Smile Direct Club was a 'disaster waiting to happen'

Following Smile Direct Club's closure, the dental profession discusses the risks it posed to patient safety and the role of regulation in the aligner industry.

Following Smile Direct Club’s closure, the dental profession discusses the risks it posed to patient safety and the role of regulation in the aligner industry.

Andrew Culbard, clinical director of aesthetics, Scottish Dental Care

Dentists and dental leaders around the world have been outspoken about the risks surrounding Smile Direct Club and the lack of planning and oversight of a dentist or orthodontist during treatment. While this treatment may have been successful for many patients, some will likely not have achieved the outcome they desired.

Unfortunately, concerns raised by the dental community did not deter patients from the allure of a ‘cheaper alternative’. Smile Direct Club employed aggressive marketing tactics, which I feel at times put profits before safety.

Many claims were, in my opinion, misleading. One example was that Smile Direct Club provides the equivalent care and supervision as an in-person consultation with a qualified dentist. I was shocked to later learn that the company had taken steps to silence dissatisfied customers by locking them into non-disclosure agreements, effectively blocking them from leaving negative reviews of their poor treatment in return for a refund.

Now thousands of patients will be left without a means to complete treatment and will likely be required to seek the help of a dentist or orthodontist, incurring additional costs.

Patients should be aware that, in some cases, there may be long-term dental health complications. My advice to patients who have been left mid-treatment would be to seek the opinion of a certified dentist or orthodontist as soon as possible. They can look at your unique situation and advise the best course of action.

Matt Everatt, Laboratory editor-in-chief

This is the perfect example where a regulator should have stepped in from the outset and stopped them. It would have genuinely protected patients.

Sadly, now we have thousands, probably tens of thousands, of patients that will need to see a dentist or orthodontist and pay to have treatment done again.

Guilherme Xavier, lead orthodontist, Dulwich Dental Office

The dental community have been shouting from the rooftops about better regulation of unlicensed pseudo-offices that purport to straighten your teeth at half the cost. As the old saying goes, if it is too good to be true then it normally is. This was a disaster waiting to happen.

While there is no doubt Smile Direct Club would have delivered their promise to some patients of straight teeth at half the price, they are normally the ones with excellent gum health and mild mis-alignment of their teeth.

However, even these patients are now left in a precarious position of having paid for their smile, with no recourse for recovery of their payment, and an uncertain future of who to see to takeover their orthodontic case.

‘Immune from disciplinary action’

This collapse is not surprising to the thousands of dentists who rallied the General Dental Council (GDC) for better regulation. Smile Direct Club seemed to be immune from any disciplinary action. The end result, as always when the fad of cheap and cheerful is exposed, is an array of patients who will have gum disease, with the worst case scenario being loss of one or more teeth.

There will also be very little chance of any medicolegal action against Smile Direct Club as there is no doubt their initial paperwork that all patients sign will contain a long list of disclaimers.

What can patients who have been affected by their closure do? The first thing is not to panic. Second, a specialist orthodontist will be able to help by completing an initial assessment. Third, a new treatment plan will have to be made that may involve starting from scratch or possible incorporation of the old movements into a new treatment plan.

Aligners may still be suitable but in some cases fixed conventional train track braces may be more suitable. The best advice is to consult a board certified specialist orthodontist.

Rustom Moopen, principal dentist, Panshanger Dental Practice

The news of Smile Direct Club going bankrupt is all over the news over the last few days. The problem with the company’s offering to the general public were manyfold with no quality control. This resulted in endless refinements, trying to fix problems that simply were not possible with basic aligners with no thought to patient assessment or safety.

Effectively, Smile Direct Club was selling an impossible dream.

For a number of years now, the profession has been warning the general public and the regulatory bodies to intervene on behalf of patient safety to no avail. Thankfully, its bankruptcy means that their impossible promises to straighten teeth safely will no longer cause harm.

Unfortunately, we will be seeing the fallout from this for years, from patients who will have lost teeth, loose teeth, relapse or recession to the companies that financed these treatment plans where patients will now not receive neither treatment nor their money back.

There will be new players similar to Smile Direct Club to occupy the void left by its bankruptcy, and we should be wary that history is not allowed to repeat itself.

Chrystal Sharp, orthodontic therapist

In light of the current news that Smile Direct Club has filed for bankruptcy, as an orthodontic therapist this comes as a positive announcement. Remote unmonitored aligner treatment is not comparable to aligner treatment provided by a skilled dental professional.

I’m hopeful the current situation has raised awareness for future orthodontic patients along with concerns to regulatory bodies. Increasing guidelines is essential for the protection of both patients and dental professionals from a future recurrence.

At the heart of any dental/orthodontic treatment provided by dental professionals is informed consent obtained from direct interaction at a consultation phase, for the safety of patients, quality of care and protection of harm.

It’s upsetting to see the situation the patients now face in finding a dental professional to finish their orthodontic cases. However, for the dental professionals taking over their care, this position is less than desirable. Patients’ expectations of the outcome of their orthodontic treatment may be practically unachievable or financially simply unaffordable, owing to the unregulated online aligner treatment that was provided leaving some patients in a worse situation than where they started.

Until stricter requirements are enforced, it may only be a matter of time until a similar unmonitored remote aligner company exists.

Smile Direct Club was a ‘disaster waiting to happen’