From at-home orthodontics to coconut-flavoured floss: Meet the startups disrupting the dental industry

For decades the experience of caring for your teeth looked something like this: Visit the dentist every six or nine months. Take home a new toothbrush from the hygienist. Use it to brush at least twice daily. Repeat.

If you or your child needed teeth straightened, you got a referral to an orthodontist, hoped your insurance and savings could cover it and paid whatever price you were quoted.

But today a host of companies are disrupting the dental industry with everything from at-home orthodontic impressions to coconut-flavoured dental floss in Instagram-worthy packaging to a $290 toothbrush alternative that promises to clean your teeth in six seconds.

Some are competing on price, slashing costs we'd come to think as fixed. Others are injecting luxury into the banal, working to position the age-old tasks of brushing and flossing into the realm of wellness lifestyle capturing the attention of kombucha and SoulCycle enthusiasts.

SmileDirectClub, the U.S.-based company that provides at-home, dentist-directed teeth straightening using clear "aligners" — similar to the ones provided by Invisalign — launched in Canada in November.

Orthodontic care from home

The teledentistry startup was launched four years ago and employs 3,000 people. It flips the traditional orthodontic business on its head by sending patients kits they can use to take impressions of their teeth themselves, eliminating the need for bricks-and-mortar clinics. 

As a result the prices are as much as 60 per cent less than traditional orthodontic care, says Alex Fenkell, who co-founded the company with Jordan Katzman. 

As you can imagine, anytime there's a disruptive element or product that gets introduced, the establishment gets excited and worried.- Dr. Jeffrey Sulitzer, SmileDirectClub's lead dentist

The two met at summer camp when they were 13 years old. Fenkell says, "We both had a full mouth of metal wired braces. It was a pain point in our youth."

As grown-up business partners, Fenkell says they were "shocked by the prices" and how much of the potential market for teeth straightening didn't have easy access to orthodontic care.

The at-home model allows SmileDirectClub to offer straighter teeth to people who live prohibitively far from the nearest orthodontist office. 

The Canadian Institute for Health Information says that in six of the 10 provinces people have access to less than one orthodontist per 10,000 square kilometres.

The company does have some physical locations, however, so-called SmileShops where those who live in major centres can opt to have their mouth scanned. Fenkell says the company has five Canadian locations open now and will open two more by the end of the year.

Flat price and payment plans

All SmileDirectClub treatments cost $2,350 for Canadian customers. Alternatively, they can pay a $300 deposit followed by monthly payments of $99.

The company can offer a flat fee because it doesn't take on complex cases. 

"We focus primarily on mild to moderate misalignment, which involve crowding or spacing of teeth," says Dr. Jeffrey Sulitzer, the company's lead dentist.

If a patient presents with a bite that needs to be corrected or misalignment that's more severe, the company refers to a traditional orthodontist, he says.

SmileDirectClub follows the better known Invisalign, which pioneered the use of clear aligners as an alternative to traditional braces that adhere to the teeth.

Customers receive a set of disposable aligners each a little different based on where the teeth are meant to be, shifting gradually into their desired position.

But teeth straightening isn't the only part of the dental business to change in recent years.

Sleek toothbrushes and Insta-worthy dental floss

If you're a regular podcast listener, you may have heard an ad for a sleek looking electric toothbrush called Quip, with a subscription service that delivers new brush heads on a "dentist recommended schedule."

Danish entrepreneurs just raised $1.5 million through crowdfunding of their Unobrush, a device that looks nothing like a standard toothbrush and promises to clean teeth twice as well in only six seconds. The company's website explains that users bite down on a patent-pending medical foam that moulds to the teeth and uses pulsing to clean them all at once. The foam device then slides into a docking station that sanitizes the Unobrush using UV light.

Beam Dental, another company based in the United States, links data from the electric brushes it provides to the dental insurance it sells. Brush well and your insurance premiums will go down.

Even humble floss is getting a makeover.

Catherine Cu co-founded Cocofloss with her sister, Chrystle Cu, a dentist in San Mateo, Calif., just outside San Francisco.

"She had been practising dentistry for several years in the Bay Area and she was so perplexed at this weird paradigm where she had a very healthy and young patient base who invested a lot in self-care, in going to the gym and eating the right foods, but for some reason or another were not flossing," says Catherine Cu.

The two decided to invent a floss that would remove more plaque because it's more textured, and that comes in stylish, colourful packaging that customers don't mind leaving out on the bathroom counter. It's available in some retail shops like Sephora and Anthropologie, but most customers buy through the company's website, both through individual purchases and subscriptions, she says.

Not all of these changes have been as welcome as better and prettier dental floss, though.

Concerns about treatment quality

The Canadian Association of Orthodontists has major misgiving about the quality of treatment with the SmileDirectClub model, where treatment plans and patient monitoring are done remotely, says association president Jay Philippson, an orthodontist from Duncan, B.C.

"We should be concerned about quality of care. If I start a case I want to be sure I can finish it as best as possible. People at the direct-to-consumer companies, they can't monitor the patients as well as we can," says Philippson. 

Regulatory agencies in Canada are going to have an issue with it as soon as there is a complaint.- Jay Philippson, Canadian Association of Orthodontists president

He says dentists creating and monitoring treatment plans from afar don't have as complete a picture of a patient's dental history, including X-rays and full patient files. 

"Regulatory agencies in Canada are going to have an issue with it as soon as there is a complaint."

At SmileDirectClub, Sulitzer, who has been practising for 34 years, says he doesn't find the misgivings surprising. 

"As you can imagine, anytime there's a disruptive element or product that gets introduced, the establishment gets excited and worried," he says. 

But Sulitzer says that when he talks to wary dentists and orthodontists about the treatment process, company mission and that it doesn't take on complex cases, many come around.

Fenkell draws an analogy to the auto industry, where there are vehicles at many price points. If only traditional orthodontic treatment is available, he says, it would be like saying that "unless you can afford a Mercedes-Benz, you don't deserve to drive."