For anyone who had braces before ortho game-changer Invisalign came around in 1997, there was no greater joy than when the day came to march into the orthodontist’s office to remove the wires and brackets that moved teeth at glacier speed. For me, it meant a freedom from the migraine-inducing task of placing tiny rubber bands around sharp little brackets; a release from the discomfort of housing a mouth full of metal; and an instant makeover worthy of a She’s All That– style, slow-motion reveal. I don’t remember the exact day—somewhere around 1994—but I do remember naively thinking I was officially done going to the dentist, for good. Sadly, the business of wearing a retainer entered my life, and those dreams were short-lived. And because younger me was in charge of how often I wore my retainer, my chances of a lifetime with perfectly straight teeth were slim.
Today, the teeth-moving game is light years away from what my post-pubescent nightmares were made of. Metal braces are still a viable straightening option, but there are many other solutions that promise a faster, more affordable and accessible process than ever before. More than 6 million people to date have been treated with Invisalign—the brand name has become synonymous with clear plastic aligner trays. However, its patents began to expire in 2017, so it’s no longer the only name in the game. With today’s need for immediate gratification, it’s no surprise that teeth straightening is also getting the 1-800-Contacts treatment with a slew of new DIY teeth-straightening retailers—there’s SmileDirectClub, Byte, Candid, SnapCorrect and Smilelove, among others—changing the way people think about getting their teeth “fixed.”
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At Candid’s chic West Hollywood studio on trendy Robertson Boulevard, there’s no sign of the normal medical accoutrement that can evoke anxiety in the minds of patients who suffer from “dentaphobia.” There are no dental chairs, drills or sickle probes. Instead, the sleek, bright studio houses white, stylized textured pods reminiscent of Miami’s artsy Faena district, with nothing more than a comfy chair and a 3-D scanner. There are no dentists or orthodontists on site either, but just like at the Apple Store, a consultant greets clients and guides them on their direct-to-consumer journeys. A 10-minute 3-D scan creates images of the teeth, which are then sent to an outsourced orthodontist. Within a month, a box of custom aligners—two sets for every month of treatment—arrives on the client’s doorstep.
Candid, which also offers at-home modeling kits in lieu of an in-store scan, has nine retail shops in major cities like Austin, Boston, New York and San Francisco, and has plans to open 66 additional studios in 2019.
SmileDirectClub, the biggest player in the direct-to-consumer aligner game, has 225 SmileShops throughout the U.S. and Canada. Clients can visit a brick-and-mortar shop just once or mail in a modeling kit from home to get started. The convenience factor is a big selling point, but the real appeal is in the fixed price point the DIY brands offer, generally less than $2,000 from start to finish, whether treatment lasts three, six or nine months—a far cry from the $5,000–$8,000 costs estimated for in-office straightening. But there’s one major drawback that both the American Association of Orthodontics (AAO) and the dental community find worrying: The total orthodontal visits required throughout the entire treatment, and this goes for all of the aligner services, amounts to zero. These dental startups rely on teledentistry to monitor patient progress, and depending on the brand, checkups are performed remotely by either a licensed dentist, orthodontist or dental technician.
In October 2017, the AAO lodged complaints against online aligner companies with dental boards and attorneys general in 36 states, alleging the companies are creating medical risks by bypassing in-person checkups. The organization has also issued a consumer alert warning, cautioning consumers to think carefully before opting for a procedure “without an in-person evaluation or ongoing in-person supervision from a medical professional.”
The companies advertise that their plans are best suited for those with mildto-moderate straightening needs, and the dentists we spoke to stress that in-person evaluations are always needed before any orthodontic treatment. “If you’ve had a regular cleaning and your dentist has examined your teeth and gives the OK to proceed, then those with mild orthodontic needs may benefit,” says Rockville, MD cosmetic dentist Joe Kravitz, DDS. Chevy Chase, MD cosmetic dentist Claudia Cotca, DDS says she cannot recommend DIY straightening and wants the public to know there’s no substitute for seeing a qualified dental professional in person. “Academic credentials, training, clinical skills and expertise are all vital in assessing and treating a patient,” she adds.
New York cosmetic dentist Irina V. Kessler, DDS says buyer beware after having to correct some of these DIY treatments herself: “Moving teeth requires continuous patient monitoring. Not solely through photos, but also in person, where progress and potential complications can be assessed. I have redone many cases that were started with DIY straightening, and patients are lucky if they get away with minimum damages. Consumers need to consider the overall time, compliance and cost involved.”
Dr. Kravitz agrees, and adds there are some factors a scan or mail-in impression won’t be able to detect. “Patients who have had periodontal disease, large fillings, veneers and/or crowns are at risk of losing teeth, which they wouldn’t know unless they’ve had a full, in-person dental evaluation.” Dr. Cotca says the list of drawbacks associated with mail-order straightening is long and concerning, “from incomplete diagnosis and potential tooth loss to other complicated conditions such as the onset of temporomandibular disorder (TMJ/ TMD). Comprehensive hands-on evaluation, imaging, testing and data collection is an expert-level requirement.”
Beverly Hills, CA cosmetic dentist Laurence R. Rifkin, DDS says there’s more to it than just moving teeth—dentists need to also assess if patients are wearing their trays for the recommended 22 hours a day. “Without X-rays, photographs and models, there’s no way to see what the preexisting bone is like or if there is any gum recession. Regular monitoring of patient compliance is also needed to determine how to properly schedule the right sequence of trays.”
Despite warnings from the pros, the at-home straightening trend continues to grow exponentially. Dr. Cotca says one thing all patients, including those who take matters into their own hands, should never do is fall back on regular checkups. “Increased oral hygiene and maintenance during treatment adds to a healthier prognosis and better final result.”
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