Brave New World

When Philip B. Hanson looks at China, he sees an emerging market for dental products that is almost unfathomable. “The last population estimate I saw was 1.3 billion,” says Hanson, global team leader for dental products manufacturer 3M ESPE. “That’s a lot of teeth.”

Demand for dental services from China’s growing middle class is fueling an oral health care boom in that country. And the same thing is happening in other places with millions or even billions of teeth, including India and Brazil.

“The thing about China and most emerging markets — and you have to be careful with these generalizations — is that wonderful economic growth is happening in these places,” he notes. “As the economy grows, more people are earning more money, which allows them to access better medical and dental care. So as people choose to spend a part of their income on dental care, it’s good for business.”

And with consumers becoming increasingly smile-conscious on a global level, demand for cosmetic dental procedures has skyrocketed. “For people who have a little more money, there is a large and growing elective-dentistry market,” Hanson says. They want the straight and dazzling teeth that are seen as a universal mark of success, the so-called “social six” of a nice veneer job, as Hanson puts it. “The social six. You know. The six front teeth.”

So 3M ESPE, a division of 3M Health, one of six major business segments of the Minnesota-based global technology company claiming $30 billion in annual sales, is finding growing demand from China for its indirect restorative materials, composites, adhesives, finishing and polishing systems, and a host of other dental products, Hanson reports.

Likewise, consumer-product giants such as Colgate-Palmolive and Procter & Gamble vie for brand recognition in Chinese cities with populations the size of European countries. Colgate billboards court Chengdu’s 14 million residents. Crest toothpaste manufacturer Procter & Gamble boasts a new research center in Beijing, population 19 million.

“Everything that is happening in the developed market is happening in China and other emerging markets,” says Hanson. “It’s a race — and it’s happening faster and faster and faster.”


Market expert and Mentor columnist Jim Ferrell of The Aneheim Group, a former vice president and general manager for DENTSPLY International, who now publishes annual, monthly and weekly industry analytic tools — including the Dental Industry Review, DentalFax Weekly and the China Connection report — acknowledges that the trend is too vast to ignore.

Globally speaking, as the middle class rises, so does demand for dental procedures. “It’s the same model you will see all over the world, and this is what’s happening in most of the emerging markets,” Ferrell explains. “India is another good example. When you have 1.2 billion people, even if only 5% of them are wealthy or middle class, that’s still a lot of people.”

Other industry-watchers agree. For example, the Chinese and Indian markets for dental implants and final abutments grew by 34% in 2010 alone, according to iData Research, a Maryland-based market research and consulting group. In a series of studies released last year, iData also predicted double-digit growth in implant use in additional emerging markets, including Brazil.

The implant boom has resulted in expanding demand for dental biomaterials and bone-graft substitutes. The market for implants in India and China will reach almost $400 million by 2017, iData forecasted. Robust sales are also expected for the Brazilian implant market, where iData indicates “the number of implant procedures using bone-graft substitute material will more than double in volume to over 2 million procedures in 2017.”



American manufacturers of dental products and equipment are rushing to meet the growing demand of emerging markets, notes Jim Ferrell, a market expert and publisher of DentalFax Weekly. “If you go to a trade show in China, all of the large American and European companies have booths and are selling,” he says. But they have competition, as there are plenty of homegrown competitors for these emerging markets, as well.

“There are probably 300 to 400 dental manufacturing companies in China that primarily sell to the Chinese market,” Ferrell reports. “None of them have done much exporting to the West yet. But it’s going to happen.”

And while American optical and medical products were leading exports to India according to a 2007 Congressional Research Service analysis of United States and Indian trade, India’s own dental care equipment manufacturing sector has been growing steadily in recent years.

“India is … becoming a manufacturing hub, supplying dental equipment and material to less developed countries,” reports Modern Medicare, an Indian publication that follows the country’s health care equipment and technology industries. The May 2012 article ran under the headline, “Dental Care Equipment Market in India: Driven by Increased Demand.”

Neighboring Pakistan also prides itself on a thriving dental and surgical equipment manufacturing sector. According to an article in the Daily Times of Pakistan, which covered an international health care trade show held in Karachi in July, the country exports $225 million worth of products — primarily disposable instruments — to Europe and the Middle East, as well as to the United States, Mexico and Brazil.

Across the Pacific, Brazilian manufacturers have also been expanding their operations to meet domestic demand, and are looking to tap international markets, according to the Maryland-based consulting group iData Research. This is just the latest indicator that there’s no time like the present to start gaining a foothold in — or a larger share of — the world’s emerging markets.


The bright smiles and sparkling veneers worn by the upwardly mobile in many of these emerging-market countries are far from universal, however. Statistics on the availability of dental care in nations around the world vary widely. But even while elective procedures boom, signs point to an alarming lack of access to basic oral health care for untold millions of people.

To put the findings in perspective, the United States, with an estimated 136,417 working dentists, has one dentist for every 2242 people, according to 2007 statistics compiled by the World Dental Federation (or FDI) in its most recent Oral Health Atlas. By comparison, India, with 34,500 dentists, has only one working dentist per 33,885 citizens. China’s situation is even more dire. With an estimated 16,232 working dental professionals, China’s ratio works out to be one provider for every 82,296 citizens, the FDI reports. According to some estimates, in fact, it’s believed that less than 10% of China’s population has ever been to a dentist.


Even amid such a crisis, there are people who see opportunities, both to address needs — and to capture emerging markets. One of them is Kathleen T. O’Loughlin, DMD, MPH. As executive director of the American Dental Association (ADA), O’Loughlin visited China in September as part of a professional delegation participating in an FDI meeting. During her travels, she had a firsthand look at the oral health care system that serves China — and gained a sense of what it might become.

Currently, much of China’s dental care is provided through a system of public and private hospital dental departments, specialized dental hospitals and an estimated 10,000 private dental clinics. Several clinic chains have been established since the government began allowing the private ownership of hospitals and clinics in the 1980s, according to a 2012 white paper on the Chinese dental system produced by the ADA.

While in China, O’Loughlin had the chance to visit a state-of-the art corporate dental practice that caters to wealthy clients. The practice was started by a United States-educated Chinese graduate of the Wharton School, who opened the office with venture capital money. O’Loughlin also had the opportunity to tour huge dental hospitals with several hundred chairs and crowded waiting rooms.

Still, dental disease is rampant in China and is expected to grow. Less than a quarter of Chinese 5- and 6-year-olds are free of tooth decay, according to the ADA white paper. Along with prosperity, sugar consumption is rising. “This may lead to a greater prevalence of dental caries in view of the low fluoride intake and poor oral hygiene of the average Chinese citizen,” the paper noted.



Although the provider-to-patient ratio is not favorable in many countries with emerging dental markets, that has not curtailed rising demand from a growing middle class. And countries like China are responding by opening new dental schools.

O’Loughlin heard much about efforts to address the nation’s vast and growing need for dental care. Although dozens of new dental schools have opened throughout China’s provinces in recent years, the Chinese dental professors with whom she spoke said they worried about the skills of the new graduates. Some asked for the ADA’s help in establishing accreditation standards for new dental practitioners.

Other professionals she met were eager for quality continuing education that would help them master endodontic, orthodontic and implant procedures. Some sought wider support from United States dental products manufacturers for Chinese trade shows. Still others hoped for American guidance on managing private practices, O’Loughlin reports.

Grasping China’s demand for dental products and services, she left the country convinced of an emerging market for American dental expertise. “We’re developing a business plan,” says O’Loughlin, who has continued the conversation with her Chinese counterparts. “We’ll present them with some ideas, hopefully soon.”


When Vista Dental CEO Gary Pond first visited China in 1994, he did not speak the language. Travel was arduous. Manufacturing was controlled by state-owned enterprises. “It was considered a fairly spooky place,” recalls Pond, whose Wisconsin-based company manufactures endodontic and general dentistry products.

Over the years, Pond has had a chance to witness the country’s transformation into the world’s second largest economy. The factory he set up in China supports his manufacturing plant in Racine by supplying low-cost subassemblies for products that are then finished by his American employees. Looking back, he is glad he took the leap of faith required to work in a foreign country. “It opened my eyes to a lot of things,” Pond says. “It made me a better CEO.”

And Pond, who is now preparing for his 90th trip to China, sees the lessons he learned as essential for anyone who is contemplating the possibilities of tapping into emerging global markets.

“Go carefully,” he advises. “Get to know how people live their lives in the country where you want to do business. Be patient. Ask questions, and then ask follow-up questions.

“And most of all,” Pond says, “listen to the answers.”


Gary Pond has been working closely with China since 1994. He has found his experiences fascinating, rewarding and challenging. When asked for advice for companies contemplating entering emerging global markets for dental products, he offers the following tips:

  1. on the market,” Pond emphasizes. “You need to spend time traveling to the dental shows, traveling to the clinics, and getting a real feel for the opportunities.”
  2. Pick Your Partners Carefully. “You need to be very selective about which partners you pick,” he cautions, “because a lot of people will promise you everything but then deliver nothing.”
  3. Understand the Costs. “Getting your arms around the cost to get a product approved for use is both substantial and lengthy if you are going to do it above board,” he says. “There are companies that play in the gray market. They take the risk and don’t register their products. If you get caught, that would not serve you well. You have to go through the formal approval process.”
  4. Take Your Time. Pond opines that when working in foreign countries, Americans can tend to rush to judgment. “We just want the end result — to get there as quickly as possible,” he says. “My suggestion is to take your time. It’s not fun, but it’s the best way to ensure the results you seek.”
  5. Spend Time on the Ground. Pond believes it’s critical for top management eyeing emerging markets to take a hands-on, in-the-field approach. “You can’t go to China and stay at the Hyatt and make a day trip here and a day trip there and even begin to fathom the obstacles you will have,” he says from personal experience.
    And, after decades of doing business in China, Pond admits that he is still learning, and still making mistakes.
MENTOR January 2013, 4(01): 24 – 27.

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