Japan Today

Professor says teaching and practice of dentistry in Japan needs radical reforms

By Kevin Rafferty

A leading clinical professor has issued a “wake-up” call to Japan’s health and education ministries to make radical reforms to the teaching and practice of dentistry, warning that without reform, the country will not reach its targets and the rightly cherished healthcare system may collapse.

Mikako Hayashi, Professor of Restorative Dentistry and Endodontology at Osaka University, says that Japan’s health insurance scheme needs urgent change from one where dentists are rewarded for drilling and filling teeth – and in the process damaging them – to a preventative regime.

Hayashi challenges Japan’s politicians and bureaucrats, university educators and clinicians, and also criticizes major aid-giving bodies like the World Bank, Japan International Cooperation Agency and Bill and Melinda Gates Foundation for not giving dentistry a higher priority.

She described dentistry as the Cinderella of the healthcare system, consigned to the back kitchen, when its beauty should be appreciated since good teeth are a leading indicator for a long and healthy life.

Hayashi uses several expressions in English to make her point about the importance that good oral health plays in the quality of life. “The expression ‘Down in the mouth’ suggests that having oral problems is a good indicator of general health,” she says. Also, “Any plan or policy which ‘has teeth’ is a good one, with prospects of success; if it lacks teeth or bite, it is not to be taken seriously.”

Hayashi on Saturday will give the opening lecture at a two-day international symposium at Osaka University attended by several hundred prominent academics and dentists, including Professor Helen Whelton from Ireland, who has just become president of the International Association for Dental Research, the leading dental research body, Professor Nairn Wilson, who helped steer the London Dental Institute at King’s College to be the biggest dental university in Europe, and other professors from North America, India, Korea and Thailand as well as Japan.

Hayashi says that new research is uncovering vital connections between oral health and systemic disease, especially between periodontitis or gum disease and cardiovascular problems. “Recent research suggests that it is essential for anyone undergoing heart or brain surgery to get a dental all-clear first,” she says.

She cites research that, “One of the lessons of aging gracefully is that the more teeth you keep, the sharper your brain will be.”

She applauds the Japanese government target of 80:20 – meaning that at the age of 80, the average Japanese would have at least 20 natural teeth – but warns that present dental policies encourage drilling and filling – “which is the highway to dental hell.” What starts with a small cavity to be filled, then turns into a larger cavity to be excavated and filled, then to a crown and a tooth pulled, a bridge and dentures. “All the time the financial costs of treatment rise, along with the pain.

Hayashi says that research in Sweden and recent work in Ibaragi-shi near Osaka suggests that regular dental checks and careful preventative care plus a healthy lifestyle should mean that a person would not lose more than a single tooth over 20 to 30 years.

But Japan’s health insurance scheme does not reward dentists or patients for preventative care or healthy teeth. Hayashi warns that the government’s financial pressures and heavy debts, which are already twice those of Greece as a percentage of gross domestic product, will strain the health insurance scheme, so it is urgent to switch from a curative regime that tries to fix problems to one that tries to prevent problems before they occur.

“This will be cheaper and healthier for everyone, patients, dentists and the government’s finances,” Hayashi urges.

She suggests revamping the health insurance scheme to give every Japanese a national insurance number at birth with the obligation to register with a doctor and dentist, and free dental check-ups and care until the age of 18. Thereafter, preventative care, including checks, removal of biofilm or plaque, and application of fluoride, would be covered by cheap insurance, but heavy maintenance would be expensive unless patients kept to a healthy lifestyle.

Hayashi advocates major changes to clinical teaching to ensure better diagnostic and clinical skills of new dentists. At the moment it is possible for a dental student to pass the computer test for a license without having treated a real patient, and most students get their licenses with much less hands-on clinical experience than their peers in other developed countries.

For all her complaints about the quality of Japanese dental skills, Hayashi asserts that the government health insurance scheme, which assures access to affordable medical care by all Japanese, should be cherished and strengthened.

“Personally, I find it more than immoral to look at the U.S. and some countries in Europe and see some people with gleaming white teeth and dazzling smiles – for which they pay vast sums and for which dentists are rewarded handsomely – while many people cannot afford basic dental care and suffer the problems of a life down in the mouth,” she says.

If Japan can fix the finances of its universal health insurance scheme, it will be in a good position to export its skills and expertise to other areas of the world. Hayashi sadly points out that 2.9 billion people in the world do not have access to dentists. They include growing numbers in the U.S., which spends $130 billion a year on dental care, but almost 40% of Americans do not visit the dentist.

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I am for everything she says here except for the mercury and fluoride.

Mercury is toxic (+vaporizes) and takes the place of calcium. You definitely want a ceramic filling and not a amalgam (mercury) filling. Amalgam filling also expand and contract greatly leaving gaps for bacteria or even cracking your tooth. A ceramic filling is more sensitive at first, but that will go away after a month or two and the surface will smooth out (much better).

Fluoride is very similar to mercury in that it is absolutely toxic and swaps with the calcium. People in China around coal plants (unscrubbed) have big issues with the fluoride (+other emitted metals) weakening bones and causing a myriad of health problems. ADA will claim that fluoride has a temporary effect of strengthening teeth at low dosages and will even claim that fluoride is needed in baby formula. -Stay away from fluoride and it is a toxic byproduct of the coal and mining industry.

Best tooth powder you can make yourself. Baking soda + Xylitol (toxic to cats/dogs!!) (+i added coral calcium) ---> my teeth/gums have never been better + I got rid of the mercury (amalgam fillings). Absolutely true --> people with great teeth are healthier. Xylitol is great for anyone with tooth pain issues.

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+1 for Badsey. In Pittsburgh they once they had a toxic fog of fluoride that etched the glass in people's windows, not to mention killing people. The is also evidence that fluoride helps aluminium cross into the brain, which could have something to do with Alzheimer's. Which is why the FDA is phasing out fluorinated no-stick cookware.

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Which is why the FDA is phasing out fluorinated no-stick cookware.

Try the new nano-ceramic coated cookware (usually green/blue). -Works way better, pans still aluminum however. Soda (phosphoric acid -lowest ph used in food, colas) in a aluminum can is probably the worst for aluminum and is absolutely the worst for eating away teeth (very low ph). People with amalgam (mercury) fillings will sometimes drink these high-acid (low ph) sodas to feel better (probably bonds with the metal in the blood). So if you are one of these cola drinkers with many amalgam (mercury) fillings it is a definite warning that you have a mercury issue. =Stop drinking the phosphoric acid and save your teeth, get rid of the mercury tooth fillings and you won't need to drink the cola to feel better anymore.

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Anything to do with the "come back 3 or 4 times for one procedure" theory of dentistry that seems to be common in Japan?

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Anything to do with the "come back 3 or 4 times for one procedure" theory of dentistry that seems to be common in Japan?

That's just pure corruption on the part of the dentists. My wife yelled at one recently and got her money back. So they know they are corrupt. I had one dentist tell me they couldn't clean my top and bottom teeth on the same day because of insurance rules, lol. Biggest load of BS. Depends on where you are though, I guess. I had a very good dentist when I was living in Kyoto. Spoke good English, too.

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Hayashi says that new research is uncovering vital connections between oral health and systemic disease, especially between periodontitis or gum disease and cardiovascular problems.

This isn't new research. The connection between root canals and disease was disclosed by Dr. Weston Price as far back as 1910.

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When dentists told me "You don't necessarily need to quit smoking. You could just cut down a little" I knew they were full of it. Such pre-1964 thinking is highly irresponsible and dangerous.

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They make Japanese patients come back time and again for a simple filling that could be done in 30 minutes in the UK.

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Wish more dentists here would do composite fillings! It seems that they only know of 2 options - ugly metal fillings, or ridiculously expensive (not covered by insurance) ceramic fillings.

When someone looks at my teeth they are always amazed at how i dont have any fillings, when in fact i have about 10. Its just that they are not used to the idea that fillings dont have to be seen!

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My husband was told he needed to have some work done using a laser to remove build up under his gums which was causing bad breath...he got rid of it using an electric tooth brush and flossing with one of those water pump types.

My Dentist I use now uses up to date technology and practices but they sure do charge allot for a simple cleaning even with insurance and want me to come in every 3 months..In the US I only went every 6 months to keep my teeth maintained. On top of all the corrupt dentists over charging for maintenance and wanting you to come back multiple times for a simple procedure there are many dental clinics who aren't even up to date on technology or practice.

I went to one clinic before when I asked to have my teeth checked and cleaned..they kept telling me the white spots in the grooves of my teeth were cavities..they were not cavities they were seals to prevent cavities and they refused to believe that because they had never heard of it..then when it came to cleaning my teeth? they brushed them with a tooth brush...then charged me 2000 yen.

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