In Las Vegas a couple weeks ago, at the annual CES consumer electronics fest, personal care companies were vying not for our eyeballs but our mouths.
A toothbrush that uses radio frequency to send a wave of charged molecules to the tooth’s surface? Trippy. A “plaqueless” brush that uses optical sensors to measure film buildup on your enamel? Like a wearable, but for teeth. An AI toothbrush-and-app combo that identifies 16 different zones in your mouth and grades your hygiene with an emoji? I tried this one. When I brushed for longer than two minutes, the recommended length of time, the toothbrush smiled back at me.
Mouth tech, particularly in developed markets like the US and Europe, is having a moment. And high-powered toothbrushes are just the tip of the dental pick. Consumer health companies are pitching portable water flossers, dental floss subscriptions, at-home LED whitening kits, and direct-to-consumer smile aligners. The global oral care market is projected to grow to nearly $41 billion by 2025, up from $28 billion in 2017, according to Grand View Research.
It’s both a digital phenomena—our collective obsession with self-presentation has driven us to swipe and whiten our smiles before pressing “send”—and one in which the physical goods we buy to clean up our mouths every day are being upgraded with a dose of technology.
“Social media and the internet more generally provides a way for us to examine our appearances a little bit more,” says Charlotte Markey, a professor of psychology at Rutgers University who researches body image and eating-related behaviors. The hashtag #teethwhitening brings up a mere 1.7 million results on Instagram, many of them before-and-after photos, while searching Google for the phrase “How to brush your teeth” results in hundreds of thousands of YouTube tutorials.
And, Markey adds, there’s a seemingly infinite number of products to try and things you can do to yourself that didn’t exist a generation ago—or that you couldn’t easily access a generation ago. Your dental floss used to be the whatever jumped out at you because of its placement on the pharmacy shelf, or whichever box had the lowest price. Now, as I learned, you can spend hours comparing dental floss reviews online, order your choice directly from the brand’s website, and have it arrive at your front door every three months. Meanwhile, wireless chips, motion and pressure sensors, display technology, inductive charging, and machine learning applications are being jammed into everyday health products.
There’s also a much more practical reason for the increased interest in oral health. Oral diseases affect more than half of the world’s population. In the US, millions of people struggle with tooth decay and cavities. According to the Centers for Disease Control and Prevention, more than 80 percent of people in the US have had at least one cavity by age 34, and within the past five years, more than 40 percent of adults reported suffering from mouth pain. Dental caries (that’s tooth decay) in young people age 2 to 19 had a prevalence rate of nearly 50 percent in 2015 to 2016. But that prevalence also goes down as family income levels increase, which shines a ceiling-mounted light on the ugly truth of oral care: It’s inherently classist. Pricey gadgets for your mouth are a nifty thing, sure, if you can afford it.
During CES I had the chance to try a not-yet-released brush from Oral-B, called the iO. It’s the successor to the company’s tech-enhanced GeniusX toothbrush. Toothbrushes, it seems, now follow the same naming conventions as cars.
Both the iO and the GeniusX are marketed as “AI” toothbrushes, meaning some aspect of their tooth-cleansing prowess is credited to machine intelligence. The GeniusX ranges in price from $180 to $250. The iO, which won’t ship until August, doesn’t have a list price yet, but a company rep told me it’s not unreasonable to think it would also cost around $200. The non-smart electric toothbrush I use at home costs $40.
Oral-B, which is owned by Procter & Gamble, promised a much better experience with this mouthpiece. When I met up with one of the company’s public relations representatives, she pulled out a large cardboard suitcase. I expected her to extract the iO from this suitcase and hand me the wand, but she indicated I was supposed to take the entire suitcase with me. This toothbrush loaner kit came with an iPhone, a tube of Crest (another P&G brand), a sleep mask, and flimsy white slippers. The superfluous swag had Oral-B’s logo silkscreened on it. Bizarrely, the kit also contained a coaster-sized bar of chocolate. The chocolate bar had “Oral-B” stamped on it.
Right in the middle of all the accessories was the main event: An electric toothbrush that looked like the midlife crisis version of my current electric toothbrush. Mine is old now, caked in paste. This new one was a clean, shimmery midnight blue. It had a tiny display between the power button and the “mode” button. The brush head came in a white box marked “Disinfected,” which made me wonder if someone had tried the iO before I had. Oral-B’s PR team assured me it had not been used before, but they also asked for mine back when I was done with it.
It didn’t take long—about a day and a half, or three brushing sessions—for me to want to upgrade my toothbrush. From the Oral-B iO app, I learned that my average brushing time was one minute and 34 seconds. Not long enough, only half a song. My brushing covered 71 percent of the surfaces on the outsides of my teeth, while the insides of my teeth were only 38 percent covered. Standing in a Las Vegas hotel room, with the stink of casino smoke fresh on my clothes, I was suddenly disgusted by the backsides of my teeth.
Burst Oral Care was founded in 2017 as a way to “fuse together the offline and the online” personal care market, according to cofounders Brittany Stewart and Hamish Khayat. I recently video chatted with them to find out more about the floss kit they’d sent my way. “Floss like a boss,” the interior of the box read, with six-step instructions (six!) for getting started. I repeated the catchphrase “#flossyposse” aloud to my editor for about a week. It got old much sooner than that.
Stewart and Khayat teleconferenced in from Los Angeles, where they both live. Khayat used to run a kids’ toothbrush brand called Rockabilly Kids, he tells me, and the frustration of competing with consumer-goods giants for retail space made him want to flip the oral care model on its head. To learn about Burst as a company is to ingest a mouthful of buzzworthy phrases. They’re a totally distributed office, which means they have no central office and their 32 full-time employees work remotely. Stewart, a ringer for the actor Zosia Mamet, says that around eight of those employees are single mothers, which she sees it as a testament to Burst’s family-friendly, flexible environment. Its customer support reps are called Dental Hygeniuses.
Burst is a DTC company—that’s direct-to-consumer, similar to how makeup company Glossier and luggage company Away are eschewing traditional retail channels and selling their stuff through their own websites. Burst is also a subscription business. If you buy the $70 Burst Sonic Toothbrush, which offers charcoal-infused bristles, a built-in timer, and 33,000 sonic vibrations per minute, then you’re automatically enrolled into a recurring delivery of $6 replacement brush heads every 90 days. (The company says you can opt out of the subscription program at any time.)
And then there’s a Burst Ambassador program, which pays people who promote the products. Stewart says that around 25 cents of every dollar in sales goes into a profit-sharing pool. The company claims around 25,000 ambassadors across the US, all of them dentists or dental hygienists. Nearly 10,000 of them are part of a Facebook group for all things Burst ambassador-related. I requested access, but at the time of publication, hadn't been accepted. Most of the public Burst-related posts I found online—on Facebook, YouTube, Pinterest, and ADentalTip.com—offered the $70 Sonic toothbrush for $30 off.
Stewart says the company uses a “proprietary algorithm” to determine how much these people get paid. There’s a variety of things that ambassadors can do to promote Burst, whether on social media or through “IRL” recommendations, all of which add up to a profit-sharing percentage. She calls it a kind of “direct referral 2.0.”
You wouldn’t be wrong to think this sounds a little like a multilevel marketing company, the kind that pays commissions to people who acquire and distribute products on the company’s behalf. These can quickly devolve into pyramid schemes, defined by the US Federal Trade Commission as businesses that promise consumers or investors “large profits based primarily on recruiting others to join their program” and push for “inventory loading,” which forces recruits to buy more products upfront than they could ever feasibly sell.
Whether or not the Burst ambassadors are encouraged to purchase inventory is a matter of who you ask. Initially, a dental office buys one Burst toothbrush at a reduced cost of $20, and then, upon the successful first sale of a Burst toothbrush, the dental office receives a refund for that $20. One spokesperson tells me that there is no inventory or product that ambassadors must buy for retail purposes, while another spokesperson followed up to say that “ambassadors do not ever buy bulk inventory—all sales are made via their promo code online on our website.” However, a Burst webpage for the company’s Office Sales and Gift Program—which Burst representatives say is a separate program from the ambassador one—notes that dental offices can receive discounts on brushes and oral care products when purchased in bulk.
Stewart and Khayat say Burst is not a multilevel marketing company, that they borrowed things they liked from direct selling companies and implemented some of those tactics. (“WE ARE NOT AN MLM,” their website states, in all caps.) Larry Cheng, a partner at Volition Capital and an investor in Burst, also insists it’s not a multilevel marketing model. “The dental offices don’t really take inventory. It’s probably closer to an affiliate model. You don’t get paid on recruits and their sales,” he says. “It’s more gamified.”
Burst’s latest oral care product, the one the company shipped to me, is floss. This is not just any floss. It’s expanding, charcoal-coated, mint-and-eucalyptus flavored, antimicrobial floss. Like the toothbrush, it is subscription-based. It is also supposedly eco-friendly. You pay $13 upfront for the floss and dispenser, and after that receive a new floss refill bobbin every 90 days for $7. The idea is that you reuse the plastic dispenser. Floss has never been so involved before.
But, damnit, I liked the floss. I make it a point to carry floss and use it a few times per day, but that’s your standard waxy drug-store variety. It hadn’t occurred to me before that expanding floss, which grows thicker when it comes in contact with saliva, could be better for teeth like mine that are crowded (known as “tight contact” in dentistry). The charcoal infusion seemed to do little more than offer a dark palette for the grimy bits of food to land on. But the floss’s minty scent tricked my brain into thinking my mouth must be that much cleaner than when I use unscented floss.
Both the floss and the AI toothbrush had surprised me. They seemed subjectively better than the basic oral care products I had been using for years. But they had also sparked a desire for the potentially unnecessary, as newfangled things are prone to do. I was now tempted to track, to measure, to optimize. These products promised actual cleanliness—not “clean” in the nebulous way so many wellness products are—and with it, a certain kind of access to better health. I recalled the time at a women’s conference late last year when a meditation coach started promoting her own line of Ayurvedic mouth care products, products you’re supposed to eat and sniff and swish before brushing and flossing. My Goop-y senses were on high alert.
Was any of this really necessary? No. It was not. But is mouth care important? Unanimously, yes.
The connection between our oral health and our overall health is something that only really came into public awareness around 2000, following the release of the first US Surgeon General’s report on oral health, says Lisa Berens. Berens is an associate professor at UCSF’s School of Dentistry who researches dental public health for socioeconomically marginalized groups. Now, the CDC, the Mayo Clinic, and the American Dental Association all emphasize the various ways in which the mouth is a window into the overall health of the body, often showing signs of nutritional deficiencies, infection, or disease, including cardiovascular disease and diabetes.
The relationship between our mouths and the rest of our bodies may even be bidirectional, Berens says: People with diabetes are more likely to have periodontal disease than people without diabetes, but periodontal disease can also make it more difficult for people to control their blood sugar, increasing the risk for diabetes-related complications.
In short, good oral hygiene is critical. Is it critical enough to spend hundreds on an AI toothbrush? Or a “smarter” water pick? Or a subscription service for charcoal floss?
Berens references studies that have shown that electric toothbrushes may offer a slight advantage when it comes to reducing plaque and gingivitis, particularly toothbrushes with a rotating oscillation mode. That said, she still uses a manual toothbrush. There is certainly a market for high-powered toothbrushes, she says, but that kind of technology may never reach the populations that she focuses on in her work. “If you put it into the context of the masses, those who are underserved, underprivileged, under resourced … you can’t help but factor in the feasibility of it.”
Mouth care may be having a moment in tech circles, but then there’s the other end of the spectrum, the one Berens is referring to. As of 2016, a reported 23 percent of Americans didn’t have dental care insurance. Millions of people live in places where it’s difficult to get access to any dental care. The Atlantic has written about the “partition between dentistry and the rest of medicine,” as well as the erosion of state-provided dental care for Medicaid patients. America is in the midst of a serious dental crisis, as Senator Bernie Sanders referred to it back in 2012, when he was chairman of the Senate Subcommittee on Primary Health and Aging. Low-income populations are especially vulnerable, and disproportionately affected by a lack of access to basic dental care.
It seems almost ludicrous in that context to think that an AI toothbrush and iPhone app could be part of the solution. But if those insights are that valuable, then it’s an elite portion of the population who will have access to them.
Carlos De Jesus, vice president of North America oral care at Procter & Gamble, says he takes his responsibility in improving the health of America seriously. “For us to be successful, we need every single US consumer to have better oral health,” he tells me over the phone. “We have 99-cent toothpaste, all the way up to a $300 toothbrush, so that we can meet you where you are.” De Jesus also notes that the penetration of powered toothbrushes in the US is still only at 10 percent, and that presents a huge opportunity to get more people using them.
Berens, who worked as a dentist before becoming a public health researcher, tells me she thinks it’s best to keep it simple. That involves brushing with fluoridated toothpaste and flossing daily. If people have access to fancier products, go for it, she says. But the main goal is getting people into good habits.
I had saved images of the Oral-B iO AI toothbrush and its app on my phone for reporting purposes, and I found myself going back to the photos a couple weeks later, using the app insights as a kind of heat map for where I needed to brush more. I was seriously tempted to order a new brush, to splurge on something smarter, but ended up sticking with my old Oral-B electric toothbrush. I did replace the brush head, though. It cost $15 for a three-pack.