When winter vacation and summer vacation are approaching, there are always a group of parents who start the "face management" of their children, and bring children with oral problems such as having a floor, a small chin, or jagged teeth into the oral clinic to consult with orthodontics. At present, the voice urging "early correction of malocclusion" in the market is always heard: "Don't miss the golden age of orthodontics for children"; "The earlier the correction, the better the effect", etc., stimulate parents' sensitive nerves to pay attention to children's health.

According to the Expert Consensus on Early Correction of Children's Malocclusion in China issued in 2021, the prevalence rate of children/adolescents' malocclusion in China had reached 67.82% in 2000, and the incidence rate had an upward trend, "seriously affecting the dental and maxillofacial function, facial beauty, growth and development of nearly 260 million children in China". According to the data of Guohai Securities, the number of orthodontic cases in China in 2021 was 3.3 million, with a penetration rate of 0.23%, far lower than 1.4% in the United States, which shows that the domestic orthodontic market for children and adolescents does have a broad growth space.

In the face of the market demand of children's dentistry, the head dental service enterprises have successively made a layout. In 2022, Meihao Medical (formerly China Dental Medical Service Group), listed on the Hong Kong Stock Exchange, plans to invest 92 million yuan to build Wenzhou Children's Hospital and Lucheng Children's Hospital; Another 5.6 million yuan was invested to renovate the Wenzhou Hospital building and expand the children's dental service room. In November 2022, Riel Dental Children's Early Correction Development Center was inaugurated. In 2020, Tongce Medical spent 150 million yuan to acquire the oral cavity of children with clover.

With the release of epidemic control, children's orthodontics is expected to restart the situation of both supply and demand. The department of pediatrics and dentistry, which was originally subject to low customer price, added the early orthodontics project, "the performance of pediatrics can be easily improved by more than 30%," observed the orthodontic director and partner of an oral chain in Hangzhou.

In the first year of 2023, the procurement results of dental implants have been released, and the average price of the implants to be selected will reach more than 900 yuan, with an average decrease of 55%; In this context, institutions are looking for new growth points. So, will orthodontics for children, which is at the intersection of the two high-quality tracks of orthodontics and orthodontics, become a potential track in the future? What are the opportunities and challenges for dental service institutions? What tactics did upstream consumable manufacturers use to seize the market?

Must orthodontics for children be done early?

The malocclusion refers to the deformity of teeth, jaws and craniofacial in the process of growth and development of children, such as crowded dentition, sparse dentition, buckteeth, bulbous, small jaw, partial jaw, etc.

In addition to genetic factors, the reason for the high proportion of malocclusion is that children have bad oral habits in the process of growth and development, such as lip sucking, unilateral chewing, tongue licking, bite, sleep grinding, mouth breathing and finger sucking. On the other hand, it is directly related to "weak mastication". Effective mastication stimulation can promote the healthy development of the jaw. However, due to the gradual refinement of modern children's feeding, the frequency and intensity of mastication are greatly reduced, which will lead to the narrowing of the jaw and dental arch. However, if the number of teeth is still so large, there may be problems such as irregular bone mass and crowded dentition.

So, must children's orthodontics be as early as possible? This is not the case. Although "early detection and early treatment" is the intervention principle, the best correction time should be determined according to the specific situation and growth and development status of the child's deformity.

"Many parents are anxious to give their children orthodontics. One reason is that the parents of the children in the lower age group are all focused on their children's health. In the fifth or sixth grade or junior high school, the children do not have enough time to do homework, and half an hour of orthodontic function training every day can not spare time," observed the orthodontic director and partner of an oral chain in Hangzhou. In her view, some cases that are not suitable for early treatment may greatly prolong the orthodontic cycle if they are intervened too early. "Children will have no patience."

The journal Family Medicine, sponsored by the Chinese Association of Preventive Medicine, has reviewed the best intervention time for children's malocclusion under different reasons: due to bad oral habits, abnormal tooth change and other factors, tooth skeleton deformities, such as the overgrowth of primary teeth, mandibular recession, partial jaw, upper and lower teeth, tooth impaction, early deciduous teeth, late eruption of permanent teeth, serious tooth position abnormalities, etc., should be treated as soon as possible. If the baby tooth is covered with the sky, the correction can be started as early as 3.5-4 years old.

If the deformities are abnormal teeth or facial muscle function, asymmetric facial bone development, underdevelopment/overgrowth, or small chin, permanent teeth, embedded permanent teeth, and adenoid face caused by oral respiration (maxillary protrusion or mandibular retraction), girls should be corrected before the age of eight or nine, boys should be corrected before the age of 11.

If the tooth and jaw deformity is only a simple tooth problem, the best time to correct it is 10-14 years old for women and 12-18 years old for men. If it is skeletal deformity, you should go to the hospital when the growth and development basically stops (i.e. after the age of 15); If the simple orthodontic method cannot solve the problem, it needs to be combined with surgery.

China News Weekly once reported that children's orthodontics are too young. In order to treat reverse jaw, children's dental institutions let three-year-old children wear appliances for 12 hours every day. Teeth correction for children who are too young, on the one hand, the children's poor cooperation, and on the other hand, it may also bring "shadow" to children who are not mentally mature - correction becomes a painful experience.

In short, when the head of the family finds that the child has abnormal growth and development of the tooth and maxillofacial, he/she should take the child to the regular hospital to consult the orthodontic specialist in time to assess the appropriate age of the child for orthodontic treatment. At the same time, while preventing the lag of intervention, attention should also be paid to avoiding the situation of induced consumption and excessive medical treatment.

Who can give children orthodontics?

"Children's bones have strong plasticity, such as willow branches, which can be moved with a little force. Moreover, children often have no periodontitis, osteoarthrosis, apicitis, and missing teeth. Therefore, compared with complex adult orthodontics, children's orthodontics is relatively simple." The above orthodontic director said, "Therefore, many people have a misconception that orthodontics is wearing a braces, and any dentist can do it. In reality, if a pediatric dentist helps a child fill his teeth and treat his teeth, the child and his parents will feel good, and they will also give the orthodontics to the doctor."

Strictly speaking, orthodontics should be operated by professional orthodontists, especially for complex cases accounting for 2/3, which need to be judged by orthodontists in combination with their specialty and experience. In the United States, orthodontists and dentists are two professions. The median annual salary of the former is between US $300000 and US $400000, while the latter is about half. Orthodontics is post-undergraduate education, and many orthodontists' undergraduate majors are actually physics or mathematics.

The Consensus of Experts on the Early Correction of Chinese Children's Malformation also points out that due to the complex knowledge system of early correction, doctors engaged in early correction need to undergo professional training to learn the characteristics of children's growth and development of teeth and maxillofacial regions, and to constantly update their knowledge of early correction of children... Children's stomatologists, stomatologists and orthodontists should actively participate in the basic treatment of prevention and intervention, Too professional and complex treatment should be led by orthodontists.

However, in China, by November 2021, there were only 6041 orthodontists certified by the Professional Committee of Orthodontics of the Chinese Stomatological Association. According to the survey of Guohai Securities, the number of cases completed by orthodontists in North America is the highest in the world, with an average of 98 cases per person per year. According to the highest calculation, Chinese orthodontists can complete up to 600000 orthodontic cases every year; However, in 2021, 3.3 million cases were actually completed in China, and the gap of orthodontists was about 5.5 times, so the mainstream of orthodontic business was still operated by general dentists.

The gap of orthodontists is also a key factor restricting the development of children's orthodontics. For mature orthodontists, they have been busy with adult orthodontics and have no time to spend a lot of energy on child orthodontics. As the orthodontic director of the above-mentioned Hangzhou chain institution, 6000 adult orthodontic cases have been completed, but only one case of the first orthodontic treatment for children has been done. However, dental institutions, the main force providing orthodontics for children, generally lack professional orthodontists.

Before 2015, in the era when the demand for orthodontics had not yet erupted, there was little demand for dental implants, dental crowns, general anesthesia surgery and so on with high unit price in the field of dentistry. Children were generally basic projects such as dental caries treatment and dental fillings, with low customer price and low profit margin. Independent operation was often difficult to support. It was as a drainage project for adult oral cavity.

With the improvement of economic living standards and consumption capacity, the population has higher requirements on the experience of oral prevention and oral diagnosis and treatment services. In addition, the rise of children's orthodontic consumption has raised the unit price of children's oral consumption, invigorated the pediatric business, and made the emergence of specialized institutions for children possible.

According to the public information query, Jicheng Dental and Ruilei Dental, which mainly focus on dental diagnosis and treatment, were established in 2015; Square oral cavity was established in 2017; The eight Sanya Children's Dental Clinics acquired by Tongce Medical were all established in 2016-2017. Open the websites of many dental institutions, and the science popularization and service entrance of orthodontics often appear in eye-catching places.

According to the financial report of Tongce Medical, Pediatrics, as one of the four major departments, appeared in the financial report of Tongce in 2017. The revenue of Pediatrics in that year was close to 164 million yuan, accounting for 17.95% of its total revenue. In 2021, the revenue of Tongce Medical Pediatrics will be close to 530 million yuan, accounting for 20.25% of its total revenue, with a year-on-year increase of 32%. It is the fastest growing department.

Erya's entrepreneurship is not smooth sailing

Despite the strong demand, the entrepreneurship of children's oral industry also faces a series of challenges. As early as 2016-2019, many children's dental institutions in China received financing, including Orange Dentistry, Square Dentistry, Ruilei Dentistry, etc., but it has entered a relatively quiet period in the past three or four years. On the one hand, under the influence of COVID-19 epidemic control, offline service institutions are generally impacted; On the other hand, children's oral entrepreneurs are also overcoming a series of challenges such as operational efficiency and customer stickiness.

In 2020, when Tongce Medical acquired Sanye Children's Oral, it signed a gambling agreement, and the net profit corresponding to the equity ratio transferred will not be less than 40 million yuan in the next three years (2021-2023). According to the semi-annual financial report of 2022, the third half of the year from 2021 to 2022 achieved 14.7161 million, only 37% of the promised profit in 50% of the time.

First of all, professional pediatric dentists are scarce in China at this stage. There are only more than 2000 pediatric dentists registered in the Children's Dental Special Committee of the Chinese Stomatological Association, which has a huge gap. In addition, as for orthodontics as the "responsibility" of pediatric performance, many pediatricians do not fully possess the qualification and professional reserve of orthodontics. There may be some problems in the professional degree in distinguishing the pathogenesis, making the correct diagnosis and correction plan, which need to be supplemented by later training.

On the other hand, children's dental institutions mainly attract children with low treatment compliance, while adolescents aged 12-15 are the main group of orthodontics. In order to keep growing children, children's dental institutions have launched full-cycle products with a service life of 5-10 years, covering the whole process from the primary stage, the mixed stage to the permanent stage.

Unlike adult dentistry, in order to alleviate children's fear of seeing teeth, clinics often carry out animated scene decoration, and close the relationship between doctors and children by playing games, telling stories, visiting clinics and other methods. However, the process of coaxing children should also be included in the doctor's normal consultation time. The long consultation time of a single child will reduce the doctor's diagnosis and treatment efficiency. The number of children that can be served per unit time is far lower than that of public hospitals.

Because of this, children's dental service institutions charge more for the same project. In order to solve this problem, children's dental institutions generally try membership system. Preset diagnosis and treatment threshold can not only circle high-end customer groups, but also increase customer stickiness. The annual fee standard is often about 2000-3500 yuan. Take the Trifolium Children's Oral Membership Card as an example, which can be divided into two types: children's card and parent's card. A single card can only be used by one person, and the validity of the card varies from 1 to 5 years; By the end of 2021, there are more than 40000 children's oral cavity members.

In addition, there is another efficiency problem of children's oral cavity: the time of treatment is concentrated on holidays; Therefore, we will face the situation of "no appointment with a doctor, no guest without a doctor". In order to save children's time and energy costs to the greatest extent, and let children learn and correct correctly, there are teenagers' orthodontic service brands and even provide door-to-door services.

In terms of customer acquisition, the best way to obtain customers for medical treatment as a decision-making consumption field is to obtain customers at low cost through brand influence. Only by opening 3-5 stores in a single city can brand effect be formed. At present, among the brands focusing on children's teeth, only Jicheng Dental has 8 stores in Shanghai and 4 stores in Tianjin, Ruilei Dental has 4 stores in Beijing, and Qingmiao Children's Dental has 3 stores in Chengdu.

In the case of limited number of chains and brand appeal, dental institutions need to adopt diversified ways to win customers, such as online, through the promotion of public comments, popular science and other marketing methods, and offline cooperation with early childhood education institutions, kindergartens, primary schools and other vertical channels. Some dental institutions, in cooperation with schools and the government, carry out public welfare free clinics, free pit and fissure sealing, oral examination, etc., in order to improve the brand reputation.

Upstream consumables for beach children's early correction

In the children's oral market, in addition to the downstream medical service providers, the upstream consumables manufacturers are also important players. In the case of children's orthodontic fever, manufacturers such as silicone appliances, invisible orthodontic braces and fixed metal braces have launched the children's version one after another.

Silicone appliance is a popular product in children's orthodontics. Silicone appliances used in domestic medical channels were basically launched in 2015, mainly including Romu Tooth Meikang appliance, MRC muscle function appliance, ETA children's tooth appliance, with prices ranging from 6000-50000 yuan. The price difference is mainly due to brand and treatment cycle.

At present, silica gel appliances are also the most abused areas. Search for "silica gel braces" on the e-commerce platform, with more than 100 content pages, and about 300 yuan/pair of "food grade silica gel braces", claiming that "it will take effect in three months, and every 3-6 months of treatment, it can expand the dental arch or change the dentition without tooth extraction, and correct bucktooth, overdenture, uneven dentition and other symptoms".

But in fact, due to the soft material and limited force, the silicone appliance has a relatively narrow indication. The Expert Consensus points out that "silicone appliance can only be used for mild deciduous tooth inversion"; The MRC muscle function appliance is also used cautiously by doctors in clinical practice because it can not achieve bone expansion.

In contrast, metal bracket braces (including ordinary steel braces, lingual invisible braces, etc.) have accurate correction positions and wide indications, and can be used in a variety of complex cases. However, metal bracket orthodontics requires high professional ability of doctors. If the invisible orthodontics supported by digital technology is compared to "the car with automatic gear", then the metal bracket orthodontics is "manual gear".

Because of its simple operation, beautiful and comfortable appearance, half of adults in China will choose invisible orthodontic braces. In order to improve the penetration rate among children and teenagers, the current invisible orthodontic giants and emerging brands have launched children's products, while reducing the price of adolescent invisible orthodontic products, and trying to bundle children's and adolescent products to achieve full-cycle product sales.

Yin Shimei and Time Angel are the two leading manufacturers of invisible orthodontics. Together, they can account for more than 80% of the share of invisible orthodontics cases in China. In 2019, Yin Shimei launched the Invisaign First series of children's correctors, designed for children aged 6-10; times