As an orthodontic consultant and the CEO of StraightSmile Solutions®, I am frequently asked to report on the pulse of the orthodontic industry. A year ago, I was one of the first bloggers to report on the Invisalign Store® experience and franchise developments. As an initial team member of the SmileDirectClub®, a Bay Area native, and a citizen concerned about corporate cannibalization, I openly welcomed the opportunity to visit both the Candid Co® and Uniform Teeth® stores in San Francisco, learning more about the future of DTC orthodontics.
Setting up the appointment online was simple, and the appointments were convenient and plentiful. Their brick-and-mortar store is in the swanky, financial district of San Francisco and, interestingly enough, is on the same block where I had my first summer job in retail at high school! Like Invisalign Stores®, Candid Co® has certainly invested in prime real estate.
I was prompted to sign a TOS online in advance to “save time.” It consisted of a medical/dental history and an informed consent form, which was more robust than that of the Invisalign Store® and other comparable direct-to-consumer (DTC) aligner companies. However, I did find parts of it confusing and redundant.
At first glance, the process seemed like any other DTC aligner company. As a matter of fact, this company has just recently been infused with 4 million dollars of funding from venture capitalists looking to invest in the DTC aligner industry. That being said, I was disappointed; the appointments were neither convenient nor plentiful. As a matter of fact, they only book appointments in the morning and the early afternoon, and the next available scanning appointment wasn’t for 3 weeks! After some due diligence, I realized that this is indeed not at all a DTC aligner company, but an orthodontic office cleverly disguised as one. This is just one of the locations of the orthodontic practice of Dr. Kjeld Aamodt, who is a fellow UCSF grad. I can hardly believe that my alma mater supports the use of UCSF in all his marketing materials. Hats off to Dr. Aamodt for rebranding his office as a DTC aligner scan shop during non-prime hours. It’s a clever use of chair time and staff utilization, but I don’t think there is anything proprietary about this process. In reality, any dentist could do the same with an in-house aligner lab and Dental Monitoring® System.
Once I scheduled the appointment, I received several texts and emails about the process and was informed that I would indeed be scanned and examined directly by a licensed, UCSF-trained orthodontist. He even named the doctors who may be doing my scan. I would also receive, as needed: a complimentary panoramic x-ray, a CBCT and oral exam for periodontal disease and pathology.
Those who were selected for Uniform Teeth® would have minimal to no additional appointments and would be using teledentistry for check-ins. Once I found out the true story, I canceled my appointment. I do not consider Uniform Teeth® to be part of the DTC revolution.
Candid® Appointment Day:
Candid was running behind on their appointments. They did text me in advance to let me know, which I appreciated. I was given a bamboo toothbrush and some sparkling water while I waited. They did check my ID to verify my identity. I waited for almost an hour to be seen, but I wasn’t bored because there was quite a lot of drama in the packed waiting room. One father was furious because although he was able to schedule a scanning appointment, the scan techs declined the patient, who was underage (13) and had no ID. Candid® only accepts patients aged 16 and older – but to the father’s credit, this policy wasn’t clearly indicated when he made the appointment. The father was given a handful of Starbucks gift cards and a profuse apology. I do respect this decision from the corporation because patients who are still growing shouldn’t be treated with DTC aligners and there’s no way to access growth in a remote setting without a hand-wrist x-ray. It’s only a matter of time before the DTC companies like Invisalign Stores® start to venture into this arena, though!
Finally, it was my turn to be seen and although the tech was very kind and professional, she was untrained. She was not a licensed RDA, DA or RDH in the state of California, either. I have to give credit to both SmileDirectClub® and Invisalign Stores® for a much better scanning experience. The Candid® Tech routinely violated numerous HIPPA and OSHA regulations; she also wore very little PPE. Her scripting was quite erroneous. The scan with a Carestream 3600 and photos was a tortuous 39.5 minutes of pure discomfort. The chairs didn’t recline, and I was forced to contort my head, face, tongue, and neck into all kinds of awkward positions for her to get her images. The quality of her records was abysmal. In reality, I’ve personally done this with the same equipment in less than 6 minutes. After the scanning session, there were some hard sells and bargaining, during which it became evident that this tech was compensated on commission. She created all kinds of BS to try to sell the aligners to me up front. I could almost say that she was practicing dentistry without a license because she was clearly diagnosing and treatment planning. Although I don’t feel that DTC Aligner companies are violating any dental board regulations, I do know that many California Dental Board regulations were inherently breached in that 39-minute appointment. Here was her diagnosis and treatment plan:
- She told me that the black triangle between my lower incisors would eventually cause decay if not corrected with aligners immediately.
- I was also told that my (at most) 3 degrees rotated LR7 would cause “severe TMJ” if not treated by aligners.
She tried to get me to buy the set-up sight unseen for an initial discount of $100. The hard sell continued, reminiscent of buying from a used car dealership. She upped her ante to $200 off if I purchased in full today. I declined and eventually, she set me up with an appointment with her treatment coordinator, Jared, who would consult with me at a later date once my treatment plan was ready for review. Since she didn’t land the sale, I didn’t get a swag bag like the others, and I was escorted out without barely a “thank you”. All in all, I would give the Candid® store experience a 1 out of 10. Since it’s supposedly a company run by orthodontists, I was very disappointed in the experience.
Visiting the scan shops is a wake-up experience for this seasoned orthodontist. The industry is changing, and you need to reinvent yourself or get lost in the shuffle. If you have questions about scaling orthodontics outside the DTC arena, please visit www.straightsmilesolutions.com for more information. Since growth modification and airway are a huge part of my consulting practice, I am absolutely excited to witness the DTC pivot into using teledentistry to help correct bites with elastics and removable functional appliances. It would be a very easy value-add to the DTC dental industry.
Post note: Team Candid® did contact me after this article was published and ensured me that any compliance concerns addressed in this letter have been addressed and corrected.