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Tech startups want to go inside your mouth

Tech startups want to go inside your mouth
From TechCrunch - January 27, 2018

D

ental care can be costly and hard to access, especially if you live in a rural community or a third-world country.In fact, the biggest barrier to dental care is cost.This is according to the American Dental Association, which saysmany rural areas lack access to dental professionals.

Other than the obvious aesthetic benefits of straighter teeth, orthodontics has legitimate health benefits. According to the American Association of Orthodontics, proper teeth alignment contributes to the development of a healthy bite. Properly aligned teeth are also easier to clean, which helps prevent plaque, bacteria buildup and cavities. Meanwhile, improperly aligned teeth can also wear down your enamel and contribute to teeth loss.

As it turns out, 65 percent of the population could benefit from orthodontic treatment, according to a study from the National Health and Nutrition Examination Survey. But in terms of those who get treatment, its more frequent in higher income groups.

The cost of braces and invisible alignersthose clear, mouthguard-like pieces of plasticvaries, but treatments can range from $4,685 to $6,500 for adolescents, and adult treatments can cost up to $7,135, according to a 2013 American Dental Association survey.Last year, the orthodontics market saw $11 billion in revenue, according to market research company IBISWorld.Its also worth noting that a number of Invisalign-maker Align Technologys patents around the planning phase of clear aligners expired last year.

Its no surprise, then, that a handful of venture-backed startups are now vying for the opportunity to straighten and whiten your teeth. Similar to Uber and Lyfts effects on the taxi industry, these orthodontics startups could potentially upend a hundred-year-plus-old industryand change how we access dental care.

Here come the startups

For those who cant afford braces or Invisalign,startups like Uniform Teeth, Candid, SmileDirectClub and Orthly aim to not only reduce the cost of clear aligners, but also the number of visits to the orthodontistwith some even cutting out the in-person orthodontist visit altogether.The rationale behind many of the startups that have popped up over the years comes down to accessibility and cost.

Uniform Teeth, which launched the first week of this year, is one of a handful of technology-driven startups that have popped up in recent years to get inside your mouth.Uniform Teeth costs $3,500, and offers treatment that is most similar to the experience of seeing a traditional orthodontist in a traditional setting. Before any treatment begins, Uniform Teeth requires you to come into its office to meet with its licensed orthodontist to get X-rays, scans and a dental health exam.

What differentiates Uniform Teeth from the traditional orthodontics experience is that Uniform Teeth does not require ongoing in-person visits. Instead, after their first sessions, patientscheck in with their orthodontist via the mobile app every week. For the last visit, patients come in to ensure the treatment is going welland that no refinements are needed.

Uniform Teeth was co-founded by Dr. Kjeld Aamodt, a certified orthodontist, member of the American Association of Orthodontists and teaching professor at the University of California San Francisco. The startups intent is to make orthodontics more affordable and accessible.

There are over 200 million Americans of all ages who need orthodontic treatment and less than 1% of the population receive care each year, Uniform Teeth CEO Meghan Jewitt told TechCrunch. This suggests a huge need for better, easier and more affordable orthodontic care.

Another startup is Candid, which virtually connects patients with local orthodontists and then enables those orthodontists to prescribe direct-to-consumer aligners.Candid entered the market last September, with its 3D-printed aligners. Candid CEO Nick Greenfield described it to me as being for people who need mild-to-moderate orthodontic work. Candid costs $1,900 upfront or $88 per month over two years, while braces can cost up to $7,000 and Invisalign can cost up to $8,000.

For us, its all about expanding access and improving affordability, Greenfield told me. Whats happening now is across health care, its 18 percent of GDP. Its growing six times the speed of the economy and youve seen many health care costs rise by five to ten times over the last 15 to 20 years.

Candid, which raised a $15 million Series A round last November, has a three-step process to straighter teeth. First, the company sends patients a modeling kit, so they can take teeth impressions at home. After patients send their impressions to Candid, its orthodontists review them to ensure Candid can treat their case.

If Candids orthodontists decide your case is more severe, meaning it might require some teeth extraction or other procedures, theyll suggest you go into an orthodontic office.

Orthlys approach is to connect patients with local orthodontists in person and then enable the orthodontists to prescribe the direct-to-consumer aligners. The idea, Orthly co-founder Patrick Lee told TechCrunch, is to streamline the process and make everything more efficient andlower prices for consumers.

Similar to Uniform Teeth, Orthly requires an initial in-person visit. Unlike Uniform Teeth, though, Orthly does not have its own orthodontists. Instead, Orthly connects patients with orthodontists in your area.

The naysayers

While Candid, Uniform Teeth and Orthly are all newer entrants, SmileDirectClub has been around since 2014.Over the last year, however, SmileDirect has made headlines as a result of the American Association of Orthodontists objecting to the way it markets itself and other violations.

SmileDirectClub is a direct-to-consumer teeth aligner startup that started with the idea of using teledentistry to virtually connect licensed dentists and orthodontists with people who want to straighten their teeth. Since its inception in 2014, SmileDirectClub says it has helped more than 100,000 people straighten and brighten their teeth.

The company ships invisible aligners directly to customers, and licensed dental professionals (either orthodontists or general dentists) remotely monitor the progress of the patient. Before shipping the aligners, patients either take their dental impressions at home and send them to SmileDirectClub or visit one of the companys SmileShops to be scanned in person.

SmileDirect says it costs 60 percent less than other types of teeth-straightening treatments, with length of treatments ranging from four to 14 months. The average treatment lasts six months.

The AAO asserts that SmileDirectClub violates the lawbecause its methods of allowing people to skip in-person visits and X-rays is illegal and creates medical risks. The organization has alsofiled complaints against SmileDirectClub in 36 states, alleging violations of statutes and regulations governing the practice of dentistry. Those complaints were filed with the regulatory boards that oversee dentistry practices and with the attorneys general of each state.

The AAO has provided additional supporting information to those states, as well, AAO General Counsel Kevin Dillard told TechCrunch. The AAOs position is that SDC is in violation of the statutes and regulations the AAO identified in the complaints. Those statutes and regulations exist to protect the health and safety of the public.

With any old-school market disruptors, there are bound to be naysayers.Orthodontic treatment is not a product, but rather a complex medical process that moves biological material, and is best done under the direct supervision of a licensed professional, Dillard said.

In most cases, Dillard said, orthodontists take 3D and X-ray imaging of patients oral structures, which can help the orthodontist identify issues, like weak roots or other structural problems that may make orthodontic treatment inadvisable or even dangerousincluding the risk of losing teeth if treatment is undertaken.

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