You Could Mess Up Your Mouth With SmileDirectClub

Until recently, if you wanted to straighten your teeth withbraces or aligners, you needed to make several trips to anorthodontist, which would cost you about $4000 or more. But for thepast few years, companies like SmileDirectClub have offered anat-home aligner service for about half the cost, which patients canuse without ever seeing an orthodontist in person—they just takepictures of their teeth, bite down on a mold, and get aligners inthe mail. Compared to traditional orthodontic care, the patient ismuch more responsible for keeping things on track. And that makesmy teeth ache.

I』m halfway through an unusually long two-year program ofInvisalign, the most popular brand of aligner. (The company behindInvisalign also makes SmileDirectClub』s aligners.) Every ten weeksI see my orthodontist for a checkup, new aligners, and advice. On arecent visit, I admitted that I』d started leaving my aligners outfor longer periods (at parties or picnics), and was making up forit by leaving them in an extra day each.

My orthodontist gently explained that while my aligners arestill pushing my teeth into place, my teeth want to shift back, andthey』ll take every opportunity to do so. In effect, I』ve been veryslowly wiggling my teeth. And wiggling teeth makes them fallout.

I no longer leave my aligners out for long periods.

And that』s why, when the American Association of Orthodontistswages an extended legal war against at-home aligner companies,arguing that remote orthodontists can』t give adequate care andcounsel, I see their point. I certainly would screw up this processif I weren』t regularly checking in with my specialist. (Myorthodontist also checks in with my dentist; my garbage mouthrequires a whole team of experts.)

Patients on orthodontic forums have similar stories. Wearingaligners is a pain in the ass, and patients are always bending therules—drinking with their aligners in, not brushing after everymeal, god knows what else. There are so many things to watch outfor—my orthodontist had to warn me off Advil and onto Tylenol—andit』s risky to do it alone.

With SmileDirectClub, I could have emailed a remoteorthodontist, but I doubt I would have shared so much informationwith them. In 2015, the New York Times talked to the soleorthodontist overseeing the at-home orthodontics serviceCrystalBraces (now closed), who spoke to 「just a handful」 of his3,600 patients. At-home patients don』t seem to be volunteering muchto their doctors.

For years, the AAO has fought to make states restrict or banthese at-home services, and SmileDirectClub has fought back withlawsuits. And every time an outlet reports on the fight, both sidesweigh in. SDC says orthodontists are just scared of competition;the AAO says no, it』s just scared of patients fucking up theirteeth. SDC says its orthodontists can handle most cases by justchecking out the patients』 photos of their own mouths; the AAO saysthat』s impossible.

When I asked the AAO for comment, they told me what they telleveryone else: They』re telling at least 35 states to punish the SDCfor breaking regulations, because they believe it』s unsafe.(Update: In a response to this story, SmileDirectClubrepresentatives wrote, 「10 of those cases have been closed with noaction taken against SmileDirectClub.」) Last November, the AmericanDental Association also 「strongly discouraged」 at-homeorthodontics.

From one angle, the fight looks like any other fight over「disruption」 of a previously entrenched industry: Airbnb vs hotels,Uber vs. cabs, Amazon vs. Borders. Orthodontic care, which oftenisn』t covered by health insurance, can feel like another productworth saving money on. But it』s not another product; it』s medicalcare. And if the largest associations of orthodontists and dentistsconsistently say this medical care can』t be done over the internet,I』m not ready to ignore them to save two thousand bucks.

Obviously that』s because I』m lucky enough to afford the moreexpensive option. If you can』t, it can be very hard to hear thatyour only available option is a bad one. And maybe you』ll end upjust fine with the cheap version—by all appearances, thousands ofpeople have.  But if you go remote, please be careful.Research as much as you can, and follow the instructions carefully.Don』t wiggle your teeth until they fall out.