• The Guardian
  Monday 2 May 2022 5

PHOTOGRAPHS: KADIR BOLUKÇU/GETTY; COURTESY OF JACK CASTLE, EMMA BURNELL AND DABI ADESOYE; DAVE SHOPLAND/IPS/REX/SHUTTERSTOCK

For months,

my mum would

video-call me

from Nigeria

just to see my

perfect teeth

I should have

gone to the

dentist, but I

was being cheap

and trying to

cut corners

Emma

Burnell’s

aligners

did not fi t

Dabi Adesoye

before (left)

and after her

treatment

two friends in 2014 , arrived in the

UK in 2019 , when it also fl oated on

the Nasdaq stock exchange with

a valuation of more than $8bn. It

had revenues last year of $ 638m

and says it has served 1.5 million

customers (it won’t say how many

are in the UK).

As well as off ering a mail-

order service with DIY moulds,

SmileDirectClub opened

“ SmileShops ” in cities including

London, Manchester and Glasgow,

where “SmileGuides” scan teeth.

“They run this wand over your jaw

and mouth and show you these

hi-tech pics of your teeth now,

then a model of what your tooth

journey will be,” says Burnell,

who paid just under £1,600 after

visiting a London SmileShop.

SmileDirectClub says about half of

its UK customers use its shops. The

other half use the DIY moulds and

never see anyone face to face.

Regulators and orthodontist

bodies are worried. Crucially,

direct-to-consumer providers

do not X-ray patients before

prescribing aligners. “Two -thirds

of your teeth sit under the gums

and when you’re moving a whole

tooth you don’t know what you’re

bumping into,” Sood says. Unseen

problems can include buried or

impacted teeth or cysts, adds the

dentist, who says her colleagues are

starting to see patients seeking a fi x

after bad experiences with direct-

to-consumer aligners.

According to Sood, tooth

decay and gum disease can also

be missed – and this has been a

growing problem while people

have struggled to access NHS

dentistry in the pandemic. (Sood

says cosmetic dentistry does not

aff ect NHS provision because

NHS-funded clinics must still

fulfi l their contracts.) Without a

full examination, including an

X-ray, “the implications of moving

teeth can be quite catastrophic”,

says Sood, including cracked or

loosened teeth.

I n February, the British

Orthodontic Society, which is

responsible for maintaining

standards, published new

guidance. It said aligner treatment

should only follow a “face-to-face

examination by an appropriate

orthodontist or dentist” and that

a patient must be given the name

and contact details of the clinician

managing their care. The General

Dental Council (GDC), which

regulates dentists, also says that

“there is no eff ective substitute for

a physical, clinical examination ”.

David Cran , who leads

SmileDirectClub in the UK, tells me

that SmileShop staff include GDC-

registered nurses and that named

dentists or orthodontists, mostly

based in the US, approve care plans

remotely using moulds or images of

customers’ teeth before aligners are

made. Dentists remain on hand if

problems arise, albeit indirectly via

the company’s dental care team.

Cran, whose previous job was

managing the Aberdeen branch of

Debenhams, says SmileDirectClub,

which is registered with the Care

Quality Commission (this is now an

industry requirement), declines to

treat complex cases – about 10% of

inquiries – and that it has a rating

of 4.4 out of fi ve on the reviews

site Trustpilot.

“There’s obviously a traditional

approach to orthodontics,” says

Cran when I put to him Sood’s

worries about the potential

problems that only a face-to-face

check and X-rays can identify. “But

the fact that we’re not doing those

severe cases and that the imagery

we take is so sophisticated means

that we’re clearly able to identify

underlying issues.”

Not all the concerns are clinical.

The startups use social media to

market themselves as slick lifestyle

brands. But this also brings them

into contact with negative posts.

In 2020, the New York Times

reported that SmileDirectClub

had a confi dentiality agreement

for US customers seeking refunds.

To receive any money, unhappy

customers had fi rst to delete

any negative social media posts

or reviews – and withdraw any

complaints to regulators.

SmileDirectClub says this

non-disclosure provision is

“customary in both the industry

and in general business practices”

in the US and is not used in the

UK. The company defended its

strategy in the US, which has

also involved suing regulators.

“When we believe that there is an

organised campaign to damage

our reputation among consumers,

dentists and/or investors, we will

defend ourselves and our mission

to democratise access to care every

chance we get,” Susan Greenspon

Rammelt, SmileDirectClub’s chief

legal offi cer , told the New York

Times. She said that fewer than

5% of customers had received a

refund; Cran says the proportion

is “much lower” in the UK.

Burnell noticed some movement

during her fi rst four sets of aligners,

but then they no longer fi t her

teeth. She complained and a new

set arrived after six weeks. She

could not fi t these either and

eventually got a refund. She has

paused her search for a new smile.

“I should have gone to the dentist,

but I was being cheap and trying

to cut corners,” she says. (Cran

tells me he would happily make

contact with Burnell to discuss

her experience.)

While some orthodontists have

safety concerns about direct-

to-consumer aligners, which, of

course, are also a potential business

threat, many welcome the industry

shake-up. “It’s consumers who lead

these trends,” says Robbie Hughes,

a dentist and the founder of Dental

Excellence UK , a clinic in Liverpool.

“And it’s clear they want access

to something fast with a minimal

number of dental appointments at

the right cost.”

Like an independent cinema

battling Netfl ix, Hughes, 37, has

set out to off er an experience. His

clinic, where prices go from about

£4,000 for aligners up to £20,000

for a full dental makeover, looks

like a luxury hotel spa. His patients

have included celebrities such as

the Liverpool manager, Jürgen

Klopp. “There is this preconception

that dentistry is still about old

high-street buildings full of anxious

patients and bad smells,” he says.

“We want to change that.”

Hughes had to extend his

opening hours last year to meet

the post-pandemic rush. Extreme

whitening is also in demand and

can be achieved with wafer-thin

porcelain veneers. “The trend here

and in other cities is to have your

teeth done and let other people

know you’ve had them done – and

that means making them stand

out,” Hughes says.

Back in London, Adesoye had

her teeth slightly whitened and

got a small chip repaired before

waiting for the aligners to do their

thing. After two months, she began

to notice the gap closing. “I’d be in

the middle of meetings and I’d just

steal moments in the bathroom and

look in the mirror and be like : ‘ Oh

my God, I wanted this for so long

and it’s happening,’ ” she says.

It took 13 months for her two

front teeth to be united. “Eji” was

no more. She posted a triumphant

video to her YouTube channel,

Nigerian in London. Her Instagram

following shot up from about

1,500 to more than 24,000. “And

I don’t think it’s because of my

teeth ; I think it’s because of my

confi dence,” she says. “I’ve always

tried to make funny videos and

it’s only now that I’m comfortable

enough to crack jokes.”

Adesoye’s friends and family

were stunned. “For the fi rst three

months, my mum would video-

call me from Nigeria just to see my

perfect teeth,” she says. Adesoye

is about to get married when we

speak. She met Jon, a teacher,

before getting aligners. “Now

I’m able to say ‘cheeeese’ as hard

as I want without feeling self-

conscious,” she says, laughing.