The Impression

Ask An Orthodontist: Why Can’t Candid Treat Everyone?

Sometimes the best treatment option for you is seeing a doctor in person.

Shannon Borden

Straightening your teeth isn’t the easiest process. You have to find the right orthodontist. Decide between braces and clear aligners. Get quoted for treatment, sometimes multiple times. 

That’s what makes direct-to-consumer options like Candid so popular. It’s a simple way for consumers to straighten their teeth without the headaches and logistics. But remote treatment like Candid isn’t right for everyone. And in a world where the alternative isn’t as easy, that can be really frustrating.

We talked to Candid’s Chief Dental Officer, Dr. Lynn Hurst, about why, in some cases, getting rejected from remote treatment can actually be a good thing.

So the first thing you do when you sit down to review a Candid case is look at a patient’s photos. Walk me through exactly what you’re looking for.

I look at the dental malocclusion, I look at the skeletal malocclusion from facial features. (Editor’s note: Malocclusion, Latin for “bad bite,” is the medical term for imperfect positioning of the teeth when the jaw is closed.) I look at what dental work they’ve had done. I look at their oral health generally. I look at their periodontal (gum) health. 

Gum health is probably the number one reason our orthodontists reject cases. 

When you’re looking at gum health, where’s the line between suggesting a dental cleaning before treatment and rejecting treatment altogether?

If the periodontal issue is gingival inflammation by itself, all you’ll need is a dental cleaning.

But if it’s gingival inflammation plus gingival recession and/or root exposure, that could mean the patient has more advanced periodontal disease. That is going to potentially require a dental cleaning, maybe even deep scaling and root planing in some cases. Which is just a fancy word for a very intense cleaning where you’re actually anesthetized because they have to go really down deep. Whatever is stuck on the teeth and causing the problems, they’ve got to get it out of there. That’s a more involved process.

If there’s suspected alveolar bone loss, we’re not going to treat that patient.

Got it. That makes sense. Given that treatment is remote, you have to be a little more conservative.

Exactly. No human being that I’ve ever met likes to be rejected — and this is a form of rejection in a way. But the advantage to the patient is that we’re turning away dollars because we’re looking out for them more than we’re looking out for ourselves. That’s just ethics 101.

Beyond gum health, what are the other big reasons Candid can’t treat patients?

Case complexity is probably one of the biggest reasons I’ll reject a case.

How do you define complexity?

Complexity, in our space, isn’t actually about how severe the malocclusion is. For us, if a case will take more than 20 sets of aligners to complete, that’s complex. That’s it. We’re limited to that right now.

There’s nothing complex to me about moving teeth. It’s just asking myself, “can I do it in the number of aligners that I have to work with?” 

What would you say to a patient who feels their case is not too complicated for Candid to treat, especially when other companies aren’t rejecting them?

We’re orthodontists. I don’t know what everybody else is at these other companies, but every Candid doctor is an orthodontist. We’re specialists in this area, and while another company may choose to treat them, we’re going to choose to put a patient’s care first. 

It’s not exclusivity, it’s expertise. Sometimes saying no to a patient may be the best thing for that patient.

Are there medical risks to moving teeth too fast?

With braces, you can move a tooth too fast, because that wire’s in there and it’s going to do what it’s going to do. It can burn the root. You can get root resorption. You can crush the periodontal ligament. You can cause bone loss. There are some side effects that are a little bit tricky.

With clear aligners, if you don’t wear them at all, nothing’s going to happen. If you wear the aligners and your teeth aren’t moving as expected, then your teeth will just stop fitting in the aligners. There’s so little damage clear aligners can cause, because the aligner is just not going to fit. If you try to force it, try to move it too fast, it’s just not going to fit. 

What would you say are the next steps for someone that Candid can’t treat?

In an ideal world, I’d like to always give them a path back to us. Sure, there are limitations in teledentistry, but we’ve got really smart people that are working every day to figure out ways to treat more patients. This is a new space, and we’re innovating — I call it ethical innovation, because we’re not just treating everybody right now. That won’t always be the case.

But if you’re looking to get started faster and don’t want to wait, go to your local orthodontist. If Candid can’t do it, we’re not saying don’t do anything. We’re just saying go to the best place to do it for you. And the best place to do it isn’t SmileDirectClub or Byte or SmileLove. It’s to go to a local orthodontist. ✧

Let’s get things straight.

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