As a Chinese, the disease you are most likely to suffer from is what?
Not cancer, not cardiovascular and cerebrovascular diseases, not diabetes-it’s oral diseases. Data from a recent oral epidemiological survey show that in China, the prevalence rate of oral diseases exceeds 90%, while the rate of medical visits is only 10%.
Many dentists I talked to expressed similar views: most Chinese people owe a debt to their teeth.
Since 2014, whether it is capital’s preference for chain oral clinics or the electric toothbrushes, orthodontics and cold light whitening that the middle class on social media are keen to discuss, a new generation of consumers are paying debts for their previous oral habits.
Your mouth determines your beauty
At 10: 00 a.m. on Saturday, Zhou Yanheng appeared on time at Saide Sunshine Oral Clinic in a high-grade office building near the 3rd Ring Road in the east. Su Wen (pseudonym), 25, was already lying on a light green dental chair. The nurse adjusted the dental chair to a more comfortable angle to avoid the sunshine outside the floor-to-ceiling window.
Every two months, Su Wen will take a long-distance bus from Weifang, Shandong Province to Qingdao, then transfer to the high-speed train and then transfer to the two subways to reach the oral clinic located in the 3rd Ring Road in the east, waiting for her orthodontist Zhou Yanheng. This time Zhou Yanheng decided to fine-tune her braces and add some force to the 28 teeth staggered in Sun Wen’s mouth to speed up the alignment process.
In the 14 independent clinics attended by Zhou Yanheng, except for a 16-year-old boy, the other 13, without exception, are all young women dressed up in a fashionable way. They expect that this famous orthodontist can completely change his face.
Few people will notice that it is not the eyes or nose that occupies the largest area of the face, but the oral cavity-nearly one third.
The shape of the teeth and jaws wrapped under a thin layer of skin determines the direction of the whole face, plus the color and shape of the teeth exposed when you laugh, chat and eat. A female blogger wrote in her orthodontic diary that the oral cavity determines your beauty.
In the latest oral epidemiological survey, the incidence rate of malocclusion in the Chinese population is 72.97%. No matter the uneven tooth shape or the “earth-to-sky” and “sky-to-earth” caused by bulging or sunken jaws, they all belong to malocclusion in medicine.
In the long process of human evolution, food has changed from coarse to fine, and the wide jaws used to chew hard food have become narrow, but the teeth have not kept pace with evolution, and their number and size have not changed much. On the increasingly narrow jaws, they squeeze each other’s living space.
According to the stricter dental and maxillofacial standards of orthodontists, the incidence of malocclusion exceeds 90%.
[The more humans evolve, The more serious the problem will be, With the development of economy, Orthodontic treatment will gradually become a necessity in our life. Zhou Yanheng is a professor of orthodontics at Peking University Stomatology Hospital, It is also the first Chinese executive committee of the World Orthodontic Alliance, From 2001 to 2002, he was a visiting professor at the University of Pennsylvania in the United States. He said that there is a phenomenon in the United States. Although Americans do not like to save money, whenever a child is born, middle-class families in the United States will save a sum of money for the child born, that is, the cost of special dental correction.
In developed countries, two thirds of the people receiving orthodontic treatment are teenagers. They usually begin to receive orthodontic treatment from about 12 years old. This is also the golden period of orthodontic treatment-with the help of the growth and development potential of maxillofacial region, teeth move faster, the treatment period is shorter, and the treatment effect will be better.
In China, due to the debt owed by the previous indifference to the oral cavity, this lesson has to be supplemented after adults. The braces house is a patient forum that has sprung up in recent years to exchange orthodontic treatment. The number of active members has exceeded 1 million, compared with 100,000 in 2012.
Zhou Yanheng said that the growth rate of adult orthodontics is relatively fast, but the absolute number of adolescent orthodontics is larger. Some schools he has been to carry out oral science education. According to his observation, half of the students are wearing braces.
Although there is no official data available on the proportion of orthodontic treatment for adults and adolescents, it is certain that both adults and adolescents are increasing rapidly.
Zhou estimates that there should be about 2 million patients in need each year-compared with only 3,000 orthodontists in the country. I asked the orthodontists of two 3A hospitals in Beijing, and several orthodontists have already made appointments after 2018.
[It is also a kind of debt repayment. I owed too much in previous years,] Zhou Yanheng said.
Not only orthodontics, but also treatment projects related to oral aesthetics have been growing at a high speed in recent years.
If you look through the data, you will find that the incidence rate of other organs of the human body is measured in units of x per 10,000 and x per 100,000. However, the incidence rate of tooth-related diseases is generally measured in units of x per 10,000, and the number x is not too small.
Take the pigmentation of teeth as an example. Although there is no recognized national epidemiological survey data, we can roughly estimate it from the following data: 300 million smokers; 40 million patients with dental fluorosis; Tetracycline teeth that generally troubled people born in the sixties and seventies of the last century; In addition to the dozens of foods that can cause tooth dyeing, it is no wonder that half of the people in a survey are not satisfied with the color of their teeth.
Xu Tongkai is the attending doctor of the General Treatment Department of Peking University Stomatological Hospital. He is good at aesthetic restoration and cold light whitening of teeth. If he wants to hang up his number, he has to queue up at the gate of the hospital one night in advance.
He also often receives phone calls from star agencies. After receiving a certain endorsement and advertisement, some stars will want to ask him to make a cold light whitening or porcelain veneer, [this is the hard requirement of advertisers.]
[One study said that the lower third of a person’s face determines the beauty of a person’s face,] Zhou Yanheng said that he had been engaged in orthodontic work for 27 years and was very confident.
[Which effect is more significant than cutting double eyelids and padding nose? I threw him a question.
[I don’t know what will happen after the double eyelid is cut,] he hesitated a little, [but if the lower third of the face is not good, no matter how big the eyes are, she is not good-looking, absolutely not good-looking.]
I asked Dr. Zhou, a female star famous for her beauty, whose face was used by many young women as a model for plastic surgery and presented to her plastic surgeon. The comparison photos of her early years when she was wearing braces and now have triggered a controversy over whether she was orthodontic or plastic surgery.
[She has changed so much, is it possible for orthodontics to achieve this effect in terms of your major? ]
Zhou Yanheng did not answer me directly, Instead, he took out his cell phone and showed me a series of contrast photos before and after orthodontics stored in his cell phone. Pointing to one of them, he said, the patient told me that orthodontics had changed her life. The 36-year-old woman told his orthodontist that her life, work and marriage were completely different as a result, and she felt more beautiful than when she was 18.
[It can be said that he has changed his appearance.] In this sunny clinic overlooking the East Third Ring Road, he burst out laughing specially, revealing a row of neat and white teeth.
Completely Collapsed Oral Health Defense Line
The clock went back to the last century. Liu Jiangqian, director of medical quality of Riel Dental Department, worked in the Department of Stomatology in xuanwu hospital, Beijing. She still remembered that the overall oral condition of people at that time was extremely poor. [Regardless of beauty, many people, by middle age, half of their teeth were broken.]
Huang Zhen, editor-in-chief of the World Dental Tribune, was still working in the Department of Stomatology of Beijing Hospital at that time. What he saw was almost the same as that of Liu Jiangqian. [His mouth was full of tartar, his teeth were covered, and his gums were swollen and bleeding… This was not a very serious situation. It was very common in China at that time.]
He wrote in the Elephant Association that it was not until the 1990s that the teeth of the Chinese people who appeared in the first few minutes of the news broadcast were greatly improved with the help of dentists-because some medical experts wrote to senior officials that the quality of leaders’ teeth was related to the image of the country in diplomatic occasions today.
So far, China has launched three nationwide oral health epidemiological surveys, the latest of which occurred between 2005 and 2007.
According to the survey report, the defense line of Chinese oral health has basically collapsed:
As a representative of the middle-aged, the prevalence rate of caries, which we usually call worm teeth, is as high as 88% in the 35-44 year-old group, while the prevalence rate of caries in the 65-74 year-old group, which is represented by the elderly, is 98%, which corresponds to a low and poor consultation rate-ranging from 10% to 20%.
Another important indicator of oral health-periodontal health rate is 14.1% for middle-aged people and 14.5% for the elderly.
Two deep-rooted misconceptions have profoundly affected the oral health of 1.3 billion Chinese: only toothache requires going to a hospital, and the elderly will definitely lose their teeth.
Several doctors met in the interview all remembered that at the beginning of their practice, there were many emergency cases in the stomatology department, [when they came to the hospital, they all had toothache, and they came to the hospital only when the pain was too great.]
As the hardest part of human tissue, teeth are also the most vulnerable. During its lifetime, it has to chew an average of 50,000 kg of cold, hot, sour, sweet, or hard food, and billions of bacteria work together to erode your gums and teeth day after day.
Of course, we are not without help. The < Guidelines for Oral Health of Chinese Residents > > recommend four easy-to-obtain and cheap oral health habits: oral examination once a year, tooth washing once a year, brushing teeth in the morning and evening, and using fluoride toothpaste.
However, few Chinese can do these things:
In the above-mentioned oral epidemiological survey, the middle-aged (35-44 years old) can reach the four proportions recommended by the guidelines: having an oral examination once a year, washing teeth once a year, brushing teeth in the morning and evening, and using fluoride toothpaste are 8.4%, 2.3%, 36.3%, and 42.3% respectively. The oral habits of the elderly group are worse as a whole, with the compliance rates of 12.1%, 1.5%, 22.1%, and 32.5% respectively.
More intuitively, only 36.3% of the middle-aged and 22.1% of the elderly have performed the simplest procedure of brushing their teeth in the morning and evening.
The most intuitive consequence of ignoring the oral cavity is the loss of teeth.
On average, the 65-74-year-old lost 9.86 teeth on average. Among the elderly over 60 years old, 12.63% have no teeth in their mouth. If the age is enlarged to 80 years old, nearly one third of the elderly do not have a tooth in their mouth.
We have always regarded the drop of teeth as a natural law, not a disease. In fact, the concept of “old-fashioned” is already “old-fashioned”.
According to the 8020 plan proposed by the World Health Organization-at the age of 80, 20 teeth with chewing function and no loosening can be kept. Only in this way can normal chewing function and matching quality of life be guaranteed.
Stomatologist Zhu Wangyong noticed in 13 years that his grandfather was extremely thin, At first he even worried about the old man [giving birth to bad things] (tumors). After reading his medical report, According to his professional inference, Grandpa should be suffering from severe malnutrition caused by oral diseases. When he asked Grandpa to open his mouth, he was shocked-severe periodontitis, almost one-third of his teeth had been lost, and the rest was baggy, painful when touched, and actually lost chewing function.
[Grandpa seldom eats meat because he can’t bite it. Rice and vegetarian dishes are cooked to a pulp and he doesn’t chew very much, so he swallows them directly,] Zhu Wangyong commented, [Only without malnutrition can there be ghosts.]
However, the old man regarded this as a natural law and endured it silently. He did not speak to his grandson, who was a stomatologist. In front of the detailed oral treatment plan drawn up by his grandson, the old man also strongly refused. Zhu Wangyong [coaxed and tricked] to let the old man complete the last step of his treatment plan-wearing movable dentures.
Zhu Wangyong scored 60 points for his treatment plan and implementation effect. Although it was not the most perfect plan, Grandpa was finally able to eat delicious food, which was the most fulfilling thing for him as an stomatologist in that year.
History of Oral Civilization Changes
The history of changes in a country’s oral civilization is the history of economic changes in the country.
According to Huang Zhen’s observation, in general, the oral health of nationals in developed countries is healthier than that in developing countries.
Because the concern for oral health is the top concern in the field of health, when the economy develops to a certain level, both the country and the individual will focus on the heart, liver, spleen, lung, kidney and other large organs and part out of the oral cavity.
Compared with Taiwan’s experience, when the per capita GDP rises from US $3,000 to US $10,000, the number of stomatologists per 100,000 people grows fastest, and the number of stomatologists is the most important indicator to measure the degree of development of a region’s oral consumption market.
No one can say exactly when China’s oral medicine market will start.
Philips began selling electric toothbrushes in China in 2002. No matter inside the company, In the mass consumption market, electric toothbrushes are a niche category: only a few categories of people use electric toothbrushes: those who study abroad and return home, some employees of foreign-funded companies, and those who have serious oral problems are recommended to go to the dentist.
At the beginning of this century, it was not popular to see a dentist regularly. People would only see a dentist if their toothache was too much to bear. It would take more than 10 years before the concepts of preventive oral examination and regular tooth cleaning were gradually accepted by the middle class in China’s first and second tier cities.
[This is also the persistent ailment. It is too late to see a doctor until the pain occurs. The injury is irreversible. The next step is to pay a series of expensive dental expenses,] Zou Qifang said. [Why can’t preventive maintenance be done? ]
Zou Qifang is the founder of Riel Dentistry. He opened his first clinic in the embassy district on Chang’an Street in 1999. At that time, more than half of the customers were foreigners-it was a kind of inertia for them to meet their dentists regularly in high-grade office buildings.
Although it is not well known to the Chinese, it is almost the consensus in the oral field: teeth are consumables that need regular maintenance and maintenance-brushing teeth twice in the morning and evening; Use fluoride toothpaste and floss; Even if there are no symptoms, clean your teeth regularly and see a dentist.
Zou still remembers that a young French who came to China to work had a routine oral examination in Riel and the doctor made a set of oral medical plans for him. The young man told the doctor, “Doctor, can I not do this today? I have no money yet. I will come again when I get my first month’s salary.”
[I thought at that time, this young man, after going to work, has money, the first thing is to go to see a tooth, where is our young man? What’s the first thing to do with money? Maybe a meal, maybe karaoke.]
In sharp contrast, a middle-aged man wearing a gold chain has been unable to eat normally for several days under the double attack of periodontitis and dental caries. After seeing the treatment plan provided by the doctor, his first reaction was [too expensive].
[I said that you wear a gold chain, and you have more than enough teeth to look at half of it. Are these two consumption consciousness in sharp contrast? ]
During the 11 years from 1999 to 2009, Riel strictly controlled his expansion rate and opened only one clinic a year. By 2009, Riel had 11 chains.
Until 2010, Riel Dentistry received an investment of US $20 million from Qiming Venture Capital and Kleiner Perkins Huaying, two established venture capital funds, for the expansion of clinics.
After receiving the second round of investment in 2011, Riel Dentistry expanded from 11 clinics to 84 now. In the rapid expansion, Riel’s number of users still keeps a 40% growth rate every year.
Hu Xubo, the managing partner of Qiming Venture Capital, has given a clear node. In first-tier cities such as Beijing and Shanghai, when the per capita GDP exceeds 100,000, it is the beginning of the rapid growth of high-end oral consumption.
Take Beijing as an example. In 2014, the per capita gdp just reached an inflection point of 100,000. It was also in this year that high-end oral consumption represented by electric toothbrushes and oral chain clinics ushered in an outbreak period.
Shen Tianhong is the senior director of the Greater China Health Care Business Department of Philips, one of the two largest manufacturers in the global electric toothbrush market. He carefully studied the growth rules of Philips’ 17 major markets in the world-each market is actually the same. When your economy goes up and your disposable income goes up, your consumption in the field of oral care will definitely increase.
Philips’ experience in the United States and Germany shows that since the advent of electric toothbrushes, the household penetration rate has not been high. When the penetration rate of electric toothbrushes reaches 5%, the consumption of this category will see explosive growth at a certain point in time.
Philips Electric Toothbrushes have been waiting for this day since they entered the Chinese market in 2002-until 2012, Philips Electric Toothbrushes grew at a rate of 60% to 70% per year, with sales doubling tenfold in four years.
Procter & Gamble’s research report also shows that the market share of electric toothbrushes in China has seen explosive growth since 2014. Compared with 2013, the market share has doubled. By 2016, it will show an annual growth of at least 50%.
As a standard for middle-class families and a symbol of consumption upgrading, electric toothbrushes are warmly sought after and discussed on social media-Philips’ electric toothbrushes and Dyson’s vacuum cleaners have the highest exposure rate in a reader survey conducted at the beginning of this year.
Capital’s preference for the oral medicine market is obvious. In 2014, Lenovo Holdings invested 1 billion yuan in Baibo Oral, another chain of dental clinics in the market. In the following year, Baibo Oral opened 95 new clinics at one go.
Zou Qifang felt that this fast-growing market confirmed his prediction at the end of last century, [Chinese people are the same as people in all countries in the world. With the development of economy, they will pay more and more attention to their own health, and oral health is one of the important links.]
Unexpected Chinese Consumers
In the first clinic opened by Riel Dentistry on Chang’an Street, I met Ms. Wang, a 78-year-old piano teacher and an old guest of Dr. Wu Jun.
At 3 pm, Wu Jun made an appointment with her. The indoor reminder bell rang to remind the doctor that the guest had arrived. If the last guest was not over, Wu Jun would ask the nurse to take good care of him and bring him to the clinic after the end.
She asked me to guess her age. In front of her, the woman in blue jeans and black Mizuno sneakers can be described by the popular saying-an age-free person, her hair has been dyed, but it is not meticulous, mixed with a few wisps of silver hair.
I guessed several times, but I didn’t get it right. She told me [78 years old] that her voice was simple and her exposed teeth did not look like the teeth of the elderly in China in my stereotype except for slight yellow (the most common color of Chinese people).
In 2001, when she was 62 years old, after her teeth fell off for the first time, she began to carefully maintain her teeth: clean her teeth twice a year; Use floss according to the doctor’s instructions; Medical records show that in the past three years, she has visited this high-end oral clinic 24 times, which is famous for its high price and quality service.
Compared with when he was young, there were only 4 fewer natural teeth and 24 more natural teeth, exceeding the World Health Organization’s 8020 plan-at the age of 80, he still had 20 teeth that could be chewed normally.
This time, Ms. Wang came to replace the last two teeth that fell off with dental implants. Wu Jun’s assistant put on orange goggles, avoided the direct light from the searchlight of the tooth chair, unscrewed a small can of lip balm, smeared her lips with cotton swabs, and smeared several more times in the places where the corners of her mouth were easily cracked.
After half an hour’s treatment, the nurse brought a cup of coffee. The 78-year-old piano teacher and the planting doctor talked about Yuyuantan’s cherry blossoms, vinyl records and the upcoming concert.
For these two dental implants, she has to pay 40,000, 20,000 each. Dental implants are beauty-related items and are not covered by medical insurance.
I am not rich,” said Wang, “but I am willing to spend my money on my teeth.
Before her retirement, Wang was a piano teacher in a university. She would take bus No 44 every time to and from the oral clinic and her home.
Hu Xubo is the managing partner of Qiming Venture Capital, which focuses on venture capital in the medical field. Seven years ago, he led the investment in Riel Dentistry. He said that in the past seven years, the public has become more and more receptive to high-quality oral services. [In fact, once you try, you will basically become addicted.]
According to a 2016 report by the Economist, the number of high-income consumers in China will blow out in the next 15 years. Statistical analysis of many types of goods and services shows that with the increase in annual income in the next 15 years, Chinese consumers will upgrade their consumption habits and turn to high-quality brands with higher prices.
Every five years, Philips conducts a China-wide consumer survey. Mr. Shen Tianhong, Senior Director of Philips Greater China Health Care Business Department, talked about the last two consumer surveys:
In 2008, consumers said, I want more income, I want to let people know that I am doing well, I want to buy a good car, I want to buy a good bag, cosmetics;
In 2013, they said, I am better off than I was in 2008, but I think there is no end to my pursuit of money and material resources. I hope to spend more time with my family. Besides buying bags and cars, I also hope to buy something that can make me healthier.
Correspondingly, Philips’ sales of electric toothbrushes increased by almost 60% to 70% every year from 2012 to 2016, with sales doubling tenfold in four years.
The price of Philips’ electric toothbrushes ranges from about 200 yuan’s entry price to 2,000 yuan. In other countries, the consumption model is pyramid-shaped, and the higher the price, the fewer people will buy it. However, in China, the model is hourglass-shaped, and the entry-level sales volume is still the best, but the second place is the flagship product with a price of 2,000 yuan-overall, due to the huge potential of the Chinese market, there are also large consumer groups at each price stage.
[Chinese consumers are always beyond our expectation,] Shen Tianhong said.
European Road or American Road?
There are two major schools in the field of oral consumption: American school and European school.
In 1920, a dentist changed the shape and color of his teeth according to the different needs of Hollywood movie stars at that time, which triggered the pursuit of dental aesthetics in the United States and was also called “Hollywood Dentistry”.
Since then, American society has never returned to its extreme pursuit of whiteness and neatness of teeth. According to Huang Zhen’s estimation, 80% of the income of American dentists comes from fees related to beauty, while only 20% is related to diseases.
As a strong class symbol and social pass, it seems that if you cannot have a white and neat tooth, you cannot have a perfect life.
An American columnist wrote in the article “Teeth of the Poor”, “If you have a bad tooth because you lived in poverty as a child, you will have little chance to knock on the door of the upper class in the United States.”
Compared with the United States, Europe still generally treats teeth as an important organ of the human body-if not carefully maintained, it will bring health crisis and affect the quality of life.
When Liu Jiangqian was studying for a master’s degree in England, the head of the department was a periodontal doctor. His teeth were not perfect, neat or white, but he had no plans for orthodontics or bleaching.
[Europe is different from the United States. Europeans advocate nature more. They do not pursue it as much as Americans. Their teeth must be very neat and white,] Liu Jiangqian said.
Although Europeans do not have such a strong desire for white and neat teeth, Liu Jiangqian was deeply impressed by their good habit of regular maintenance.
After graduation, Liu Jiangqian worked in an oral clinic in London. This clinic has been in operation for many years and dentists have changed for several generations. However, the guests who come to this clinic have not changed much. A large family, from grandparents, grandparents to grandchildren, will drive for several hours to the clinic to see their teeth, see an exhibition and have afternoon tea no matter where they move.
So, is China’s concept of oral consumption on the road of Europe? Or is it on the road of the United States?
Ask this question, is due to a 23-year-old young girl, she is saving money for orthognathic surgery-the doctor told her, according to her situation, compared with orthodontic treatment, orthognathic surgery for oral morphology changes are more obvious. Her monthly salary is 6,000, orthognathic surgery costs 60,000, by June this year, she will save up to 30,000, and then brush 30,000 credit card installments, can gather enough money for surgery.
She told me that she thought it was worth tens of thousands of dollars to change a normal oral cavity for a lifetime, which was worth more than buying a car. [If I don’t look good, my teeth are not good, and I will still be unhappy.]
In fact, she is a beauty with deep outline. If she hadn’t mentioned it, I hadn’t noticed that there was what abnormality in her mouth.
In Shen Hong’s view, China’s consumer culture may be closer to that of the United States, because China, like the United States, is a highly competitive country with better teeth, more confidence and more spirit than others in all aspects.
Professor Li Gang from the Department of Stomatological Preventive Medicine, School of Stomatology, Fourth Military Medical University, analyzed China’s oral consumption concept from the proportion of various oral treatments. In China, the proportion is in turn filling teeth, cosmetic restoration, tooth extraction and prevention.
Prevention comes last, which is not a healthy consumption concept. What is more noteworthy is that oral consumption related to the United States ranks second.
Perhaps divisions are forming. My colleague Shan Shan told me that she interviewed a special summer camp for high school students last year. Children of migrant workers and children of the rich experienced a week of social life together. At a glance, the difference between children of the poor and children of the rich is clear at a glance, because children of the rich are all wearing braces.