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    Inside Dentistry

    November/December 2007, Volume 3, Issue 10
    Published by AEGIS Communications


    Direct-to-Consumer Marketing: How Messages from Manufacturers Are Driving Dental Consumerism

    Allison M. DiMatteo, BA, MPS

    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 web sites. 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 about 10 years ago.

    "The impact of direct-to-consumer messages 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 manufacturer that launched its own major public relations and marketing campaign targeted toward 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 found 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.1 In 2006, prescription drug sales in the United States totaled $252 billion.2

    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, virile Web, print) and are irrefutable, asserts 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 researchers 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 service Web site 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 Jeffrey S. Riggs, 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 professionally 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 in 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 stations, 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 dentists and hygienists to educate themselves so that 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 (now owned by Johnson & Johnson) and LUMINEERS® by CERINATE® (still owned by Den-Mat). 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 somewhat controversial (See Pros, Cons, & Conundrums, previous page). 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 100,000 phone calls to the advertised 800 number that were then routed directly to a dental office.

    Nobel Biocare also created a nobelsmile.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 advertising. 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 it 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 messages 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 customers 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 messages 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 undertaken direct-to-consumer marketing have found real profit centers from those activities and, therefore, dental direct-to-consumer marketing overall is going to be ever-increasing, suggests Joyal. In terms of specific products, some may continue with their current level of promotions and others may increase and/or refine their advertising, he says.

    But manufacturers 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," he says. "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 dentists didn’t need a Web site, today it’s a necessity. If they don’t have one, they could be 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 dentists have changed, and he says the move to more elective services that has been underway for at least the last 10 years is now certainly in full swing.

    "Because those cosmetic efforts are largely out-of-pocket expenses, it requires active consumer engagement," Giegerich 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 [ie, consumer] 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 it’s 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 then more 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 of 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 year for help in 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 manufacturers 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 ad 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 that they provide. As reported in the October issue of Inside Dentistry, such internal marketing can involve the décor of the office environment (eg, 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 manufacturers, 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 caregivers—need to examine the treatment options that they offer today and be sure that 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 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 manufacturers and view them as a way to expand their role with patients. Ultimately, dentists 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 higher proceeding value.

    "If there is the opportunity to explore a therapeutic area that is best for the patient and can be 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’s conducted ethically and well, and his sentiments echo those of others. Direct-to-consumer marketing can be an opportunity for both dentists and manufacturers 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 on 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 dentists to be the gatekeepers for specific brands—like mouthwashes or toothbrushes."

    And while some traditional dentists 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."

    SIDEBAR 1

    Pros, Cons, & Conundrums of Direct-to-Consumer Marketing

    There are potential benefits and drawbacks for dentists and consumers when it comes to the consequences and impact of direct-to-consumer marketing initiatives. For patients, there is a certain level of awareness that might not be on their radar as consumers, explains Jeffrey S. Riggs from GlaxoSmithKline. Direct-to-consumer marketing of a specialty over-the-counter product (eg, Sensodyne Pronamel) could make them aware of the dental problem that the product is intended to resolve. For dentists, the marketing messages hopefully, in many cases, create a dialogue between the consumer and the dental professional, which is a healthy thing for the practice of dentistry today, he says.

    THE UP SIDES

    1. Identification of disease that requires intervention. "You tend to, by virtue of the direct-to-consumer campaigns, increase diagnosis of either a related disease or disorder or, in some cases, a surprise issue can surface simply by having people more interested in seeing their physician or dentist," explains Matt Giegerich from CommonHealth.

    2. More informed dialogue between patients and dentists/physicians. "We think that customers who market our technologies differentiate themselves and are able to attract new patients with the procedure and, in fact, realize higher acceptance rates for different types of care," says Michael Augins from Sirona Dental Systems, LLC. "What’s more, many times our customers find that patients are interested in treatments for things they might not have known about or been diagnosed with before."

    3. Greater patient engagement in treatment/health process. By marketing brands directly to consumers and stimulating their interest and participation in any health-oriented subject, what results is a more engaged participant, believes Giegerich.

    According to Nobel Biocare’s Kevin Mosher, more so than ever, consumers are also looking to research their own healthcare decisions. They’re actively seeking out alternative options, he says.

    "With today’s direct-to-consumer marketing, you have a very receptive audience, and when you advertise, you want to make sure you’re getting a return on your investment," Mosher elaborates. "You want to be sure that it’s creating some effect and some impact on your business, whether you’re a manufacturer or a practitioner."

    4. Better loyalty to and compliance with recommended therapies or lifestyle modifications. Robert Lee, BDS, MBA, from GC America says that the level of dental health in the United States has never been higher. The fact that patients are so much more aware and want to learn more about dentistry (both preventive and cosmetic) is at least partially the result of direct-to-consumer marketing, he says.

    THE DOWN SIDES

    1. Overzealous patients. Giegerich admits that sometimes over-exuberantly engaged patients can side-rail, derail, or confuse the dentist/patient dialogue because they think they know more than they really do. This can require a process of explaining and unraveling what might have been concocted erroneously in that person’s mind. "So, empowerment has a downside if it’s not truly smart, informed, and accurate," Giegerich warns.

    Similarly, Riggs suggests that a potential negative consequence from direct-to-consumer advertising could be a patient potentially distorting the focus away from what’s most important from a dental/oral health perspective. For instance, if a dentist is working a certain course of therapy and dealing with the most prioritized issues as they relate to a specific patient, being distracted by a patient’s interest in something less important could become an issue.

    Or, a patient could form a potentially undereducated decision about his or her own oral care based on an advertisement that wouldn’t be what the dental professional would have chosen for that patient, says Augins. Yet, based on the information they garnered from the marketing messages, the patient could be set in his or her ways about what they want or need, and that takes away from the dentist’s autonomy, he says.

    2. Inappropriate prescribing. Giegerich notes that although it’s been mostly refuted, the only other "negative" to direct-to-consumer advertising that he’s aware of is the potential for prescription drugs to be inappropriately prescribed by physicians. However, he says that research has proven that this is not the case.

    3. Losing out to more technologically savvy dentists. Augins notes that some people have a problem with direct-to-consumer advertising when patients potentially want a service that a given dentist doesn’t provide. Suggests Fred Joyal from 1-800-DENTIST, if dentists don’t adapt the new technologies that patients see advertised and eventually inquire about, then they run the risks of (a) losing their patients to other dentists, and (b) not having a practice to sell. "More and more people are going to be demanding the high-tech dentistry and comfort-conscience dentistry that they see advertised," he says.

    SIDEBAR 2

    Marketing the Messages about Oral Cancer Screening & Prevention

    Oral cancer is the sixth most deadly cancer, yet most potential patients—most of the public—aren’t aware of that fact, or of the disease. For this reason, getting information out about the risks for oral cancer and how dental professionals can assist in the early detection of abnormal, precancerous, or cancerous lesions or oral tissue is of significant importance to two dental product manufacturers in particular: LED Dental, Inc, the maker of the VELScope®, and Zila Pharmaceuticals, maker of ViziLite® Plus.

    "As consumers are becoming more educated on their own about their health, now’s an important time to get the message out about oral cancer screenings," believes Dale Johnson, vice president of marketing for Zila. "From Zila’s perspective, the dental professional will always be the primary focus of our messages about ViziLite Plus so that consumers know to see their dentist for more information and either for assurances that they don’t have oral cancer, or so that it can be recognized early."

    According to Steve Semmelmayer, director, president, and CEO of LED Dental, because oral cancer is a much more serious threat than most consumers realize, there is a need to somehow create consumer awareness of both the risk of oral cancer and the fact that products like VELScope make it possible to reduce that risk. "Our primary tactic is to pursue a fairly aggressive public relations program and, when done well, public relations can provide incredible bang-for-the-buck to create awareness among current and prospective patients," he says.

    Currently Zila has a great interest in being able to reach members of the public with information about oral cancer screenings using the ViziLite Plus and their need to talk to their dental professional about it, as well as communicating those messages through different types of media, Johnson says. In the future, television and print advertisements will supplement their Internet site as important mechanisms for continuing to make information available to consumers, he says.

    "Oral cancer screenings are a very important way in which general dentists can contribute not just to their patients’ oral health, but to their systemic health," Semmelmayer says. "As we say in one of our advertisements: ‘It feels great to save a tooth. Imagine how it feels to save a life."

    1 Matthews M. Who's Afraid of Pharmaceutical Advertising? IPS Policy Report #155.May 17, 2001. www.ipi.org.

    2 Herper M, Kang P.World's 10 Best-Selling Drugs. Forbes.com.


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