• The Guardian
  4 Monday 2 May 2022

Smile like you mean it

‘Invisible’ teeth

aligners are big

business, thanks in

part to the rise of

video calling – but

some health experts

are wary, writes

Simon Usborne

Without a full

examination,

the implications

of moving teeth

can be quite

catastrophic

Correction via
plastic aligners
takes one or
two years

Jack Castle

wanted a perfect

smile for his

wedding

When Dabi

Adesoye was growing up in Ibadan ,

a city in Nigeria, everyone called

her “Eji”. In Yoruba , Adesoye’s fi rst

language, this translates roughly

as “gap teeth”. It might have been

a compliment – in Nigeria, a space

between the top front incisors is

seen as a mark of beauty, Adesoye

says – but she hated hers.

“The idea that people were

looking at my face and the fi rst

thing they would see is this

massive gap just made me feel so

uncomfortable,” she says from her

home in south-east London.

Adesoye, who is 27 and moved

to the UK fi ve years ago, had metal

braces in her teens , but they were

painful and unsightly. She ended

up having them removed early.

The gap only grew wider. She would

clamp her mouth shut for photos,

until she did the opposite to make

out that she didn’t care. “But, really,

I’d absolutely hate the pictures,”

she says.

In summer 2020, Adesoye,

who works in sales for a fi nance

software company, reached for

her laptop to perform what is

now an increasingly common

search: “adult braces”. She had

become aware that orthodontics

had changed radically since

her childhood. For so long an

uncomfortable, food-fl ecked rite of

passage for teens, the “train tracks”

of yesterday have become hi-tech,

aspirational – and barely visible.

Rather than submit to fi xed

metal or more camoufl aged ceramic

braces, adults are lining up to wear

snug, clear plastic teeth aligners

that achieve the same results. The

correction process takes one or

two years , requiring a new aligner

with a marginally diff erent shape

every week or two. After treatment

is complete, patients must wear a

retainer at night for the rest of their

lives to stop their teeth regressing.

To the consternation of many

orthodontists, anyone can order

aligners online, based on a 3D

scan or a DIY mould of their teeth,

without even having to look at a

dentist’s chair. The rise of these

disruptive startups has created

fi ssures in a traditionally slow-

moving industry, as regulators try

to keep up with innovation and

consumer demand.

While aligner technology is

continually improving, the devices,

which should only be removed

for teeth brushing and eating, are

not new. Invisalign , the biggest

manufacturer of aligners, started

life in a Stanford University

dorm room 25 years ago. But

orthodontists report booming

demand recently, particularly

since the start of the pandemic,

as social media and the ubiquity

of video calls have thrown up

new mirrors in our homes.

“We call it the Zoom boom,”

says Anshu Sood, the co-owner of

Helix House Orthodontics , a clinic

in Nottingham. Sood is also the

director of clinical practice at the

British Orthodontic Society , where

84% of members last year reported

a pandemic surge in adult patients,

mostly aged 26 to 55.

Sood, whose aligner patients

typically pay about £4,000,

says younger people who were

already open to the idea of making

aesthetic changes suddenly had

the time and cash to achieve them.

Young men are increasingly signing

up; men now make up almost half

of Sood’s patients, compared with

about 20% only fi ve years ago.

Jack Castle, 29, a lorry salesman

from Nottingham, had never had

cosmetic work done, but wanted

a perfect smile for his wedding.

“Looking back at old pictures, I

just can’t imagine getting married

with those teeth,” he says.

Then there are the video-callers,

says Sood. “They are people in their

30s and older who don’t spend

their days looking at their phones

and taking selfi es, and were not

particularly self-conscious. But

suddenly they were looking at

themselves all day on screen .”

Emma Burnell, 47, had aligner

treatment in 2020. “My secret plan

was to come out of lockdown with

this amazing new smile,” she says.

Like Adesoye, Burnell, a political

consultant and writer, has bad

memories of ineff ective teenage

braces. (The NHS continues to fund

metal braces for under-18s who

need them, but not adults, unless

they have a medical reason. Teens

are increasingly going private for

clear aligners.)

“No photos of me smiling

existed at all,” Burnell says. She

was resigned to a life with crooked

teeth, until lockdown – during

which she conducted training

courses and social gatherings

online – turned a niggle into a

glaring issue. “Suddenly, I was just

seeing my teeth the whole time .”

Adesoye paid £4,000 for her

treatment, which involved several

appointments with an orthodontist

and dozens of aligners over 13

months. “I took painkillers the

fi rst day, because there’s quite a lot

of pressure, but you do get used

to it,” she says. Then she waited,

constantly checking mirrors in the

hope the gap might begin to close.

Burnell took the more direct and

controversial route. In the rapidly

expanding direct-to-consumer

market, patients can have their

teeth scanned in a high-street store,

or even make their own moulds

using a mail-order kit. Design

software then uses the scans or

moulds to print the aligners.

The marketing for these services

gives them the feel of a coff ee

subscription startup rather than

a provider of serious dentistry.

They have huge social media

presences and paid partnerships

with infl uencers and celebrities.

But their biggest selling point is

price. Direct-to-consumer aligners

start at about £1,500, paid up front

or in monthly instalments.

Burnell went with

SmileDirectClub , the biggest player

in the direct market. The American

company, which was founded by