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Is SmileDirectClub (SDC) a DSO?

Feb. 18, 2020
SmileDirectClub maintains that it is not a provider of dental services, rather its licensed dentists are the true providers. Dr. Chris Salierno discusses how the DSO label that SDC has adopted may not be the best thing for other types of DSOs.
Chris Salierno, DDS, Chief Editor, Dental Economics

Short answer: yes, and SDC will serve as a valuable case study for other DSOs that are exploring teledentistry.

A recent NBC News report discussed concerns with the business model of SmileDirectClub, citing more than 1,800 Better Business Bureau complaints, as well as Congressional investigations into whether or not SDC is “misleading consumers or causing patient harm.”

SDC maintains that it is not a provider of dental services, rather its licensed dentists are the true providers. In press releases such as this one, it states, “SmileDirectClub is a dental support organization ("DSO") that pioneered a teledentistry platform in 2014 to democratize access to teeth straightening solutions by enabling state-licensed dentists and orthodontists to offer remote management of clear aligner therapy at a fraction of the historical cost and without necessitating in-person office visits.”

Is SDC really a DSO? If so, what do allegations like the ones made in the NBC News report mean for the DSO community?

We should begin with the definition of a DSO. The prevailing definition, which is used even in the Wikipedia entry for DSOs, is found on the Association of Dental Support Organizations website. “Dental Support Organizations (DSOs) contract with dental practices to provide critical business management and support including non-clinical operations. The creation of DSOs has allowed dentists to maximize their practices with the support of professional office management. The DSO model enables dentists to focus on the patient while delivering excellent dental care.”

I would argue that this definition is broad enough to probably include the legal relationship that SDC maintains with its dentist providers. The key differentiator is, of course, that most DSO dentists operate in brick-and-mortar practices while SDC dentists use a teledentistry platform to provide care remotely.

As traditional dental practices and DSOs consider how to offer teledentistry services in their communities, they would do well to learn from the challenges that SDC has encountered. In the fall of 2019, California increased restrictions on teledentistry in response to direct-to-consumer aligner companies such as SDC. Improving access to care by reducing financial and/or geographic barriers is the goal for teledentistry, but better access cannot come at the expense of quality of care.

SDC is on the bleeding edge of teledentistry and is challenging the kinds of services that can be performed without direct supervision. DSOs that are seeking to provide diagnostic and therapeutic services without direct supervision should perhaps not operate so close to that edge.

Chris Salierno, DDS, is the chief editor ofDental Economicsand the editorial director of thePrinciples of Practice Management and Group Practice and DSO Digest e-newsletters. He is also a contributing author forDentistryIQandPerio-Implant Advisory. He lectures and writes about practice management and clinical dentistry. Additional content is available on his blog for dentists atthecuriousdentist.com. Dr. Salierno maintains a private general practice in Melville, New York. You may contact him at[email protected].