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

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.

© Japan Today