In the wake of SmileDirectClub collapsing, the British Dental Association has warned that the collapse of the remote-orthodontic giant will not close the door on the clear risks to patients presented by remote orthodontics.

The business model - offering patients plastic aligners based on a 3D scan of their mouths or via an impression taken from at-home moulding kits - can lead to fundamental changes to a patient's mouth that may be irreversible.

The BDA has regularly raised concerns directly with regulators - the Care Quality Commission and General Dental Council - about this practice since 2019. The professional body warn that the bankruptcy of the market leader should not be viewed as a substitute for meaningful regulation to protect patients.

In 2021 the GDC published guidelines, stressing that orthodontic patients need to be fully assessed by a dentist, that direct dentist-to-patient interaction - the basis for informed consent - is essential, and that patients must know the name and registration number of the dentist responsible for their care. However, it did not offer any clarity on what sanctions it might utilise and how the regulator backed up its assumption that such models of care are ‘safe for many people.'

Dentists have stressed the risk of misdiagnosis and lack of informed consent in the absence of face-to-face consultations throughout the course of treatment. The BDA has seen cases of patients with advanced gum disease that have been provided with these aligners, potentially leading to tooth loss.

In 2020 an investigation into the provider by U.S. network NBC revealed a wide range of complaints on treatment outcomes. Patients were not required to have any in-person assessment with a dentist, and unhappy customers were made to sign non-disclosure agreements.

British Dental Association Chair Eddie Crouch said: ‘Dentists are left to pick up the pieces when these providers offer wholly inappropriate treatment. It shouldn't have taken a bankruptcy to protect patients from harm. It requires decent laws and effective regulation. Sooner or later, someone will find a way to make remote orthodontics turn a profit. Before that time proper safeguards must be in place.'

The British Orthodontic Society also expressed its great concern for those patients who have been left abandoned following the announcement, suggesting that SmileDirectClub patients anxious about their treatment should contact an orthodontist or dentist at the first opportunity to discuss their options. They can be assured of professional and sympathetic care as well as an understanding ear.

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Anjli Patel, BOS Director of External Relations, commented: ‘As dental professionals, we have a duty of care to our patients following treatment for a minimum of 12 months as is right and proper. For a corporate entity to abdicate responsibility in this way is nothing short of scandalous. The BOS calls on the regulatory bodies in the UK to ensure any company providing direct to consumer Orthodontics in the UK is subject to similarly rigorous standards of practice as UK based providers of Orthodontic care.'

The Oral Health Foundation cited their concern of the potential consequences of patients being left without proper guidance and support midway through treatment plans. The charity said they were ‘deeply troubled' by the financial impact of patients being abandoned, with many having paid out thousands of pounds.

Dr Nigel Carter, Chief Executive of the Oral Health Foundation, said: ‘The closure of SmileDirectClub has created an upsetting situation for many patients who were undergoing dental treatments. We are extremely worried about what impact this will have on the oral health and mental wellbeing of thousands of people currently undergoing treatment. Our hearts go out to the patients who placed their trust in SmileDirectClub. The sense of abandonment they now face is truly distressing.

‘It is infuriating to see patients left out in the cold, ripped off, and left out of pocket. The financial losses some patients might now incur are inexcusable, and it's a stark reminder of the consequences when companies prioritise profits over the wellbeing of those they serve.'

Meanwhile, Dr Guilherme Xavier, lead orthodontist at Dulwich Dental Office, said SmileDirectClub's sudden shutdown ‘was a disaster waiting to happen' and could leave patients vulnerable to tooth loss and huge repair costs.

He said: ‘The dental community have been shouting from the rooftops about better regulation of unlicensed pseudo-offices that purport to straighten your teeth at half the cost. As the old saying goes, if it's too good to be true then it normally is. This was a disaster waiting to happen.

‘While there is no doubt SmileDirectClub would have delivered their promise to some patients of straight teeth at half the price, they are normally the ones with excellent gum health and mild mis-alignment of their teeth. However even these patients are now left in a precarious position of having paid for their smile, no recourse for recovery of their payment and an uncertain future of who to see to take over their orthodontic case.

‘This collapse is not surprising to the thousands of dentists who rallied the General Dental Council for better regulation. SmileDirectClub seemed to be immune from any disciplinary action. The end result, as always when the fad of cheap and cheerful is exposed, is an array of patients who will have gum disease, with the worst-case scenario being loss of one or more teeth.'