With many people obligated to conduct their work remotely and utilizing various telecommunication services, many have become self-aware and self-conscious about their physical presentation. This is a new phenomenon known as the Zoom Effect. I noticed this immediately when I returned back to my office in June 2020. It seemed as though every day I had at least one patient inquiring about options for straightening their teeth. With so many choices out there from in-office to the new direct-to-consumer (DTC) orthodontic treatment, it is my hope that this article will help to navigate the confusing world that is clear aligner therapy and finally answer the questions: How to straighten your teeth at home, and Do direct-to-consumer companies actually straighten teeth as advertised?
How to Straighten Your Teeth at Home: The Process
As a provider of Invisalign and conventional braces, I was highly skeptical about DTC orthodontic treatment such as Smile Direct Club, Candid, and Byte, just to name a few. Knowing everything one must do and consider prior to even starting orthodontic treatment, I didn’t think that the cheaper alternative was feasible. However, I decided to go undercover as a potential customer to find out more information about Smile Direct Club and Candid, the two big DTC companies.
Smile Direct Club is the trailblazer for direct-to-consumer clear aligners. Treatment with this company will cost you about $1,950, or $2,290 if financed. This is their flat rate regardless of the complexity of your particular case. A 3-D mouth scan is taken at one of their convenient locations, or if you would rather not go into the store you can use their guide to take your own putty impressions at home, then mail them in. Once the scan or impressions are sent, an orthodontist or general dentist will review your case and, if you are approved, they will send you a 3-D simulation of your teeth moving from the start position to the finished position.
Candid uses the same business model, with the biggest difference being that Candid’s price is $2,400, or $2,775 financed. Also, Candid exclusively uses orthodontists (dental specialists that receive extra training after dental school for doing braces), and not general dentists.
If you approve the case proposal, they will send aligning trays to your home with instructions on the correct wearing method and how long to wear them, and voila! In a few short months, your teeth are aligned and you are the star of your Zoom meetings. All of this for under $3,000, as compared to the cost of traditional braces, which ranges from $3,000–$5,000, or Invisalign, which costs between $4,000–7,400.
Here is a short two-minute video of how Invisalign works.
The best part is that all these changes happen inside your own home, without frequent visits to the dentist’s office. Sounds like a great deal. But I see some big limitations.
Direct-to-Consumer: A Potentially Problematic Approach
One problem I see with these direct-to-consumer companies is the lack of comprehensive dental care. Visiting an orthodontist is not like getting the oil in your car changed or following some beauty tips that you came across online. Orthodontics is a medical procedure that should be managed by a professional. This is important because, while many patients think solely about the aesthetics when considering getting their teeth straightened, there are more factors to consider, such as your bite, gum health, and jaw health.
There is no way even the best dentist or orthodontist can screen for proper oral health based solely on pictures and a scan, and this is a major limitation in the direct-to-consumer model. Without a full set of X-rays and a thorough clinical examination, severe problems could go unnoticed and untreated or, even worse, you could potentially lose teeth.
Smile Direct Club and Candid ask in their questionnaire if you have seen a dentist in the last six months and even go so far as to strongly recommend that a dentist should be consulted prior to treatment. But, unfortunately, they are not verifying this information before treatment begins.
Both companies have mastered the art of utilizing staff as the liaison for the dental specialist and have made it difficult to actually speak with the dentist or orthodontist about your case. As a dentist, I actually don’t mind this; it is very beneficial to have a well-trained staff that can answer most questions. However, every alignment case is different and sometimes requires the dentist or orthodontist to modify the original plan. It is not as simple as applying activated charcoal to your teeth, which most people can do without professional advice.
I tried to contact the dentist at Smile Direct who created my treatment plan (who I found out no longer practiced dentistry) and asked very technical questions that only a dentist should answer. However, instead of speaking to the dentist as I had requested, the assistant on SDC’s staff made diagnoses over the phone. Under no circumstances should a patient be stopped from speaking with the treating doctor if they request.
Smile Direct Club claims 96% customer satisfaction and a 4.2 out of the maximum five-star rating for their services. Candid does not currently talk about their success rate. But what are those ratings based on? There is nothing in the reviews that actually talk about the success and effectiveness of the aligner themselves, simply patient satisfaction. Remember, orthodontics is not just about creating a straighter smile; it is also about improving the function of your teeth.
What I found suspicious in Smile Direct Club’s contract is that there is a non-disclosure agreement, allowing them to take legal action against a patient if you make any negative or disparaging comments about them or their product on social media. With over 1,000+ complaints about SDC in the last 12 months on the Better Business Bureau, you have to wonder about the quality of service that is actually being provided.
Invisalign Braces, Smile Direct Club, or Candid Aligner: Which Is Better?
In-office clear aligners, such as Invisalign and Clearcorrect, have been and continue to be the leaders for in-office clear aligner therapy. One of the most obvious distinctions these companies have is their attachments, or what some call “buttons,” on the teeth. Think of these buttons as anchors that help attach the aligners to the teeth, moving them more precisely and predictably. DTC tray aligners are limited, as they rely solely on the pressure of the tray to move the teeth; this can cause unpredictable and unsafe tooth movements. Also, according to studies, people with more complex cases must exercise caution before opting for at-home alignment therapy.
For now, these disparities will continue to exist. If you can only afford the direct-to-consumer route, I would suggest Candid as the best option. Candid’s aligners are made by Clearcorrect, a reputable company that is used in dental offices. Also, Candid utilizes orthodontists exclusively, unlike Smile Direct Club’s use of orthodontists and general dentists, making Candid’s level of expertise more predictable. Also, Candid is the first company to utilize a third-party dental monitoring device that allows customers to take more accurate pictures of their mouths for the check-up with orthodontists.
I believe that, because Candid is still privately owned and not a publicly-traded company like Smile Direct Club, they can provide a higher level of service than some of their competitors. However, as they continue to grow, this level of quality may not last.
Here’s What I Recommend
Dental professionals take an oath to do no harm, and there is a level of personal care that is taken when being treated in-office versus by a large corporation. Dentists and orthodontists, in the majority of cases, are not only aiming to give you a more attractive smile but also treating and preventing orthodontic problems that you may not even know exist. I can’t tell you how many times I have recommended in-office orthodontics to a patient not because they had crooked teeth but because of a functional problem that was going to cause significant issues for them in the future.
Even though I do believe some practices of the direct-to-consumer clear aligners are unethical, I actually think it’s important that these and in-office orthodontic solutions coexist for now. Smile Direct Club, Candid, and other similar service providers are simply a product of a severely broken healthcare system that has created a disparity for orthodontic treatment. And although I may not agree with their practices, I do believe they are an important driving force that has disrupted a historically monopolized market to innovate ways to make orthodontic treatment more affordable for consumers.
My biggest recommendation is to adjust your expectations for the final result and only use direct-to-consumer companies for correcting very minor crowding or spacing issues in your teeth. It is important to first visit your local dentist to make sure you are healthy enough to pursue orthodontic services and to make sure your case is simple enough to benefit from direct-to-consumer orthodontics.
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