ensure all aspects of their treatment are performed and are progressing in the best interests of the patient.”

The statement reiterates the ADA’s commitment to patient safety and quality care and encourages those using or considering using a direct-to-consumer dentistry service to consult a dentist and discuss care options.

“Oral health and overall health are deeply connected, and the ADA encourages all patients to find a dentist they can visit regularly,” the ADA said. 

For more information on the ADA’s position on DIY dentistry, visit, MouthHealthy.org/DIYdentistry. 

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