Today’s blog was contributed by Oyihoma Saleh from the Global Prosperity group.
Summary:
- Brazil has one of the world’s largest dental markets and the highest number of dentists globally, yet tens of millions of Brazilians remain nonconsumers of dental care due to geographic concentration, fragmented small clinics, and affordability barriers. The issue was not a lack of dentists or technology, but a delivery system never designed to serve the mass market.
- Drawing on firsthand experience, Dr. Carla Sarni redesigned dental care around accessibility, throughput, affordability, and quality—offering same-day care, installment payments, specialization, centralized procurement, and integrated services under one roof.
- Through franchising and systematization, Sorridents transformed Brazilian dentistry into a scalable, professionalized model serving millions of low- and middle-income patients, creating steady demand where none existed before, and demonstrating how reorganizing systems can convert nonconsumption into durable markets.
Brazil’s dental market, valued at roughly $7.28 billion, is the leader in Latin America and the third largest globally, behind the United States and China. The country also has the largest share of dentists in the world, with more than 402,000 professionals, about 20% of the global total, trained across over 630 dentistry schools that produce more than 23,000 graduates annually.
Brazil’s constitution declares healthcare a right of all citizens, implemented through its public health system, Sistema Único de Saúde (SUS), which covers both medical and dental care. While Brazil has expanded oral health provision, access remains uneven. An estimated 120 million Brazilians lack access to public dental care, and roughly 20 million have never visited a dentist.
This paradox is reinforced by geography and structure. More than 70% of dentists practice in the wealthier South and Southeast, while just under 30% serve the North, Northeast, and Center-West combined. Although Brazil has 44,500 dental clinics nationwide, according to the Federal Council of Dentistry, most are small, owner-operated practices clustered in higher-income urban areas. The result is a fragmented system that leaves poorer communities with limited access to private dental care despite the country’s unusually large supply of dentists.
Dr. Carla Sarni entered Brazil’s dental profession at a moment when its contradictions were impossible to ignore. Brazil had no shortage of dentists or clinics. But for most people, especially the poor, good dental care remained out of reach. If you were wealthy, private clinics offered modern equipment and high clinical standards. If you were poor, care was delayed or avoided altogether. For millions, dentistry was something endured only in emergencies. In our research we refer to this phenomenon, where people would benefit from a product or service but lack access, as nonconsumption.
Reimagining dental care
Sarni grew up in Pitangueiras, a small agricultural town in the northern region of the state of São Paulo, the daughter of a bus driver and a hairdresser who sewed clothes to supplement the family’s income. When she was admitted to dental school nearly 300 kilometers from home, her family could not afford it. Sarni paid her way by selling the clothes her mother made and completed a five-year program in four years. During a rural internship, she treated low-income patients using modern dental equipment—care typically reserved for elite urban clinics. The experience stayed with her: high-quality dentistry was possible for the poor when care was deliberately organized to reach people who were usually nonconsumers.
After graduating in 1995, Sarni moved to São Paulo and took a job at a clinic in a middle-income neighborhood. The conditions shocked her—poor hygiene, outdated tools, rushed procedures. “I hadn’t studied and sacrificed this much to deliver substandard care,” she later recalled. She left for an upscale clinic on Paulista Avenue, where standards were excellent but incentives were misaligned: dentists were paid by days worked, and clinics closed even as patients waited in pain. Within two months, she quit again.
Her third job, in Vila Cisper, finally gave her room to act. The clinic was owned by a businessman who leased the space and equipment, giving Sarni unusual autonomy over care delivery. She adapted dentistry to her patients’ realities, offering installment payments, extending hours, emphasizing same-day care and prioritizing treatments that saved teeth rather than extracted them. Demand followed.
Located next to a public health center, the clinic absorbed patients whenever public services were unavailable. As volume grew, Sarni re-negotiated with the business owner to purchase the client list in installments, and assumed responsibility for the space and equipment. She worked Sundays and hospital shifts to stabilize cash flow, using the additional income to add chairs, expand capacity, and hire staff.
Sarni had not set out to reimagine dentistry, but experience taught her that the problem was not a lack of dentists or technology; it was a system never designed for the masses who couldn’t afford existing care. Dentistry in Brazil was built around thousands of small, independent clinics, where ownership, financing, procurement, and location decisions rested with individual dentists. While this structure worked for wealthier patients, it made affordable, reliable care difficult to sustain at scale. Expanding access would require reorganizing this value network, not simply improving clinical practice.
Building and scaling a new value network
By the early 2000s, Sarni was assembling a value network fundamentally different from traditional Brazilian dental practices. She realized that serving low and middle-income patients at scale would require coordinating access, cost, quality, and patient volume in ways no individual practitioner could manage. In 2000, she took out her first bank loan to purchase a nearby building, reshaping the clinic into something Brazilian dentistry rarely offered: a modern, welcoming environment designed to deliver high-quality care at prices ordinary patients could afford.
Relaunched in 2001 as Sorridents, meaning “smiling teeth” in Portuguese, the clinic reorganized how care was delivered and consumed. Capacity expanded from five to twelve chairs, with care redesigned around accessibility and throughput. Patients were guaranteed same-day service, including walk-ins, and nearly half of treatments were paid for in installments. Patients returned frequently, averaging more than four visits per year, shifting dentistry from episodic intervention to ongoing care and converting nonconsumption into sustained demand.
Sorridents broke with the fragmented structure of traditional practices, offering a broad range of services under one roof—imaging, whitening, implants, and orthodontics—supported by modern equipment typically unavailable in neighborhood clinics. Dentists were organized by specialization, improving utilization of both staff and equipment, while direct procurement from manufacturers reduced costs without compromising quality. As a result, Sorridents delivered care at prices meaningfully lower than elite private clinics while offering a more reliable experience than public facilities.
By 2003, convinced of the soundness of her model, Sarni began looking for ways to take it to the rest of Brazil. She realized that scaling would not come from opening more locations herself, but from reorganizing how dentistry was practiced and owned. Many dentists were highly satisfied operating within the Sorridents system and the more enterprising of them wondered if they could build something similar for themselves, but lacked the capital and operational expertise to do it on their own.
Sorridents responded by establishing partnerships and later franchising, separating clinical practice from clinic ownership and systems management. Dentists focused on care delivery, while Sorridents centralized brand, site selection using geolocation tools, standardized clinic layouts, training, procurement, and quality oversight. In exchange for a share of clinic revenues, the company reduced startup risk, ensured consistency, and enabled the model to scale across geographies without sacrificing affordability or quality. By 2015, Sorridents had grown to 175 clinics and delivered 2.4 million dental appointments, more than 80% to low-income patients.
Sorridents’ impact
Sorridents transformed dentistry in Brazil from a fragmented, entrepreneur-led practice into a professionalized system of clinical care capable of operating at scale. Today, it is the largest dental service organization (DSO) in Latin America, operating 500 clinics across 21 of Brazil’s 26 states and has served more than 6 million patients. Sorridents network employs over 3,000 dentists and 3,500 additional staff, generated approximately $165 million in revenue by 2021, and commanded an estimated 63% share of Brazil’s dental franchising market.
By making high-quality dental care affordable and repeatable for low and middle-income Brazilians, Sorridents did more than grow a company. It created a new market. Through a market-creating innovation that reorganized how dentistry was delivered, owned, and scaled, Sorridents turned widespread nonconsumption into steady demand, stable professional livelihoods, and durable access to care. In doing so, Sorridents offers a wider lesson: prosperity can be built when systems are designed to bring millions more people into everyday markets as reliable participants.
