“The fact of the matter is that you’ve got over 750,000 people who’ve been able to get access to this type of care and they’re really happy,” she said. Greenspon Rammelt, SmileDirectClub’s chief legal officer, said state dental boards were trying to stifle competition. That same month, SmileDirectClub sued California’s dental board, accusing it of trying to “squelch the competitive threat.” The board has filed a motion to dismiss the suit. In October, Gavin Newsom, California’s governor, signed legislation requiring dentists to review recent X-rays before prescribing orthodontic treatment. The company spent heavily on television and social media ads, promising to give people “a smile they love.” It also recruited influencers and celebrity spokesmen like the N.B.A. SmileDirectClub grew quickly, fueled by $440 million in funding from venture capital and private equity investors. Larson, a professor of orthodontics at the University of Minnesota and a practicing orthodontist. “Very few of my patients go from beginning to end in the way that I envisioned or planned,” said Brent E. Traditional orthodontists, who make money from in-person consultations, said that cutting dental professionals out of the process was dangerous and that regular visits were a key to avoiding new dental problems. Anything after that is considered outside the company’s official refund policy and comes with the nondisclosure provision, which it said it began using in 2016. SmileDirectClub offers refunds within 30 days after the aligners arrive. Then the aligners, which cost $1,850, or around a third of the cost of traditional braces, are sent to customers by mail. The form also states that they cannot sue the company for any reason. Potential users check a consent form saying they have had their teeth examined and X-rayed by a dentist, but are not asked to verify that. Katzman’s father, David, is the company’s chief executive, and his uncle, Steven, is the chief operating officer. SmileDirectClub, founded in Nashville in 2014 by a pair of childhood friends, Alex Fenkell and Jordan Katzman, is one of the largest of the new online health companies that sell directly to consumers. SmileDirectClub has negotiated some of the general release forms with those who have asked for refunds, she said. “When we believe that there is an organized campaign to damage our reputation amongst consumers, dentists and/or investors, we will defend ourselves and our mission to democratize access to care every chance we get,” she said. Greenspon Rammelt added that SmileDirectClub’s legal moves were necessary to protect itself. It does not publish the success rate of its aligners. It said fewer than 5 percent of its customers had received a refund. SmileDirectClub pointed to an average customer rating of “4.9 out of 5” on more than 100,000 reviews on its website. Susan Greenspon Rammelt, SmileDirectClub’s chief legal officer, said in interviews that the vast majority of users were happy with the company. Caplan, a professor of medical ethics at the New York University School of Medicine. “They’ve been almost like nervous bullies to critics,” said Arthur L.
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