Though Anna Rosemond, now 33, had braces when she was young, a couple of years ago she noticed her teeth were again starting to crowd. So when she saw a Groupon deal for SmileDirectClub, she jumped on it.

“I thought, ‘This looks like a really cool way to do braces,’ ” said Rosemond, who made her own teeth impressions with putty and used a “smile stretcher” — a device that pulls apart the lips and cheeks — to take pictures of her mouth. A few weeks after she submitted the items, plastic aligners arrived in the mail, beginning what the company describes as Rosemond’s “smile journey.”

On that trip, there would be no time-consuming visits to a dental office, as her treatment would be overseen online through a SmileDirectClub-affiliated dentist or orthodontist — at a cost of only $85 a month and a $250 down payment, according to the firm’s website.

Initially, she said, the aligners sent in 2017 seemed to be working. But over time, Rosemond said, she grew concerned: “My teeth were literally moving at an angle.”

Rosemond is part of a wave of patients who have embraced this do-it-yourself approach to orthodontia, hoping to attain a perfect smile without the high out-of-pocket cost and potential inconvenience of traditional braces or tooth aligners.

To be sure, technology enables consumers to do more at home, and dental care — with its limited insurance coverage — offers a large potential market. Home teeth-whitening kits have largely displaced in-office treatments, for example.

Now, teeth straightening is the newest dental frontier, with startups like SmileDirectClub, Candid, Smilelove and SnapCorrect advertising their services aggressively on billboards and social media.

When results are good, the DIY approach can yield thousands of dollars in savings. But when the treatment plan doesn’t produce results or goes wrong, consumer-patients like Rosemond voice their frustrations in Facebook groups and complain to the Better Business Bureau or the Federal Trade Commission that they have nowhere to turn for help.

The companies do not make information public about success rates or problems — although SmileDirectClub says it has achieved a rating of 4.9 stars out of 5 on nearly 58,000 Google reviews — and there are few scientific studies of outcomes for direct-to-consumer orthodontics.

To get a simple refund after an initial 30-day period, patients are often asked to sign what SmileDirectClub calls a “release,” stating the consumer won’t complain publicly, which it says is fairly standard in business. A shareholder lawsuit against the firm says those releases suppress consumer complaints, leaving investors in the dark.

Consumer complaints to advocacy groups and regulators, including the FTC, the Food and Drug Administration and state attorneys general, as well as lawsuits, are accumulating.

Yet, SmileDirectClub, the company with the largest market share of direct-to-consumer orthodontics, says it’s achieving its aim of disrupting the entrenched orthodontia industry.

Recent SEC filings show SmileDirectClub spent more than half its revenue on marketing.

THEY SAW THE OPPORTUNITY

The direct-to-consumer teeth-alignment industry was enabled by the arrival two decades ago of Invisalign, clear plastic aligners that offered an alternative to the hated “metal mouth” look of braces so familiar to a generation of children. Invisalign, however, is dispensed by dentists or orthodontists during in-office visits, so it’s more costly for consumers.

While Invisalign sales remain high — its manufacturer, Align Technology, reported a record $2 billion in worldwide total revenue in 2018 — patents on the product began expiring in 2017.

SmileDirectClub saw the opportunity early and launched in 2014, with backing from Camelot Venture Group, a private investment group that also backed Quicken Loans and 1-800 Contacts. Initially, the startup’s aligners were made by Align Technology; now, SmileDirectClub does its own manufacturing.

Nashville-based SmileDirectClub, which says it has served more than 750,000 customers worldwide and represents 95 percent of the at-home clear-aligner industry, went public on Wall Street in September 2019. Its customers almost tripled — from 90,000 to 258,000 — from 2017 to 2018, according to SEC filings. But the company has yet to post a profit, also according to its SEC filings.

CONCLUSION FOR ONE CUSTOMER

As for Anna Rosemond, after sending multiple photos of her teeth to SmileDirectClub via Facebook Messenger, she said she was told to complete her treatment, despite her concerns about her teeth moving at an angle. Eventually, the company agreed to send her new aligners, but she said they didn’t fit.

Fed up, Rosemond said, she stopped her credit card payments to SmileDirectClub. She ignored calls and emails about being sent to collections.

She said she consulted an orthodontist who told her, based on his review of previous X-rays and photos, she had a crossbite because of the SmileDirectClub treatment and would need braces with rubber bands to correct the issue.

She recently finished nine months of traditional orthodontics treatment from that orthodontist and loves her smile now that the braces are off.

“I’m so much more confident,” said Rosemond. “And my bite feels great.”