Oral Care Innovation: Hygiene and consumer behaviour
‘A smile is the shortest distance between two people’ [i]
Beautiful smiles with healthy, white teeth can enhance our social connections. Daily oral care is an essential regimen for most people aiming to maintain oral health. It can prevent tooth decay (dental caries) and gum inflammation (gingivitis) progressing to gum disease (periodontitis) and maintain attractive appearance, avoiding discoloration and bad breath (halitosis).
The Oral Microbial Community and Hygiene Habits
Good hygiene is essential for oral health. Recent advances using molecular methods for analysis of complex bacterial communities have shown the richness of the oral microbiome. Failure to follow good oral habits results in prolonged accumulation of biofilm in the form of dental plaque. The plaque forms when pioneer species, so called ‘early bacterial colonizers’ (such as Streptococcus and Actinomyces), adhere to pellicle-coated enamel (saliva-derived proteinous coating on the tooth surface) followed by secondary, plaque forming ‘late colonizers’ (such as Fusobacterium, Porphyromonas, Prevotella, Veillonella, Capnocytophaga, and Actinobacillus)) that have the capability to form biofilms with a range of other genera and species.
‘The mature plaque biofilm has many features of multicellular organisms, with species cooperating to make nutrients available, resist environmental stress, and communicating to regulate their overall numbers.’ [i]
Tooth decay is prevalent affecting billions of people worldwide; it happens when acid production from bacterial metabolism of dietary carbohydrates supersedes the mechanisms promoting pH homeostasis, including bacterial alkali production. Diet with high levels of fermentable sugars has resulted in a change in the biofilm encouraging acid formation. There is a shift in the microbiome towards flora (plaque-forming bacteria, such as Streptococcus mutans) that produces acid and thrives in an acidic environment, causing enamel demineralization. Gingivitis and periodontitis are also caused by dental plaque accumulation and poor oral hygiene increases periodontitis risk by 2-to 5-fold. Last but not least, oral malodor is socially awkward and isolating. Recent research suggests that poor dental care may be also associated with serious health problems. In cardiovascular disease, the gingivitis plaque bacteria entering bloodstream may lead to atherosclerosis and an increased risk of heart attack or stroke. Also in dementia, respiratory infections and diabetes complications may arise due to gum inflammation.
Motivating Consumer Behaviour
Oral microbiome proliferation must be controlled by oral hygiene care, conventionally by mechanical means, toothpastes and mouth rinses. Good oral health is largely attributable to regular twice-daily tooth-brushing for 2 minutes and different methods of active ingredient delivery; in the form of toothpastes, gels, powders, waters and mouth rinses. Toothpaste is an abrasive dentifrice, used in conjunction with a toothbrush. It functions to mechanically remove food and control the dental biofilm as well as deliver active ingredients to maintain the aesthetics, suppress bad breath and prevent tooth decay and gum disease. Adherence to good oral health habits differs across population – it is low in the teenage population, at the time when lifestyle habits are formed.
A Growing Sector, but is it innovative?
According to market research, the toothpaste market is valued at $ 26.09 bn (2018) and projected to reach $ 36.98 bn by 2024, with CAGR of 6.1% [i]. The oral care market overall is driven by growing awareness about oral health but also rising prevalence of dental disease due to lifestyle changes (including sugar-rich diets, alcohol consumption and smoking) and loss of teeth in the ageing demographics. The impact of dental diseases and disorders on people’s everyday lives is subtle and pervasive, collectively, they create substantial pain and suffering. There is a growing number of small dental clinics sharing the expertise, however, the industry challenge is being highly dependent on retail stores and direct communication with consumers. [ii] Oral care routines rarely change dramatically, however, as consumers now pay more attention to their own health and wellbeing, understanding how their oral health impacts on them emotionally draws a parallel between diligent oral care and a beauty routine[iii]. Dr Nick S. Jakubovics, Journal of Dental Research Editor-in-Chief and Senior Lecturer in Oral Microbiology School at Newcastle University, talks about how the major challenges in oral care are maintaining gum health and preventing tooth decay,
“Although current products are reasonably effective, the global burden of oral disease remains higher than any other disease condition. The difficulties in maintaining oral health stem from the complexity of the system. Dental plaque typically contains hundreds of different micro-organisms interacting with one another and with the tissues in the mouth. On top of this, environmental factors such as diet and smoking also have a major impact on oral health. We have begun to realise that destroying dental plaque completely is an unrealistic, and possibly unhelpful, aim. Instead, we need more sophisticated science-based approaches to oral care that maintains dental plaque in a healthy and controlled state and prevent the overgrowth of more pathogenic species”.
Toothpaste that amazes your mouth
Innovation presents a challenge for the oral care industry, in particular due to the diverse global regulatory landscape. Unilever, in their Open Innovation call, invite submissions from new technology partners to improve and differentiate their products. Looking for the ‘wow’ factor in toothpaste, they focus on new sensory experiences e.g. taste with new flavors, the feel of a new texture, even sound, and new active ingredients. These may include a range of functionalities from cooling agents which impart superior fresh feel, to agents for slow sensory release, new naturals and even confectionery ingredients.
When looking at new toothpaste technologies, it is important to consider that that toothpaste is used to enhance the effectiveness of cleaning with a toothbrush. Toothbrush type, technique, duration and frequency of brushing play a great role in oral health, e.g. using a powered toothbrush is significantly more effective in reducing plaque, bleeding and gum inflammation than using a manual toothbrush.[iv] There is also an ongoing call for innovation in tooth brushes. At the latest tech show, CES 2020, Colgate have showcased a ‘Plaqless Pro’ toothbrush that glows blue when plaque is detected and turns white when cleared. An embedded sensor detects the presence of plaque for every single tooth and the app synchronises with a smartphone to show the consumer their map of brushed and unbrushed teeth.[v]
An industry that provides consumers with the same narrative of oral care every day want to ‘revolutionise the feeling people have when they clean their teeth’. The ultimate goal is to develop a toothpaste that will make consumers want to brush their teeth, leave the mouth with a sense of blissful freshness – a product that consumers will truly love. [vi]
Dr Katerina Steventon, NBIC Senior Innovation Consultant