Toothpaste & Toothbrushes

INDUSTRIAL CODES

NAICS: 32-5611 Soap and Other Detergent Manufacturing, 33-9994 Broom, Brush, and Mop Manufacturing

SIC: 2844 Perfumes, Cosmetics, and Other Toilet Preparations Manufacuting

NAICS-Based Product Codes: 32-5611D and 33-99945101

PRODUCT OVERVIEW

Dentistry

Humans have long been concerned about their teeth. A simple explanation is perhaps that, in advanced stages, decayed teeth cause pain that can become so unbearable the sufferer begs to have the source of the pain extracted. Hippocrates and Aristotle (500–300 BC) wrote about treating decayed teeth and extracting teeth. During the Early Middle Ages in Europe, surgery and dentistry were professions practiced by monks, who were among the educated class. After a series of Papal edicts prohibited monks from performing surgery or extracting teeth, barbers assumed many of the duties of monks because the tools of the barber trade—sharp knives and razors—were useful for surgery. Barbers eventually split into two groups: surgeons formally trained to practice medicine and lay barbers who performed routine services like shaving and tooth extracting. More than 100 years later, the distinction between barbers and surgeons still stood. The Little Medicinal Book for All Kinds of Diseases and Infirmities of the Teeth was written by Artzney Buchlein for barbers and surgeons. Published in Germany in 1530, it covered tooth extracting, drilling, and filling.

Dentistry began to develop as a profession in the 1700s. In the first half of the century, The Surgeon Dentist, A Treatise on Teeth, was published in France (Pierre Fauchard, 1723). In the last half of the century, trained dentists began to practice in America, both immigrates educated in Europe and native-born Americans. Paul Revere, the famous American Revolutionist, was a dentist. He placed advertisements in a Boston newspaper offering his services as a dentist.

Dentistry science and education progressed in the 1800s. The first dental book was published in America in 1801, called Treatise on the Human Teeth (Richard C. Skinner). The American Journal of Dental Science began publishing in 1839. The first dental school was established as the Baltimore College of Dental Surgery in 1840. The American Dental Association was formed in 1859. Harvard University Dental School was founded in 1867. By 1880, there were 28 dental schools in the United States, mostly in the East. By 1890, Willoughby Miller, an American dentist in Germany, noted that tooth decay was caused by bacteria in his book, Micro-Organisms of the Human Mouth, a technique widely accepted as the most effective measure for the removal of plaque around the gumline.

Toothbrushes

The toothbrush ostensibly dates back to 3500–3000 BC, when the Babylonians and the Egyptians made a brush by fraying the end of a twig. Around 1600 BC, the Chinese developed chewing sticks. One end was chewed and softened until it became bristly. The aromatic sticks cleaned and freshened. The Chinese are also credited with inventing the first natural bristle toothbrush in the 1400s by attaching boar bristles to a bamboo handle.

The first modern toothbrush is credited to William Addis of England around 1780. The handle was carved from cattle bone and the brush was made from boar hairs. Addis and his later descendants produced and eventually exported high-quality English brushes. Natural bristles were placed in holes that were bored into a bone base and kept in place by thin wire. By the early 1800s, the bristled brushes were in general use in Europe. The downside to boar hairs was that they were rough on the gums so sometimes horsehair was used.

In Colonial America, tooth brushing was considered a genteel activity. Many people scraped rather than brushed their teeth because using boar bristle toothbrushes was painful. By the time of the Revolution, toothbrushes became more common. In 1844 a handmade toothbrush with a 3-row natural bristle brush was patented by Dr. Meyer L. Rhein. In 1885 the Florence Manufacturing Company began producing the prophylactic brush in Massachusetts in association with Dr. Rhein. The American toothbrush market continued to grow, but fundamentals had not changed; toothbrushes consisted of a handle to grip and natural bristles to clean.

Toothbrushes changed after Du Pont invented nylon in 1937. Nylon quickly became the primary source of bristles, replacing natural bristles. The first nylon toothbrush was Doctor West's Miracle Toothbrush, introduced around 1938. During this period, proper oral hygiene was publicized by various public health programs. For instance, North Carolina established a Division of Oral Hygiene in 1931 to educate the public about preventive dental care. During World War II, a shortage of rubber led to the invention of plastic. The plastic handle with nylon bristles became the prevalent model for toothbrushes.

Toothpaste

Toothpowders were popularly available in England in late Victorian times. Druggists, chemists, and dentist-surgeons mixed their own products. These were proprietary products from closely guarded recipes. Small ceramic pots in vogue in England during this period reveal much about the earliest available commercial toothpowders. Hand-lettering on the lid advertised the seller's location, and proclaimed the product's superiority in maintaining gum and teeth health, while freshening breath. Surviving ceramic pots advertise flavored tooth powders, such as areca nut and cherry. The areca nut has astringent properties. Cherry toothpowder was tinted pink by adding carmine coloring, not cherries. Lids decorated with cherries or their blossoms, along with the pink tint, allowed romantic brands to emerge. Brands from the era include White Rose, Coral, Tomato, Carnation, and Damask Rose.

Many people in Colonial America had bad teeth. Except for homemade recipes, toothpowder, and toothpaste were not available. An early toothpowder recipe might call for items such as salt, mint, dried iris, pepper, and even ground charcoal. The development of toothpaste in the United States started in the 1800s. Dentist Nathaniel Peabody wrote a book called The Art of Preserving Teeth, and is alleged to have been among the first to add soap to toothpowder, circa 1824. Chalk was added to toothpowder in the 1850s. During the same period, a toothpaste in a jar called Crème Dentifrice was developed by Dr. Sheffield in Connecticut, where Sheffield Pharmacy is still located. Sheffield's son graduated from Harvard University and studied in Paris, where he observed the use of collapsible metal tubes for artists' paints. He originated the idea of putting his father's jar dentrifice into collapsible metal tubes in the 1880s. Colgate introduced tube toothpaste in 1896.

Toothpaste in the collapsible metal tube became the norm within 20 years. Early toothpaste patents from the second decade of the twentieth century show products that included pulverized fluoride mixed with triphosphate of calcium, and also a bubbling dentrifice that included calcium fluoride, calcium carbonate, and sodium carbonate (also called soda ash or salt). Advancements in synthetic detergents after World War II replaced the soap in toothpaste with emulsifying agents such as sodium lauryl sulphate (a detergent common in present day toothpaste) and sodium ricinoleate (a salt with thickening properties). By the 1960s, after research documented the efficacy of fluoride, fluoride toothpastes were marketed nationwide. Toothpaste is a drug with cosmetic benefits, as classified by the Food and Drug Administration, which approves active ingredients and oversees labeling claims. As a result, fluoride is the active ingredient in almost every toothpaste.

Fluoride

Research into fluoride began in 1901 when a dental school graduate named Frederick McKay left the East Coast to practice in Colorado Springs, Colorado. McKay found local residents with grotesquely brown stained teeth, and few cavities. Convinced the brown mottled stains were related to the water supply, McKay researched the issue for more than 30 years. McKay eventually hypothesized that water high in naturally occurring fluoride caused mottled enamel and, yet, was also associated with a low rate of tooth decay. By 1931 McKay convinced H. Trendley Dean, head of the Dental Hygiene Unit at the Public Health Service (PHS), now known as the National Institutes of Health, to mobilize federal resources for studies to determine the ideal level of fluoride in drinking water in order to reduce mottling but maintain the low rate of decay. Studies continued for almost 10 years. During that time, the PHS laboratory developed a method to measure fluoride levels in water with an accuracy of 0.1 parts per million (ppm). Dean and his staff compared fluoride levels in drinking water across the country. By 1940 the optimum fluoride level was identified.

It took four more years to convince just one community to add fluoride to its public water supply. In 1944 the City Commission of Grand Rapids, Michigan—after discussions with researchers from the PHS, the state health department, and other public health organizations—voted to add fluoride to its public water. In 1945 Grand Rapids became the first city in the world to fluoridate its drinking water. Fluoridation involves adjusting the natural level of fluoride in water to between 0.7 and 1.2 parts per million (ppm). That ratio of about one part fluoride to one million parts water is roughly comparable to one minute in two years, or one cent in $10,000.

Grand Rapids researchers monitored tooth decay among approximately 30,000 local schoolchildren for 15 years. The cavity rate among Grand Rapids children born after fluoride was added to the water supply dropped 60 percent. Since then, more than seventy studies have proven that fluoride reduces tooth decay. Fluoride forms a coating on tooth enamel that protects from streptococcus mutans, the bacteria that causes decay. Enamel is made of closely packed mineral crystals. Fluoride is a mineral found in soil and rocks, and in the mouth it assists in the re-mineralization of tooth enamel. Re-mineralization is the process in which minerals such as fluoride, calcium, and phosphate are deposited inside the enamel. Community water fluoridation led to reduction in decay rates of 30 to 60 percent in children younger than eight; 20 to 40 percent in children ages eight to twelve; and 15 to 35 percent in older children and adults. Because fluoride is proven effective, most communities add fluoride to the water supply. For instance, forty-three of the fifty largest U.S. cities have fluoridated drinking water systems. Water fluoridation costs an average of 50 cents per person per year. This simple and affordable public health measure benefits all residents served by the community water supply regardless of age or economic status. Community water fluoridation reaches over 144 million people, or 62 percent of Americans on public water supplies. Of course, some communities do not fluoridate water, and many Americans drink well water and so are not part of a public water system.

One hundred million Americans do not have fluoridated water, or approximately one-third of the U.S. population. Children who live without fluoridated water may obtain prescription fluoride pills from the doctor or dentist. Fluoride is so important that the Surgeon General advises all adults and children not only to ingest fluoridated water or fluoride pills, but to apply additional fluoride directly to the teeth. The most common and effective way to apply fluoride to the teeth is with toothpaste and a toothbrush.

MARKET

Toothpaste and toothbrushes, together represented a $1.9 billion market in the early 2000s. Toothpaste comprises $1.6 billion of the $17.0 billion soap and detergent industry, according to a data collected in the U.S. Census Bureau's 2002 Economic Census. Toothbrushes represented $275 million of the $2.0 billion broom and brush industry. Many of these toothpaste and toothbrush products have the American Dental Association Seal of Acceptance, a symbol of dental product safety and effectiveness for more than 125 years. Although strictly voluntary, 300 companies participate and more than 1,100 dental products carry the Seal of Acceptance. Of these, 40 percent are products sold to consumers, and besides toothpaste and toothbrushes, include dental floss, mouthwashes, and mouth rinses. The rest are professional products prescribed by dentists or used in dentistry practices.

Toothpaste had a product shipment value of $1.4 billion in 1997 and $1.6 billion in 2002, an increase of 12 percent. Toothbrushes had a product shipment value of $225 million in 1997 and $275 million in 2002, an increase of 18 percent. During the same period, the U.S. population grew 6.6 percent.

One potential driver of the market was that toothbrushes must be replaced every 3 to 4 months, sooner if they begin to look worn and frayed. Knowledgeable consumers may be replacing their toothbrushes more often. Another force driving the market was the introduction of affordable battery-operated power toothbrushes. In 2000 Oral-B (owned by Procter & Gamble) launched its first battery-powered toothbrush at an entry-level price. Although affordable power toothbrushes are available for under $10, they are still approximately three times as costly as manual toothbrushes and thus the sale of these devices drove up the value of all shipments.

Manufacturers claim power toothbrushes remove plaque and stains better than manual toothbrushes. Most dentists, however, agree that a manual toothbrush works just as well to apply fluoride to the teeth. One benefit of powered toothbrushes is that newer models come with built-in two-minute timers. Timers are intended to help users brush for longer. Manual brushing becomes habitual and people often become lazy. Laziness results in failure to brush for the recommended two minutes, and failure to properly use the Modified Bass brushing technique:

Hold the head of the toothbrush horizontally against teeth with the bristles part way on the gums. Tilt the brush head to a 45-degree angle so the bristles point under the gum line. Move the toothbrush in tiny horizontal strokes so bristle tips stay in one place, but the brush head waggles back and forth. This allows bristles to slide gently under the gum. Do this for 20 strokes to assure adequate time will be spent cleaning away as much plaque as possible. Use a very gentle motion. Brushing too vigorously or with large strokes can cause tooth erosion. Roll or flick the brush so that the bristles move plaque out from under the gum line toward the biting edge of the tooth. Repeat for every tooth. Work tooth by tooth or area by area. For the insides of front teeth, hold the brush vertically. Again, use gentle back and forth brushing action and finish with a roll or flick of the brush toward the biting edge. To clean molars, hold bristles straight down on the flat surface. Gently move the brush back and forth or in tiny circles to clean the entire surface.

The market for toothbrushes is dominated by Oral-B. It makes the top five best-selling manual toothbrushes, which together held 30 percent of the market share based on sales through drug stores. These top five bestsellers are Indicator, CrossAction, Advantage Plus, CrossAction Vitalizer, and Advantage. Battery-powered toothbrushes are becoming more popular since their introduction by Oral-B in 2000, but do not yet dominate the market. Power toothbrushes have replaceable heads, allowing manufactures to follow the classic razor-and-blade model in marketing, making more money on replaceable head refills than on the power toothbrush itself. The market for toothpaste is dominated by the brands known as Crest and Colgate.

Toothpaste and toothbrushes are classic nondurable consumer goods. Nondurable goods are purchased for immediate or almost immediate consumption and have a life span ranging from minutes to three years. Nondurable goods are destroyed by their use so consumers need to repeatedly replenish their supply throughout the year. For instance, conscientious brushers will buy four toothbrushes every year. The nondurable consumer goods market is characterized by a large variety of affordable products to tempt consumers, sometimes resulting in fierce price competition among manufacturers to gain new customers who will become loyal to the new brand. Many consumers are very loyal to a toothpaste brand, and will use the same brand throughout their entire lifetime.

KEY PRODUCERS/MANUFACTURERS

The market leaders do not leave much room for new entrants into the toothcare market. The top three toothpaste manufacturers in the United States together capture more than 80 percent of toothpaste market share. Market Share Reporter 2007 shows Colgate-Palmolive Company with 36 percent of the market, Procter & Gamble with 32 percent, and GlaxoSmithKline with 15 percent. The top two toothbrush manufacturers in the United States together captured 63 percent of the market in 2005. Procter & Gamble had 43 percent of the market, and Colgate-Palmolive Company had 23 percent.

Colgate-Palmolive Company

With annual sales surpassing $10 billion, Colgate-Palmolive sells oral care, personal care, home care, and pet nutrition products in 222 countries. Oral care is its specialty. William Colgate started as a soap and candle maker in 1806 in New York City. In 1873 it began making toothpaste in jars. Colgate introduced tube toothpaste in 1896. By the time Colgate celebrated its 100th anniversary in 1906, its product line included over 800 products and it was still a family business run by five Colgate grandsons. Colgate began educating children about oral health in 1911 by distributing free toothbrushes and toothpaste, with hygienists on hand to demonstrate proper brushing. By the 1920s Colgate had operations in Canada and Europe, eventually expanding through acquisitions into Asia, Latin America, and Africa. Colgate merged with Palmolive-Peet to become Colgate-Palmolive-Peet Company. Two years later, in 1953, Colgate-Palmolive Company became its official name. In 1968 Colgate introduced Colgate MFP toothpaste. MFP stands for sodium monofluorophosphate. In 1983 it launched the Colgate Plus toothbrush. In 1997 Colgate Total brand toothpaste was introduced and became a U.S. market leader, second only to Procter& Gamble's Crest. Colgate-Palmolive introduced Colgate MaxFresh toothpaste in 2004.

Colgate-Palmolive has 12 brands of toothpaste, each with individual products to support. Among these 12 brands are products designed for long-lasting fresh breath; toothpaste and mouthwash 2 in 1; cavity prevention; and tartar control. Newer brands focus on baking soda and peroxide whitening formulations, and plaque and gingivitis prevention. Colgate-Palmolive has 11 brands of toothbrushes, each available in different formats. For instance, the Colgate Navigator is available in full head, compact head, and cleaning tip formats.

GlaxoSmithKline

This company is the rusult of the 2000 merger of Glaxo Wellcome and SmithKline Beecham. It is primarily a pharmaceutical company that employs over 100,000 people in 116 countries. GlaxoSmithKline has roots in the United States, the United Kingdom, and New Zealand. SmithKline represents the U.S. side. It started as a drugstore and drug wholesaler in 1830 in Philadelphia. Beecham represents the U.K. side. Sales of Beecham's Pills, an alleged laxative, grew, and by 1859 mechanized production methods were devised to meet demand in Africa and Australia. Glaxo represents the New Zealand side. Glaxo produced milk powder in bulk for industrial and military customers starting around 1873. Glaxo milk powder was seen as a safe alternative for bottle feeding babies. The Glaxo Baby Book was published from 1908 until the 1970s to give mothers advice from nurses about infant feeding. Every day more than 200 million people around the world use a GlaxoSmithKline brand toothbrush or toothpaste.

GlaxoSmithKline products include Dr. Best, a leading toothbrush brand in Germany, and Macleans toothcare products in Australia. GlaxoSmithKline makes two global toothpaste brands. Sensodyne is known as Shumitect in Japan, and Aquafresh is known as Binaca in Spain. Both brands are popular in the United States. According to Market Share Reporter 2007, Sensodyne is one of the top five U.S. brands. Aquafresh is well-known as the striped toothpaste, and comes in many varieties.

Procter & Gamble (P&G)

Procter & Gamble's best-known toothcare brands are Crest and Oral-B. P&G acquired Oral-B (and by default, Braun) when it acquired The Gillette Company in 2005. In March 2007 P&G announced that it would phase out certain Crest toothbrushes in favor of Oral-B brushes. Crest toothpaste was introduced in 1955, as a relative latecomer to the market compared to Colgate's 1873 product launch, and is the bestselling U.S. brand. Crest was the first nationwide launch of a fluoride toothpaste based on fluoride research. Procter & Gamble worked for 25 years to improve Crest by testing over 70 formulas. It confirmed that Advanced Formula Crest with the fluoristat cavity fighting system offered better cavity prevention than original Crest, and launched the improved product in 1981. Oral-B started in California in 1950 and innovated dozens of toothbrushes since, including the first angled toothbrush in 1981. Oral-B was the initial manufacturer to target children, first in 1984 with its Star Wars toothbrush and then in 1986 with Muppets toothbrushes and toothpaste. Braun is known for its innovations with powered brushes including the first to combine vertical and horizontal movements. The Oral-B Ultra Plus, the first new generation Oral-B toothbrush in 30 years, was launched globally in 1987 in partnership with Braun. It featured a rounded head, longer handle, and thumb grips. In 1991 Oral-B launched its Edison Award-winning Oral-B Indicator toothbrush with patented fading bristles that signal the consumer when it is time to buy a new toothbrush.

The original Crest brand of toothpastes, toothbrushes, whiteners, flosses, and rinses includes ancillary brands known as Pro-Health, Whitening, Cavity Prevention, Tartar Protection, Sensitive Teeth, MultiCare, Baking Soda, Gels, Liquid Gels, Striped, and For Kids. The Oral-B family of toothbrushes has expanded to consist of 14 manual-brush brands and 10 power-brush brands.

Other companies offering toothpasre products include Church & Dwight with headquarters in Princeton, New Jersey, making toothpaste under the brands Arm & Hammer, Mentadent, Aim, and Pepsodent; Johnson & Johnson with headquarters in Racine, Wisconsin, making Reach toothbrushes and Rembrandt toothpaste (Rembrandt announced an ancillary line called Rembrandt Classic in 2007); Tom's of Maine with headquarters in Kennebunk, Maine, making fluoride and fluoride-free toothpaste known for exotic flavors derived from natural oils.

MATERIALS & SUPPLY CHAIN LOGISTICS

The Census Bureau reported that in 2002 the soaps and detergent industry used $6.0 billion worth of materials to produce $17.0 billion worth of products. The value of materials used declined slightly between 1997 and 2002, from $6.1 billion to $6.0 billion. The majority of these materials were organic and inorganic chemicals; surface active agents; soda ash, caustic soda, sodium tripoly-phosphate, and potassium; and perfume oil mixtures and blends.

Toothpastes require many of these same products. The organic chemicals used in the production of toothpaste are used as a preservative to provide long shelf life. Inorganic chemicals used in toothpaste occur mostly as salts. In toothpaste, surfactants act as wetting agents that change the surface tension of a paste, gel, or cream to assist cleansing, foaming, and emulsifying. Soda ash is another name for salt and in toothpaste is primarily used to improve cleansing characteristics. In toothpaste, perfumes impart a pleasant aroma. Toothpastes today typically contain fluoride, coloring, flavoring, sweetener, as well as ingredients to create a smooth moist paste, and to make the toothpaste foam.

The Annual Survey of Manufactures, published by the Census Bureau, reported that in 2002 the broom, brush, and mop industry used $950 million worth of materials to produce $2.4 billion worth of products. The value of materials used increased to $1.0 billion in 2003, $1.1 billion in 2004, and $1.2 billion in 2005. The majority of these materials were plastics products; metal products (shapes and forms); yarns and textiles; wood brush handles and backs; paperboard; plastics resins; and dressed hair (including bristle and horsehair).

Toothbrushes require many of these same products. Toothbrushes come in many shapes and sizes and are typically made of plastic molded handles and nylon bristles. Toothbrush models include handles that are straight, angled, curved, and contoured with grips and soft rubber areas to make them easier to hold and use. Oral-B introduced in 1996 the Advantage Control Grip toothbrush, with patented micro-textured nylon bristles and an ergonomic dual material handle. Toothbrush bristles are usually synthetic and come in a range of texture levels, from firm to extra soft. Although harder bristle versions are available, dentists recommend the use of soft bristles because vigorous brushing causes tooth abrasion and wear. Toothbrush heads range from very small for young children to larger sizes for older children and adults and come in a variety of shapes such as rectangular, oval, and round.

DISTRIBUTION CHANNEL

Toothcare products are distributed in two distinct channels. Within the industry these are known as the consumer channel and the professional channel.

The consumer distribution channel is part of the general retail network. This broad channel for distributing toothcare products to the consumer includes a throng of outlets: drugs stores such as CVS, Rite Aid, and Wal-greens; food stores including Whole Foods and health food stores; mass merchandisers including Kmart, Target, and Wal-Mart; and nontraditional retailers including e-commerce Web sites. This retail universe now includes warehouse club stores like Costco and Sam's. Within this channel, hundreds of toothpaste brands and dozens of toothbrush brands compete for shelf space, along with dental floss, mouthwashes, and mouth rinses.

The professional distribution channel is growing rapidly, especially as a source of tooth whitening products. It is a distribution channel of choice for manufacturers because of the intimate environment within the dental office. When dentists agree to distribute toothcare products, it represents a valuable product endorsement and is, in effect, free advertising for the manufacturer. Manufacturers prefer this channel because statistics show that sales increase when professionals are present to influence choices. Dentists can steer patients towards professional or prescription whitening and/or fluoride products when appropriate, and steer patients away from dangerous product combinations.

A popular product available only through the professional distribution channel is Colgate Visible White, a professional take-home whitening kit with a higher dosage of whitening ingredients than is available in the consumer channel. Also available is Colgate Platinum Professional Whitening System in overnight, daytime, and gentle-plus doses. The professional channel distributes products with higher dosage amounts than products sold in stores. For instance, Crest's Professional Whitestrips Supreme features 14 percent hydrogen peroxide, the whitening agent.

Higher dosing is based on the assumption that purchase and use decisions will be influenced by dentists with intimate knowledge of patients' dental needs who are better placed to recommend appropriate products and ensure they will be properly used.

The professional distribution channel is also a source of fluoride products with a higher dosage than is available in stores. Store toothpaste delivers approximately 1,000 ppm fluoride to the teeth. Colgate PreviDent 5000 Plus, a prescription-strength toothpaste delivers 5,000 ppm fluoride. Dentists tend to stock only products that use ingredients proven effective. For instance, highly educated dentists are generally skeptical of efficacy claims regarding mouthwashes, and are more than likely to endorse only fluoride mouth rinses. Examples available in the professional channel include Colgate Phos-Flur Anticavity Fluoride Rinse in cool mint, gushing grape, cherry, and bubble gum, and Phos-Flur Gel Rx, a prescription-strength fluoride that contains four times the fluoride of store products.

KEY USERS

Users of toothcare products are every human being with teeth, although pet toothcare products are also available. Even if people do not still have teeth, they use toothcare products to take care of false teeth. It is estimated that toothpaste and toothbrushes have penetrated close to 100 percent of U.S. households.

ADJACENT MARKETS

Dentistry services are an important market adjacent to toothcare products. These services include expensive in-office treatments such as:

• Custom fitting of individualized tooth mold trays produced to fit teeth for whitening with a peroxide solution.
• In-office whitening treatment that takes between 1 to 2 hours and costs approximately $600 to $1,000.
• Replacement of metallic cavity fillings with composite plastic resin fillings that can be custom tailored to match the color of the client's own teeth.
• Repair of chipped teeth.
• Refacing of teeth with products such as U.S. porcelain veneers.

Other products which are adjacent to the toothpaste and toothbrush markets include gum, candies, tooth ache medicines, dentures, and athletic mouth guards used by many participants in sporting activities.

RESEARCH & DEVELOPMENT

GlaxoSmithKline claims to regularly spend £8 million (around US$14 million) on research and development each day. This equates to $562,000 every hour. Over 15,000 people work in the many areas of research & development at GlaxoSmithKline. Toothcare products are only a small part of the overall GlaxoSmithKline. Pharmaceuticals make up a large part of their product mix.

Research & development scientists worked for twenty-five years at Procter & Gamble to improve the original Crest formula. During that time period, they tested seventy formulas.

Since nondurable consumer goods such as toothpaste and toothbrushes tend to be in vogue for only four to five years before new formulations and styles are introduced, R&D must keep current on industry trends. For instance, Crest research & development took advantage of new synthetic organic flavoring materials to create and launch new formulas. Crest products are available in flavors like lemon ice, cinnamon, peppermint, vanilla mint, strong mint, and mild mint. Crest Just for Kids flavors include bubblegum and cinnsational swirl. Research & development also resulted in liquid gel formulations sold in an upright plastic jar for those interested in a change from the 100-year-old tube concept. The gel user can choose flavors such as cinnamon rush and extreme herbal mint.

One goal of research & development is to expand the range of products to go beyond the traditional use of merely using toothpastes and toothbrushes to apply fluoride to the teeth. Manufacturers have introduced products to get the consumer interested in plaque control, tartar control, and gum care—especially the gum disease known as gingivitis. Manufacturers have been helped in this regard by media coverage.

Recently, heart disease and stroke have been linked to oral infections. National media coverage spotlighting inflammation of the gums spawned much interest in the topic. Studies link heart disease and stroke to gum infections; the risk seems to increase with the severity of the oral infection. There is not yet enough evidence to establish oral infection as an independent risk factor for heart disease or stroke. Researchers have found an association between gum disease and heart disease, stroke, and bacterial pneumonia. However, an association between conditions does not mean that one causes the other. More research is needed to conclude that mouth infections cause these serious health problems. R&D is melding perfectly with media coverage fueling fears that consumers need products developed to be and advertised as anti-plaque/anti-gingivitis.

For instance, the Washington Post reported in early 2007 that a twelve-year-old boy in the Washington, D.C. area, Deamonte Driver, died of complications resulting from an untreated dental abscess, after bacteria from the untreated tooth spread to his brain. The boy had undergone two brain surgeries and more than six weeks of hospital care before he died. Media coverage of such incidents brings attention to the subject of oral health and provides manufacturers opportunities to market their products.

CURRENT TRENDS

Throughout the modern history of dentistry, the trend was to focus on children. Only 20 years ago, dentists thought fluoride worked primarily by strengthening the developing teeth of children before they grew into the mouth, young children were the focus of fluoridation efforts. Adults are now the focus of fluoridation efforts. We are, after all, adults for a longer period of time than we are children.

Emerging research is highlighting the need for adults to continually apply fluoride to their teeth, in the form of toothpastes and fluoride mouth rinses, to fight decay throughout life. Minneapolis dentist Terese A. LaLomia recently reiterated that "The regular use of fluoride toothpaste and fluoride mouth rinse helps to protect the permanent teeth from decay and sensitivity, allowing patients to keep their permanent teeth much longer." Among adults aged sixty-five to seventy-four, 26 percent nationwide have lost all their natural teeth.

Mouthwash and fluoride mouth rinse are two different products. The Food and Drug Administration classifies products as cosmetics, drugs, or a combination of both. Mouthwashes are cosmetic, while fluoride rinses are a drug with cosmetic benefits. Mouthwashes are a purely cosmetic solution of alcohol, flavor, perfume, and color that temporarily suppress bad breath and refresh the mouth. Fluoride rinses are approved by the Food and Drug Administration, because use of the product coats the teeth with fluoride, a proven preventer of cavities. Rinses deliver 225 ppm fluoride to the teeth and are clinically proven to be a useful adjunct to toothpaste for those who are cavity prone. According to Minneapolis dentist Terese A. LaLomia, mouthwashes advertised as anti-plaque/anti-gingivitis products are no more effective than rinsing with plain water. Only rinses with fluoride prevent streptococcus mutans, the bacteria that causes the plaque that leads to tooth and gum disease.

Fluoride rinses are both affordable and effective. The only problem is finding one on the shelf at the store. The American Dental Association lists 225 approved mouth-washes, and only 25 approved fluoride mouth rinses. Approximately 12 percent of mouthwash and mouth rinse products contain fluoride.

Xylitol is just beginning to become trendy with consumers. The Food and Drug Administration approved xylitol in 1986. Scientific studies prove xylitol prevents cavities. Research confirms that xylitol inhibits the growth of streptococcus mutans, the oral bacteria that cause cavities. In the presence of xylitol, bacteria lose the ability to adhere to the tooth, stunting the cavity-causing process. A natural sweetener found in plants and fruits, it is now available in sugar-free gum, mints, and toothpaste. "I recommend products that contain xylitol for cavity prone patients, especially those who rarely go one year without getting cavities," explained Minneapolis dentist Terese A. LaLomia. Epic Gum contains xylitol. It comes in three flavors, peppermint, spearmint, and cinnamon. Packages of 60 pieces sell for $4 and are available behind the counter in pharmacies. Epic also sells mints, toothpaste, and mouthwash.

TARGET MARKETS & SEGMENTATION

Cosmetic whitening is an important segment of the market. The most recent advances in toothcare include the development of whitening products. The first consumer home tooth bleaching product was introduced in 1989. Colgate-Palmolive makes 21 tooth-whitening products. Colgate-Palmolive introduced Colgate Simply White toothpaste in 2003 and Colgate Whitening toothbrush in 2004. Whitening toothpastes remove only surface stains, such as those caused by smoking, tea, or coffee. The cosmetic whitening segment can be tied to the aging population. As teeth age, they yellow from the inside out. Whitening products contain hydrogen peroxide. Arm & Hammer (made by Church & Dwight) sells Advanced White toothpaste with baking soda to reduce acid in the mouth and peroxide to whiten teeth.

Children are an important segment of the toothcare market. Some parents know that getting fluoride onto baby teeth before the permanent teeth erupt is proven to reduce dental disease by 60 percent. Many parents are willing to pay any price for any product to protect their children from disease. Children's products also target working parents who may be willing to spend any amount of money on toothcare items that promise to make the nightly brushing ritual before bedtime easier.

Children are also an important segment of the tooth-care market because toothpaste brand loyalty is high. In marketing to children, manufacturers hope to plant the seeds of brand loyalty early. Oral-B began targeting children in 1984 with Star Wars toothbrushes and in 1986 with Muppets toothbrushes and toothpaste. Crest followed with Crest for Kids in 1987. Colgate targets children with Dora the Explorer, Barbie, and Sponge Bob Square Pants products. Colgate also sells battery-powered character toothbrushes, some specially designed for girls ages six to thirteen. Oral-B targeted the children's segment worldwide in 1995 with the launch of Squish Grip and Gripper brushes designed for children in different age groups. In 1997 Oral-B partnered with children's programmer Nickelodeon. The success of Nickelodeon children's toothbrushes and toothpaste made Oral-B the U.S. children's oral care leader. In 2001, Oral-B entered into an agreement with The Disney Company to launch children's products featuring Mickey Mouse, Winnie-the-Pooh, Buzz Lightyear, and the Disney Princesses.

People with sensitive teeth are also an important, and underserved, segment. Pain caused by sensitive teeth is called dentinal hypersensitivity. It is one of the most common dental complaints. At least one-fifth of all adults suffer from sensitive teeth. According to GlaxoSmithKline, 40 percent of the global population suffer from it. Products are needed to address the complaint, because dentinal hypersensitivity can be serious. It can cause general oral hygiene neglect and diminished brushing. Since fluoride is not applied often enough to the teeth to prevent streptococcus mutans, the bacteria that causes such problems, from working, the result can be plaque build-up, gingivitis, periodontal disease, and eventually tooth loss. There is room for growth in this segment because these products can be hard to find, and because dentinal hypersensitivity is the most common side-effect of teeth whitening.

Colgate has only one product for sensitivity relief, Colgate Sensitive Maximum Strength Plus Whitening. It contains potassium nitrate. Toothpastes with 5 percent potassium nitrate as the desensitizing agent, when used twice-daily, have been proven to relieve dentinal hypersensitivity within two weeks. This is the maximum amount of potassium nitrate allowed by the Food and Drug Administration to treat sensitivity. GlaxoSmithKline also has only one product for sensitivity relief, Sensodyne. According to Market Share Reporter 2007, Sensodyne is a U.S. bestseller, third after only Crest and Colgate.

RELATED ASSOCIATIONS & ORGANIZATIONS

Academy of General Dentistry, http://www.agd.org

American Dental Association, http://www.ada.org/public/resources/history/index.asp

American Dental Hygienists Association, http://www.adha.org

Centers for Disease Control and Prevention, http://www.cdc.gov

Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, http://www.cdc.goc/oralhealth

National Center for Health Statistics, http://www.cdc.gov/nchs/fastats/dental.htm

National Institutes of Health, National Institute of Dental and Craniofacial Research, http://www.nidcr.nih.gov

National Oral Health Surveillance System, http://www.cdc.gov/nohss

BIBLIOGRAPHY

"ADA Seal Product List." American Dental Association. 6 June 2006. Available from 〈http://www.ada.org/ada/seal/adaseal_productlist.pdf〉.

"Ancient Toothpaste Recipes." Dr. Weevil. 25 January 2003. Available from 〈http://www.drweevil.org/archives/000500.html〉.

"Broom, Brush and Mop Manufacturing: 2002." 2002 Economic Census. U.S. Department of Commerce, Bureau of the Census. December 2004.

"Gum-Chewers Have New Reason to Smile." General Dentistry. July/August 2002.

"History of Dentistry." American Dental Association. Available from 〈http://www.ada.org/public/resources/history/index.asp〉.

"Hygiene and Personal Care." Franklin Court Material Culture, U.S. Department of the Interior, National Park Service. Available from 〈http://www.nps.gov/archive/inde/Franklin_Court/Pages/hygiene.html〉.

Lazich, Robert S. Market Share Reporter 2007. Thomson Gale, 2007, 311-312, 557.

"Oral Health 2000: Facts and Figures." U.S. Department of Health and Human Service, Centers for Disease Control and Prevention. Available from 〈http://www.cdc.gov/oralhealth/factsheets/index.htm〉.

"Oral Health in America: A Report of the Surgeon General." U.S. Department of Health and Human Services. May 2000. Available from 〈http://www.surgeongeneral.gov/library/oralhealth/〉.

"Oral Health: A Window to Your Overall Health." Mayo Clinic Dental. Available from 〈http://www.mayoclinic.com/health/dental/DE00001〉.

"The Story of Fluoridation." U.S. Department of Health and Human Services, National Institutes of Health. Available from 〈http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/Fluoride/StoryFluoride.htm〉.

"Toilet Preparation Manufacturing: 2002." 2002 Economic Census. U.S. Department of Commerce, Bureau of the Census. December 2004.

"What Are the Differences in Rinses?" Academy of General Dentistry. Available from 〈http://www.agd.org/consumer/topics/mouthrinse/main.asp〉.

see also Soaps & Detergents