In Letter to Harvard President, Assoc. Dental School Professor Criticized for Involvement in Teledentistry

Marc B. Ackerman, an assistant professor at the Harvard School of Dental Medicine and the director of orthodontics at Boston Children’s Hospital, is at the center of a growing controversy surrounding SmileDirectClub, a teledentistry company that is a part of an emerging industry of lower-cost, mail-order teeth aligners.

In September, a dentist sent a written complaint to University President Lawrence S. Bacow and to other employees at the School of Dental Medicine and Boston Children’s Hospital alleging that Ackerman violated ethics standards in his research on products made by SmileDirectClub, per the Boston Globe.

In October 2017, the American Association of Orthodontists filed complaints in 36 states alleging SmileDirect’s treatment was unsafe. Former patients complained of cracked or misaligned teeth and chronic jaw pain. In Massachusetts, consumers and dental organizations have filed a dozen formal complaints against SmileDirect with Attorney General Maura Healey.

The Journal of Dental Research and Reports published an article in May 2019 by Ackerman analyzing the “clinical effectiveness” of SmileDirect technology. In it, Ackerman favorably reviewed the SmileDirect treatment — which costs under $2,000, compared to the at least $5,000 that traditional braces often cost.

University Spokesperson Jonathan Swain confirmed that Bacow received an emailed communication with concerns about Ackerman. The email was also addressed to individuals at the School of Dental Medicine, per Swain.

“Based on that, the response was handled by the Dental School and Bacow did not respond directly,” Swain wrote in an emailed statement, referring further questions to the School of Dental Medicine.

Heather Denny — the director of communications at the School of Dental Medicine — declined to comment.

“Because Dr. Ackerman is not an employee of Harvard School of Dental Medicine, but rather Boston Children’s Hospital, we are not able to provide comment on this,” she wrote in an email.

Kristin Datolli, a spokesperson for Boston Children’s Hospital, also declined to comment,

“We don’t comment on issues related to our staff members,” she wrote in an email.

In 2018, the Massachusetts Board of Registration in Dentistry also investigated allegations that Ackerman and other dentists who were using SmileDirect technology were violating Massachusetts regulations by providing substandard care, though the board did not take disciplinary action.

Ackerman also did not declare any conflicts of interest at the conclusion of his May 2019 paper. He told the Globe that was standard practice, because he was not paid for the research and he designed the study himself.

In an emailed statement to The Crimson, Ackerman denied having “financial interest” in SmileDirectClub.

“It is important to note that I do not receive any financial compensation nor do I have any financial interest in SmileDirectClub,” he wrote.

However, the Globe reported that Ackerman “acknowledges” receiving financial benefits from SmileDirectClub, including payment for expert testimony and fees for treating digital patients on SmileDirect. The Globe also reported that SmileDirect has donated $176,000 to the American Teledentistry Association — a nonprofit founded and run by Ackerman out of his home — over the past two years.

Ackerman, however, stressed in his email to The Crimson that his work at the American Teledentistry Association is “on a volunteer basis.”

Ackerman wrote in an email to The Crimson that he is “not disputing the fact that complaints have been filed” against SmileDirect, but is “not in the position to judge” the bad experience of individual patients, such as those profiled by The Globe.

“It is my understanding that out of 750,000 patients treated by the SmileDirectClub platform, the Massachusetts Dental Society selected just seven cases to refer to the state attorney general’s office,” Ackerman wrote. “As a comparison, I perform several dozen second opinions every year for patients who have been in traditional treatment with braces and now have severe problems. As with any dental (or medical) procedure, there are likely to be some instances of failure.”

Liz Brady DiTrapano, a spokesperson for SmileDirectClub, declined to comment and referred The Crimson to statements in the Globe.

Jeffrey Sulitzer, who serves as chief clinical officer at SmileDirect, told the Globe that teledentistry exams such as those conducted over SmileDirect’s platform are as efficient and safe as in-person exams, “if not even more.”

Sulitzer said in a statement to the Globe that SmileDirect meets the standard of care by having “state-licensed doctors managing, prescribing, and directing the care from the very beginning to the very end.” Licensed dentists review photos and scans of SmileDirect customers’ mouths and can edit treatment plans before approving them and during progress checks every three months.

In his email to The Crimson, Ackerman defended his nonprofit and teleorthodontic technology, although he said there are still “ways to improve teledentistry.” He stressed that he was speaking from his role as the executive director of the American Teledentistry Association, not as an employee of Boston Children’s Hospital.

“Through the nonprofit association, we created an organization whose mission is to increase access to dental care through advocacy for and implementation of innovative teledentistry guidelines and solutions that reach a much larger population, many of whom reside in underserved areas,” Ackerman wrote in his email. “There are critics who do not like this alternative approach because it means competition for traditional and potentially more costly solutions.

“Ultimately, the promise and potential of teledentistry is about more than one clinician,” he added. “It’s about harnessing the technology at our disposal to create efficiencies and provide greater access to dental care, much like we see with telemedicine.”

—Staff writer Camille G. Caldera can be reached at camille.caldera@thecrimson.com. Follow her on Twitter at @camille_caldera.