Your competition might not be who you think!

January 22, 2018
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One of the proudest moments of my professional career was when I was inducted into Fellowship in the American College of Dentists. The ACD, the oldest honorary society for dentists, considers itself ‘the conscience of dentistry’. It promotes ethics and values. It teaches courses in dental schools and I’ve been proud to have taught in the ethics course at Hackensack University Medical Center for the past 2 years.

I’m really upset. And, to my knowledge few people are upset enough. So, consistent with the mission of the ACD and my own conscience, I’m writing to bring to your attention a problem that is threatening to change dentistry as we know it. And not for the better.

I’ve been trained to look at trends ever since reading books by Naismith and Toffler. I’ve seen the “Corporate Dentistry” trend take off and grow. I’ve listened to the predictions of Industry leaders like Henry Schein’s Stan Bergman. And, I’ve written about its dangers to the consumer as well as dentists.

Now there’s another trend that is starting to take hold that will impact dentistry as perhaps no other trend has. Combined with the “Corporate Dentistry” trend, it will spell the death nell for private practice and comprehensive oral health care. It will change the dentist-patient relationship and make dentists W-2, assembly line-like craftspeople pushing a corporate entity’s product to the naïve, unsuspecting public.

Worse Of All, No One Seems To Notice Or Care.

DIY Healthcare

The DIY (Do It Yourself) movement has always existed and the rise in healthcare costs have seen a rise in healthcare DIY. Smile Direct Club (SDC) jumped onto this trend by offering ‘take your own molds’ and get custom aligners and save 60%. They follow the “make your own night guard”, “whiten your own teeth” and other DIY products. SDC has even opened brick and mortars offices, where you can come in and get scanned. They have a storefront office on Park Avenue in Manhattan!

Invisalign, previously a Business to Business (B2B) entity and also a public company, recognized the threat of DIY and the value in this market and invested in SDC. It now owns 20% of the company and has a seat on their board. Invisalign makes SDC’s aligners in their state of the art factories. They say that the material is different from the B2B version but do we really know? And, does it make a difference?

Invisalign, through SDC is now my competitor. I recently saw a television commercial. Do you have any idea how much such a commercial in the New York market costs to make and air?

Who paid for that commercial? Did the profits generated from 6 million Invisalign patients cared for by dentists pay for part of it? You bet it did.

Sleep medicine has become big business, even as the many patients with sleep issues remains grossly undiagnosed. Somnomed, based in Australia was one of the first companies making MAD’s (mandibular advancement devices) to treat these patients. They call their appliance “The World’s Leading Oral Appliance For Sleep Apnea Treatment”.

In November, Somnomed acquired Strong Dental, a Canadian laboratory that makes another popular MAD called SUAD.

Recently, Somnomed entered the Direct To Consumer Channel by opening RSS or Renew Sleep Solutions clinics. They are now in 9 states and plan to open an additional 12 centers in 2018.

Do you see a trend?

I do.

Invisalign and Somnomed are going Direct To Consumer, DTC.

The “there’s enough room for everyone” argument doesn’t, in my opinion, hold water. Once a trend like this has begun and profits realized, there’s no stopping it. These entities are purely profit driven and will grow and expand unchecked if the trend and lack of regulation continues.

The DTC trend will continue. It presents a CLEAR AND PRESENT DANGER to patients, dentists and the profession. These products do NOT offer comprehensive oral health solutions. They focus on niche symptoms such as crooked teeth and sleep disturbances. They market solutions to these symptoms.

If left unchecked, the trend will continue, fueled by better marketing and a public perception that they will save money.

Where are Dentistry’s and Consumers’ Advocates? Where’s the FDA, CDC, ADA and others? Where are the State Dental Boards and the Dental Schools?

Missing In Action…MIA!

These formerly B2B companies have made a calculation. They believe that they will not loose as much business from their Direct to Dentist (B2B) channels as they will make from their DTC, Direct To Consumer business. PROFIT is their motivation.

They must have done the calculations. They must have done the research. They must have concluded that Dentistry is fragmented, Dentists are wimps and TOOTHLESS. They have projected that the ADA and the Government Agencies won’t intervene. And so far, they’re correct.

Left unchecked, what will this trend mean? What COULD happen in the near future? When will other B2B companies make the same calculation?

Eventually, solo and even small group practices who cannot compete for new patients with the massive media campaigns these large companies employ will not only see more Corporate offices as competition but they’ll see Invisalign, Renew Sleep Solutions, Nobel Biocare, Straumann, CEREC, Glidewell and other formerly B2B Company clinics sprout up. Who knows, maybe Schein, Benco and Paterson will join in the feeding frenzy too?

Like their “Corporate Dental” cousins, these DTC clinics will not only market more effectively, they will be able to negotiate better contracts with insurers. Fueled by private equity or even Wall Street, they can outspend and operate way more efficiently than small, standalone dental practices.

What can be done?

I’m not going to sit back, do or say nothing. I’m going to act.

I’m going to write the organizations to which I belong, the ADA, AGD, ACD, NYAD and others.

I’m going to stop using Invisalign and switch to ClearCorrect. I will never again use a Somnomed nor a Suad appliance, though I have made several in the past.

I’m going to tell the reps of these businesses exactly WHY I’ve stopped. I’m voting with my mouth and my wallet.

And, I’m writing this to YOU so you can pass this on and act as YOU see fit.

Dentistry is at a crossroads. It is very possible that the days of the small, stand alone dental office is over. It’s happening in Medicine and the threat and trend, to me is clear. If we choose to be silent then we are complicit.

I believe this trend is NOT in the public’s best interest. I believe that patients doing their own Orthodontics, treating their own symptoms without attending to underlying causes is a health risk. I believe that individualized, personalized care is on life support. I believe that this trend is certainly NOT in Dentistry’s or Dentists’ best interest either.

Thanks for listening and if you choose to act, thank you for that too.


P.S. I have other ideas too. If you’d like to share yours or hear more, contact me at

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Dr. Michael Goldberg is one of the leading educators on dental practice management in the United States.

Michael ran and sold a prestigious group practice in Manhattan and has been on Faculty at Columbia University and New York-Presbyterian Medical Center for 30 years including Director of the GPR program and Director of the course on Practice Management.

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