Open for Business

Faceless dental treatments of the kind offered by Smile Direct Club, among others, are all the rage. But are they really the future?

GOOD STARTUPS invent better ways of doing things. Grammarly’s artificial intelligence, for example, trumps ordinary built-in spell checkers, helping users improve the substance and structure of their writing. Peloton’s pricey stationary bikes rid owners of excuses for not exercising by removing friction from fitness, creating an army of avid enthusiasts.

There’s also snake oil, of course. Theranos promised diagnostic miracles from a few drops of blood before being exposed as a fraud. UPS and FedEx challenger Shyp actually did what it said, offering Uber-style parcel pickup and shipping for just five bucks—but that was way too cheap for Shyp ever to become profitable.

Say what you will about Smile Direct Club, it’s here and, for the time being, real. But it also faces headwinds. It had one of this year’s worst IPOs among America’s so-called unicorns (startups with billion-dollar-plus valuations). Soon after, California Governor Gavin Newsom stood with the dental industry and signed Bill 1519 into law, protecting patients by requiring review of X-rays by a dentist before aligners can be delivered, and preserving consumers’ right to complain to the state dental board even if they signed a nondisclosure agreement or arbitration clause. Smile Direct’s stock tumbled.

The company argues that California’s new law creates “unnecessary hurdles,” as if placing one’s teeth under the care of an in-person orthodontist is suddenly outmoded. Obviously it isn’t, and pressure is mounting.

The American Dental Association accuses Smile Direct of endangering patients and deceptive practices. Taking a similar stance, the American Association of Orthodontists has filed complaints with multiple state dental boards and attorneys general.

For independent providers, competing with a company that can afford to lose millions is challenging. Or is it? Smile Direct acknowledges that treatment with its aligners alone can’t solve difficult cases. Its consent form states that its service isn’t equal to that of an orthodontist: “Because I am choosing not to engage the in-patient services of a local dental professional,” patients must agree, their new smile “may still be compromised.”

Meanwhile, patients are keeping orthodontists busy. Substantial numbers of people never even consider direct-to-consumer dental. Some marketing experts suggest orthodontists aren’t losing many patients because Smile Direct buyers were unlikely to seek in-person treatment in the first place. And of course, dentists and orthodontists have a formidable marketing advantage that dentistry by mail can’t compete with: you, and the compassion, wisdom and genuine caring you bring. Now more than ever, tools like social media make it possible to create a personal brand that’s more compelling than any national player.

Will Smile Direct Club fail to fully hatch like so many startups that made big promises and couldn’t deliver? It’s still too early to tell, but put-up-or-shut-up time is coming.

Would we ever submit to dental treatment that wasn’t delivered in person? Absolutely not. Hell no, in fact.