Need to know
- SmileDirectClub is offering at-home teeth straightening in Australia
- The company claims it can save you up to 60% of the cost of traditional braces
- But experts are concerned about the lack of professional supervision in so-called DIY dental treatments
DIY teeth straightening kits claim to be a cost-effective alternative to seeing a professional orthodontist.
Do teeth-straightening kits work?
For those of us who covet a straighter smile, DIY dental kits certainly sound tempting (and cheaper than you'd expect to pay a professional).
But Australia's peak dental bodies warn that it's a case of buyer beware.
"It's about buying a dental impression kit over the internet, taking moulds of your own teeth, receiving a set of clear plastic aligners in the mail and then doing your own orthodontic treatment at home without any direct supervision from an orthodontist – and that opens the door to potential problems," says Dr Howard Holmes, vice president of the Australian Society of Orthodontists.
There are many dangers and limitations of consumers attempting to move their own teeth with at-home kitsDr Carmelo Bonanno, president of the Australian Dental Association
"If you're a young adult with healthy teeth, healthy gums, no wisdom teeth and a normal bite who only has very minor crowding or crooked teeth, it might work for you," he adds.
"But that's a big 'might'. And although it may seem cost-effective, when you take on board the risks that come with it and the potential ongoing costs if you don't get the results you're after, or if you develop dental complications, it's actually not going to work out that much cheaper than seeing a specialist in the first place."
Dr Carmelo Bonanno, president at the Australian Dental Association, agrees: "With respect to orthodontic treatment, there are many dangers and limitations of consumers attempting to move their own teeth with at-home kits," he says.
What is SmileDirectClub?
SmileDirectClub was founded in the US five years ago by two friends – Alex Fenkell and Jordan Katzman – who met as teens, both bearing a mouthful of braces. Their mission as adults, they say, was to make "it affordable and convenient to transform your smile".
The result? A home-use teeth-straightening kit that customers can order on the internet.
Kay Oswald, president of International SmileDirectClub, claims the company has helped more than 700,000 people globally, and has started trading in Australia this year due to "a demand for a more affordable and convenient alternative to traditional braces".
We're making it easier for the customer to transform their smileKay Oswald, president of International SmileDirectClub
"We're making it easier for the customer to transform their smile by eliminating the need for timely in-office visits," he says.
"The average clear aligner therapy plan takes six months, whereas traditional braces take an average of 18 months. Mild to moderate cases [which can be treated by SmileDirectClub] include space between teeth, crowding, rotations and some minor bite correction."
SmileDirectClub's at-home teeth straightening kit.
How does the service work?
After passing a basic dental history quiz, you buy an impression kit to make moulds of your smile at home (or visit a 'SmileShop' to have it done – there are a limited number of branches across Sydney, Brisbane, Melbourne, Adelaide and Perth).
Once SmileDirectClub receives the moulds, it has them "reviewed by an AHPRA [Australian Health Practitioner Regulation Agency]-reviewed dentist or orthodontist". The company then custom-makes plastic aligners and posts them to you, instructing you to wear them continuously for 22 hours per day, except when eating, drinking, brushing and flossing.
Oswald says its web-based teledentistry platform enables customers to communicate with "dental techs and prescribing doctors" via text, email, chat or phone.
"Remote check-ins are required every 90 days to ensure the customer's smile is progressing as planned," adds Oswald.
What are the downsides?
The notion of "remote check-ins" begs the question: is it really safe to use such kits if a dentist or orthodontist is never looking in or probing around your mouth?
"The fact that there is no face-to-face contact is a concern," says Dr Bonanno. "These sorts of treatments, if not undertaken correctly, can cause permanent damage to the teeth, gums, jaw or jaw joints. We are aware of reports overseas of inferior treatment results."
Dr Holmes adds that no orthodontist would ever consider treating a patient without first reviewing an X-ray of their teeth and jaws.
"Because you're moving teeth through the jaws, through the bone," he says. "And if there are no X-rays and no clinical examination, the person supposedly overseeing that treatment won't be able to diagnose or detect gum disease (with associated bone loss around teeth), cracks in teeth, tooth decay, extra teeth hiding in the jaw bone, or even more sinister things like tumours or cysts."
These sorts of treatments, if not taken correctly, can cause permanent damage to the teeth, gums, jaw or jaw jointsDr Carmelo Bonanno
By comparison, a specialist orthodontist will thoroughly assess and address all dental issues – and leave you with a good-looking smile, a stable bite and no muscle or jaw problems, adds Dr Holmes.
"These are all really important from a dental health point of view and it goes beyond a quick cosmetic fix … which is essentially what these direct-to-consumer companies offer," he says.
"They can do treatment in six months because they're not fully addressing all the tooth alignment and bite issues and, in some cases, [they're] actually making them worse."
How much does SmileDirectClub cost?
SmileDirectClub has two pricing options: a one-off payment of $2499, or $99 a month for 24 months on top of a $399 deposit ($2775 in total).
You may also need to pay $79 for a remote impression kit if you're unable to visit a Smile Shop for a free imaging appointment.
Costs for traditional metal braces can vary, but are roughly in the range of $5000 to $9000 for a standard 18-month plan.
Invisalign claim their treatment costs are similar to those for traditional braces, and while they don't advertise specific costs, they do recommend speaking to an Invisalign-trained doctor for precise costs based on the complexity of your treatment.
"That said, a budget- or time-conscious patient who doesn't want 18 months of braces or aligners and just wants slightly straighter teeth may be surprised at quicker, more limited treatment options orthodontists can also offer," says Dr Holmes.
"And they can do it safely and in the same time and for roughly the same cost as if you order an impression kit or visit a retail scan shop and then try to do it yourself."
Whichever path you choose, if you're considering DIY straightening kits, experts say it's critical to ask questions and do your research.
"We recommend consumers at least seek a face-to-face consultation with a dentist or orthodontist beforehand," says Dr Bonanno.
SmileDirectClub and Invisalign both use clear aligners to straighten teeth, but there are several key differences between the services.
Invisalign vs SmileDirectClub
Although SmileDirectClub and Invisalign are both based on the same principle – teeth straightening with the use of clear aligners – an Invisalign-trained dentist or orthodontist is involved in the Invisalign process every step of the way, says Dr Holmes.
He adds that the other difference with Invisalign is that in some cases orthodontists will attach little resin "dots" or "buttons" onto some teeth as part of the Invisalign teeth-straightening process.
"Without those small attachments, the teeth are not going to move in the way they're supposed to, and anything you order online won't have those put on your teeth because you're not physically seeing an orthodontist," he says.
"So a lot of the movement you're after just won't work by just having the plastic aligners. You need these sort of adjuncts plus regular supervision and adjustments along the treatment journey to ensure you get a successful result with clear aligner therapy."
What to do if something goes wrong
If you have an issue with treatment by a registered orthodontist, there are avenues open to you.
"There's a complaints process, there are regulators, that particular orthodontist is going to be accountable," explains Dr Holmes.
By contrast, with more than 1000 customer complaints about SmileDirectClub on the Better Business Bureau's website in the US, dental bodies here are concerned about Australian consumers hopping on the DIY trend.
"Governments should protect the public by legislating to control the provision of do-it-yourself dentistry," says Dr Bonanno.
It's not possible to contract out of consumer rightsSarah Agar, CHOICE head of campaigns and policy
Oswald tells CHOICE that "liability for clinical care issues with treatment is no different than it would be in a traditional dentist or orthodontist setting".
But the terms on SmileDirectClub's Australian site say that users must agree to release the company, its affiliates and third-party service providers "from all claims, demands and damages" arising from or connected to their "use of this site and its services".
According to Sarah Agar, CHOICE's head of campaigns and policy, if SmileDirectClub uses these terms and conditions to try to prevent customers from claiming a refund if the product doesn't work, this would probably break the Australian Consumer Law.
"It's not possible to contract out of consumer guarantee rights," she says.
Greater complexity, more complications
A spokesperson for AHPRA and the Dental Board of Australia did not directly respond to questions about whether there should be tighter laws to protect consumers.
But the spokesperson did say they are aware of the increase in DIY dental offerings and that it's important for consumer health regulators to monitor any complaints from consumers.
"The more complex a patient's dental concerns, the greater the risk that a DIY product will not be fit for purpose and may lead to other complications," says the spokesperson.
"Any consumer considering a DIY dentistry option should make sure they understand how the treatment will work, what are the risks, what are the intended outcomes and what are the costs.
"If this information is not clear, AHPRA would recommend you seek advice from a registered dental practitioner before proceeding with a DIY offering."