Henry Schein Q1 2022 Earnings Call Transcript

Participants

Corporate Executives

• Graham Stanley, Vice President of Investor Relations and Strategic Financial Project Officer
• Stanley M. Bergman, Chairman and Chief Executive Officer
• Andrea Albertini, President, International Distribution Group
• Lorelei McGlynn, Senior Vice President and Chief Human Resources Officer
• Ronald N. South, Senior Vice President and Chief Financial Officer

Analysts

• Jeff Johnson, Robert W. Baird
• Jason Bednar, Piper Sandler Companies
• Justin Lin, William Blair
• Elizabeth Anderson, Evercore ISI
• Nathan Rich, The Goldman Sachs Group, Inc.
• Justin Wang, Credit Suisse Group AG

Presentation

[Operator]

Good morning, ladies and gentlemen, and welcome to the Henry Schein First Quarter 2022 Earnings Conference Call. [Operator Instructions]

I would now like to introduce your host for today's call, Graham Stanley, Henry Schein's Vice President of Investor Relations and Strategic Financial Project Officer. Please go ahead, Graham.

[Graham Stanley, Vice President of Investor Relations and Strategic Financial Project Officer at Henry Schein]

[Technical Issues]

[Operator]

Excuse men, Graham, can you speak a bit louder. You should far from the phone.

[Graham Stanley, Vice President of Investor Relations and Strategic Financial Project Officer at Henry Schein]

Our conference call remarks will include both GAAP and non-GAAP financial results. We believe the non-GAAP financial measures provide investors with useful supplemental information about the financial performance of our business, enable the comparison of financial results between periods where certain items may vary independently of business performance, and allow for greater transparency with reflect to key metrics used by management in operating our business.

These non-GAAP financial measures are presented solely for informational and comparative purposes and should not be regarded as a replacement for corresponding GAAP measures. Reconciliations between GAAP and non-GAAP measures can be found in the supplemental information section of our investor relations website and in Exhibit B of today's press release which is also available in the investor relations section of our website.

Lastly, the content of this conference call contains time-sensitive information that is accurate only as of the date of the live broadcast, May 3, 2022. Henry Schein undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this call.

[Operator Instructions] during Q&A to allow as many listeners as possible to answer their question within the one hour we have allotted for this call. We've updated the format of today's call with Stanley covering the business performance, followed by Ron's review of our financial results and we hope you find this format beneficial.

And with that, I would like to turn the call over to Stanley Bergman.

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Thank you, Graham. Good morning, everyone. Thank you for joining us. Before we get into the details of today's call, I would like to take a moment to express my appreciation once again to Steven Paladino, who retired last week after 35 years of outstanding service to Henry Schein. For the excellent execution of Steven succession plan and the smooth transition of his responsibility to run so, I'm certain that investors will appreciate working with Ron and Graham and we continue -- as we continue to build our Investor Relations communications.

Ron is joining us on today's call and will discuss details of our first quarter financial performance and full year guidance. Ron will discuss that in a moment. At the start of the call, I would like to highlight that 2022 is off to a strong start with record first quarter financial results as we successfully execute on our 2022 to 2024 strategic plan. It sets out our winning proposition. Our winning proposition is that customers rely on us to an exceptional experience, delivering differentiated solutions that make their practices more successful and improve patient outcomes.

And our BOLD plus one priorities, which we have discussed with investors in the past, is as follows. The B stands for building complementary software, specialty and services businesses for high growth, operationalized one distribution to deliver exceptional customer experience, increased efficiency and sales growth. And the OL stands for one shine to broaden and deepen relationships with our customers that is with our entire product offering, service offering. And the D, the Drive stands for driving digital transformation for our customers and for Henry Schein.

So our BOLD priorities will be executed in the context of the plus one aligning our key stakeholders, which, of course, our suppliers, customers, shareholders, investors and Team Schein members and society. Today, we are affirming our full year 2022 GAAP diluted EPS guidance of $4.75 to $4.91, reflecting the solid growth and stability of our business. Two, emphasize we are very, very excited about our 2022 to 2024 strategic plan, which started at the beginning of this year. And we believe we're on a very, very good trajectory in that regard.

So let me comment on two topics that are on the minds of many investors that being inflation and also global supply chain. We are continually monitoring the potential impact of inflation on our business. The impact journey varies by product category for both merchandise and equipment and to return an extend, it also varies by geography. We estimate that on balance, price inflation on our product offering, so far this year has been about 3%. Some of our manufacturing partners are currently implementing additional price increases which obviously will in all probability impact at 3%. But so far, it's been about 3%. While we have generally been able to pass along these increases to our customers, we do seek to reduce supplier increases wherever possible.

Of course, we are aligned with our customers in that regard, where customers wish to explore alternative sources of products because of these pricing pressures, we are typically able to offer various less expensive alternatives given our broad product assortment of national brands as well as our wide selection of Henry Schein corporate brands and own brand products. Our extensive offering to our customers, provides many options and is an important differentiator for Henry Schein in the marketplace given the extensive options that we uniquely offer, we believe to our customers. The impact of inflation on our equipment business, we significantly deferred due to the lead times between confirmation of an equipment ordered by manufacturers and delivery of the equipment.

So generally, we book orders in advance with our manufacturers for delivering at a future date, and that's generally at a confirmed price, so not much inflation in the first quarter, some of course, but not much on the equipment side. In addition, inflation largely impacts the traditional equipment products, as average selling prices for digital equipment continues to decline, although somewhat modestly. Now turning to the supply chain pressure on our business. Here, the situation is relatively stable, pretty similar to the fourth quarter. Of course, we continue to experience extended lead times for certain products, which are primarily impacting equipment.

So on the consumables side, merchandise side, we generally have products, may not be every single product option in a particular category where we have basically the products and the lead time problems are, in fact, impacting our equipment deliveries. The recent lockdowns in China, we've received a lot of questions on that are so far not having a significant supply chain impact on us. As most of our manufacturing partners are located outside the affected regions and ports are largely operational from our point of view, with of course some delays. Now, this may be slightly different for specific suppliers of ours of finished goods. Our team is actively managing these inflationary and supply chain matters, which are reflected in our financial guidance.

Turning now to the Ukraine. Henry Schein has relatively low dental sales to customers and really no direct presence in either Ukraine or Russia. So the conflict itself is not directly impacting our business per se. Of course, it could impact our suppliers. Consistence of our long-standing commitment to humanitarian work and disaster relief, our team continues to support refugees and displaced persons in and from Ukraine as we have done, for example, with refugees from Syria other parts of the Middle East and of course, elsewhere, our support is through the delivery of health care product donations in partnership with several of our suppliers and with international NGOs that we've worked with for a long time, -- and yes, in this case, through our local teams on the ground in Poland.

And there are other on-the-ground teams that are working with us to provide these really support these relief programs, these humanitarian relief programs. So we're actively supporting refugees to managing of donations of products, clothing and yes, in some instances, money. We also are responding to those affected by natural disasters around the world, such as floods in Australia and East in Germany and continuing to work in advancing health equity, advancing health care equity has been a key component of Henry Schein's success for many, many years. Our goal is to advance access to oral care and in many respects to primary care as well.

Turning now to the business review of recent accomplishments starting with our, Dental Distribution Business. So, the first quarter growth in our dental business was driven by strong global equipment sales, as dentists continue to invest in their practices. And consumable merchandise sales recovered well during the second half of the quarter, in line with the decline of COVID-19 infection rates. So let me peel the onion a little bit more for you. In North America, we believe, consumable merchandise sales were impacted by lower patient traffic in January as a result of Covet 19, but we're progressively stronger in February and March.

Sales were also impacted by lower sales of personal protective equipment. I'll refer to that and Ron will refer to that as PPE products for the rest of the call. This decline in patient traffic was primarily a result of appointment cancellations, staffing shortages and some office closures given the spread of COVID. Although, we believe patient traffic has now returned to the levels of early December 2021. We are seeing similar trends globally, but obviously. [Technical Issues]

[Operator]

Excuse me. This is the operator, I apologize that there will be a slight delay in today's conference. [Operator Instructions]

[Andrea Albertini, President, International Distribution Group at Henry Schein]

Yeah. Lorelei, both lines are disconnected, the mainline in the backup. I don't think that's a function of our phones.

[Lorelei McGlynn, Senior Vice President and Chief Human Resources Officer at Henry Schein]

Yeah. Everything is disconnected.

[Operator]

Right now? Well, Yes.

[Lorelei McGlynn, Senior Vice President and Chief Human Resources Officer at Henry Schein]

Bergman we can hear you? Please proceed.

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Sorry, we had evidently the line disconnected, but let me continue. I think I don't know where we ended. I think on the Lorelei we ended. So the decline in patient traffic was primarily the result of appointment cancellations, staffing shortages and some office closures given the spread of COVID, although, we believe patient traffic has now returned to December 2021 levels. I think I covered that already, and I think it went through. The global trends are somewhat varied depending on the region of the world.

So lower sales of PPE products in the quarter were primarily as a result of lowest labs sales. The glove market has been quite volatile for about a year, maybe a little longer, not much longer at 15 months. We expect glove pricing will be increasing -- will be an increasing headwind on for a few quarters, so prices peaked in the second quarter of last year that's 2021. Nevertheless, if you exclude PPE products, North American consumable merchandise internal sales growth in local currencies was quite solid. Despite the softer start to the quarter, we gained momentum as the quarter progressed. This was supported by good growth in sales to new DSO accounts.

Our North American dental equipment business has a very had a very good quarter with strong sales in both traditional and digital category, particularly in digital restorative restoration equipment. Our equipment order book in North America remained strong at the quarter end consistent with the backlog at the beginning of the quarter. So new orders continue to come in at a very nice rate. As commented earlier in the call, we did not see a significant impact from inflation on this quarter's equipment sales due to long lead times for equipment as we had largely locked in supplier prices for orders shipped during the quarter.

Our equipment results benefited from sales to some of our large DSOs as we believe that anticipation of further price increases. Also, we believe that anticipation of further price increases is modestly providing some of the elevated demand we see today, it's not a huge impact of -- as some orders coming in from customers who expect pricing to go up and would like to get in the date before the prices go up and not a huge impact. But I nevertheless point that out to you. We continue to experience supply chain issues for traditional equipment arising from component part shortage delays in office build-outs and renovation as well as longer lead times for digital imaging technology.

This is not that the product is not available it's just taking a little longer from the digital stride to deliver our orders. Having said that, if a practitioner needs anything urgently we of course, we'll make sure that we supply both traditional equipment and digital imaging. We now expect these equipment delays will continue to be factored through the second half of the year and will provide further support for good and will provide further support for good equipment sales over the next few quarters. In fact, bottom line is we remain bullish on the equipment market and especially the digital dental equipment product offering and we expect to continue demonstrating good growth in the digital category, including intraoral scanners.

And now -- the last period of time, the impact of digital 3D printings we're starting to see that flow through as well, that demand to be of interest. We continue to look for innovative ways to add value to our customers and last month, we hosted THRIVELIVE in Las Vegas. This is a three-day dental educational conference that it replaces with successful Dentrix business with dentistry conference we have held in years prior to COVID. We designed this inaugural event to offer a learning path to every member of the dental office from the front office to the hygienist in a dentist themselves. So everyone from the staff, Adrina all the way to dentists, participating in this conference and the program which is designed for the various players in the office.

We were also able to select from over 50 CE credited courses led by more than 40 leading commissions with the strong educational focus on digital technology and practice management solutions that Henry Schein has quite a bit of competency in advising our customers. The customer feedback we received has been most positive and at events like THRIVE, at least from our point of view, position us to connect with our customers in deeper ways and positions our team to help drive greater productivity and provide better clinical care in their practices, educational type events like this provide great sales opportunities as well.

Turning now to the international Dentrix business. International equipment sales were also quite strong for the quarter. International consumable sales were impacted by similar trends as in North America, including lower PP&E and COVID-19 related product sales and by decline in patient visit, particularly during the first half of the quarter. That said, compared to North America, the impact of COVID-19 was more pronounced internationally, especially in Europe. So still a bit more in Europe. Patient traffic picked up at better paces as the quarter progressed and COVID-19 restrictions were relaxed in certain parts of Europe, and we expect these markets to continue to recover.

We also expect the Australian market to start to recover having reached a peak COVID-19 infection rate towards the end of the quarter. This should help recast of our consumer prices in Europe, Australia and our billion business were strong throughout the first quarter. Now I see China impact our business note, our growing Chinese business is still a relatively small part of our global dental business. These lockdowns also intensified during our fiscal second quarter, so that they had little impact in the first quarter. I remind you though is we have a nice growing business in China, but it's not material in the real concept in the relative size of Henry Schein relative to has global consolidated sales.

Returning to dental specialties and technology and value-added services. Sales of our dental specialty products were solid during the first quarter, specifically oral surgery, which consists of dental implants and broad regeneration products. In particular, sales of BioHorizons, implants grew by double digits this quarter, executing well in North America, where this business is primarily focused and with the market for restorations continues to be quite strong. Camlog and dentist brands in Europe, primarily in Germany, also had quite a good quarter -- first quarter for the implants and the bone regeneration products in Europe. We have also had success selling our ACE bone regeneration products into the large DSO market.

And this is really another very good example of the dental in our bone strategy, leveraging one side strategic priorities. Now, within our endodontic products offering and endo business is also quite solid. We recently launched our EdgePRO Laser which is actually often quite a successful launch, having been well received at last week's AEA meeting here in the United States. We do believe that EdgePRO Laser offers outstanding cleaning, debridement and Disinfection, coupled with greater value compared with competing products.

Meanwhile, our priority in the orthodontic business is our real clear aligner product line, -- in March, we completed the U.S. domestic launch of the Studio Pro 40 product that's the software. And we are now rolling out the software update globally. Software features advanced treatment planning and utilization tools. Obviously, I think investors are aware that the endodontic sales were not great in the first quarter because of practices not being a full capacity i.e. as a result of COVID.

So overall, our solid position in Dental Specialty products is built upon strong customer offering. And our commitment to meaningful ongoing investments in R&D, there are questions on that, happy to provide further color during the call. Turning to technology value-added service sales, they also increased by double-digits during the first quarter in both South America and International. We believe, Henry Schein One offers one of the broadest product offerings of dental practice management and related software and services and is the largest contributor to sales in the sector of technology and value-added services.

Growth within Henry Schein One continues to be driven primarily by a recovery in patient traffic to dental offices, which generates demand for our revenue cycle management solutions and also by cloud-based solutions, our cloud-based solutions that create flexibility, scalable services to drive practice efficiency and yes, patient engagement too. As another example of our commitment to expanding our technology product offering, have begun making our Jarvis Analytics software product available to private dental practices whereas previously, the Jarvis software was available primarily to DSOs.

Also within our value-added services business is our E-assist business, which provides the revenue cycle management solutions for insurance reimbursements. We are quite pleased with the integration and performance of this business, which we acquired last year. So now turning to our Medical business, where the global medical sales were excellent, as we achieve further penetration into existing customer accounts. Internal sales growth in local currency, if you exclude PPE and COVID-19-related products also continued to be strong.

The US patient traffic to physician offices and alternate care sites and that, in particular, in our case, the Ambulatory Surgical centers was up consistently to our quarter one versus the prior year. Sales of medical laboratory equipment were up double-digits, while demand for non-COVID point-of-care diagnostic test was also quite strong. Sales of PPE products declined by double-digits compared to the strong first quarter last year. As I mentioned earlier, we expect further pricing declines for gloves throughout the rest of the year, net prices to remain above pre-pandemic levels. Sales of COVID-19 tests were extremely strong during January, very strong and declined sharply towards the end of the quarter.

The future of these products is difficult to predict as we face the somewhat offsetting forces of new variants, spreading rapidly trading demand along with increased availability of Home cash on the other side and many of which are being paid for by the government in the US.

So that's a broad overview. Now, Ron will give you more specifics on the financial results for the first quarter. So Rob, here you go. Thank you, and welcome to your first call.

[Ronald N. South, Senior Vice President and Chief Financial Officer at Henry Schein]

Very good. Thank you, Stanley, and good morning, everyone. So turning now to our record first quarter financial results. Total net sales for the quarter ended March 26, 2022, were $3.2 billion, reflecting growth of 8.7% compared to the prior year period. Internally generated sales were up 7.7% in local currencies. And when excluding sales of PPE and COVID-19 related products, internal growth in local currencies was 8.9%. As Stanley mentioned, prices for PPE products and specifically gloves, increased last year due to market volatility and supply chain disruptions.

More recently, prices of these products, along with COVID-19 test kits have declined. This pricing volatility, combined with a strong Q1 prior year sales comparison is driving a year-over-year decline in sales of PPE and COVID-19 related products. Detailed from sales performance are contained in Exhibit A in our earnings press release issued earlier today. Operating margin for the first quarter of 2022 was 7.7%, representing a decrease of 17 basis points compared with the prior year GAAP operating margin. When compared with prior year non-GAAP results, operating margin decreased 71 basis points.

Operating margin contraction was due to higher operating expenses, primarily as a result of increases in payroll, commissions and travel of entertainment since most of our operations have returned to normal this year. Year-over-year contraction was also due to the unusually high operating margin in the first quarter of last year. Turning to Taxes. Our effective tax rate for the first quarter of 2022 was an even 24%. This compares with an effective tax rate of 25.1% for the first quarter of 2021 on both a GAAP and a non-GAAP basis.

GAAP net income attributable to Henry Schein for the first quarter of 2022 was $181 million or $1.30 per diluted share. This compares with prior year GAAP net income of $166 million or $1.16 per diluted share and prior year non-GAAP net income of $178 million or $1.24 per diluted share. Amortization from acquired intangible assets for Q1 2022 was $32.2 million pre-tax or $0.14 per diluted share. This compares with $29.7 million pre-tax or $0.13 per diluted share in the same period last year. And foreign currency exchange negatively impacted Q1 2022 diluted EPS by approximately $0.01.

I'll now provide some detail on our sales results for the first quarter. Global Dental sales of $1.8 billion increased 2.2% compared to the same period last year with internal sales growth of 3.5% in local currencies. Global Dental consumable merchandise internal sales increased 1.3% in local currencies and excluding sales of PPE and COVID-19 related products, internal sales in local currency increased 4.7%. Global Dental equipment internal sales growth in local currency was 11.9%. North America, Dental internal sales growth in local currencies was 4.8%, which was driven by especially strong performance in equipment, which internally grew 13.2% compared with the prior year period, with strong performance in both traditional and digital categories.

This growth also comes off a difficult comp as Q1 2021 internal equipment sales growth in local currencies was 17.4%. North America Dental consumable merchandise internal sales in local currencies increased 2.6% compared with Q1 2021 or 7.3% when excluding sales of PPE and COVID-19 related products. International dental internal sales growth in local currencies was 1.8% compared with the first quarter of 2021, where we had an exceptionally strong sales quarter with internal sales growth of 17.9% in local currencies. International Dental consumable merchandise internal sales in local currency decreased 0.5% compared with the first quarter of 2021 and increased 1.3% when excluding sales of PPE and COVID-19 related products.

Sales were impacted by an increase in COVID infections, especially in January and February. This sales growth is also against a typical comp as the internal sales growth in the prior year was 19.2% in local currencies. International dental equipment internal sales growth in local currencies was 10.1% and this is also against a difficult first quarter 2021 comp and such growth was 12.9% in local currencies. Sales of dental specialty products were approximately $236 million in the first quarter with internal growth of 7.2% in local currencies compared with Q1 2021 when we had an exceptionally strong sales quarter with internal sales growth of 18.3% in local currencies.

This quarter, growth was strong in our oral surgery category, which consists of implants and bold regeneration products. Technology and value-added services sales during Q1 are $179 million, an increase of 23.4% compared to the prior year, including internal growth of 11.1% in local currencies. In North America, Technology and Value-Added Services internal sales growth was 10.3% in local currency. This growth was driven by our practice management business with strong growth from Dentrix and Ascend. Our revenue cycle management business also exhibited solid revenue growth. Internationally, Technology and Value-Added Services internal sales increased 15.7% in local currency compared to the prior year. This growth was driven by a strong performance in the UK, which benefited from a favorable comparison to the prior year, when the lockdown was just beginning to ease.

During Q1, our technology and value-added services businesses together with our dental specialty products achieved total sales growth of 13.1% and internal sales growth in local currencies of 8.7% and this total sales growth is in line with our double-digit growth goal for the full year. Global Medical sales during Q1 were $1.2 billion grew 18.3% compared with the same period in 2021, with internal sales growth of 14.7% in local currencies, led by growth and COVID test kits and other point of care diagnostics. We sold approximately $250 million in COVID-19 test kits in the first quarter of 2022, including multi-asset flu and COVID-19 combination test case. This compares with approximately $180 million in test kits in Q1 of 2021. We expect continued volatility in sales of test kits for the remainder of the year.

Excluding sales of PPE and COVID-19 related products, Global Medical internal sales in local currencies increased 14.5% compared with Q1 of 2021. Regarding share repurchases, we did not repurchase any shares of Henry Schein stock during the first quarter, because we had a 10b5-1 plan that did not result in any shares being repurchased during the quarter. We intend to put in place an additional plan that is effective as of tomorrow, May 4. As of the end of the first quarter, Henry Schein had $200 million authorized and available for future share repurchases. This program remains a core pillar of our balanced capital allocation strategy, which also includes ongoing disciplined investment to support organic growth and strategic acquisition.

Turning to our balance sheet and cash flow, we continue to benefit from significant liquidity, providing our businesses flexibility and financial stability. Operating cash flow for the first quarter of 2022 was $93 million compared with $63 million for the first quarter of last year. Turning to 2022 financial guidance, I will conclude my remarks by noting that we are affirming our 2022 full year GAAP diluted EPS guidance range of $4.75 to $4.91, reflecting growth of 7% to 10% compared to our 2021 GAAP diluted EPS of $4.45 and growth of 5% to 9% compared with our 2021 non-GAAP diluted EPS of $4.52. We expect 2022 full year sales growth of approximately 5% to 8% over 2021 versus our previously communicated expected sales growth of 6% to 8%. This change primarily reflects the latest foreign exchange rates and a decrease in sales of COVID-19 test kits.

As Stanley mentioned earlier, the future demand for test kits is difficult to begin. However, given recent trends we now estimate sales of COVID-19 test kits to be 15% to 25% lower than 2021 as opposed to the 10% decline we had previously communicated. We continue to expect full year 2022 operating margin expansion of 20 to 25 basis points over the 2021 non-GAAP operating margin, an expansion of 39 to 44 basis points over the 2021 GAAP operating margin.

Our guidance is for current as well as completed or previously announced acquisitions and does not include the impact of future share repurchases, potential future acquisitions or restructuring expenses, if any, Guidance also assumes that foreign currency exchange rates will remain generally consistent with current levels. The end markets will remain stable and consistent with current market conditions, and that there are no material adverse market changes associated with COVID-19.

With that, I'll now turn the call back to Stanley.

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Thank you very much, Ron. Unfortunately the beginning part of our core when Graham made his introductory remarks. We're not fully broadcast to our participants. There was a problem with the operator and then eventually call got disconnected. I think my remarks and Graham's Range were fully picked up.

Graham, you may want to repeat certain of your remarks Please, Graham. Thank you.

[Graham Stanley, Vice President of Investor Relations and Strategic Financial Project Officer at Henry Schein]

Sure. Thank you, Stan. So I'd just like to state that certain comments made during this call will include information that is forward-looking. As you know, risks and uncertainties involved in the company's business may affect the matters referred to in forward-looking statements. As a result, the company's performance may materially differ from those expressed in or indicated by such forward-looking statements.

These forward-looking statements are qualified in their entirety by the cautionary statements contained in Henry Schein's filings with the Securities and Exchange Commission, including in the risk factors section of those filings. In addition, all comments about the markets we serve, including end market growth rates and market share are based upon the company's internal analyses and estimates.

So with that, I'll hand the call back to Stan because I think everybody heard the rest of the statement at the beginning. Thank you, Stanley.

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Thank you very much, Graham. So operator, please for further questions, open the line for questions. Thank you.

Questions and Answers

[Operator]

You're welcome. [Operator Instructions] We have our first question comes from the line of Jeff Johnson from Baird. Your line is open, please go ahead.

[Jeff Johnson, Analyst at Robert W. Baird]

Thank you, guys. Just two quick ones maybe and then I'll get back in queue. But just Stanley, could you give us any update maybe just on April trends that you're seeing in the Specialty Dental area, the general dental area and medical. And then, Ron, just for you from a guidance standpoint on the 5% to 8% revenue growth. I think a lot of us just look at organic growth for Schein. It tends to be a very consistent metric in your business. Could you just give us kind of how we should be thinking about maybe organic growth given that you do a lot of acquisitions and currency obviously is a big impact this year. Thanks, guys.

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Thank you, John-- equipment sales remained strong in April with internal sales growth double-digit numbers. As we indicated, we expect at least at this moment, equipment sales remain strong for the balance of the year. Now in North America, we're particularly encouraged by the most PPE sales in April. How the PPE sales were lower than prior year due to the lower price of gloves. The pricing of gloves has had quite a bit of an effect. Therefore, while underlying growth is good, ex PPE and the general PPE excluding gloves is pretty good. Home Health Dental merchandise internal sales growth in local currencies.

So if you take out the PP&E is okay. It's pretty good. And now international, so that was about North America. If you look at our international components, again, PPE is having quite a bit of an impact the particular gloves. But we're quite encouraged because from a European point of view, most of the markets now are back to full swing major markets that we're in.

Also, Australia reached a peak towards the end of the quarter, last quarter and the back in business again, we've continued the nice growth we've experienced in Australia for a while. For whatever reason, Brazil continues to be very good. It doesn't seem to have been impacted at all in the first quarter and continues to be strong in April. Now we've seen quite a bit of disruption as we held from newspapers, of course, particularly in Shanghai. But I think now other parts of the country in Beijing, although it is a total lockdown. So our China sales are impacted in April.

Having said that, please remember, China is relatively immaterial in the context of our $12.5-or-so business. And on Medical, very similar results, primarily here in North America where we do our medical business is. And that continues to have a very, very good growth non-COVID -- non-COVID-related products, excluding diagnostics and the PP&E. So Ron, can you provide certain sort of color on the -- what you took in accounts and coming up with your guidance.

[Ronald N. South, Senior Vice President and Chief Financial Officer at Henry Schein]

So Jeff, if you recall our original sales guidance was 6% to 8%, and components of that included about a 0.4 acquisition and a point for the 53rd week this year. So that left us with about 4% to 6% of internal growth, whether it be through price increases or from increased volume. I think we're taking down the sales growth some 5% to 8%. And the extra point we're taking off the floor there is really a combination of what we're seeing in trends in the coming test.

As we said, we're expecting those sales to be 15% to 25% lower than last year versus our original guidance, 10% lower and also the FX headwinds. So you can kind of do that math and say so internal number now will be something that's closer to saying 3.5% to 5.5% or 6% in terms of the internal number that we're still aiming for this year. I don't know hopefully that makes sense.

[Jeff Johnson, Analyst at Robert W. Baird]

Guys, thank you.

[Operator]

Our next question comes from the line of Jason Bednar from Piper Sandler. Your line is open, please go ahead.

[Jason Bednar, Analyst at Piper Sandler Companies]

Hi. Good morning. Thanks for taking my questions. A couple for months. Just actually wanted to first come back on the top-line guide there, the point there. Just to confirm, coming the bottom-end of that guide coming 100 basis points lower to now five day reported for the year. It looks like 50 basis points of that is COVID test kits. So just to confirm that the balance of that is just FX, I guess, are there any other good guys or bad guides kind of within that revenue guidance that we should be considering, whether it's drug pricing or anything else that's playing out here just as we think through some of those mechanics?

[Ronald N. South, Senior Vice President and Chief Financial Officer at Henry Schein]

Jason, I'd say your estimate on the COVID test kits and the FX are pretty reasonable, and that really -- those are really the components. There's not offsetting items that we're pointing this time.

[Jason Bednar, Analyst at Piper Sandler Companies]

Okay. All right. Perfect. And then just thinking through how the first quarter played out, I mean, our earnings came in significantly better than how you were communicating it back in February. I think the original guide was for earnings to be slightly lower on a year-over-year basis. Can you talk about where the outperformance came versus expectations? Was it a quicker recovery in the top line and like in core trends in dental and medical better expense control. Just I guess, where you beat the street by over a dime. So I guess where did that outperformance come from in your eyes?

[Ronald N. South, Senior Vice President and Chief Financial Officer at Henry Schein]

Well, I think a couple of areas, right? So like I said, COVID test kits to $250 million in the quarter. And while we're taking down the full year of COVID test kits, I don't think we didn't expect to do quite that well in the first quarter with the test kit sales. I think also, we're really happy with our gross margins in the dental business. I think that in spite of some of the pressure we're feeling on gloves, we still get did fairly good on the margins there. And then of course, equipment, equipment came in much better than what we, I think, had originally expected.

And we like -- and as we said on the call, we remain bullish on equipment. So I think all those things when combined got us to a good place on the quarter. There's other things. I'll acknowledge that our -- we did well on effective tax rate. We did well in a few other areas. But I think that we are -- between the good margins that we experienced in Dental, not just in gloves but a non-PPE sales as well, we were really kind of helped us out for the first quarter.

[Jason Bednar, Analyst at Piper Sandler Companies]

All right. Very helpful. Thanks, Ron.

[Operator]

Our next question comes from the line of Justin Lin from William Blair. Your line is open. Please go ahead.

[Justin Lin, Analyst at William Blair]

Hi, good morning. Thank you for taking my questions. I guess first of all, just can you talk about your Dental market spending growth outlook for 2022 and beyond? Do you think the elevated spending per visit levels from 2020 and 2021 can persist? Or are you seeing a decline already?

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

I think generally, from a dentist point of view, taking into account COVID impacted locations. I think generally, we're in positive territory from visits to dentist. From what we can tell the higher-end procedures remained quite strong, in other words, some specialty products at the high-end, seems quite strong. But at the moment, we're more or less back to where we were in December of 2021 plus you never know where this variant is going to have an impact. But right now, although we did have pretty bad January from a business point of view and February, March started getting better, April looking okay. I think we're actually stable leading positive.

[Justin Lin, Analyst at William Blair]

Got it. Thank you. The line was a big surprise last week and just wondering, any visibility on your end regarding sort of the declining consumer sentiment that some of these companies are seeing, maybe especially around your -- I know it's a small part still, but your Reveal Clear Aligner Business?

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Our reveal Clear Aligner Business is relatively small. Our growth is impacted by new accounts, particularly from DSOs that are not taken on to the line. So I don't think our sales are much of an indication, although obviously, in the first part of the first quarter, visits for elective procedures without it came back again.

But I'm not sure we are the right party to give you an indication of the market in general. Suffice us to say, we remain quite bullish for our Reveal Aligner having said that, it's a very small business, a relatively small business compared to the market.

[Justin Lin, Analyst at William Blair]

Okay, that's fair. Thank you very much.

[Operator]

Our next question comes from the line of Elizabeth Anderson from Evercore ISI. Your line is open. Please go ahead.

[Elizabeth Anderson, Analyst at Evercore ISI]

Hi, guys. Thanks so much for the question. I was wondering if you could provide some additional detail on the North American medical account penetration. Was that to just sort of broadly expanding your range of certain clients? Was that sort of share gain wins versus peers? Any additional details there you could provide would be super helpful.

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Yeah. Elizabeth, our medical business focuses on the alternate care area, mostly physician offices, whether they are independent or part of a group or impact, in fact, a large part of it is with the medical practices are owned by IDNs. We also have businesses that focus on the government, we have businesses that focus on smaller ambulatory surgical centers, and we have businesses that folks are provide, as such as Renal Treatment Centers and Cancer Centers.

That's -- we do not service the long-term care during a way, not the acute care area and obviously, not the drug store. So that's really in our business. And in that area, we have been gaining market share for that's a decade, just very good execution. I would say that ones continue to point to gain market share. Obviously, the PP&E and the test the spot numbers, sometimes magnified, sometimes would reduce our underlying business performance. But essentially, within that particular plan that I described, we continue to gain market share.

We do add to new products, which contributes but I would say, including, by the way, we entered the home care space in a small way, and we'll expand that but I'm not sure if that contributed at all to the internal growth is the acquisition growth. So overall, the business is just gaining market share.

[Elizabeth Anderson, Analyst at Evercore ISI]

Got it. That's very helpful. And Ron, maybe one for you, as we think about the cadence of opex, going forward for the rest of the year. Could you help us think through the puts and takes of the increase in wages and some of the other labor type costs that you called out versus some of the ongoing impacts of the cost-cutting brands that you guys have put into place?

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Yeah. I mean, we're dealing with wage inflation like everybody is, right? And our normal cadence of salary increases as a company goes into effect people want. So we will see an increase in payroll costs going forward and that is taken into consideration when we talk about operating expenses and our planned operating expenses -- expansion -- or the margin expansion, I should say.

[Ronald N. South, Senior Vice President and Chief Financial Officer at Henry Schein]

Unfortunately, we had to put in a freight surcharge. We've done this in the past to deal with increased cost utilities. But generally, our customers, which sets deck as requirement.

[Elizabeth Anderson, Analyst at Evercore ISI]

Got it. Thanks.

[Operator]

Our next question comes from the line of Nathan Rich from Goldman Sachs. Your line is open. Please go ahead.

[Nathan Rich, Analyst at The Goldman Sachs Group]

Hi. Good morning. Thanks for the questions I'll ask them both upfront. I guess, maybe on the dental equipment business. It seems like you're seeing longer lead times and you expect those kind of delays to continue through the second half of the year, but you had a strong first quarter from a revenue standpoint, and it doesn't sound like the outlook for dental equipment at least on the revenue side, has changed this year. So can you maybe just talk about how you've been able to work through the supply issues -- and also what you're still seeing just in terms of demand for capex from practices?

And then just a quick follow-up for Ron, it looks like the seasonality of earnings this year is a little bit different than what you've seen historically. And so I guess, should we think about kind of earnings towards the back half of the year is closer to what go-forward run rate of the business will be once kind of PPE normalizes some of these equipment supply issues resolved. It just would be helpful to get your color on kind of what the back half of the year means for the longer term go forward? Thank you.

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Yeah. So, well, two very good questions. First of all, the demand for dental equipment, both traditional and digital has been quite strong actually since the early part of the time we practices went back at the COVID. So I guess from the second quarter, third quarter post third quarter of 2020. So it's done pretty well. The demand is there. There's one particular challenge, and that is on the chairs, units and lights, that part of the traditional business. We had a big supplier exit the market. And the other two major suppliers, plus three or four other smaller ones have had a challenge keeping up with our demand.

Because we were a big customer of the business that closed out on the chairs units in line side of the business. The capacity has increased, we certainly can provide the equipment, traditional equipment to any customer urgently need this. Having said that, demand continues to grow, supply increases, but there is still a bit of an imbalance. And we don't see, at the moment, the time when this demand for traditional equipment will significantly reduce that is the view as of this very moment.

On the digital side, demand continues to grow. Digital dentistry is growing rapidly. We have a number of suppliers providing us with product. They all do want extent or another, have some challenges in providing satisfying our demand, though some are far less challenged than others. And the demand is being -- and we continue to cellular with a slight buildup in the backlog in that regard. And there it's related to the suppliers having parts -- challenges.

So the market is stable. There is a problem in satisfying all of our purchase orders. And the demand is good. So dentist are investing in their practices. I might add the same is on the medical side. So practitioners are generally investing in the practices. We have a good selection. We're getting good manufacturing support. And the equipment business both in dental, medical, domestic and globally is quite strong.

[Ronald N. South, Senior Vice President and Chief Financial Officer at Henry Schein]

And regarding your question on seasonality, I'll tell you, it's a very good question, and it's a very difficult question to answer. You're right. Historically, our -- there were some seasonal trends. They were somewhat nuanced, but there were some seasonal trends to our business. And I think as we went into the panic and or coming out of the pandemic a lot of that has -- that dynamic has changed.

And I think that there are so many different factors, whether they be call it test kits, pricing of PPE, demand for PPE, the day is a kind of predicting increased sales in the fourth quarter for equipment tax-incented equipment purchasing are difficult now. So I think admittedly, our sales, our earnings are probably going to be a little choppier than they have been historically. And that's really just driven by the dynamics in the market in which are operating right now.

[Nathan Rich, Analyst at The Goldman Sachs Group]

Thanks very much.

[Operator]

We have time for one last question coming from the line of Matt Miksic from Credit Suisse. Your line is open. Please go ahead.

[Justin Wang, Analyst at Credit Suisse Group]

Hello. This is Justin Wang, stepping in from Matt. Thank you so much for the question. We were wondering if you could provide any color on infant trends in the US as well as OUS? And how you've seen these carry into April as well as your expectations for Q2? Thank you very much.

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

This implant trends continue to be quite strong. As I noted, the higher end of industry seems to be doing quite well. Our strength, of course, is in North America, and in Europe, of course, we have a presence in Asia, but we're not as large in those markets. So on a global basis, the Asian market and the some developing world markets are growing at a faster rate than the European. We're particularly strong in Germany and the US market. So in the markets we're in, I think, we're doing okay. We're gaining market share.

But from a global point of view, there are other markets that are growing faster than we're not really in, but I would imagine the other markets we have a setback because of sales in China and Russia and Eastern Europe. So overall, I think from our point of view, the markets continue to be quite good and we continue to gain market share with a number of very important introductions of products in the Specialty areas, implants, we got one genre growth through generation endo and of course, to the [Indecipherable] Thank you.

[Justin Wang, Analyst at Credit Suisse Group]

Thank you.

[Stanley M. Bergman, Chairman and Chief Executive Officer at Henry Schein]

Unfortunately, Sure. We will have to end the call. We are a few minutes over, but this interruption was beyond our control. Thank you, everyone, for the interest. We changed the format. And if you have to see that a little bit on the format or on the press release. Hopefully, it's more concise, satisfied investor needs, but we will doing much would appreciate any input from our investors. As you can tell, we remain bullish about the business.

We're quite happy with our 2022 to 2024 strategic plan -- we're making very good progress. I think we have an outstanding management team behind the plan. And generally think our bone plus One strategy will increased shareholder value in a nice consistent way as we've done for the past 100-plus quarters so -- as a public company.

So thank you for your interest and feel free to reach out to Graham or to Ron. And look forward to seeing people at the speed the people at the future conferences next month ahead and have a great time. Thank you.

[Operator]

[Operator Closing Remarks]