Inside Dentistry
November/December 2007

The direct-to-consumer marketing that sprang forth from the pharmaceutical industry has infiltrated dentistry. Messages targeting consumers about the benefits of specific dentist-performed procedures or dispensed products are increasingly appearing in television commercials, magazine advertisements, and websites. Consumer response to these messages has been similar to what was experienced in the drug industry when campaigns for such products as prescription Claritin were first introduced 10 years ago.

"The impact of direct-to-consumer messaged on consumer empowerment and the effect that has on prescribing, compliance and loyalty for individual brands is the same in the dental community," explains Matt Giegerich, president and CEO of CommonHealth, one of the world's largest marketing communications companies in the healthcare space and the direct-to-consumer mastermind behind such pharmaceutical brands as Claritin, Levitra, Crestor, and Avandia, among others. "Whether it's to treat a life-threatening disease like cancer or a purely cosmetic concern like teen acne, the recipients of these messages are a consumer base interested in their own opinions, engaged in the process, and willing to take charge of the outcome."

As a result, there is an ever-growing presence of dental companies in the media trying to reach out to consumers and brand their offerings, observes Kevin Mosher, general manager and vice president of Nobel Biocare, the all ceramic and dental implant product manufactures that launched its own major public relations and marketing campaign targeted towards consumers in 2005. ‘Manufacturers are encouraging consumers to ask for specific products when they go to their practitioners, and I think this trend will increase because the pharmaceutical industry has demonstrated that there is a return on such an investment."

A survey by the United States Food and Drug Administration for that 51% of respondents who saw a doctor within the past 3 months said that an advertisement for a prescription drug motivated them to seek out more information about the medication. In 2006, prescription drug sales in the United States totaled $252 billion.  

The huge lifts in sales, shares, prescribing, and intent to prescribe for specific brands - including those in the dental category- that result are based on the activation of different marketing channels (eg, broadcast television, viral Web, print) and are irrefutable, assert Giegerich, whose company also developed the direct-to-consumer strategies and messages for Discus Dental. The phenomenon isn't going to change, he says. What's more, whether for dentistry or pharmacy, the primary effect of the direct to consumer marketing activities is the same: consumer empowerment drives the consumer demand that drives both office visits and, ultimately, the volume of prescriptions in the categories (ie, lifestyle, cosmetic, dermatology, impotence, cancer) that are heavily marketed.

"We're clearly an information society today, and we passed a major milestone last year when the first baby boomers turned 60," explains Mosher. "This segment of the population doesn't simply accept what the man in the white coat says. They question, they want input, and they look for information resources themselves. There is data to show that this demographic actively researches its healthcare decisions."

Yet, ironically, there is currently no general voice telling the public about what is available at a dental office, so when a manufacturer does it through direct-to-consumer marketing, suddenly the consumer is hearing something new and great about dentistry, explains Fred Joyal, CEO and founding partner of 1-800-DENTIST Since its inception in the 1980s, the mission of 1-800-DENTIST has been to inform the public about modern dentistry and the importance of regular dental visits. This goal has been consistently achieved through the company's own direct-to-consumer marketing initiatives: commercials that air 5,000 times each month on network television and a referral website to complement the telephone number brand.  

While some may think that direct-to consumer marketing activities conducted by manufacturers are something "out there" that's happening in the background they're not. They're on the rise, having an impact on dentistry, and influencing how the recipients of the messages think about their necessary and elective oral care. To complement last month's cover feature about how, when and why to market the dental practice, here's an inside look at how direct-to-consumer marketing has made its way into dentistry, and with what effects.

The Methods of Manufacturer Direct-to-Consumer Marketing

"Whether it's a dentist-prescribed product/ procedure or a specialty, dentist-recommended over-the-counter dental product, one potential barrier to marketing messages is the fact that statistics suggest that 50% of Americans still don't visit their dentist regularly", says Jefferey S. Rigs, director of marketing for GlaxoSmithKline. For dental consumer marketing programs that combine direct and professionally initiated communication some people won't be impacted or, in other words, "get the message."

For example, when GlaxoSmithKline's Sensodyne specialty dentifrice brand was introduced, it was initially promoted exclusively through dental channels, growing a very healthy professional recommended business, Riggs recalls. As a result, all marketing efforts for the product were targeted directly at dental professionals until 1989, at which time the decision was made to go direct-to-consumer via television advertising.

"There's been consistent and steady growth in our Sensodyne business over the years since the start of television advertising," Riggs admits. "However, we certainly haven't abandoned in any way our professional marketing. "In fact, we've only grown our emphasis and effort with dental professionals."

"When GC America, Inc, began its penetration into the consumer marketplace with its dentist-dispensed MI Paste, it did so in a quiet way," comments Robert Lee, BDS, MBA, the company's director of marketing. There were patient leaflets at the dentist's office, information about the product contained in brochures accompanying bleaching product regimens, and that was the extent of it, he says. Marketing was targeted primarily toward the professionals who would recommend the product to their patients.

Then, a significant change and addition to the marketing strategy occurred earlier this year when GC America began to actively market MI Paste directly to consumers, Lee says. It started off with a Web site (mi-paste.com) geared toward the patient and written in a patient-friendly way. Google advertising was introduced at the beginning of the summer, along with the use of specific key words, resulting in an almost immediate jump on Web site hits. Also, dentists can link their own Web site to the GC America mi-paste.com site so that patients can access more information about the dental problems resolved by the product. Finally, in certain geographic areas, paid promotional news segments that discuss MI Paste are being picked up by local station, Lee says.

"In addition, to support the dental professionals in this shift in strategy, we came out with a marketing kit for professionals that contains all of the tools for dentist and hygienists to educate themselves so they can become more familiar with how to present the product to patients," Lee explains. "Many dentists are not comfortable with selling or marketing a product or treatment modality, even if they are passionate about it. This marketing kit helps them overcome that barrier."

But perhaps the most referenced and revered examples of a professional dental product manufacturer's foray into the world of direct-to-consumer marketing remain the successful positioning of and ongoing sales/requests for such brands as Rembrandt and LUMINEERS® by CERINATE®. Both brands were formulated by Robert Ibsen, DDS, founder and owner of Den-Mat, who began advertising to the consumer in the late 1980s, first with the Rembrandt line of products and then, after the sale of that brand to Gillette, with the company's LUMINEERS porcelain laminates.

Using marketing messages based on careful consideration of what people want- such as comfort and convenience- Den-Mat continues to advertise that those experiential qualities are available and can be obtained from a qualified dentist, Ibsen says. To date, the advertising channels used to spread those messages have included television, the Internet, and magazines among others.

Throughout the years, Ibsen has observed both an ebb and rush of consumer responses to Den-Mat's direct-to-consumer marketing initiatives that have been dependent upon the public's different levels of interest at a given time, as well as variations in the chosen channel for the marketing messages (eg, the publications themselves). "What happens with direct-to-consumer marketing varies depending on the product and what people want," Ibsen admits. "You never know what works."

However, what Ibsen has found to be true is that an informed patient is more likely to ask a dentist for a procedure, which is one of the benefits he sees to direct-to-consumer marketing. For this reason, as reported in Inside Dentistry's May 2006 issue, Den-Mat focuses its advertising on its product's differentiating points in an informative way.

"One of the big trends in all facets of medicine is the increasing degree of education that patients have when they come into the practice," explains Michael Augins, president of Sirona Dental Systems, LLC. "I think that direct to consumer marketing contributes to that education and, when done well, can be very much a positive thing."

The positive impact of direct-to-consumer marketing is that it opens up people's minds to the possibilities of different procedures-whether they're necessary or elective (eg, cosmetic). Practices themselves can engage in direct-to-consumer marketing to differentiate themselves based on the procedures they provide that others don't, as well as making the general community at large aware of that, Augins suggests.

However, he comments that direct-to-consumer advertising in dentistry is still both relatively nascent and some-what controversial. In the dental industry, there are some professionals who haven't incorporated a particular technology that might see those marketing efforts as a negative for their business, Augins says.

Regardless, today's consumers are interested in the type of information forthcoming through some direct-to-consumer messages, believes Mosher. When Nobel Biocare launched its public relations campaign in January 2005, it was aimed at consumers and, subsequently, print and Internet advertising were added followed in April 2006 by television and some radio spots for both implants and all ceramic restorations, he recalls.

"I would say consumer response has been overwhelming. Consumers are interested in dental solutions that may be applicable to themselves or people they know," Mosher says. Since the television campaign launched, Nobel Biocare has logged more than 100,00 phone calls to the advertised 800 number that were then routed directly to a dental office.

Nobel Biocare also created a nobelssmile.com Web site. Anyone who responds to any of the consumer campaigns can go to the site and look up a doctor who provides the services being advertised. Depending on the month, Mosher says they receive between 50,000 to 75,000 visitors to the Web site.

Clearly, realizing success through direct-to-consumer mechanisms takes time and commitment, Mosher suggests, and it's about reach and frequency. "You have to commit to a direct-to-consumer campaign," he explains.  "It's not something you dabble in. You have to do it on an ongoing basis and only over time do you begin to really reap the full benefits of what they can offer."

Trends and Predictions

Giegerich forecasts continued growth in the area of direct-to-consumer marketing of dental products and services. The single biggest reason for this prediction is demographics an aging baby boomer population that represents a quantitative force in terms of numbers of adults moving through the system as well as the qualitative characteristic regarding boomer attitudes toward self (eg, self- improvement, self-entitlement, self-empowerment).

"Those dynamics are really changing the nature of many categories in marketing in a lot of different areas, "Giegerich explains. "As it relates to anything health oriented, anything cosmetic-oriented, or anything that gets at a sense of self, then it's certainly a boomer-oriented subject, and they're taking charge of those areas that they believe have an impact on either their expression of themselves or their own opinion of themselves."

Patients are taking more responsibility for their health-health in general and their oral health, observes Riggs. They seek information and opportunities to connect with brands that are important to them, and one way that they are increasingly doing this is via the Internet, he says. So companies are using online opportunities to communicate with dental professionals and consumers.

Taking into consideration the use of messages targeted to a combination of audiences, Riggs speculates that future consumer marketing will encompass a mix of messaged from dental professionals and direct-to-consumer. "There's a great heritage and history now of the combined effects of professional promotion and direct-to-consumer promotion he notes.

However, companies like Sirona will- for now- continue supporting its dentist consumers by assisting them in their own direct-to-consumer efforts to market its technologies directly to their clientele, Augins explains. In terms of broader media play, Sirona considered testing direct-to-consumer in select markets, but it's something that the company wants to do somewhat cautiously, he says.

"You probably won't see us (Sirona) jump in with both feet in direct-to-consumer marketing until we at least do some tests to see how it affects our customers and the dental communities they serve, " Augins elaborates. " In the future we're looking at testing paid media like magazines, television and direct mail, but we'll approach that cautiously because we don't want to alienate anyone, and there's still a segment of the dental industry that's not totally on board with broad-based, mass media advertising of dental products."

Those dental product manufacturers that have taken direct-to-consumer marketing overall is going to be ever-increasing, suggest Fred Joyal. In terms of specific products, some may continue to grow with their current level of promotions and others may increase and/or refine their advertising, he says.

But manufactures aren't the only ones likely to increase their direct to consumer contact in the future. To accomplish their objectives for communicating with patients about the products and services they provide, dentists may undertake their own direct-to-consumer marketing activities and in fact, Mosher believes every dental office will have to have some form of direct-to-consumer strategy of its own in the future.

"If you consider what's going on, I think it makes sense," says Joyal. "The baby boomer generation and those after that generation clearly research their healthcare decisions. If other dentists show up in their research process and you don't guess what? You're not in their evaluation process, and you don't get benchmarked against the alternatives that are there in the marketplace."

Lee notes that whereas 15 years ago dentist didn't need a Web site, today it's a necessity. If they don't have one they could possibly missing out on a percentage of the market that's looking for a dentist, he says.

Mosher advises dentists that successfully employing direct-to-consumer strategies isn't an exact science. Rather, whether for a specific dental product or procedure or a dental practice, it takes time to build up a brand and to develop awareness of it in the community, he says.

What It Means to You

General dentistry has undergone many changes during the course of the past decade. There is now a business imperative to move toward more voluntary and cosmetic oriented procedures as a result of decreased cavity rates, observes Giegerich. The routine practice dynamics that drove revenues and profits for individual dentist have changed, and he says that the move to more elective services that has been underway for at least the last 10 years is now certainly now in full swing.

"Because of those cosmetic efforts are largely out-of-pocket expenses, it requires active consumer engagement," Gigerich explains, referring to the costs for straightening adult teeth using modern alternatives or for in-office power bleaching that would require full consideration on the part of the consumer. "That means that the patient is now an active part of the dialogue, and they need to be engaged in what the brand proposition is or the value proposition. That they come forward and ask for or about a particular dental therapy is a vital part of general dentistry now, and its not going to go away."

With that said, the direct-to-consumer messages from manufacturers to consumers- or potential dental patients- have made it that much easier for dentists... easier in terms of talking, communicating, and even just drumming up new clientele. Consumers learn about what dentistry has to offer and are more then likely to see a dentist, find a dentist and ask for services that the dentist would like to offer that are profitable for the practice, explains Joyal.

"Dentists can tag along on the promotion that's going on and draw attention to themselves, rather than having to do all the recognition development themselves which is what it was like before the manufacturers were doing advertising," observes Joyal, whose company is contacted by an estimated 2.5 million people each ear for help finding dental care, some of whom ask for information about dentists who provide a specific service or procedure. "A potential negative of direct-to-consumer advertising by manufactures affects those dentists who have not incorporated new techniques or technologies, because consumers are going to start to expect dentists to be able to provide what they've heard about."

According to Augins, a number of Sirona's dentist customers have reported back that they've been able to attract new patients through their own marketing of the CEREC technologies and other procedures like whitening or laser dentistry. To assist them in those efforts, the company provides as slicks and other marketing materials for use by the dentist in marketing directly to the patient.

Joyal says it behooves dentists to effectively promote within their office all of the services they provide. As reported in the October issue of Inside Dentistry, such internal marketing can involve the décor of the office environment (ef, posters/wall hangings) newsletters, brochure displays, and simply telling/ communicating with patients about the products and services the practice offers. "As a result of direct to consumer marketing by manufactures, the dentist is now in the position of only having to reinforce the message, rather than present it for the first time," Joyal says. "Dentists have a responsibility to repeatedly tell their existing patient base about all of the things that they do and offer so that when a patient decides they're interested they know they can consult with their own dentist about it, rather than have to look for a new dentist."

Simultaneously, dentists- the care-givers need to examine the treatment options they offer today and be sure they are evolving those treatment modalities to match the changing needs, expectations and awareness of consumers, emphasizes Mosher. There is an abundance of information available today, and with that come knowledge and expectations and essentially transparency, he says.

If consumers are learning that all ceramic crowns are more attractive options for a beautiful smile, or that dental implants are a more successful treatment modality vs a three-unit bridge because two teeth don't have to be damaged in the process, they now have the knowledge of those options and expect them to be offered, Mosher explains. "So the dentist needs to be evolving his or her treatment options to match the growing and changing expectations of the consumer, or else those consumers may very well seek out someone who does offer what they want.

Conclusion

Giegerich suggests that savvy practitioners will embrace the direct-to-consumer marketing activities conducted by dental product manufactures and view them as a way to expand their role with patients. Ultimately, dentist can use it as a great way to continue to build their practices beyond typical maintenance dentistry and into more high-end services that are billed at a higher level, with a a higher proceeding value.

If there is an opportunity to explore a therapeutic area that is best for the patient and can bee seen as a benefit for the dentist as well, then direct-to-consumer marketing could take the relationship between dentist and patient in a new direction," Riggs explains. "It could expand opportunities for good patient care and/or potential incremental treatment"

Augins admits that his personal opinion is that direct to consumer advertising can be great for the dental profession if it conducted ethically and well, and his sentiments echo those of others. Direct-to-consumer marketing can be an opportunity for both dentists and manufactures to expand the acceptance of their products and attract new customers to their base, he says.

"I think there's a very good thing going for dentistry, believes Lee. "Television programs are doing a lot for elective dentistry and pharmaceutical companies that are already advertising products direct-to-consumer have started a natural progression for dentist to be the gatekeepers for specific brands like mouthwashes or toothbrushes."

And while some traditional dentist may not like the idea of selling products or procedures, Lee is confident that companies will come forth with programs designed to help train dental professionals in how to overcome the barriers that could be stumbling blocks to greater profitability. He recalls that dentists haven't typically been trained to consider the practice as a business.

"Dentistry has changed in so many ways in the last 5 or 10 years compared to when we came out of dental school," Lee says. "So my message to dentists about direct-to-consumer marketing is to maintain an open mind because change is the only constant, and it's not going to stop here."