Disruption in the market is often seen as a good thing. It brings in new ideas and greater competition, gives consumers greater access to the product and levels informational divides. But not all disruptions are positive. Sometimes they can impact consumer safety and circumvent established processes that ensure patient protection. This is what the American Association of Orthodontists is claiming direct to consumer products like Candid Co., Smile Direct Club, and SmileLove.
These products upend the traditional orthodontic model by providing clear aligner trays to the patient without an in office visit. Traditionally, orthodontic work requires an initial in office visit where the orthodontist takes scans of the patient’s mouth, discusses plans with them and goes over options. In a normal case, braces are the cheaper option but they take longer and are visible, something that tends to bother older patients. Invisalign is extremely popular because it is nearly invisible and can come out at meal times. While it is slightly more expensive many patients opt for it.
Direct-to-consumer products, on the other hand, will advertise that they work even quicker and for a lower price and without all the cost and markup of going to a dentist or orthodontist. Typically a patient will take pictures of their teeth at home and email them into the company.
Sometimes a physical location is available for initial scans, but this is often the only in-person contact the patient will have with the company, usually with a technician but never with a licensed professional (dentist or orthodontist). After this, a set of aligner trays will be mailed to the patient for use in a progressive plan and the entire treatment is carried out using teledentistry. This is what the American Association of Orthodontists is warning about, saying that patients should be careful of any program “without an in-person, pre-treatment evaluation or ongoing in-person supervision from a medical professional.”
We spoke with a provider for invisalign in Calgary about some of the advantages of the traditional orthodontic route. The first thing they mentioned was price. While people typically think of direct-to-consumer products as cheaper, they argued that these products tend to be very expensive for what you actually get. The actual cost of each aligner is around $4-5 per plastic aligner and with some of the direct-to-consumer services you are limited to only 20 trays per arch which limits the overall treatment time to 4 to 5 months. These products tend to cost around $2,000 depending on the specifics of the case yet the at-home aligners cost only about $160-200 to produce. With the limited amount of attention received by a licensed professional and the fact that it’s the consumers who are treating themselves at home, this model has some major markup.
In comparison, with an orthodontist you would pay about $4,000-5,000 for 1.5-2 years of treatment and the orthodontist will continue to make adjustments until your teeth are completely straight and all bite problems have been corrected. Typically with an orthodontist there is no limit to the amount of aligners that you receive – you receive as many aligners are needed, and on average patients typically need about 40-60 aligners to achieve excellent results that will last a lifetime. So to put this into perspective, the orthodontist will completely straighten teeth and fix the bite so that you have no future problems while the direct-to-consumer offerings can only do a limited amount of tooth straightening and does not address or correct the bite at all. Also within this price point you would be seeing the orthodontist 15 to 20 times and getting quite a bit of individualized care.
It’s worth noting that orthodontists are specialized dentists with an additional three years of training after four years of dental school, so their time is valuable. So for the $4,000-$5,000 you are not only purchasing the plastic, but you are getting complete alignment and bite correction as well as an orthodontist carrying out the treatment for you over 2 years. The orthodontists we spoke to asked us: has anyone ever gotten a Hollywide smile in only five to six months with braces? So why would anyone expect any different from only five to six months with aligners?
It will be interesting to see how the industry adapts around the potential disruption of these at home aligner companies. Anytime there is a new entrant into the market that challenges the existing structure it can get ugly (think Uber, AirBnB, Netflix), but when it comes to one’s health it seems prudent to be extra cautious and not necessarily choose the cheapest option. Whatever one’s opinion about telemedicine and direct-to-consumer products, consumers are advised to weigh their options carefully.