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This was the most difficult interview I ever recorded for Protrusive Dental Podcast. I was approached by a representative from Smile Direct Club to appear on the podcast. I had mixed feelings but knew this was an opportunity to ask some good questions and gain an insight into how this active and significant stakeholder in clear aligner therapy (whether we like it or not) operates.
Need to Read it? Check out the Full Episode Transcript below!
Protrusive Dental Pearl: In terms of efficiency in doing your IPR, be sure to plan your IPR and your ClinCheck so that a lot of the IPR happens in one go when the contact is more aligned.
The highlight of this episode:
10:13 Current market trends for clear aligners
12:59 Animosity Between Smile Direct Club and Dentists
17:19 Patients that are suitable for Smile Direct Club
19:33 Smile Direct Club’s Workflow/Patient Concern
30:32 Patient Education about Direct Smile Club
33:44 SDC’s ‘Lifetime’ Aligners?
37:11 SDC’s Night Time Aligners?!
43:20 SDC’s pop up shop within Dental Practice
46:55 Dental Boards vs Smile Direct Club
53:16 Patient Support Network?
If you enjoyed this episode, you will also like GDP Alignment vs Specialist Orthodontics
Click below for full episode transcript:
Opening Snippet: Carrying out orthodontics is radiographs, temporomandibular joint assessment, Periodontal probing, periodontal diagnosis. Where is that in the workflow? So essentially what I'm asking Dr. Ataii is if someone doesn't see you and goes to perhaps to one, the pop up shops in the street, what is the workflow? And do you think there's something that should be improved in the workflow and let's learn about the workflow first I think before we can then as dentist be critique that.Jaz’s Introduction:
Hello, Protruserati. I’m Jaz Gulati and welcome back to the most difficult interview I’ve ever had to do. When the opportunity first came to discuss with a representative from Smile Direct Club, you can imagine my initial thought I was like no way, I’m not giving them any airtime, right? That was the initial thought. And then I just pause and I thought okay, this is an opportunity. So I posted this about this invitation to our group on Facebook Protrusive Dental Community and oh my god, you guys are hilarious. The amount of stuff you guys came out with saying do this, do that, ask him this some real tough questions or whatnot. And then Jonathan Doron, one of my buddies, one of the Protruserati, he made an awesome comment, right? And he got me thinking, okay, so amongst all of them on there, read his comment out it says, “If you think Smile Direct Club are doing something wrong, as most dentists do, then why not have them on and debate it. They’re already here and providing the treatment whether you do or not. It would be an interesting break from the usual format, which you know, I love already. And it would genuinely like to see them come on and have a discussion in good faith.” And that was the most beautiful thing. So Jonathan, thank you so much, because that really helped me and it was a guiding comment for me in terms of how I’m going to approach this interview. Because look, I’m gonna be straight up with you all. A) I don’t want to get sued. Okay, I want this podcast and I want to be able to feed my family in the future as a dentist, so I don’t want to get sued by anyone for any kind of thing, defamation, right? So I came and approached this podcast in a sensitive way. And I feel as though would I have asked certain questions in a different way. Had I seen Dr. Ataii, Dr. Payam Ataii, our guests and he was lovely. So thanks so much for being so lovely, Dr. Payam Ataii. So had, I would have asked him in a different way? Had I known him a bit better? And also, in a private situation, not in a publicly aired podcast. Yes, I would have asked in a completely different way, but to preserve the good faith and good nature of a debate, and because at the end of the day, yes, he’s a representative of Smile Direct Club. But he’s a human and you know, he’s smiling back at me. I didn’t feel like making him feel bad. So that’s the angle I came up with. Now, we do discuss concerns about patient safety, because for me, the way I’m approaching it is very much same as Jonathan, Smile Direct Club are here to stay. Whether we like it or not, they’re here. In fact, when I watch her cricket, I watch her videos, but the only thing I watch on TV is cricket. And on Sky Sports. Every fifth commercial was Smile Direct Club. So they are everywhere. They’re on tik tok. They’re on TV adverts, all our patients by the time they’ve come to see me for an Invisalign consultation. They’ve seen the adverts, they know about Smile Direct Club. So my agenda is how can we raise the patient safety? Because what I don’t want to see is people patients, because people are, our people are our patients, right? Them having suffering or having problems because they have problems even with my treatment and your treatment. Let’s face it, right? Orthodontic treatment doesn’t always go even by a specialist, you know, there’s always some complications. But as long as treatments are done with the patient safety being number one concern then that is the most important thing. So I do challenge Dr. Ataii on patient safety. And so this episode is here for you to listen to and enjoy. And for you to make up your own conclusions about what you feel. And you need to kind of read between the lines. And I encourage you to be open minded and learn because I think at the very least let’s learn about the workflow of Smile Direct Club, so we know where they’re coming from, and how it may actually suit certain patients. But why there is this friction animosity between Smile Direct Club and dentists and what the future may hold. The Protrusive Dental Pearl I have for you is related to orthodontics and one of the things that we discuss it that those patients who go on to have Small Direct Club aligners or retainers, they do it without attachments, and they do it without IPR. So this is interesting and really crazy, they have something called nighttime aligners. Blew my mind, right? So I discussed about that. And I probe about that and I challenged about that. And I request about that, that we need research thereafter. So if this is gonna be working, if nighttime aligners for less than 12 hours is an option, and it’s working and it’s out there, then I want to know when As in the interests of science and the progression of dentistry, I want to know what cases it works for, what the success rate is, etc. So as an opportunity for research, but just backing up a little bit now, the tip for IPR, very basic, but if you’re an experienced aligner practitioner, then you know this already, but some of the dentists listen there might be new to aligners, new to Invisalign, new to *insert brand of aligners. When you are told that you need to do some IPR. And I’ve said this, like four or five times on a podcast before I’m sure I have, but I think I’m gonna say it because I met a dentist the other day, and he was Oh, my God, I had the longest appointment ever. I do so much IPR, do you know, how difficult is to 0.5 millimeter IPR, between every tooth between 6 to 6 and it took me like an hour and a half and the patient was in agony. And so the problem is, my friend, my colleague here approached a situation that he thought when on the ClinCheck, because he was using Invisalign, when it went yellow 0.5 He thought, Okay, today, I need to make 0.5 Okay, this is not true, guys, okay? All that yellow means is that there’s a collision that’s about to happen. And so you need to create some space. So you need to do you know, 0.1 or 0.2, get some space, okay? And then a few weeks later, you can do another 0.1, 0.2. In terms of efficiency, then there is so much more efficient, if you actually clever in your planning of your IPR and your ClinCheck to actually plan it so that a lot of the IPR happens in one go when the contact is more aligned. And then you can get a better quality of IPR as well, rather than doing it sequentially at different times, so you can be clever in the planning. So there’s so much more I can go into an IPR. And if you haven’t already checked out the ultimate IPR episode. Please do, something I’m really proud of, the work spent loads of time to make and it covers the main different ways of doing IPR in one episode, and clinical videos, etc. And I discuss more about planning, orthodontics and IPR. So do check that one out. And now let’s join our much anticipated episode with Dr. Payam Ataii, a representative of Smile Direct Club aligners. Can you believe it is happening? Here you go.
Main Interview:
[Jaz] Dr. Payam Ataii, welcome to the Protrusive Dental Podcast. How are you? [Payam]I’m fantastic. Thank you for having me. [Jaz]
It’s great. And this is a real opportunity here for dentists to learn more about the current trends in aligners, about the, you know, the Smile Direct Club, let’s just talk about the elephant in the room. Smile Direct Club has come along, and a lot of dentists have got scared and worried. And it’s a great opportunity to have a bridge, a discussion here today, which will be the main meat of what we’re discussing. So I’m very excited to get into that. When I told my community that someone who works very closely with SDC, we will astray, they got very excited. Yes, we had some comments of concern and whatnot. I said, Listen, you know, one of Stephen Covey’s habits, for success was seek first to understand and then to be understood, so I’m really looking forward to having our discussion now, please just describe your role, and also what it where it is that you do and where you’re based. And just a little bit about yourself, Dr. Ataii? [Payam]
Sure. Yeah, so I’m based in Orange County Southern California, United States. And I’ve been treating patients with clear aligners, a little over 19 years, I was one of the early adopters, when if you remember clear aligners were born and with Invisalign, and kind of mass produced in a way. So I was one of the early adopters, I became faculty at aligner, kind of had a teaching position for 14 years with aligner. And as you kind of grow in the aligner space, and your patients kind of grow with you, I noticed that there’s other options coming in the market, you know, being, you know, Smile Direct Club being one of them and these options and opportunities, instead of me kind of shying away from the mic wanting to find out what it’s all about. So for the past year, year and a half now, a couple years now I’ve been offering Smile Direct Club as one of additional aligner services that I also offer to my patients with, you know, Invisalign and other strommen now has ClearCorrect. So there’s multiple aligners that fit different modalities of patient treatments. [Jaz]
And do you exclusively do orthodontics aligners? Or do you, are you a generalist? Because I just saw recently a video on YouTube, you talking about I think, sleep apnea, which is a very good video, by the way, you present yourself really well. Tell us about you know, is that all you do? Is it more to it? [Payam]
Yeah, so I’m a general practitioner, so I do practice general dentistry, drilling, filling crowns just few minutes ago, I just got done doing a class two that I thought was going to be simple and it turned in to be a big deep decay. So I still do general dentistry, I do crown and bridge and yes, Sleep Apnea is one of the things that I got and start treating patients about 14 years ago, because when you start to do aligners, you’re going to notice that these removable type of appliances like clear aligners or anti snoring if you will, kind of open the other avenues of not just drill and fill but patients you start to see airway, you start to see better oral care so now you start to going whole health and full body. [Jaz]
Absolutely agree. When I did my Orthodontic diploma, the first thing I started to notice in people was beyond the teeth. I started to notice people’s faces more. You know, who’s long faces, short face and all these things that was the most biggest revelation when I started to learn more about orthodontics, so I completely agree with you there. So first question, generic question Dr Ataii is, what are the current market trends for clear aligners? Like, we’ve seen a boom right, like, and I don’t know how far back this goes, you’ve been in the game way longer than I have and are we gonna expect this boom to continue? What is the current state of play in that rod? [Payam]
Yeah, absolutely. Look, when I first started talking about aligners, and this is back in 2003, talking to dentists and just general practitioners and some orthodontist that look, there’s this plastic appliance that you can kind of put in an upright teeth and kind of move them around. And these minor at that time, minor movements can create volumes of beautiful smiles. And, you know, it wasn’t really accepted until about maybe 2010. When all of a sudden you saw aligners being pitched on the media. You know, obviously social media wasn’t as big but still had its growth in marketing. So patients started to kind of look at their smiles as instead of veneering. Because remember, 2008 2009 2010 it was all about veneers. You know what kind of, how thin is the veneers, how DaVinci veneers. Emaxs that was starting to give abroad. And I remember, at one point, we talked about those ceramic crowns. Ceramic crowns, I mean, no gold? How’s that possible? How you gonna cement it? So, you know, when you start to see that rise of patient education. And you start to notice that, you know, the aligners are really in demand now, I mean, they’re discreet, they’re easy, and I see it on the rise. And I you know, when you start to look at the math, and when even Invisaligns numbers that they say we’ve only treated 10% of the population, you know, 10% is all that they’ve really penetrated that’s 90% left to be treated that have malocclusions absorbed. So I think it’s on the rise. I think that clear aligners are going to be the right, right there with white fillings. I mean, they’re just kind of escalating to a point where a lot of companies now are delivering this even now you see what Smile Direct Club remote, and having those tele dentistry kind of on the rise as well. [Jaz]
Well, I’ve seen the obviously trends increase in general practice, but also amongst specialist I know, plenty of specialists who, initially are specialist community perhaps was a bit resistant to accept clear aligners. And then what I found is speaking some colleagues that actually they’ve moved to no longer doing fixed appliances. They’re a specialist, but they’re no longer doing fixed appliances. And they just choose to niche themselves into being just the best time there is including monotherapy. I think that that talks that speaks a lot of volume actually [Payam]
Add that because advances in actual technology, we think about the treatment plan software, I mean, look at the advancements where we’re at in 3d. So I’m glad that they’re considering themselves removables. I think removables is the way to go honestly, but go on sorry, didn’t mean to interrupt. [Jaz]
No, please. That’s a, I’m very welcome interjections like that. That’s good. So dentists are concerned about Smile Direct Club as competition. So the competition being that okay, look, I’m a general dentist, and orthodontist. And now, there’s a feeling of animosity because the dentist feel like we’re being undercut. And that now, you know, on social media, dentists say, Oh, DIY aligners or mailorder aligners to try and make it seem or just try and just refer to SDC aligners as inferior if you like. So they try and use different terms, what not, we got to have to go through all of them. But why do you think that? And where do you think animosity comes from? Is it just because dentists feel like financially, they’re now getting a smaller slice of the pie? [Payam]
So let’s go back to about year and a half, two years ago, when I had the same feeling. So the main reason why I wanted to look under the hood and see what it is that Smile Direct does. Because you only see the cheapest price or the you know, the reality is that patients tend to go towards something inexpensive, rather than us being the expensive route. And then you start to demographically look at these patients. Well, when I first had engagements with Smile Direct Club, I realized, look, it’s not justified for us to be worried because if anything, the amount of marketing and dollar that they spend in educating patients, not every patient is a candidate for Smile Direct Club. So here’s the fact, the fact is that Smile Direct Club only treats those minor movements, you’re talking, you know, the social six, they’re not correcting crossbites, they’re not doing full class twos or class three type orthodontics. And a lot of times those patients actually get rejected and guess what they go back to? Us. So the patient already knows they don’t qualify for $2,000 deal. And now they know that they tried every avenue not to pay that 2000 And guess what? Now they’ve been kind of I like to say now they’re a warm lead, right? So for us when you start to look at the overall patient IQ, look they’re starting to get smarter. I mean, this idea of social media has really gotten to a point where my 14 year old says, Hey, Dad, are you giving me Smile Direct Club? Are you give me Invisalign? What are you giving me? Your 14, how the heck do you know? I mean, he might have heard things. But his social media folks are talking this, 14 year old friends are talking. So I don’t think they’re undercutting if anything, I think they’re helping increase that patient IQ with the amount of marketing dollars they spent. And out 10 patients, how many of them are really a candidate? Probably about three, guess what happens to the rest, that’s like seven of them that are going to come back to our laps, we as practitioners have to be prepared to have the conversation. Look, it’s a great tool. It may not be for you. But it serves a purpose for those underserved minor social six tooth movements that patients are looking for, they’re not looking for perfection, if good is good enough, that they’re happy with that, there’s the $2,000, but be prepared for you to pick up the difference of patients that are coming to your practice, rather than cutting them off and say, you know, as a matter of fact, I joined what’s called a Partner Network in their group where they actually send the patients over to me, I get to have a crack at them for fillings, crowns, because they’ve been advertising this $2,000 deal, patients are coming in to get a scan or an impression. And guess what they walk out with? An idea of their cavity, their tooth, and maybe or maybe not, there’ll be a candidate, but they hope that they will be and guess what happens when they’re not a candidate? They come back to my practice for full price fee. I think that’s where we’re missing the boat, we’re missing those. I cannot spend millions of dollars advertising my practice, but I can join a company that does [Jaz]
I just want to agree straight away, because there might be some things in this podcast that we disagree with. And let’s do that in a winning good camaraderie and good spirit to have a good educational discussion today. But I have to agree that the presence and marketing that Smile Direct Club have brought like, you know, that awareness. And I do think that is fueled over the past few years, how many conversations we’re having with our patients regarding orthodontics, and straight teeth. So I would definitely give that as a as a bonus thing. And that’s it, you know, lots of dentists are worried and concerned and stuff, but for sure, a lot of dentists may not have considered that the free marketing that kind of getting is there. Okay, so let’s Yeah, I completely wholeheartedly agree with that. You mentioned about some cases being rejected, and maybe three out of 10. So that’s really interesting to know, because one question further down as a spin off was, Do you know what percentage of applicants it turns down? Because they’re not suitable for treatment? [Payam]
Yeah, so, I know that I can give you based on my experience. So patients are going online, my office happens to land in their zip code, they come in to get a scan or an impression. And I said, I mean, I see some of them that there’s no way in heck that they’re going to kind of, you know, qualify, because young and three or four millimeters of movements, that Smile Direct, really accommodates. And I don’t want to burst their bubbles, because I don’t want them to think I’m trying to sell them my office. So I can tell you out of 10 I’ve literally have seen about three to four get accepted with Smile Direct Club and the rest is every [Jaz]
10 that come to you as the sort of middleman between you and Smile Direct Club and then getting it, three out of that, three to four out of those 10 will actually be eligible based on their malocclusion to have the treatment? [Payam]
Right. Absolutely. [Jaz]
That’s really fascinating. That’s fascinating. [Payam]
Keep in mind, they have state licensed doctors that look over these patients, right? So they have their own treatment planning software that their state licensed doctors are looking at. And if their doctors don’t feel comfortable if they want an x ray, they want some other information, again the patient comes back to me and at that point if the patient hasn’t been accepted they get, I think like three rounds of doctors that look at them you know that these, Smile Direct doesn’t want to say no to money, let’s just be honest here, they’re gonna say yes, but they’re doctors those seven that did not get treatment is probably because their doctors didn’t feel comfortable. So when you say do it yourself or do it your self type of a scenario it’s really I’d like to market that as a telemedicine, the doctors still behind the wheel. Now the phone calls and all that little attachments and IPR Okay, that’s all out of the way. So in my mind, if you look at a patient in your practice out of 10 of them how many of them have minor movements that fits right in that smile direct club category that for, you know, three to four patients? [Jaz]
Well that I think is well and good patients coming to see you, you’ve got so much experience and you know general dentists and getting get a feel for what you’re about and stuff that’s good. But what about the patients that go to a pop up shop in the mall or High Street wherever and they never get to see a dentist face to face. So let’s talk about this. There is a concern because when someone things that I would check before carrying out orthodontics is radiographs, temporomandibular joint assessment, Periodontal probing, periodontal diagnosis. Where is that in the workflow? So essentially what I’m asking you Dr. Ataii is if someone doesn’t see you and goes to perhaps the one that popped up shops in the street. What is the workflow? And do you think there’s something that should be improved in the workflow? And let’s learn about the workflow first, I think before we can then as dentist be critiqued. [Payam]
So what I want to tell you is I’m basically a pop up shop. Right? I’m bait, when I when we talk about the Partner Network that’s given the way that the olive branch has been extended from Smile Direct Club to the general practitioners and orthodontists say, Look, we’re more than happy to refer these patients to your office. These are our consumer patients, you scan them, you send them, but if there’s cavities, or fillings or cleanings, go ahead and do it, let us and our doctors make the decision. So here’s the way it works. The workflow, the patient, either they send the impression that a pop up shop in my office or at home, they send it in and that 3d software, the doctor gets to look at. As scenario where the movements are beyond what Smile Direct Club has within their own system. They then reject the patient or tell the patient I’ve seen this, it’s an email that goes we’re not 100% confident that your smile can be reached. And here’s the best you got to get some patients like that’s fine with me. They went from here to here. They’re OK with it. But some patients say no, I want something more. So they’re given that opportunity, because the doctors behind the wheel are the ones that say yes or no. From there, these pop up shops or at home or my office. They’re just the center to scan just like how, as an orthodontist, you go somewhere to do a ceph, right? The reality is there’s software and the doctors are who’s behind the wheel. Now, I can tell you, I’ve had some cases that patients have come in, they’re like in the middle of treatment. And I look at that patient I go, this was an ideal patient, why? The two teeth are banging against each other. There’s some mobility going on, as you know, time space and pressure, that pressure is needs to get maybe into approximated. And I look and I say all it needs is an IPR. But the patient hasn’t been told IPR, the patient accepted. And I look at their video. And I’m like, wait, the video shows that the tooth still has an overlap. And the patient says, Yeah, I know. But I thought they would fix that. Meaning that the patients saw the movement, but still wanted to override that movement. That’s the main problem. The main problem is how do we get the patients to understand and I know smile, direct club is doing a good job in educating the patients. I just don’t feel that the patients understand what they’re really getting. Because the movement they show, clearly, you’re going from here to here, is that good enough. Patient says that is good. But maybe I can push a little bit more. Maybe I can get you know, I’m gonna be okay with this. But maybe because they say like, remember, Smile Direct Club says lifetime aligners. So what happens is, the reality is not the pop up shop, not the doctor, but the patient education part of it. And that’s what I see smiledirectclub really doing now. I see them now saying, Hey, here’s, I see before I used to see this big fat spaces, and they’re closing them. Now I see these minor spaces, I see these minor movements. I think they’re starting to now catch on to show Hey, patients, these are the cases that will be ideal for you to kind of come over for us to help treat. And I don’t know if that helps you any. [Jaz]
Now that that does an annual evaluation of that case that you described, where perhaps it could have benefited from IPR. It might make sense. But again, when they come and see you, that’s great. But let’s say they go to a mall, and they have a scan. At what point does the doctor do they get to see A) they get to clinical images? Do they get radiographs? Do they get paid on the probings? Do they get a joint assessment? Do they get to see the biotype of the gingiva? At what point does that happen? Did that happen to someone who doesn’t come through you because you can’t blind yourself, you’re going to look at that. Right? So where does that happen when they do the impression themselves? At what point does the doctor have input on that? [Payam]
Yeah. So if you’re doing minor movements, for me, if the tooth and scan show a healthy tooth structure, then I’m going to maybe just simple closure through two or three millimeters, I’m fine with no X rays because I have a 3d or a scan of that patient. But there’s times when they ask X rays, there’s times when they ask for the patient’s to go be seen, for instance, an open bite or a there are certain cases that these patients have to now go outside the mall and get those additional radiographs or films. How many of those cases are like that? Again, I go back to that my experience that, you know, we I can tell you one or two times they requested X rays on cases that have been really simple. I’m like, wait a minute. I don’t need X rays for that even in my own practice. But the doctor wanted it for some reason. Maybe it was a uprighting of a molar they were doing or maybe bicuspid movements, but because it’s the sixth anterior teeth typically radiographs and those TMDS I mean, think about it if you’re just moving as an orthodontist. If you’re just bringing teeth back, you’re not moving bicuspids or molar and you just reclining back a few millimeters, I don’t know if X ray or stuff is needed, we’re talking what 16 aligners at most, maybe 10 aligners at most, less than three months. These are the type of treatments we’re talking about. Beyond that, I’ve seen them request X rays and Perio probing and additional information. Now, does the patient follow up with it? No, I’ve seen patients come to my practice saying, You know what, just tell me how much your cost is, again, they educated the patient. Now the patient got burned out, and is finally coming to do the work through a potential practitioner. So I see it in both realms. I have not seen pop up shops necessarily take X rays, but then again, it’s up to the doctor, the clinician to request it if should they wish [Jaz]
My only concern is like you from a scan, you can’t tell who has got periodontal bone loss because sometimes you get pocketing six millimeters and you think that gingiva was fine. So what about those patients that could be because we don’t want to be doing orthodontic movements on teeth that, obviously are involved in active periodontal disease. And the other scenario to discuss as dentists here because it’s a dental podcast, you know, it’s not for patients is trauma, history of trauma. So one of the things I will check for, amongst other things is Okay, have you ever had trauma before, because then you’re significantly at risk of root resorption. If you’ve had a trauma as far as orthodontic treatment, we know that so is that part of the screening within Smile Direct Club? And it’s great. If not, then perhaps that needs to be a discussion that we should have as clinicians who want to at the end of the day, it’s all about patient safety at the end of the day. [Payam]
So let’s talk about Smile Direct Club, what they provide, they provide a portal, they provide a process for clinicians, state licensed clinicians, they have a few 100 of them, but for them to look at the photos, look at those 3d scans. Look it from all different angles of the patient’s really gum tissue, if they want and want to request the perio probe or an x ray, they can. Remember Smile Direct Club, what they’ve done really well is they’ve kind of created this process and software and an app where the patient 24/7 has access to a doctor or to a call center. Think about even in my office, I’m working Monday to Wednesdays, Thursdays half days, they only have access to me at that time, right? So Smile Direct Club provides this basic portal, if you will, in process, what the doctor does with it is like in your case, you look for trauma. In your case, you look for periodontal issues. And if the scan is not enough, then they do request for that. I think that’s the misconception that doctors don’t know and I didn’t know. I didn’t know that there’s actually a doctor behind every case, there is. Now some doctors have dedicated their entire practice to this. Some doctors are actually practicing orthodontist, few of them I actually met that there was a meeting that I got to meet a few what they call ELPs. And these are doctors within the smile direct network. And they’ve been kind of like really proactive about fine tuning. What case are we going to ask for x rays, what case do we know if it’s just simply closing? Do we really need because that the scan images is a really good image you can see gum tissue, you can see puffy gums. But if you see red puffy gums, and on the photos, red puffy gums are there even at the Pop up shop, you’re taking photos, then they’re going to request that and that’s what the portal allows them to do. [Jaz]
Some dentists will say that, well what kind of system is this because aligners don’t work without IPR and attachments? What would you say for that? [Payam]
So, here’s been my experience. For rotations, 20 degrees or more, you’re going to need an attachment. For extrusions, you’re going to need an attachment for short clinical crowns, you’re going to need an attachment, IPR if you’ve got teeth that are overlapping. And even if you have greater than four millimeters of overlap, you know, I am just for your doctors listening, I just use the dummy version of a perio probe, you know, I just show it to my patients. Look, here’s a perio probe here’s what three millimeters looks like. I put that horizontally over their teeth. And if I could show them, this has got two or three millimeters of overlap. This is going to be an area where it’s going to be a problem. We may need attachment, we may need to put your teeth on a diet, IPR. You know, I kind of say that to them. Smile Direct Club, if you notice a lot of their cases are spacing cases. A lot of their cases that go through the treatment are this minor overlap. There’s no extrusions, very limited posterior movements, very little rotations. So when you look at the type of patients and you look at the before and afters on their social media posts, you’re going to notice out, these are like four or five month type six less than six month treatments. But the image that the dentist has is they’re treating everybody. Well. That’s not true because you have at least what 70% of patients out there that have class one bite with minor crowding less than four millimeters. That was one of the aligners statistics they used to teach all the time. So that’s who they’ve tapped into, they’ve tapped into that market, those aligner cases that you do that are three to six month cases. You know, I don’t think these patients even want attachments, or they even want to have that, you know, they’re looking for the cosmetics, literally, [Jaz]
It’s a really simple case. And if I can do it without attachments, in the old time, I would it makes sense. So it kind of paints a picture of the ideal avatar ideal case forSmile Direct Club And why it can work without attachments and IPR. So I get that. But then it’s also like, I guess the danger is patients doing something and then not being happy with the end result, but then not really realizing that actually it took to get the desired result, they should have had IPR and they should have had attachments. So how do we educate? The problem is how do we educate the patients so they can make a better informed choice whether they do go ahead with a limited outcomes with Smile Direct Club? Or they get the whole cake with by going to a dentist, just like you said, how can we educate those patients so that they can make better decisions for themselves? [Payam]
I think this is where Smile Direct Club is really making headway with their Partner Network, right? So the doctor partner network is really their way of saying, Guys, look, we’re here to help you, we’re going to get these patients regardless, we have our doctors, we’re going to reject, you know, these potential six or seven patients potentially, it’s going to land maybe on your lap. So if we can at least agree that give us a crack at those simple case like myself, I had a patient who had wore aligners 10 years ago, okay. She didn’t wear her retainer. She came to my office, and she had started getting diastema between her anterior incisors, and a little bit of rotation on the lower anterior crowding, right? So I asked her, I says, Have you been wearing your trainer? Oh, no, I lost it. I’m so sorry. All right, well, you know, what am I going to quote her? It’s going to be another 5000. It’s going to be another 2000. It’s going to be you know, 10 aligners, 15. And she felt as if I owed her aligners because she paid me already. Now remember, she did this 10 years ago, and I’m looking at it. I’m like, You know what, I have a perfect solution to your problem. She says, What is it, I said, you’re going to need retainers, retainers are at least 500 bucks, you’re going to need at least some sort of an office interject which it’s got to be at least 1000 bucks on my end. I’m going to give you this opportunity of using Smile Direct Club, you get your retainers, you get your and you have the treating doctor, I’m still your doctor for your everything else. But because you weren’t a good patient and didn’t wear your retainer. I don’t feel comfortable charging you another fee. But guess what, all of this is built in for you and they get lifetime aligners. That was a perfect candidate because she had a small diastema, little rotation that would have worked less than three, four months changing her aligners and she wanted to only wear it at night, they have this nighttime aligner that works perfectly for her, this is where Smile Direct Club has really done well in my practice, because now I know that there are certain patients A) it’s affordable B) It’s a remote, the patient is a rep. It’s funny, the patient’s dental rep, by the way, should have known better to where the typical, she’s always traveling. And so this remote version, and the telemedicine really helps her, there’s an app 24/7 she can reach someone because she told me Oh, I tried calling your office and 10 years ago, I gave you aligner to try calling my office like when, right? So I think there’s room for growth if this partner network is a tool to help educate these patients, in my opinion. [Jaz]
Well please educate me because what does it mean by lifetime aligners, what does that mean? [Payam]
So SDC, smile direct club gives lifetime aligners. So let’s say they lose their aligners. They don’t wear the retainer T shifts, they’ll do it again for them at no charge. [Jaz]
Wow. So this is essentially [Payam]
Things could change, but that’s as of today. [Jaz]
Okay, so let’s say that a patient has correction, and they wear their retainers for like six months, and let’s say it was a rotation and typically a rotation will relapse. And it was the patient’s own bad life choice not to wear their retainer that they can just pick up the phone be like, Hey, I have a Give me some more aligners. Okay. Is that essentially the way? [Payam]
That’s what happens. And I think it’s, they might do a $90 charge for additional retainers, but for aligner tooth movements. Currently, they’re not charging the patients. I can’t do [Jaz]
Yeah, we can’t. We can’t do that. But this is splitting me how I feel about this because A) I feel like wow, this is amazing for patients who are just, you know, because patients have relapsed all the time. So firstly is as a consumer Wow. But as a doctor as a dentist, my concern is it’s almost encouraging a bad behavior. It’s encouraging repeat orthodontics which is obviously associated with risks, gingival risks, resorption risks. So I don’t I’m not quite sure how I feel as a consumer, I feel great. As a doctor who’s paramount importance is patient safety, lifetime aligners, I can see why they do it. But the that is almost like an encouraging behavior. How do you feel about that? [Payam]
Well, so look, I am sure that they put some parentheses in that I’m sure that not every patient is going to go through. But from a clinical standpoint, I know aligners are the safest, right? So we talked about root resorption, there hasn’t been a single indication of the tooth just stops tracking, right, the aligner pops up. So there’s no real bone hitting the apex of the root and the root getting resorb. Periodontal issues, Let’s say the patient had to have a crown done, or had to have, like you said some other dental treatments, Is it really fair to the patient to pay something, you know, when you say lifetimes, you got to think about what the patient’s necessities work, because during the life of the patient, they’re gonna go through some dental treatments, right? They’re gonna go through some sort of filling maybe some sort of crown, maybe a bridge. So the reality is, you’ve got to kind of look at it in a general sense, and not look at it from a, I am always a positive person. I’m always like, hey, you know what, that’s great. That actually helps. I’m sure there’s boundaries, because I’ve heard one of my patients pay 99 bucks again for a retainer. So I’m sure there’s some fees associated to it. But the word lifetime, to me, what that tells me is not necessarily encouraging bad behavior, but rather that patients are going to be caring more about their teeth. So think about it. And this statistic, I can give you, four out of 10 patients, okay, they just did a poll, they said that they brush their teeth, they take better care of their teeth after Smile Direct Club treatment, right? Because now they want to protect their investment. So I think it’s actually encouraging better oral health rather than encouraging bad behavior, because there’s a whole parameter that they have to read as to what lifetime aligner means, right? New crown, new this, new that. So we have to kind of be a little bit more the complexities of, I guess patients mindset is different than us as clinicians, right? [Jaz]
No, and that helps. And I appreciate that answer. Thank you. Next thing as a someone who does orthodontics, if my patients were wearing their aligners for nighttime only, that doesn’t sit well with me. I trained them, have to wear it 22 hours and stuff. So how does the science within orthodontics? How does that work in terms of nighttime aligners, what’s different about these nighttime aligners that allows it to even work at a, you know, as a biomechanical, biological level? How does tooth movement have that happen? For less than 16 hours of movement, or at least 12 hours? If it’s just nighttime? If it’s eight hours, Please enlighten me, [Payam]
Right. So much slower pace. That’s how it happened. So we need three things that I mentioned time, space and pressure, right? You put enough pressure, you put enough time, something’s gonna move, right? The problem is osteoblastic and osteoclastic activity happen when there’s some sort of trauma introduced, they move much faster, right? So if we create some sort of traumatic event, now you get that cellular activity, if we don’t, what happens you put the pressure, the tooth kind of moves, and hopefully the next aligner creates that momentum going and going. So the nighttime aligner torque has been altered. It’s their own secret sauce that they’ve put together, I can tell you that I had a patient. Again, diastemas are perfect. And you know, small spacings are perfect. I had a patient who wore his aligners. Instead of taking literally three, four months, he took a little longer took, I think, nine months for him. But his teeth were closed, and it looked fantastic. And it was in retention next time I saw him because I see patients once every six months when they’re doing these types of treatments for their cleanings. And I think that the torque and the tooth movements, instead of being that traditional 0.25, or the 0.3 millimeters changes. In my mindset, look, as long as they’re wearing the aligners and lifting a little over 10 hours, you’re gonna get some sort of movement. Now how much torque? Believe me there’s pressure built in, right? And there’s your trauma as long as they wear it. So in my mind, I can tell you, I’ve seen all types of patients, the most compliant ones are the ones that you kind of fit their schedule into your schedule and create a treatment plan based on them. If you tell them this is the way it is. I’ve always done it at they’ve had a few that fallen off and they just don’t comply. So I think this is a good option for patients that are willing to wear it, they’re an attorney in the morning but at night they get home they can pop it on, right? Let’s try that and I think time, space, pressure with their torque it’s I mean they have results as a, was a 1.6 million cases that Smile direct club has treated and a fair good share of my when my time [Jaz]
What I would love for to happen is an opportunity for research. I mean because because because lot of studies like imagine you’re designing a study and you’re like okay, we’re gonna give these patients like what Invisalign aligners from dentists. And we’re going to compare 18 hours wear versus nighttime only wear. Now, with my limited knowledge of ethics and evidence base, with my limited knowledge. I feel as though that that would not pass the ethics committee because they’re like, Well, are they potentially getting a substantive treatment because from the from what we know about biomechanics, it might not work. But because the SDC are able to offer this option, it’s a great opportunity to collect data, and then that could then in the future, help to inform us in terms of okay, which malocclusions, which movements, which kind of patients benefited from the nighttime aligners, and that could really be a massive paradigm shift. Because to me that makes like, Whoa, how is that possible? But you’ve obviously told me that our patients are happily wearing retention now after having teeth straightening. So I’ve got to change the way I think this and I think it’s I really do hope there is some documented research that happens from this and presented and I think this is how, this is the bridge between Smile Direct Club and dentists becoming stronger, which would be an opportunity to advance orthodontics. And, you know, having shorter time orthodontics is an advancement of in our field. Okay. So I hope and if it’s not, I would love you to feed that back to them. Because we want data we want something to feed and change our paradigms. [Payam]
Yeah. So to that, yes, there’s actually a few opportunities there. They’re, number one, let me just back up, 19 years ago, when I was doing clear aligners, nobody wanted to participate in a research. It was Invisalign. Invisalign, even the Dental Board didn’t accept it, I actually was, I call got a call from California Dental Board about billing a non orthodontic appliance to an insurance called MetLife. That it’s not considered and what is this Invisalign? What is this thing you build? Right? So, until that has actually been accepted until we as clinicians really start to take in and do what you said it accepting this, you won’t see much research, however,Smile Direct Club on their own. There’s research going on, there’s one in South Africa, there’s had researched r&d that’s running it. I mean, I’m aware that there’s a huge study going on with the whole nighttime aligner versus the actual PDL, ligament movements. You know, there’s a couple of schools that they’ve gotten involved with kind of running these types of different cases, yes, you’re gonna see things coming out soon. But it could have been even faster if us as dental community would accept it, and say, Hey, I’d like to be participant in this r&d. I like to be fair, because, you know, for the first few years, I remember I myself, did I rejected the mess of $2,000. Are you kidding me? $2,500, for you’re undercutting me, but now that I know what cases they do, how they do it, who their doctors are, I kind of get it. I’m like, Yeah, this is actually this could actually work for us for those minor tooth movements. And eventually, it could actually be scaled as a good partner for other treatments that I want to give my patients with a clear aligner treatments. I mean, again, I’m agnostic of who I treat [Jaz]
What’s in it for you? And like, for example, if a dentist in the UK or US whatever, decides to become a partner, like essentially like a pop up shop within a dental practice, what’s in it for you? [Payam]
Yeah, so we get paid for our time with the scan and taking those impressions. So we actually get paid for that timeline that we’re spending with the patient, just like you would send the patient to a scan, like a CT or some type of a scan, same thing. And financially, it’s actually pretty rewarding, because what they’re paying us is our actual time. And at the same time, we get to have these patients come to our practice, they get to see our office, they get to experience our staff, some of them have their own dentist, and they say, My dentist doesn’t agree with me being here. I said, I’m sorry to hear that if you want to ever change or we’re here for you, otherwise, I send them back to their dentist. We’ve actually been very successful in gaming, I can tell you easily we gain, we get about 15-20 patients per week that come in for a scan. And we gain over 50% of them as patients literally that we know for cleanings, for fillings and you know, I have to do an exam, I bring them on a different day to do the exam. We just get the scan done. We don’t want them to feel we’re upselling them dentistry, but we tell them, hey, if you like and you need a checkup, we’d be loved to be your patient, be your dentist for you and keep you as a patient. So I think that’s also an opportunity other than getting paid for our time. [Jaz]
One thing I really want to do in this interview is come in a mindset of open mindedness and when I’m when I pitch this to my communities that okay, I’m going to speaking to a representative SDC. You can imagine that like what Okay say this, say that. And I was like, no, no, I’m gonna come in with an open mind. And you know, let’s be positive. And so far, I think we have have gained some positives. And I hope you felt that I’ve challenged you as well, equally. That is it. Okay. Is that kosher? And I think that’s a good debate to have. Now, yeah, I see that as a benefit for the doctor. Because automatically, I think that most patients who have orthodontics from me will benefit from some edge bonding, some composite here and there. And that gives a, you know, an opportunity to get some work done. That is another avenue of gaining patients, like you said, so I can get it from your perspective, how that’s happening. So that does clear a few things up for me. How is this model being done worldwide? Or is in the US only in terms of partner dentists? [Payam]
Yeah, so the Partner Network gives these patients the opportunity to come to the dental offices in the US that I know of, I’m not quite sure internationally or globally, what they’re doing, I do know that they’re planning on rolling it out. But for us, it’s only a year and a half or so old. I mean, when I came on board, that was the main reason,what’s in it for me, you know, Why would I do this? And you know, there’s patients that come in now, sometimes what’s called a, they’re middle of their treatment. And, you know, we still gain them, because the reality is, some of them say, look, I kind of feel like I need to do more, I like what they did, but I need to do more. And right away smile direct can either continue as a patient, or they can now fast forward to us and we can kind of address maybe they need an implant, maybe they need to do veneers, maybe they need more aligners, and I can now go at a discounted fee for them because they’ve already paid 2000. So again, it gives them an opportunity for us, I don’t know, globally or world wide if they’ve rolled it out yet. I hope they have. It’s a great opportunity. [Jaz]
It’s an important question to ask. And so how it works and stuff so people getting a fair insight into what’s happening. So I think in October 2019, maybe 2019 and 2020. Apparently, California’s governor signed the legislation requiring dentists to review recent X rays before prescribing orthodontic treatment. So as you know, I would always take PAs or an OPG for that, as my you know, I was taught, and I feel that’s a good because I want to see the roots and you know, you want to, you don’t know which patient is gonna get root resorption and stuff. And then Smile Direct Club sued California Dental Board accusing or trying to squash the competitive threat. So the board has filed a motion to dismiss the suit now. And that’s what happened. So where is this sort of friction happening between the dental boards And Smile Direct Club? And where is it because that was a few years aga, here is that movement to now? And are the dental boards a little bit sort of together with Smile Direct Club in terms of okay, if you’re going to be treating patients, let us make it a safer experience now. So where are we in that regard? [Payam]
Right. So based on my knowledge, right now, that’s the case has been settled. And there is a little bit of kumbaya happening. So the doctors now can ask and the patient can upload images or X rays of their own, if they already have it from their existing or the partner network has been really a big one in California that they’ve kind of scaled this out. So that opportunity is now where smile direct has made some adjustments that the patient can get those x rays to the treating doctor. And more importantly, other boards are starting to kind of understand this is access to care. This is a remote type dentistry. It’s tele-dentistry. So maybe the doctor can get behind the computer, see the patient and request either a visual or a potential radiograph from the patient. So it’s working out a little more positive. I know that back in 2019. And I’m very well aware of that, because that’s around the timeline when I started investigating SDC. But they’ve settled and again, there was another case in another dental board in other states want to say New York or somewhere that’s also been so now there’s the boards are kind of I don’t want to say working together with SDC, but they’re not as they kind of understand the model that there is a doctor behind the wheel. And that doctor is responsible, so that treating doctor better get the things he needs or she needs to get to treat this patient. Versus the misconception was, SDC is doing it and as he’s like, look, we’re providing this platform for doctors and patients that come together. This telemedicine is what really been doing since 2014. But unfortunately, you know, the boards viewed it that SDC is the one that’s treating these patients. And finally, I think now there’s been light shed of how the workflow is and those treating doctors licensed doctors are now responsive and they can request it. So I see it as a positive. But look, it needed to happen. I mean, it happened with a line. It happened with aligners too. You know, these are class two medical devices, they are made for regulations, and you have to know what’s going in patient’s mouth. So I’m not against that, I just want to make sure that other doctors understand the process and the opportunities given with an open mind, just like I now have become, because look, there could be another aligner company that comes up and says, you know, we have this version of doing aligners now, or we have this, and you have to give an opportunity to see exactly what it is that these companies offer. And to me, it’s education to this public. It’s treatment to the public. And I like to be on the, I always say, the cutting edge, not the bleeding edge. So I’m asking [Jaz]
That was a tough question. That was a tough question. I think you did. Just so well done for taking that tough question. Where do you think is gonna go in the future in terms of bridging and getting rid of this, if that’s the aim, I’m sure it is animosity that many dentists and orthodontists have towards Smile Direct Club. Like, for example, like on that note, did you feel like you were like entering the dark side? Initially, when you and you sort of said, Okay, I’m gonna be fine, or did you feel like oh, my god, what am I doing? [Payam]
Oh yeah, my other aligner rep, my Invisalign rep, my quick rep, every one I said look at do you see all the logos on my I have Spark, I have Invisalign, I have ClearCorrect, I’m agnostic, because not every patient is going to accept the type of treatment that I have in mind. Remember, it’s when you look at it, I have multiple composite fillings that I feel the patients with, there’s one that’s two millimeter of cure, there’s one that’s four millimeter cure, I use some proposed. Same thing with aligners. I think Smile Direct Club is perfect for this minor tooth movement, remote type of treatment. And it’s ideal for the I like to say access to care, but at the same time, I believe the dark side is going to go away slowly, as new doctors come to the market, like the older doctors, it’s very even, it’s hard to even convince them about Invisalign. Let’s just be straight here. I mean, you get those 30 to 40 year old age doctors, they’re kind of okay with Invisalign. They may not quite understand Smile Direct Club yet, but you get those younger new grads, and they’ve seen social media, they’ve seen how it works, these doctors are going to change the dental market, I will tell you, my son, I see him if he becomes a dentist, which I hope, I see him being more behind the computer and setting up, you know, even remote type of treatments, than just the way we do it where we have to have tactile feeling, you know, I mean, you have caries detection that are just simply with a little scanner, you can see caries, you can see you know, Periodontal that’s coming out, you have AI happening, you know, Smile Direct Club is actually working on that AI technology right now as we speak. I don’t know if I’m overstepping my bounds, I’m telling you, but reality is, they’re really advancing. What I feel is the future of dentistry, Invisalign is doing it. You know, I see 3M kind of slowed down a bit, I’m hoping them catching up again. But the reality is, that’s the future so I’ve kind of done away with the older generation of dentists, including myself with the white hair. I think the newer generation gonna have a much easier time accepting and not calling it the dark side. [Jaz]
Very good. And would you be willing Dr. Ataii take one more tricky question but I have sugar coated it, so it’s not like the question that the dentist, the dentist want me to ask a specific in a specific way, which involves like, waiver forms and that kind of stuff. I’m not gonna go there. The way I’m going to ask you, the way, I’m not gonna go there, because I think that’d be unfair to you come and give me a good time as a representative of Smile Direct Club. So I want to be it, puts you in a fair way. So there are some avenues I could take, which will be I think, unfair, let me ask you in a fairway, which is even when I do aligners, things sometimes go wrong. Okay? Sometimes my patient ends up with an AOB when I didn’t intend for it to happen, or sometimes a posterior open bite, and then I do some corrections. Or I find that a patient develops, or my colleagues come to me when patients develop TMD, because that’s kind of thing I’m interested in, and then I’m there to help the patient where the most important thing patient safety, so when things go wrong with any aligner treatment, okay, and let’s say yeah, let’s assume let’s make them a number that 5% of all cases, okay, hopefully not 5%, 1% Of all the treatment that I do with the aligners, there’ll be a complication. And let’s say that we apply that same 1% to Smile Direct Club or any brand of aligners. And then sometimes you need a doctor on board to help out. How can the patients, the people public who get Smile Direct Club with remote doctors get the help they need? Because sometimes you need just a special eye cast on it. So is there a dedicated support network and how does it work? [Payam]
So that is actually one of the key questions that I looked at the very first because like I mentioned to you before, my office is Monday through Wednesday, half day Thursdays they only have access to me three and a half days. That’s it. Smile direct club has created not just the app, but the portal that 24/7 At any time, they can call customer service, customer service where triage either goes to a hygienist or to the treating provider. So that portal if the patient and I can tell you out of 1,000,005 or million six cases, there’s going to be a few cases that didn’t go the right way. Right away. I was actually involved in a just doing some consulting with one of the docs and says hey, there’s a smile direct patient and she’s getting recession because the teeth are proclining forward. And I said well what did they do? They said nothing customer service go went to the treating doctor, treating doctor did a visual like a face to our What is it like a zoom type? And you need to get to a periodontist. You need to stop the aligners, stop where you’re at, go to a periodontist. They sent the patient to the periodontist, periodontist said yes it’s procline, you had recession, there were some abstractions, you know, you just don’t go any more forward anymore and start the intrusion. And they brought came back and she started with some intrusion and they stopped so she wasn’t going to really go forward anymore for procline the teeth anymore. And I thought that was a great example of how this 24/7 access to care helps. Because right away the treating provider the stabilized treat I was actually contacted. That particular doctor has his own practice as the patient that comes to practice. She’s like, I’m like 600 miles away, I can’t get to you then I gotta get you a periodontist. Smile Direct Club aided the patient in finding a local perio. It’s the same way if the patient comes to my practice and I get a posterior open bite, how am I going to triage that? Either I have to cut the aligners. I have to do some IPR and bring it back. So in my mind, hopefully those cases don’t happen. But out of a million I’m sure it has. But that’s the one story I can tell you that I saw that they took care of it right away. Now, there are patients who don’t wear the aligners at all, right? And now you’ve got a whole different problem, right? They got, now you got to go back and start them all over again. They didn’t wear the aligner, they have a cavity now you gotta go get clearance. So but the ones that are active treatment and something goes sideways, they stopped right away by contacting Smile Direct Club and they guide the patient which way to go. [Jaz]
Who’s checking there? Because when I see and this just me just being curious that we’re not you know, I see my patients every I know some people are way more remote but I see our patient every four to eight weeks, you know, depending I’m just seeing how is tracking going, any issues and stuff. Do they get like check ins with a doctor they have a zoom every six weeks? How does it work? [Payam]
So the work that the way it works is that they have a little self check that they have these little cheek retractors and their own camera. So every 90 days, I think it’s like it used to be 90 now I think it’s 60, they do little photo they take the front side side with aligners and with aligners off, upper and lower. They send that in Smile Direct Club at that point has their own between treating doctors and their own back end because I’ve seen hygienist, I’ve seen treatment coordinators that are kind of like watching these patients from there. If there’s a problem they don’t fit the you know, they don’t check box, all the bite is okay and all those things it goes to now the treating doctor. the treating doctor then scheduled a zoom call or some sort of a communication with the patient to either continue or go to a small shop get rescanned. We got to read retool it. So they do have self check ins done through the app. Again, it used to be 90 days, but I think they changed that to 60 days now. [Jaz]
Okay, brilliant. I really appreciate your time, Dr. Ataii. And I think it’s, you know, difficult to stick your head up and say okay, I’m you know, you’re brave, I think, and I thank you for coming to speak about a difficult, and I think it’s a very sensitive topic. But I think you represented yourself very well. And like, I’m not here, and I’m assuming somebody out there. I’m not here to promote Smile Direct Club, I’m also not here to just put you guys down because I wanted a environment like, this is a forward thinking podcast, that’s what Protrusive is about. And I want it that is not SDC, whether we like it or not. We’re out there. You’re aligning. So my perspective I was coming from as okay, what’s the safety like, let the dentists understand the workflow. And so I go away now from this chant, thinking, Okay, I’m glad that of all the cases that you see, seven, or six to seven are rejected, and that makes you feel better. And then those cases that don’t get attachments and IPR, I get it, I still have some concerns. And that’s normal as a dentist to internalize some of the stuff. But I feel as though we’ve what we’ve covered today gives the dentists an insight and they can make up their own mind where they stand, but I do think the other end is conversation now. I do feel that you have helped the reputation of Smile Direct Club amongst dentists for sure. And I think you’ve held up really well. So I really appreciate those tough questions that you that you answered. Thank you. Are there any points that you would like to finish with while you have the microphone to dentists all over the world? [Payam]
Yes. So first and foremost, never judge, you have to always, again, I’m a practicing dentist, and my patients come first, right? And always, always, we have to have the standard of care and financial means balance. So I need to make money in order to keep my doors open at the same time without standard of care to make sure I treat patients. And that’s what I think smile direct is doing. I think what they’re doing is now Smile Direct Club is kind of balancing with this partner network with this, educating, with the kind of pushing to the dental community that look, we’re not here against you, we’re here to actually help you. Because you’re not planning on picking up a car and driving 2000 miles in some remote area to treat these patients. We’re going to bring these patients to you. And I think that marketing itself again, patient education, has really helped, I would say the dental industry, we just have to now see how we can create those guidelines to make it fit for us.
Jaz’s Outro:
So there we have it, guys a perspective from Smile Direct Club. Thank you Dr Ataii. And like I told you the intro, I could have approached it in a different way. Like, there are so many things I could say but okay, I don’t want to land myself in legal trouble. I told you that guys already. And also I wanted to respect the human, the human that was with me, and I think he took all the questions in good faith. He was smiling back. And if you listen to this, you didn’t see a smile. He was very good. He was a good sport. So let’s commend that. And I think there is a lot more to be discussed in a super private episode. Maybe one day who knows. But I think for a public, this podcast has gone Spotify and everything. So I hope this scratches an itch and gives us some insight into, you know, I learned a lot in terms of how Smile Direct Club aligners works, okay? Has it changed my opinion? It has a little bit in a way because I like the fact that it rejects a lot of cases and it should and I think it allows for us to have these conversations because like I said, whether we like it or not Smile Direct Club are here to stay. So let’s have those conversations to bridge the gap between them and us and hopefully, we can ultimately work up to patient safety, the highest level of patient safety. So hope you enjoyed that and I’ll catch you in the next one