Former Lyft executive Nick Greenfield had what he thought were great teeth. They were, in fact, the envy of most 12-year-olds: Greenfield never endured the preteen trauma of braces. His body just naturally produced the kind of perfectly aligned teeth that Austin Powers could only dream of.
But in his mid-20s, something happened–his teeth began to shift. First slowly, then all at once. What was once an upstanding block became a crowded neighborhood.
“I watched as my teeth went from straight to overlapping,” recalls Greenfield. Teeth cleaning appointments went from quick and simple to grueling plaque extractions. Flossing became a nightmare.
In the prime of his adult youth, Greenfield was forced to admit he might finally need braces. He succumbed to the reality of wearing liners, but the actual steps involved to begin the process left him disappointed, if not shocked. Getting braces required multiple, reoccurring trips to the orthodontist, and the price hovered somewhere between $5,000-$8,000.
“I almost fell out of the dentist chair–I thought, ‘Whoa, that [price] is insane,” says Greenfield. “I looked into the industry and saw that there was a tremendous opportunity to help people like myself access affordable oral care and take advantage of some of the best practices of telehealth.”
In early 2017, Greenfield founded Candid, a direct-to-consumer teeth alignment company. The startup sells at-home modeling kits for consumers to take molds of their teeth that are then analyzed by a network of orthodontists across the country. Via telemedicine, the orthodontists create custom treatment plans with 3D-printed aligners. Patients wear their custom-made aligners for several months to straighten their teeth, followed by a nighttime retainer.
Prices start at $1,900 up front (or $88/month for 24 months). If one’s dental plan provides orthodontic benefits, they can potentially be reimbursed by their insurance company. Candid also accepts FSA and HSA debit cards.
In a way, Candid offers the more affordable, less time-invasive version of Invisalign, which recently topped $1 billion in sales. The flourishing orthodontics industry counts over 6 million American customers a year, with $11 billion in revenue. Industry analysts expect a 12% annual growth rate over the next four years.
As Greenfield explains, telemedicine made significant inroads within the medical market, from GPs all the way through specialists, “but oral health has kind of been left by the wayside.”
The Warby Of Teeth Alignment
Within the first few months of establishing Candid, Greenfield assembled a team of orthodontists–including chief dental officer Dr. Lynn Hurst, with over 30 years in practice–to help ensure the safety and procedural vision of the product. The company also interviewed hundreds of orthodontists on best practices.
Next, Candid needed to figure out the specific telemedicine laws that apply to each state, compounded with the added complexity of integrating dental care. “We spend a bunch of time working on the legal questions around how [the telemedicine] industry is going to evolve,” notes Greenfield..
From there, the startup focused on differentiating itself from other so-called DIY braces companies within the market. Candid wanted to promote a safe, orthodontic-tested service, albeit in a modern, approachable fashion. It wasn’t enough to come up with a dental solution; the founder wanted a solid design, from the teeth molds to the shipment boxes. For inspiration, Greenfield looked to the leaders within the digitally native space: Glossier, Warby Parker, and Hubble contacts.
“We wanted to build a brand that really resonated with our customers,” explains Greenfield.
Breaking The Mold
By September 2017, Candid released its sleek, easy-to-use $95 kit. The white, stark boxes prominently feature a holographic silver emblem logo. Inside, the product better resembles a kids’ science project: the approachable photo-enhanced directions and clear, friendly language attempt to make the mold procedure more fun than a hassle. The mold itself is bright Play-Doh blue in Bento-like storage boxes–a far cry from the sterile, humorless persona generally attributed to dental care.
The entire process of crafting the molds and taking multiple pictures of one’s mouth takes 20 minutes. Thereafter, one simply drops the impressions in a self-addressed package and uploads the images to the Candid site. A week later, an in-state orthodontist reviews the molding for the clear aligners. Within six to eight weeks, the aligners show up at one’s doorstep. Clients then engage in ongoing video check-ins with their orthodontist for anywhere from three to 10 months, depending on the treatment plan.
Greenfield says Candid targets two audiences: busy adults who don’t have the time (or money) to engage in traditional orthodontic care, as well as rural or minority communities who lack access to dental offices. Many adults who had braces in their youth find themselves, much like Greenfield, dealing with shifting teeth–or simply stopped using their retainer somewhere along the line. These “mild” cases are Candid’s sweet spot–not children or severe cases that require heavier lifting by orthodontists. (If a candidate has the latter, Candid gently refuses service and refunds the $95 kit cost.)
Candid recently raised $15 million in venture capital, a milestone Greenfield credits to the company’s marketability. Adults now comprise half of orthodontic patients, reports Colgate. Many of the investors Greenfield personally spoke to complained that they too harbored cosmetic dental complaints. “It’s estimated that over 50% of people need some type of orthodontic care,” says Greenfield. “We were able to show them the market size–the opportunity.”
Growing The Market
The goal is to expand the market by appealing to consumers who otherwise wouldn’t consider themselves a candidate for braces. Greenfield predicts that’s almost 100 million adults in the U.S. alone. Likewise, Candid serves as a financial supplement for orthodontic practices.
Despite the obvious industry opportunity, the at-home market is not without controversy. Last November, the American Dental Association (ADA) issued a statement strongly discouraging DIY orthodontic treatment. The American Association of Orthodontists (AAO) soon followed suit, warning consumers, “Moving teeth is a medical procedure and needs personal supervision by an orthodontist.”
Kevin Dillard, AAO general counsel, filed complaints with dental boards and attorneys general in 36 states regarding online aligner companies, such as Candid competitor SmileDirectClub. He tells Fast Company that a substantial percentage of consumers claim their self-made aligners puncture their gums–or worse, twist their teeth into more crooked positions.
“Orthodontic treatment is a complex medical process . . . Any number of things can go wrong,” says Dillard. “It might be cheaper on the front end, but if it causes you to lose teeth or have a gum tissue, then it’s going to be a lot more expensive in the long run having to repair all of those problems.”
Greenfield strongly opposes the term DIY in reference to Candid, noting the service provides complete oversight by a licensed orthodontist. The difference from traditional services, he says, is that it’s simply remote. A customer engages in video sessions with their orthodontist, “making sure everything is going smoothly,” says Greenfield.
A rep for Candid states that the company has a “good relationship” with the AAO, but confirms that the association has not endorsed the treatment. Dillard explains that while the simulation process is admirable–and a step toward more accessible oral care–it simply cannot replicate an in-office visit.
Traditionally, patients access a host of cutting-age technology that is not offered by telemedicine services, says Dillard. This includes 3-D imaging of the teeth and bone structure, X-rays, and “everything that you can’t see with a naked eye to better predict tooth movement.”
Cavities, for example, are not readily apparent in photographs, though that too is a concern during one’s braces consultation. “The worst thing you can do with a cavity is seal it under a plastic liner, because that will advance the rate at which the cavity becomes worse,” warns Dillard.
He goes so far as to say that though telemedicine sounds futuristic, in this case, it’s far from a scientific advancement. A treatment model and diagnosis on the basis of nothing more than a physical model and video footage is “like going back to the first half of the last century, before X- rays . . . I would argue it’s going backwards.”
Dr. Marc Ackerman, assistant professor of developmental biology at the Harvard School of Dental Medicine and executive director of the American Teledentistry Association, strongly disagrees. He cites the AAO clinical practice guidelines, which state, “Where limited orthodontic procedures are anticipated, diagnostic records may vary from those associated with comprehensive care.” The British Orthodontic Society guidelines, meanwhile, stress that radiographs aren’t recommended when only limited tooth movement is planned.
Greenfield reiterates that the Candid model relies on experienced, certified orthodontists who simulate all the most important pieces of the traditional experience. “We aren’t looking to replace orthodontic care or necessarily compete with existing systems, we want to make the experience better for those who can’t afford the time or money on more expensive options,” he says, stressing, “Telemedicine is the future of healthcare.”
Candid remains undeterred in its mission to bring better teeth to greater mankind. While the services currently exclude those under 18, in the long run, says Greenfield, “We would love to tackle all of world healthcare, and that would include all ages.” That means broadening horizons beyond the U.S.; Greenfield intends to expand to markets that lack greater orthodontic care, like Brazil, India, or China.
“Ultimately, we want to increase access and improve affordability to drive cost down and help people get access more frequently,” stresses Greenfield, whose ambitions sound as clear cut as the directions on his teeth model kits: “Our goal is to serve about a million customers by the end of 2020.”