SmileDirectClub collapse: “It shouldn’t have taken a bankruptcy to protect patients”

The British Dental Association has warned that the collapse of remote-orthodontic giant SmileDirectClub will not close the door on the clear risks to patients presented by remote orthodontics. [1]

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.”

[1] Multiple US reports cite SmileDirectClub’s bankruptcy filing, marking the end of a nine-year run for the startup that never made a profit as a publicly traded business. While there were questions over the status of overseas operations, the following holding message is now in place on the website of the business’s UK operation: https://smiledirectclub.co.uk/

SmileDirectClub has made the incredibly difficult decision to wind down its global operations, effective immediately. For new customers interested in SmileDirectClub services, thank you for your interest, but aligner treatment is no longer available through our telehealth platform. For existing customers, we apologize for the inconvenience, but customer care support is no longer available. Thank you for your support and letting us improve over 2 million smiles and lives.

I placed an order for SmileDirectClub aligners, but have not yet received my aligners. What should I do?

Unfortunately aligner treatment is no longer available through the SmileDirectClub platform. All orders that have not yet shipped have been cancelled at this time, and you will not receive your aligners.

Should I continue to conduct my 60-day check-ins? Is my treating doctor still available to complete my treatment?

We apologize for the inconvenience, but aligner treatment is no longer available through the SmileDirectClub platform. If you wish to continue treatment outside of our platform, please consult your treating doctor or your local dentist with any questions around future aligner treatment.

I’m on the SmilePay Plan. Do I need to keep paying for my aligners?

SmilePay customers are expected to continue to make all monthly payments until payment has been made in full per the terms of our SmilePay program. For more questions, please contact HFD at 1-877-874-3877 or support@gohfd.com.

Is the Lifetime Guarantee still in place?

No. Effective immediately the Lifetime Smile Guarantee no longer exists.

How do I ask for a refund?

There will be more information to come once the bankruptcy process determines next steps and additional measures customers can take.

The British Association of Private Dentistry has also issued a statement on the collapse of SmileDirectClub:

It was with only a little surprise that the dental profession learned today that SmileClub Direct had ceased trading overnight. It has been clear for some months that the company had been struggling financially, and appears to have decided to cease trading yesterday.
 
https://www.axios.com/2023/12/08/smiledirectclub-liquidating-sdc-bankruptcy-chapter-11
https://www.wsj.com/articles/smiledirectclub-to-shut-down-c3eb53bf
https://www.forbes.com/sites/antoniopequenoiv/2023/12/08/smiledirectclub-shutting-down-what-to-know-about-aligner-companys-liquidation/
 
Over the past few years since the inception of this company and its subsequent move into the UK market, the profession internationally has been warning the public of the dangers of this type of ‘direct to public’ aligner therapy. With the sudden cessation of trading of the biggest company in the field, the BAPD are increasingly concerned about the welfare of those members of the public who are midway through treatment with SmileDirect Club. Given the initial information on the holding page of SmileDirect Club,  it would appear these patients are now to be left high and dry without access to further treatment. Their website is now little more than a holding page with scant information as to what is going to happen to their clients.
 
The BAPD and other professional associations have repeatedly warned both the GDC and the CQC of the risks this direct to consumer orthodontics poses to members of the public. Given that the regulators’ remit is to protect the public, it seems very little was achieved by them to stop the provision of this treatment. 
There are now questions about the provision for care continuity which their registration with the CQC would require. Based on the information on their website,  there is currently no provision for this, which means that members of the public are now either in the difficult position of having to continue to pay for aligners they will not receive, while others will have to find a practitioner willing to take them on to continue their treatment at additional cost or many may simply have to abandon their treatment. 
 
The BAPD urges members of the public who have been affected, to contact their dentist. We are reassured that our members will assist SmileDirect’s customers sympathetically and professionally when approached as a result of this development.
 
Our sympathies also extend to those employed by SmileDirect Club who wake up this morning to this uncertainty as Christmas looms.

British Orthodontic Society “concerned for abandoned patients”

The British Orthodontic Society has expressed its great concern for those patients who have been left abandoned following the announcement that Smile Direct Club has ceased trading in the UK.

As the demand for adult orthodontics has increased in recent years, so has the options for patients. In the current economic climate, there was always concern that people may put themselves at risk with ‘direct to consumer’ teeth straightening. The British Orthodontic Society suggests that Smile Direct Club patients that are anxious about their treatment to 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.   

Patients who are considering orthodontic treatment should seek impartial advice at – https://www.dentalhealth.org/safe-smiles-seeing-a-dental-professional  where they can get advice about the safest and most effective way to have orthodontic treatment. The safest way for patients to straighten their teeth is to see a trained clinician at an in-person appointment who is qualified to assess the patient’s health.

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.”

BAPD Board Election – call for nominations

Full members of the British Association of Private Dentistry (BAPD) now have the opportunity to nominate candidates, including themselves, for the BAPD Board of Directors. There will be 6 Board seats up for election.
 
The BAPD Board of Directors is made up of approximately 12 members, each serving a two-year term. Board membership requires people who are committed to Private Dentistry, are willing to contribute their time and expertise, enjoy being in a leadership role, and want to further The BAPD’s work to ensure proper representation for Private Dentistry and the promotion of quality dentistry.
 
The Board currently has monthly video meetings and it is envisaged that in a post-Covid normality there will be 3 in-person 1 day meetings per year plus an annual strategic planning retreat that would last two days. Each board member will serve on at least one BAPD committee.
 
The role of the Board of Directors is to focus on providing the strategic direction of the organisation, and ensuring that resources and structure are geared to achieving our goals. The Board does not operate the day-to-day running of the organization – it delegates this responsibility to an Executive committee.
 
Please :

  • take some time to think about who you believe would make appropriate board members;
  • encourage and support nominations that will help The BAPD establish a fully representative and diverse leadership
  • confirm that nominees would be willing to serve and have the ability to make the required commitment;
  • note that self-nominations are accepted
  • note that all Board positions are voluntary (unpaid)

 
Then fill out the nomination form and submit it along with the candidate’s (yours, in the case of self nomination) election statement. The election candidate can also upload a video message (maximum 2-minutes), headshot photo and a 150-word (max.) written submission to add to their nomination. This should reflect the reasons for standing for election to The BAPD Board and why members should elect you.
 
All positions are for a 2-year term beginning July 2021.

BAPD partners with Confidential; supports dental laboratories

The British Association of Private Dentistry (BAPD) has announced that it has partnered with confidential listening and emotional first aid service, Confidential, and that it has also been urging its membership to support their dental laboratories through the Covid-19 pandemic.

Recognising the importance of mental well-being within the dental profession, the BAPD chose to partner with Confidental, a confidential listening and emotional first aid service staffed entirely by dentists. Confidental provides a 24-hour, 7 days per week, 365 days a year, service for dentists who may be struggling, for any reason, and need a sounding board or some advice on where to turn next. The pressures on the profession have never been greater, and a service such as this, by people who understand these pressures, has never been more essential.

Meanwhile, it is crucial that dental laboratories, which play a vital role in the provision of dental treatment for patients, are supported financially during the Covid-19 crisis. With fewer laboratory-made devices being prescribed because of practice closures, the effect on cash flow for small businesses such as dental laboratories, who rely wholly or in part on NHS/mixed service practices,  has been devastating, with reports of redundancies already and now business closures becoming a distinct possibility. The BAPD urges its membership to support their dental laboratories in any way they can during this difficult time.

For information on joining the BAPD, click here: https://www.bapd.org.uk/support-us/

BAPD elects Dental Students Committee

The British Association of Private Dentistry (BAPD) has announced the election of Shivam Kotecha as chair and James Wooton as secretary to the Student Liaison Committee.

This newly formed arm of the BAPD will provide fundamental input into how regulatory decision making will impact young dentists, and how it will affect their future careers. The BAPD recognises the fact that young dentists are vital to the profession, and applauds their energy and enthusiasm for positive change. The BAPD will support their cause through our work, helping to pave a brighter future for all.

In addition, the association has welcomed new committee members, Salma Daou, Rachel Derby and Zoe Wray. All three have reportedly made ‘an immediate impact’.

BAPD announces new appointments

The British Association of Private Dentistry (BAPD) has announced a new member of its Executive Committee, as well as the appointment of a volunteer Equality Officer.

The Interim Steering Committee has elected Victoria Holden to the BAPD Executive Committee. Vicky brings a wealth of experience to the profession, and the association looks forward to her contribution and support for its mission and goals.

Sarah Buxton

Meanwhile, the BAPD is delighted to announce that it has appointed Sarah Buxton to the volunteer role of BAPD Equality Officer. Sarah has been a familiar face on computer screens during Covid-19, appearing in various webinars. She also brings extensive HR legal experience with her.

In other news, the BAPD has secured representation in a series of upcoming meetings with the GDC. Jason Smithson and Simon Thackeray will provide the voice of the BAPD, raising issues directly affecting our members. This will ensure BAPD members’ concerns are raised directly at the highest level.

BAPD seeks new guidance from government to help to screen for oral cancer

The British Association of Private Dentistry (BAPD) has advised the government that it needs to change its guidance in order to help dental practices successfully screen for oral cancer.

The Association recently conducted a straw poll of its members in order to find out whether dental professionals were encountering problems in referring patients who were suspected of having mouth cancer. The results found that 676 out of the 755 respondents had experienced referral problems when seeking secondary care.

The poll comes following research, which has suggested that more than 24,000 cases of cancer have gone undiagnosed due to the Covid-19 pandemic.

Jason Smithson, Co-founder of the BAPD, said: “The comments would suggest a multi-factorial problem; however, there would seem to be some common themes. Clearly, this is a serious problem for the profession. Therefore, we have compiled a survey that we hope to present to PHE and NHSE and may impact fallow and PPE.”

BAPD composes rebuttal of CDO letter to government

The BAPD (British Association of Private Dentistry) has issued an open letter, primarily to the government, outlining a strong rebuttal of the letter sent by the CDO to parliament on 17th June. The letter reads as follows:

Dear Member of Parliament,

Re: OCDO Letter ‘Restarting dental services’

We feel that the recent letter you would have received from the OCDO (17th June 2020) requires urgent clarification with one that is less opaque, and endeavours to encompass the experience of the entire UK dental profession; perhaps highlighting some items not mentioned by the CDO but which have had a significant impact on patients and dentistry in the UK, and continue to affect the mental health of most dental professionals.

The British Association of Private Dentistry (BAPD) is an organisation established in April 2020, whose mandate is to support and represent all those operating in the private dental sector across the UK. We represent in excess of 10,000 members.

The BAPD tabled a Vote of No Confidence in the OCDO England on 15 May 2020; writing to the OCDO on 18 May 2020 with the results: an overwhelming vote from our membership in favour of no confidence. In reply, a brief rebuttal from Sara Hurley was published in the dental press on 20 May 2020 without the courtesy of a formal response, a “considered response” being promised “in due course”. To date, we continue to await that considered response despite sending a further open letter dated 20 May 2020, to rebut her initial comments and request transparency with regards to our previous unsuccessful attempts at OCDO liaison.

We are surprised by the content of this letter to all Members of Parliament (England), dated 17th June 2020, which takes a stance bearing scant resemblance to the reality experienced by patients and dental professionals during the COVID 19 Pandemic. Indeed, this letter appears to be little more than a ‘cut and paste’ of the letter to the profession received late in the evening of the 28th May 2020. Furthermore, we feel compelled to provide formal commentary on this letter; it would be remiss of us to continue to allow this misrepresentation of events that have fundamentally reduced the ability of the dental profession to safeguard the dental health of the general population of England.

We comment formally below:

QUOTE– ”On 25th March, in response to COVID-19, the CDO asked all dental practices in
England to close for face-to-face consultations and move to telephone triage for urgent dental
issues”.

COMMENT– The CDO stepped outside her remit in asking ‘all’ dental practices to close given
her authority is limited to practices with an NHS contract: whether this was knowingly or in
error remains open to clarification.

Local Area Teams apparently received formal notification from the OCDO in mid-February
2020 to prepare for centralised triage and face to face handling of dental emergencies.
Despite this, on the 25 March 2020, a whole month later, operational readiness was clearly
some distance away, with extremely limited access, regional inequalities and lack of
appropriate PPE, compounded with tardy, scant communications from the OCDO to dentists
which further reduced their abilities to provide timely care for their patients.

QUOTE– ”To meet the continuing need for urgent dental care, the dental profession stepped
forward in partnership with the NHS to deliver over five hundred urgent dental centres across
England, for face to face access to urgent dental treatment. This was an extraordinary feat.
Access to and support from these urgent dental care centres will remain available throughout
our next phase as we work with the profession to resume face to face care in all dental
practices”.

COMMENT– During the mishandled, poorly communicated and inexcusably slow rollout of
urgent dental centres, it was clear that many were initially unable to treat patients due to lack
of essential PPE and limitations in some skill sets to deal with more complex dental problems.
Throughout the staged rollout, inaccurate communications from the OCDO gave the
impression of a level of coverage and operational readiness at odds with the reality. This
factually incorrect stance was confirmed by members of the public, our members, in addition to
key workers within the UDC sites. A lack of ability to deal with all but the most basic dental
problems remains, and it is only with the reopening of practice-based dental services that
some of the more complex emergencies can now be addressed, albeit too late for many
patients. We refer you to the attached email ( Kelly Nizzer, Clinical Lead, London Region).

QUOTE– ”With this in mind I am writing to you to update on our progress with getting dental
services back up and running.On 28th May we confirmed the intent that from 8th June primary care dental services (general
dental practices and community dental services) may resume face-to-face care (both routine
and urgent) for appropriate patient groups. This announcement was preceded by the cascade
of a “prompt to prepare” guidance for all dental practices and followed by the publication of a
detailed standard operating procedure to support resumption of dental care in England”.

COMMENT– To clarify, the ‘cascade of a “prompt to prepare” guidance’ provided to dental
practices was a single letter, delivered approximately 8 hours prior to the actual call to resume
face-to-face dental provision. This letter was dated some nine days prior (19th May 2020) to its
eventual delivery on the 28th May 2020.

The second letter from Sara Hurley stating the intent for resumption of face-to-face care was
initially sent to Dentistry Magazine (an unofficial channel) and was actually released during the
morning of the 28 May 2020 as a minimally signposted link within an on-line article that was
“hidden within plain sight”. The formal letter to the profession was only released at 5pm that
day, giving a paltry 6 working days to recommission face-to-face dental care. The standard
operating procedure document was published on the 4th June, one working day before the
commissioning date, and the first release had non-functional hyperlinks to the essential linked
documents.

This catalogue of errors from the OCDO England, promulgates the almost universally held
perception amongst the profession that they have failed to provide timely, accurate and
detailed communication to dental professionals throughout this crisis. It is frankly unacceptable
and unforgivable that a caring patient-facing profession has been left hanging in the wind
when strong leadership would instinctively know that proper planning prevents poor
performance. This rings especially true for a department led by someone with a military
background. The consequent damage to patients oral health may never truly be known, but
can be laid squarely at the door of the OCDO.

QUOTE– ”Dental care will resume in a way that is safe and with flexibility for dental practices to
do what is best for their patients and their teams. This means there will be a gradual approach
to resumption of dental treatments based on clinical risk assessments, the availability of
personal protective equipment (PPE) and the ability to apply infection prevention control
measures”.

COMMENT- The lack of PPE continues to adversely affect the ability of dental practices to
reopen. In combination with the aforementioned incompetant communication was a wholly
mismanaged patient perception resulting from a lack of joined up and regular communication
to the profession, together with a culture of myth-weaving to spin a position of operational
readiness which was clearly pure fantasy.

The outcome has been a degree of panic, stress, and indeed, mental health issues within the
dental profession, the like of which has never been seen before. Most dental practices were
only made aware that they would be able to reopen via a singular report in the mainstream
media (specifically via a ‘ticker-tape’ message in the Daily Briefing on BBC1 on the 28th May).
Many dentists remained unaware of this until their patients began to contact them that
evening.

This has further skewed the public perception of the realities of patient-facing dental care at
the current time and has bolstered the fake news that dentists do not wish to see their
patients. Nothing could be further from the truth and we view this as a national scandal.
Furthermore, Public Health England then saw fit to make available stocks of PPE for sale to
dentists via dental suppliers – with strict instructions that these be made available for sale only
to NHS practices; an instruction that was only rescinded when private dentists voiced their
objection. Given that most practices that offer NHS dental services also provide treatment on a
private basis, and with no means to monitor whether this NHS-reserved PPE would be used
on patients treated privately in those practices, this was nothing short of discrimination against
dentists who only offer private dental services and patients who seek the same.

QUOTE- “We are still advising practices to minimise face-to-face care where possible and to
minimise the number of aerosol-generating procedures. Therefore, the range of dental
treatments that patients will be offered will be different to that which your constituents received
before 25th March. It is likely to be some months before general dental practitioners are able
to provide care in a way that your constituents will be used to and will depend in part on the
further easing of COVID-19 control measures”.

COMMENT– To continue the previous strategy of using the very weak evidence base to
conflate the precautionary principle with a scientifically illiterate and illogical position, will force
the profession to continue to use aerosol-generating-procedures as a proxy measure for risk,
whereas the alternative concept of aerosol-generated-exposure can provide a better proxy
measurement within the weak and partial evidence-base. No current accurate reporting of the
deterioration of dental public health is currently available, but anecdotal evidence based
around UDCs and our members reports, suggest that the illogical attempts to eliminate risk,
rather than the judicious mitigation of risk, will further impede attempts to right the wrongs of
the previous shameful and inadequate dental response.

QUOTE– ”If you have any questions regarding the delivery of dental services within your
constituency, your first port of call should be to your local NHS England and NHS
Improvement Regional Director of Primary Care Commissioning and Public Health. You can
make contact with them through your regional NHS team, the contact details of which are your
personalised MP’s guide to the NHS”.

COMMENT– We would urge you to instigate steps for a full and timely public enquiry to
evaluate the almost entirely avoidable deterioration in dental public health during the
COVID-19 crisis and to call those responsible to account, ensuring a forensic analysis of both
the poor quality leadership of the dental profession in England, and the lessons that must be
urgently learned to prevent a repeat of this catastrophe in the future.

QUOTE-”We continue to advise that shielded patients, those at the highest possible risk from
COVID- 19, should not currently attend dental settings unless absolutely necessary. If
face-to-face care is required, dental teams have been asked to align dental care provision with
the local arrangements for shielded patients or patients at increased risk. Often, that means
dental teams will consult the patient’s GP and/or other dedicated health and social care
professionals as necessary to arrange face-to-face care in a way that the patient needs.
In some cases, urgent dental care may be provided at home by a dedicated dental team. If
that is not possible or is clinically inappropriate, the provider must have appropriate measures
in place to separate shielded patients from possible COVID-19 cases.”

QUOTE– “Initially NHS England will maintain the current temporary contract arrangements to
make monthly payments in 2020-21 to all practices that are equal to 1/12th of their current
annual contract value, subject to abatement for lower variable costs. Work will continue with
the BDA on the mechanisms for the full 2020-21 contract year with the intention of
reintroducing a link to delivery of activity and outcomes.
As a dentist of over 30 years committed public service, my priority is to best serve the patient
by ensuring access to appropriate and timely dental care. However, given the precautions
necessary to minimise the COVID infection risk, I am sure you too recognise that dental
practice has to adapt the way that they offer and deliver care with changes in pace, proximity
and protection required for public and patient safety.”

COMMENT– The thinly disguised advancement of the plan to centralise and reduce the scope
of NHS primary care, has further disenfranchised the profession: this is frankly unforgivable. It
is clear that there is an agenda to change the provision of Dental Care within England without
consulting the profession; however to do it in such a sinister and underhand manner has not
gone unnoticed by the profession.

It is apparent that even the most basic working knowledge of general dental practice has not
been gained by the CDO, despite extolling her many years of public service.

QUOTE– ”I hope this update gives you the assurance of the ongoing commitment to the
nation’s oral health and that dental care continues to be a vital component of the NHS offer to
all patients”.

COMMENT- It is absolutely clear that dentistry was both forgotten by the government during
the initial lockdown, and mismanaged to a breathtaking degree by those leaders given the task
of steering the dental profession during these unique and challenging times.

This quoted letter is a gross manipulation of the truth, which should lead to the immediate
resignation or indeed dismissal of the Chief Dental Officer, Sara Hurley.

Yours sincerely,
The BAPD