During Morgan Snyder’s year of volunteering at an education charity in Bangalore, she noticed that many of the children complained of toothaches. Teachers told her that kids were missing sessions because of dental health problems, and that many did not brush more than once a day, and poorly at that. Her well-educated local friends didn’t like going to the dentist, and she observed that a culture of regular dental check ups did not exist in India.
After returning to the University of Pennsylvania for her sophomore year, she talked about what she had seen with friends. One, Josh Tycko, proposed that they tackle the problem and vie for the $1 million Hult Prize for student social entrepreneurs, which Nobel laureate Muhammad Yunus has called the “Nobel Prize for students.” This year’s prize focused on improving life for people living in slums.
Spencer Penn, an avid gum chewer in the tight-knit group of five, suggested using chewing gum as a way to address the dental health problem in India’s slums. But not any chewing gum – the gum that the group has produced, called Sweet Bites, is sweetened with 100 percent xylitol, a naturally occurring sweetener that is believed to prevent tooth decay. Xylitol-sweetened gum is common in Finland, where its efficacy was documented in the 1970s. Some gum companies in the United States that sell sugarless gum use xylitol, though most use it in combination with sorbitol or aspartame, which lack xylitol’s dental benefits. “Xylitol has been used by the Finns since the 70s,” says Thoba Grenville-Grey, who graduated from the University of Pennsylvania in May and has been helping to implement programs on the ground. “They give this to kids at the school.”
The group hopes that they can make chewing xylitol gum a common practice among India’s schoolchildren and other slum residents. The packaging is designed to look Western for extra appeal, and they have taken heed of Professor Ezekiel Emanuel‘s advice: “When it comes to health care, free is not cheap enough.”
What that means, Penn explained, is that in in order to get the poor to adopt a medical practice, “it had to be something that embedded health care into something people knew and loved.” Gum is a big and growing business in India, with nearly $500 million in annual sales. While living in Bangalore this summer, the team was able to observe the small corner stores in the slums, as well the buying habits of the residents, who would often purchase small quantities – such as one egg or one stick of gum at a time.
In order to appeal to those buying habits, they have packaged Sweet Bites, which comes in cinnamon, fresh fruit and spearmint flavors, individually — with plans for three packs — with the intention that it be chewed three times a day. Each piece has 1.06 grams of xylitol; they chose that quantity based on their calculation that three grams a day provides significant dental benefits and is affordable. (Epic Dental‘s gum, which is intended for a Western audience, cites 6 grams daily as optimal for dental benefits, but Tycko said that 3 grams was enough to significantly improve health outcomes without asking people to change their behavior or increasing the cost. Sweet Bites might make a product with more Xylitol in the future.) They’re selling the gum for 1 rupee apiece, or about $US 1.6 cents, a competitive price. The purpose of the gum, said Tycko, is not to supplant other good oral hygiene practices, such as brushing and flossing, but reinforce and supplement them. In addition to reducing cavities, they hope use of Sweet Bites will reduce the long-term side effects that can be exacerbated by poor dental health, such as heart disease and stroke.
Although their original plan was to recruit women who were already selling produce and handmade goods on the streets, after spending the past summer in Bangalore, they pivoted. Their idea of empowering women entrepreneurs “was very noble, but the reality when they got there was that it’s just not possible for people in these environments to be making small gum manufacturing facilities and selling it,” said Wharton Professor Ian MacMillan, one of their advisers. Instead, they’ve recruited a dozen local dental students as ambassadors to explain the benefits of xylitol to shop owners and to convince them to stock the gum. Dental schools in India tend to have more female students — one of the schools they’re working with is 80 percent female — so the ambassadors are primarily female, and their salaries help them pay their school tuition.
The group ultimately lost the Hult Prize (the award went to a group from India that proposed a “Doc-in-a-Box,” a diagnostic tool for community health workers that would enable them to create an electronic health record for patients living in the slums), but they intend to move forward in India and other countries.
Although the idea of using gum to fight cavities is a concept that’s easy to grasp, it’s also one that can be hard to sell to Americans enamored with instant gratification, says MacMillan. Compared to a project that reduces amputations that diabetics would need to have, this is more challenging. “You can’t see the immediate benefits of a kid not having their teeth rotting.”
Still, their Indiegogo campaign was fully funded, allowing them to quadruple their distribution of gum to 100,000 pieces over a couple months. That led to a $10,000 prize from Philips, which sells the Sonicare toothbrush, with the chance to win $50,000 more.
They’re also selling the product at cost to local organizations for distribution in schools, with plans to get it to 1.4 million children through school lunches in India within the next few years. Working with Philos Health, they have started a pilot program in the Philippines to validate the model of distributing the gum through school lunch programs, and they have dentists checking the students’ teeth before and after exposure to the gum. They’re also in talks with potential partners in Kenya, South Africa and North Philadelphia.
Bill Goodwin, a veteran in branding and packaging gum and candy who is advising them, says that Sweet Bites fills in a white space as a social enterprise that other for-profit companies — which tend to use sugar substitutes instead of xylitol because it is cheaper — do not. “Unless you’re willing to produce 100 percent xylitol gum, no dental school will be willing to partner with you, and no NGO is willing to buy at cost,” Tycko said.
If they can pave the way for other companies to do what they’re doing and increase the market for xylitol gum, even if that means increased competition, they’ll consider that a success. “Our mission when we came together was to end tooth decay as much as we can for people with the greatest dental burden. If Trident said we want to make Trident X with [100 percent] xylitol, we would be really happy,” said Penn. “The only exit strategy we’re happy with is if they start doing the same thing we’re doing.”
Wharton adviser MacMillan, who has been studying social entrepreneurship for more than a decade, says he thinks their business has enormous viability. And even if it doesn’t ultimately succeed, MacMillan says, “The beauty of what they’ve put in place is if they have to walk away, and it doesn’t work out, they will have done good.”