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Profile in Oral Health: Marketing Magic Trisha E. O’Hehir, RDH, MS

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What we can learn from the marketing of bottled water
by Trisha E. O’Hehir, RDH, MS

What's colorless, tasteless and smells like money? The answer – according to an article by Shankar Vedantam in the Washington Post, June 30, 2008 – water! Think about it. Americans spend $60 billion each year on bottled water, when tap water costs only pennies.

Hundreds of companies are now selling bottled water to Americans in a country with the science and technology to provide safe, great tasting water to the entire population at very little cost to the consumer. Our water purification technology rivals the discoveries needed to take astronauts to the moon! However, the bottled water industry is successfully using marketing to convince Americans there is a substantial difference between what's in the bottle and what comes out of the tap. Consumers are willing to pay markups of 1,000 to 10,000 times the cost of tap water. This is marketing magic!

On the other hand, efforts by the dental profession to convince Americans to prevent dental disease just aren't working. In 2000, the U.S. Surgeon General released a report on oral health in America calling dental disease the "silent epidemic." Estimates vary, depending on criteria used, but it is fair to say that at least 80 percent of our population will experience dental disease to some extent during their lifetime from caries to gingivitis.1,2 Caries and periodontal disease are preventable, but getting that message to consumers is nearly impossible and getting them to take appropriate action rarely happens. The complex cases presented on Dentaltown and Hygienetown are a testament to the enormity of the problem. We don't see message boards complaining about too little disease as many lament the fact that people with serious dental problems are not willing to spend the money needed to treat the disease.

Despite the many benefits of preventing dental disease, consumers aren't buying that message. In fact, most don't even believe dental disease is preventable, they think tooth decay and gum disease are inevitable, no matter what their socioeconomic status. Just ask your patients, "Is dental disease preventable or inevitable?" The answers will surprise you. While flying from Dallas to Boston I chatted with the man sitting next to me prior to take off. He was a 40-year-old banker, married to an attorney with a seven-year-old son and a baby on the way. He and his wife were doing well financially, highly educated, and yet did not know that dental disease was preventable. We talked about his son and as a hygienist, I couldn't resist asking if his child had any cavities. The father's answer saddened me, as he replied, "He doesn't have any cavities yet." Yet? I questioned, wondering why he anticipates his young son will eventually have tooth decay. His reply "I have fillings and so does my wife, so it's just natural that he'll have them too." That's the message being marketed to consumers – dental disease is inevitable and the damage can be repaired. Adding insult to injury, consumers feel that someone else should pay for their dental care, not them.

How can bottled water companies convince Americans to buy water in a bottle when they have perfectly good tap water and yet the dental and dental hygiene professions can't convince people to do just a few inexpensive things each day that will save them money, prevent pain and avoid an ugly smile? The answer is marketing! A comparison of bottled water marketing and oral health marketing reveals significant differences that explain water's success, and our lack thereof.

Bottled Water
How It's Marketed: There are currently more than 1,000 brands of bottled water selling from 69 cents to thousands of dollars a bottle. Grocery store brands, which may in fact be just tap water, are sold for less than a dollar, while BlingH20 sells Swarovski crystal-studded bottles for more than a million times the price of tap water. Since tap water is the primary competitor for bottled water, selling water itself is difficult. They need to convince consumers that bottled water is safer, cleaner and better tasting than tap water. Look closely at the marketing for bottled water. They are selling emotion, not water. They are selling how you will "feel" when you drink this water, rather than the water itself. You'll feel safer and feel healthier drinking their water.

Why It's Successful: People first purchased bottle water to be "chic" and then marketing went from fashion to fear of tap water quality. Successful marketing triggers emotions. People respond emotionally, not logically when they purchase. Logically you'd drink tap water, based on cost, safety and taste. But people buy bottled water to feel safer than if they drank tap water (not true, but emotion nonetheless). They buy bottled water to feel healthier, to enjoy the taste more than tap water (proven in blind taste tests to be indistinguishable from tap water). They buy bottled water to feel chic and fashionable. Success comes from marketing emotions associated with drinking bottled water and not the water itself. This level of successful marketing makes selling snow to Eskimos seem like a reasonable proposition.

What Harm it Causes: The harm comes on several levels, from pollution to undermining the nation's public water infrastructure. High levels of carbon dioxide are emitted into the atmosphere to produce and transport bottled water across the globe, when in fact the water here is cheaper and might even be safer, plus millions of plastic bottles now need to be disposed of in landfills. The pH of bottled water is lower, in many cases, than tap water and additional filtration might take out valuable minerals and also remove fluoride.

Much of the bottled water purchased in this country is in fact, tap water. Some brands feature mountain peaks and waterfalls and the word "pure" when in fact the bottle contains tap water put through additional filtration and purification to make already clean water clean! Marketing that bottled water is "safer" than tap water undermines confidence in public drinking water. This thinking reduces support for repairs and upgrades to the nation's public water infrastructure.

Oral Health
How Its Marketed: Oral health is marketed as a medical issue, linked in some cases, to overall systemic health. Marketing is based on logic and scientific evidence. People are told what they should do, what they need to do, why they should do it, how to treat disease, how to repair the damage from dental disease and how to prevent future disease. This type of marketing doesn't rely on emotion, but rather on efforts to gain "compliance." Motivational interviewing focuses on listening to what patients want and what they are willing to do to prevent dental disease. This approach creates a foundation of trust to build a plan of action to achieve the necessary actions to prevent disease. This is a logical approach, but this is not successful marketing. Successful marketing is linked to emotion rather than logic, to feelings rather than science.

Why It's Not Successful: What consumers pay for oral health falls into the "discretionary" category of purchases, just as bottled water does. The primary competition for oral health expenditures are things people purchase for fun, leisure and travel like electronics, cars, vacations, hair and nail salon visits, eating out, bottled water and Starbucks coffee, to name a few. These are emotional purchases, not logical purchases. Logic is used later to justify the emotional decision to buy. Positive emotions like confidence, self-esteem, belonging, pride, power, safety and enjoyment trigger purchases.

Unintentional marketing of the dental message happens in movies where negative emotions are associated with dental visits. Rarely is a dentist or dental hygienist portrayed as providing services that make you feel safer and healthier. Rather, the emotions triggered are extreme fear, pain and discomfort. Add to this the feeling of paying for these services is adding insult to injury.

One aspect of dentistry – cosmetic and aesthetic dentistry – has experienced successful marketing because it markets to the emotions. Pictures of bright, white, straight teeth paint a picture of confidence, fun and enjoyment. There's no logic here; no link to the science of oral health, yet people are willing to buy cosmetic dentistry more readily than prevention or treatment of disease.

What Harm it Causes: Marketing oral health using logic rather than emotion falls flat. We already know that marketing the importance of flossing to prevent dental disease doesn't work. We've been preaching that for decades and the research shows that more than 85 percent of the population doesn't floss daily and those who do are not necessarily effective at removing biofilm.³ The only reason we continue to market this way is tradition.

Marketing toothbrushing as the primary means of plaque removal also masks the fact that most dental disease begins between the teeth, not on the facial and lingual surfaces. Toothpaste companies have marketed the feeling of clean teeth using their products, when in fact most people brush for only 30 seconds and do not remove adequate plaque to prevent dental disease. Good use of an emotion to sell a product, but this isn't marketing prevention of dental disease; it's marketing a clean feeling from toothpaste.

Marketing oral health as part of the medical model doesn't tap into an emotion, therefore the desired action isn't taken. If providing information and logic worked to market health, no one would smoke and no one would be overweight. The emotional marketing of smoking cigarettes to be chic, macho or sophisticated and the marketing of convenience foods to reward yourself and enjoy life with the time you saved have worked against health.

Conclusion
Appealing to consumers' emotions rather than logic makes the difference. These emotions can be used to market oral health, with the science and logic used later to support the emotional decision. Research published several years ago by the Assistant Surgeon General of the United States Army Dental Corps General Bernier showed that military recruits bought into basic oral hygiene, not with brochures, scientific lectures or demonstration, but when oral hygiene was linked to kissability. The old adage "sex sells" might be something to consider when marketing oral health. Fresh breath sells not because it's a sign of good health, but because people with fresh breath feel confident and it boosts their self-esteem. Marketing to the emotions rather than with logic is a challenge for our science-based profession, yet the scientific research in the marketing field confirms people make choices first from their emotions, and then support that decision with logic. Link oral health to feelings of confidence, security and the enjoyment of life rather than to the avoidance of future painful disease. A beautiful smile lasts a lifetime.

References:
1. Axelsson, P.: Diagnosis and Risk Prediction of Periodontal Diseases. Quintessence Publishing, 2002.
2. Axelsson, P.: Diagnosis and Risk Prediction of Dental Caries, Quintessence Publishing, 2000.
3. Carter-Hanson, C., Gadbury-Amyot, C. and Killoy, W.: Comparison of the Plaque Removal Efficacy of a New Flossing Aid (Quik Floss) to Finger Flossing. J Clin Perio 23: 873–878, 1996.
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