Can start-ups challenge a £40bn industry? (Clue: don’t hold your breath)

[ Words: Will Peakin ]

Disruptive innovation, said Clayton Christensen, is a process whereby a smaller company with fewer resources successfully challenges incumbents. As the incumbents focus on improving their products and services for their most demanding – and usually most profitable – customers, they exceed the needs of some segments and ignore the needs of others.

“Entrants begin by targeting those overlooked segments,” observed the Harvard Business School professor, “gaining a foothold by delivering more-suitable functionality – frequently at a lower price. Incumbents, chasing higher profitability in more-demanding segments, tend not to respond vigorously. Entrants then move upmarket, delivering the performance that incumbents’ mainstream customers require, while preserving the advantages that drove their early success.”

From the Ford Model T, through the transistor radio, to Netflix, ‘disruptive innovation’ – as coined by Christensen in his book The Innovator’s Dilemma, published in 1997 – has become an obsession for entrepreneurs driven by the potential of smaller companies to out-compete and eventually destroy their bigger competitors.

The term, he argues, is often misunderstood and misused: “Disruptive innovations are not breakthrough technologies that make good products better; rather they are innovations that make products and services more accessible and affordable, thereby making them available to a much larger population.”

You could take issue with this definition – and many do – in that, for example, the iPhone contained breakthrough technologies (a touch screen with fluid scrolling and pinch-to-zoom), was more expensive than existing ‘smart’ phones, and yet it did disrupt – indeed, several – industries while making services more accessible and affordable at the same time; effectively challenging Christensen’s mutually exclusive criteria.

Whatever your take on his definition, in the personal health sector there have been attempts at disruption and innovation; Harry’s is a subscription-based men’s razor that takes a tilt at the incumbents’ expensive innovation (remember “introducing seven blades, because five is not enough”?), while Quip is a similarly subscription-based rival to the established players’ electric toothbrush (“a product combining simplicity and accessibility of the much loved manual toothbrush with the cherry-picked guiding features that dentists recommend from an electric,” say its makers).

Joining these in dental health are start-ups attempting both innovation in, and disruption of, the humble toothbrush. The prize is great; the global oral care market – comprising toothpastes, toothbrushes and accessories, mouthwashes, and other dental products – is expected to reach $60bn by 2025, up from around $40bn now (read a press statement).

“I hate brushing my teeth,” wrote Jonathan Margolis in the Financial Times last month. “Seconds into each of the prescribed two minutes, twice a day, I get bored. So, when I spotted an automatic toothbrush that claims to clean all your teeth at once in six seconds, I imagined a gleaming dental future.”

Blizzident, based in Munich, has been selling a 3D-printed manual ‘whole-mouth’ toothbrush since 2013; a giant version of the chewable brushes you see in airport vending machines but custom-made for your mouth. However, Margolis had plunged into what turned out to be not so much a gleaming dental future, but the occasionally murky world of crowdfunded products.

Danish start-up Unobrush’s blurb had testimonials from dentists, so he paid his $109 on the Indiegogo platform. Unobrush is one of many new whole-mouth toothbrushes. “I was struck by how many others were looking for a better toothbrush. Unobrush raised 70 times its target and received £2m from 30,000 backers.”

Amabrush, based in Vienna, was similarly over-subscribed; it raised almost £4m from 38,000 backers on Indiegogo and 3.2m on Kickstarter. Venice-based Unico’s pitch is to undercut the six-second brushing time; it claims a complete clean in three seconds. “I still live in hope that my Unobrush will materialise in August,” said Margolis, “and perfect dental health in 12 seconds a day becomes reality.”

Alas, for Margolis, that hope may prove to be forlorn. In June, Amabrush filed for insolvency blaming an inability of European manufacturers to fulfil the overwhelming demand and Asian manufacturers, to whom they switched, to meet quality thresholds.

“We want to assure you that we have done everything in our power to avoid this situation,” a post on its website said. “We learned a lot and we’d be happy to share our experiences with all who want to realise their ideas. So do not hesitate to contact us. We encourage you not to stop supporting and believing in novel and innovative ideas that rethink the status quo and that promise to make the world a better place. We will keep fighting for our idea and project.”

Meanwhile, Unico’s Indiegogo page has been closed for some time (having raised £325,547), with progress stalled at the ‘prototype’ phase (‘production’ and ‘shipping’ remain greyed-out). But the comments page is live with more than 850 posts, including recent, plaintive, messages from disgruntled backers complaining of not having received the product or, in some cases, having received a product that disappoints or does not work.

One start-up that Ireland’s Dental interviewed is determined to stand apart from the rest and prove doubters wrong. Based in Lyon, the makers of the Y-Brush are part of the European Union-funded accelerator EIT Health. Their brush, which claims to clean teeth in 10 seconds, is an advance on a device they developed for use in hospitals and care homes.

We asked one of the co-founders, Benjamin Cohen, about their story.

What’s your background?

I am 34 years old. I studied bioinformatics and health informatics in one of the most recognised French schools (ENS), at McGill (in Canada) and at MIT (USA). After my studies, I had multiple positions in management, as project director, team leader and operations manager in the health sector (mainly in medical devices). And then I founded FasTeesH / Y-Brush more than three years ago.

Has oral health always been of interest to you and, if so, why?

To be honest, when I was younger, I had a phobia of dentists! But I have been interested in health and biology since I was a child.

It’s said that watching your younger cousins become bored brushing their teeth was an inspiration for developing the device, but what do you think drove you to actively pursue a solution?

What pushed me to move forward is for many people in the population, tooth brushing is boring, seen as a chore because two minutes is too long. Three years ago, I met a dentist, a key opinion leader, who has helped us a lot. Yes, good tooth brushing is a real challenge. Our observation is that the current players are investing a lot to keep users brushing their teeth for two minutes, for example with games and applications for children. But in the end, toothbrushes have hardly changed for centuries. Our vision is to make brushing more accessible, faster, easier, and therefore more efficient.

How does the partnership with your co-founder Christophe Cadot work?

Christophe had developed sensors in another industry. On my side, I have supervised the industrialisation of IVD (in vitro diagnostics) products, such as pregnancy tests you can perform at home.

Did similar competitive products exist and, if so, why did you feel you can bring something new and different to the concept?

Our product is truly unique. There are indeed some products, which generally come from Asia, which are, like ours, in the shape of jaws. The problem is that these products use silicone tips several millimetres in diameter; too soft and too large to remove plaque. They ‘massage’ the teeth but have no effective plaque abrasion. On our products, we use very thin nylon fibres, thinner than a hair, like toothbrush bristles, which are really effective and able to go between teeth. We have performed many tests to prove it, and independent tests have been done on competing products.

Other start-ups have attempted to develop similar products, with mixed results; why do you believe your product stands apart from these and how will you convince sceptics (both dental professionals and consumers)?

Yes, they used silicone tips that have no effectiveness – as I explained in the previous question. Our product uses the same technologies (and improved) as a standard toothbrush (sonic vibrations and soft bristles), and acts in the same way as an electric toothbrush but brushes all teeth at the same time – the top set, then the bottom.

Our product stands apart because it is effective. We are very transparent; we conducted trials with several of our customers (and they posted their feedback without review from us!), with journalists (the same), and so on. Regarding dental professionals, we have had a lot of interaction with them and very positive feedback from around the world and we are launching a special engagement programme for the profession.

Could you describe the research and development process that occurred over the three years of the product’s development?

We carried out three years of R&D to obtain a product that is medically effective and well perceived by users. We mainly worked on the brush, which is very complex to manufacture, especially because it is flexible with nylon bristles. We worked on several aspects; the sizes of the brush, the user perception, the effectiveness, the design (with adults, and schools with children) and so on.

Can you provide detail about the clinical validation process that you have undertaken and whether there is a further validation process under way?

In terms of the efficacy – in vitro tests, with in vitro protocol dental researchers’ use, and in vivo tests, with plaque revelator, from one brushing to a six-month period.

They were supervised by dentists trained for that. In addition, since January this year, we have been selling our first product in France, under the FasTeesH brand, to hospitals, nursing homes and establishments for disabled people. This is providing a lot of feedback. And we are preparing a clinical study in France at the end of this year.

How do you intend to scale your product and business?

We have sold a lot through our website, to consumers in more than 60 countries. We will continue that. In addition to that, you’ll find our products in stores from mid-2020, first in France, and then in other countries through distributors all around the world.

You were at the Consumer Electronics Show (CES) this year; what was the response?

It was great. We didn’t expect it, to be honest, but we got hundreds of highly qualified contacts, and huge press coverage with CNN, CBS, and so on.

What has been the response of the dental profession?

Great, also. You know, dentists share our point of view; that the oral health of populations is not good, and they will promote everything that could improve that.

Do you see the Y-Brush ultimately displacing the traditional toothbrush, or will it remain something which stands alongside other types of brush?

Yes, it will displace the traditional toothbrush, but it will take a bit of time because it is very difficult to change habits.

References

• The quest for a better toothbrush by Jonathan Margolis, The Financial Times.
• About Y-Brush

Tags: Distruption, Oral Health, technology, Y-Brush