As consumer awareness of periodontal diseases heightens, and the desire for brighter, whiter teeth begins well before the Boomer years, the market for oral care products continues to develop into an attractive category.

A 2010 report from Mintel International estimated the U.S. oral care market at about $3.4 billion. However, the recession kept sales growth and new product introductions in check. Mintel noted that since 2007 the category has remained essentially flat, as many oral care consumers have trimmed back on expenditures. In addition, private label market share has risen in recent years.

Toothpaste represents 38% of total sales (about $1.3 billion), nearly twice as much as the next largest segment, according to Mintel. “With nearly universal penetration, upward momentum has proven elusive,” the report added.

However, U.S. sales of toothpaste and bleaching/whitening products reached nearly $1.6 billion for the 52 weeks ending April 17, 2011, representing more than 4% growth from the previous year, according to SymphonyIRI Group, a Chicago, IL-based market research firm. Sales data came from supermarkets, drugstores and mass-market retailers, excluding Wal-Mart, Club Stores and Gas/C-Stores.

U.S. consumers spend more than $100 billion on dental services each year. Mintel indicated that with recession-inspired economizing, “oral care segments that reduce consumers’ dependence on the dentist’s office have fared well. Floss/accessories/tools and whitening products gained in 2010.”

Specifically, according to SymphonyIRI Group, sales of bleaching/whitening products grew more than 7% in the past year. Meanwhile, U.S. sales of toothbrush/dental accessories represent nearly $1.4 billion, growing almost 4% in the past year.

“More than a product segment, whitening has become a pervasive theme that runs through most aspects of the oral care category,” Mintel’s report said. “More than six in 10 adults claim to have used a whitening product or service, with toothpaste the most commonly cited type. Consistent with other cosmetically focused product categories, whitening products of all kinds skew strongly to women and younger adults.”

The Big Picture

Product innovation in the oral care market has focused mainly on whitening teeth and addressing indications like gum sensitivity, according to Mitch Skop, senior director, New Product Development, Pharmachem Laboratories, Kearny, NJ. “Higher awareness of gingivitis, periodontal disease and resulting loss of teeth due to unaddressed gum disease have driven many more consumers to use mouthwashes and toothpastes that promise to keep periodontal disease at bay. However, dentists and oral hygienists know that is not enough. Regular deep cleanings and certain dietary supplements can promote restoration of gum health.”

He noted that naturally derived ingredients have only recently come on the scene to address oral care issues, but Baby Boomers are currently seeking age-appropriate products, including dental adhesives and rinses.

“Vanity still tends to rule,” he added, noting the popularity of whitening products, particularly among younger demographics. “Simply put, as more people get their twice yearly cleanings and are finding out they have gingival pockets that signify either gingivitis or periodontal disease, the more serious motivation to preserve their teeth sets in.”

Dean Mosca, president, Proprietary Nutritionals, Inc. (PNI), Kearny, NJ, said that, according to Colgate.com, more than 75% of adults 35 and older have some form of gum disease. “This is alarming because more recent research has shown a correlation between gum disease and heart disease, and that there are shared risk factors.”

As with many other product categories, more consumers today are looking for natural ingredients in their personal care products, according to Shaheen Majeed, marketing director, Sabinsa Corporation, East Windsor, NJ.

“Although expensive natural actives were originally the prerogative of higher end brands, the emergence of a mass market has brought these ingredients to a larger consumer pool. Increasing demand for such ingredients in the face of environmental and sustainability issues, and the need for ‘green’ and organic HBA (health and beauty aid) products are key factors in new product development.”

Probiotics

Clinical research has led to the growth of probiotics in a multitude of health categories. While science in the area of oral care remains in its infancy, researchers have acknowledged significant potential. An article in the March issue of the Journal of Clinical Periodontology, designed to explore whether the use of probiotics could influence periodontal microbiota and health, indicated a need for further evaluation.

Researchers concluded that current data “indicate an effect of probiotics on the oral microbiota and a more limited effect on clinical periodontal outcome measures. However, there is an urgent need for properly conducted clinical trials where probiotics are used as adjuncts to standard periodontal care, similar to antibiotics, using probiotic strains with, at least at an in vitro level, proven periodontal probiotic effects.”

Similarly, a review published in the July 2010 issue of the European Journal of Dentistry said “both research to unravel the mechanisms of possible probiotic action and long-term clinical trials are needed if probiotics are to provide a new scientifically proven means of preventing or treating oral diseases. Several health-promoting effects of probiotic bacteria are well documented, and there is no reason to restrict the use of probiotic products because their effects on oral health are not yet well understood; however, their recommendation for dental health purposes is not yet justified.”

Dr. S.K. Dash, president and founder of UAS Laboratories, Eden Prairie, MN, said Streptococcus mutans is the most destructive bacterial strain in the mouth, as it attaches easily to teeth and produces large amounts of acid. “During the process of bacterial digestion of the sugars, lactic acid is produced. Lactic acid creates an acid environment around the teeth, which is able to destroy the enamel of our teeth.

“Studies using orally-administered probiotics have found that certain strains can inhibit the growth of S. mutans,” he continued. “A study done on children during their early childhood reported a significant reduction in caries after 7 months of daily consumption of probiotic milk,” he said. “The conclusion was that probiotics seem to be a natural way to maintain dental health, and that daily intake of probiotics in early childhood may result in fewer dental caries.”

Early research indicated that Lactobacillus acidophilus DDS-1, from UAS Laboratories, was effective in treating gingivostomatitis, an acute inflammation of the mouth and gums. Dr. Dash noted L. rhamnosus also proved beneficial in the oral cavity.

Research suggests the mouth, much like the digestive tract, depends on a proper balance of natural probiotic organisms to remain healthy and resist disease and decay, said Tim Gamble, senior vice president, Sales and Marketing, Nutraceutix, Redmond, WA. “In the mouth, this means the control or reduction of undesirable halitosis (bad breath), tooth decay, possibly gum disease and even tooth discoloration. By supporting the population of healthful bacteria in the mouth, throat and even sinuses, indications are that populations of pathogenic bacteria can be completely excluded and/or kept at normal levels.”

Oral health products involving the application of probiotics were almost unheard of five years ago, Mr. Gamble added. However, interest has risen dramatically. “We are currently supplying and manufacturing a variety of products focused on oral health, including bulk powders (probiotic strains) as ingredients, as well as producing finished products in chewable form, from mints to berry-flavored tablets, and even pet products.”

One of the most successful probiotics in the oral care market to date, BLIS K12 (Streptococcus salivarius), can now be found in chewable tablets, fast-melt tablets, lozenges, chewing gum and stick-pack powders. The probiotic produces two potent anti-microbial proteins, which can act against bacteria implicated in sore throats, halitosis and diseases of the oral cavity, according to New Zealand-based BLIS Technologies.

Life Extension Foundation offers Advanced Oral Hygiene, a quick-dissolving lozenge that contains a combination of BLIS K12 and Ganeden BC30 (Bacillus coagulans). Mike Bush, vice president of business development, Ganeden Biotech, Inc., Cleveland, OH, said the oral care market continues to gain momentum due to strain-specific research. “Consumers are becoming aware of the fact that specific probiotics have specific utility. The best way to market products is by instilling confidence in your consumer that not only is this a good, safe product, but it’s also effective.”

Other probiotic products are gaining traction in the oral care market thanks to sound science. For example, ProBiora3, from Oragenics, Tampa, FL, is a proprietary blend of three beneficial bacteria naturally present in healthy mouths, including Streptococcus oralis KJ3, Streptococcus uberis KJ2 and Streptococcus rattus JH145. The blend promotes fresher breath, whiter teeth and supports gum and tooth health, according to the company.

Natural Solutions

Pharmachem’s Mr. Skop said studies dating back to the 1970s demonstrated that CoQ10 has a positive impact on gingival tissue and reduced pocket depth. “More studies seem to confirm this action, and some progressive dentists recommend patients supplement with it. Since then, as ingredient sourcing, processing and research have improved dramatically, other ingredients have been shown to incur positive impact on dental health.”

For example, green tea’s actives have been shown in trials and epidemiological research to promote gum health and reduce halitosis, Mr. Skop noted. Research published in a 2010 issue of Preventive Medicine indicated an association between green tea consumption and decreased odds of tooth loss.

Another study published in the Journal of Periodontology in 2009 investigated the epidemiologic relationship between the intake of green tea and periodontal disease. A total of 940 Japanese men aged 49 to 59 were given health examinations with probing depth, clinical attachment loss and bleeding upon probing used as periodontal parameters. The intake of green tea was defined as the number of cups per day in a self-administered questionnaire. Results showed a modest, inverse association between the intake of green tea and periodontal disease.

Alongside green tea’s antioxidant properties, cranberries contain A-type proanthocyanidins (PACs), the phytochemical responsible for cranberry’s anti-adhesion properties, noted Dan Souza, marketing director for Decas Botanical Synergies, Carver, MA. “In fact, the same anti-adhesion mechanism of action that is responsible for cranberry’s support for urinary tract health also helps to support oral health. Cranberry PACs inhibit bacteria from adhering to teeth and forming plaque.” In 2010, Burt’s Bees launched a complete line of toothpaste that contains Decas Botanicals’ PACran cranberry ingredient, Mr. Souza added.

Sea buckthorn berry has also gained attention recently for its ability to promote oral health. Dr. Gerald Curatola, a guest on The Dr. Oz Show, recently revealed sea buckthorn as his “secret weapon” for oral health. The berry and seed oils found in sea buckthorn combat gum and dental disease through high omega content, antioxidant properties and nutritional content. These properties support the immune system and offer anti-inflammatory effects needed to improve and maintain gum and dental health.

According to Don Stanek, director of sales for Linnea Inc., Easton, PA, other oral care nutraceuticals include the unsaponifiable fraction of Zea Mays, an herb in the Gramineae family of plants that is thought to reduce the mobility of the teeth, mitigate gum swelling and promote repairing of the alveolar bone by stimulating osteocytes. Zea Mays contains proteins, starch, fat, calcium, potassium, iron, vitamins B1, B2, B6, niacin, pantothenic acid, biotin, carotene, cellulose and lysine. 

Interest in oral health often relates to anti-microbial and anti-inflammatory activity, as well as decolorizing stains, according to Sabinsa’s Mr. Majeed. “So for us, the most popular oral care products include Berberine HCL, coleus oil, Policosanol CG, Sapindin and Venocin.”

Berberine, sourced from Berberis aristata roots, shows significant anti-microbial activity when evaluated against the oral pathogens Streptococcus mutans and Fusobacterium nucleatum, Mr. Majeed noted. Sapindin (Sapindus trifoliatus), from Soapnut Tree, may have potential application as a natural cleansing agent and for decolorizing stained teeth. Venocin, from Horse chestnut tree, supports gum integrity and pain relief, as well as antioxidant activity and circulation.

PNI’s Mr. Mosca said Celadrin, a blend of cetylated fatty acids, (and its vegetarian version, Vege-Celadrin)—while known for its joint health benefits—has been found to support the inhibition of certain pro-inflammatory cytokines in cases of gingivitis. Results from an in vitro test of monocyte-mediated inflammatory response showed significant inhibitory actions on various pro-inflammatory cytokines, indicating a potential role in different stages of inflammation, he added.

Sweet Tooth

At a time when more consumers are looking to cut back on sugar, alternative sweeteners like stevia, monk fruit (luo han guo) and polyols (sugar alcohols) represent an important category of ingredients for the oral care market.

Christos Zacharis, product service group manager, Sweeteners Division, at Danisco, said xylitol in particular offers numerous health benefits. “Xylitol has a vast amount of scientific references regarding its effect, not only on dental caries, but also on several factors leading to the disease, such as plaque and de-mineralization (the taking away of minerals from tooth surfaces).”

In fact, the European Food Safety Authority (EFSA) recently approved a “general function” health claim for the role of a range of sugar replacers like xylitol and sorbitol in maintaining tooth mineralization.

Danisco offers several solutions that improve and maintain good oral health, according to Mr. Zacharis. “For example, Xivia—our sustainably produced xylitol—has been clinically proven to reduce plaque and dental caries and help with the re-mineralization of caries lesions.” Xivia can be used to replace sugar in confectionery applications and also as a supplement in toothpaste, mouthwash and teething gels, where it increases the effectiveness of fluoride, he added. “Unlike other polyols, the product has a cariostatic effect, actively preventing more caries from forming.”

Chewing gum is the main form of delivery for ingredients such as xylitol, followed by chewable tablets. “Due to its high solubility, xylitol may very well be used in toothpastes as well as mouth rinse solutions or oral health sprays,” he said. “Having xylitol in a toothpaste helps raise the product’s profile.”

In the U.S., 24% of children aged 2-4 years already suffer from dental caries, Mr. Zacharis added. “As diets in developing countries evolve to include more processed foods and extrinsic sugars, the incidence of plaque formation and caries can be expected to increase rapidly across the globe.”

In terms of product formats, gum simply makes sense in the oral care arena, and more companies have started adding nutrients to their products. Maureen Jones, manager of Wrigley Oral Healthcare Programs at Wm. Wrigley Jr. Company, said that chewing sugar-free gum, even without the addition of health ingredients, “produces stimulated saliva, which in turn helps fight cavities, helps neutralize plaque acids, helps re-mineralize enamel to strengthen teeth and washes away food particles.”

In Australia and New Zealand, Wrigley recently launched Wrigley’s Extra Professional Calcium, a calcium-fortified gum designed to deliver 10% of the recommended daily intake of calcium, offering consumers another means to obtain this mineral, which is essential to building strong bones and teeth.

Patrick Stano, vice president, Sales and Marketing, North America, with Dr. Paul Lohmann Inc., Islandia, NY, said his company has received more interest in calcium salts for re-calcification as well as other minerals like zinc, which may help prevent tartar buildup by preventing plaque from hardening, or calcifying.

“We have had a number of requests for zinc compounds, such as zinc citrate and zinc gluconate, for their anti-microbial properties, along with magnesium and calcium peroxide for whitening, and calcium glycerophosphate and sodium pyrophosphate for tartar control,” he said. 

While traditional product formats for oral care include mouth rinses, toothpaste and whitening gels, Mr. Stano said more innovative applications like gum and lozenges are quickly coming on the scene.