Secondary Research

In India, about 85% to 90% of adults have dental cavities, along with about 60 to 80% of children. Also, around 30% of children have misaligned jaws and teeth. Over 50% of Indians with dental health issues receive treatment or advice from someone other than a dentist, such as chemists. About 51% of Indians use a toothbrush and toothpaste to brush their teeth. Around 28% brush their teeth the recommended two times a day. Therefore, access to information about dental health and how to properly maintain one’s oral health would prevent many issues and improve the overall state of dental health in India.

These figures would suggest that there is one dentist for every 5,000 people in India. A report from the Indian Dental Association noted, “For a population of over 1.2 billion, there are currently over 1,80,000 dentists” – indicating that there is one dentist for approximately every 6,500 people. Both these ratios are better than the World Health Organisation’s recommendation of one dentist for every 7,500 people. The other is that there is a huge disparity between the ratio of dentists to the general population in urban and rural areas. According to data from the Indian Dental Association, there is one dentist for every 9,000 people in urban areas, and one for every 2,00,000 people in rural areas.

Dentists point out that for too long, oral healthcare has been viewed as distinct from general healthcare. “By treating it as separate from general medicine, we’ve undermined its importance,” said Dr Chandrashekar Janakiram, the head of the department of public health dentistry, in Kerala’s Amrita Vishwavidyapeetham. “If we drew more awareness to the fact that a lot of oral health problems are connected to general health, then it would be taken more seriously.”

The Indian Dental Care market is approximately a USD 2 billion Industry, with an expected growth rate of 30% YOY. India is also one of the fastest growing dental markets in the world, and is set to become the largest single market globally.

Dental Care market consists of dental services, equipment and consumables.

The pandemic was an opportunity for start-ups in the e-pharmacy and teleconsultations spaces. There were only about three million households who were comfortable ordering on e-pharmacy portals like Netmeds, 1mg, and Medlife pre-COVID-19. But the addressable market was around 30 million to 35 million households. COVID-19 was a catalyst, and numbers grew exponentially. The post-COVID-19 forecast is that approximately 60 million to 65 million households will place orders on e-commerce portals by 2025.

Health care in India faces several challenges including inadequate access, low insurance penetration and a growing chronic disease burden.

Despite its shortcomings, India’s health care sector has a lot going for it on several fronts. A government-led push to get health care providers to embrace electronic medical records is enabling artificial intelligence (AI) to extract insights from patient data to deliver better treatment. The availability of telecom bandwidth is making medical expertise reach underserved rural markets through telemedicine and tele-consulting programs, delivered over mobile phones.

A survey done by India’s second largest dental chain, Total Dental Care, showed that Indians, on average, visit a dentist three times. Not a year. Across a lifetime. A majority of them do not floss or brush twice a day.

As such, dentistry has been a hard business to crack in India, even for established names. Almost all those who’ve established dental chains have struggled, with barely any scaling past 100 clinics. For instance, the Apollo White Dental chain—founded in 2002 by Apollo Healthcare—has grown to over 70 dental clinics. Narayana Health’s dental chain—founded in 2008—scaled to 30 clinics in six years, and was then sold to Axiss Dental in 2014. Both Apollo and Narayana are tertiary care hospital chains. Delhi-based Axiss Dental hasn’t found scaling easy either. It is shutting down clinics and has just about 50 functioning clinics at present.

Where others saw struggle, Star’s founder and CEO Amarinder Singh saw opportunity. “Everyone will need a dentist at some point in their lives,” reasons Singh. “Dentistry is an independent neighbourhood business, and the need in India was simple—dentist jo lootega nahi (not over treat or overcharge). The prevailing lack of trust and confidence gave me an indication to build a brand over time,” he adds.

In India, a majority of the population either cannot access or afford a dentist. This is made worse because dental care is an entirely out of pocket expense, unlike hospitalisation. Indians are also likely to use over the counter painkillers and/or antibiotics for toothaches rather than visit a dentist.

Preventive care in India, however, is a hard nut to crack. This is a notion that Vora also agrees with. The Ken has reported in the past on how preventive care has not grown as expected in India. Despite this, Vora sees an opportunity in this space. According to Vora, over 40% of the revenue of UK-based MyDentist—a dental chain with 600 centres—comes from people visiting regularly for cleaning and polishing.

However, conversations with some of Total’s former dentists reveal some cracks in the facade. One of Total’s ex-employees indicated that Total’s approach was inherently flawed. While the chain was looking to drive large volumes of transactions from the lower-middle class, most of these patients didn’t convert to repeat patients. In fact, while most of them were seeing a dentist for the first time, they were usually there only for immediate relief from toothache.

Since dentistry is as much about cosmetics—how the teeth look—as about medicine, it is hard to satisfy each patient.

Sekhar Chennupati, the founder of Today’s Healthcare and now an advisor at Star, believes that investment in talent and capital is directly linked to patient satisfaction. The quality of equipment, for instance, says Chennupati, affects a patient’s experience. And patient experience matters. As it turns out, cheaper dental care doesn’t equal happier patients. And patient happiness matters.

Dental health experts have pointed out that Indians consider oral health secondary to general health. Many people take dental care for granted until it is too late. Many people still perceive oral health and dental hygiene as secondary priority.

If and when dental insurance is provided, it will have a favorable influence on people's attitudes toward dental care. The availability of dental insurance will help to improve oral health. Dental insurance will encourage patients to take better care of their teeth, resulting in improved oral health.