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The whole tooth and nothing but the tooth


What are you, the patient, to do? You have a bad tooth. You know nothing about teeth. You can’t help yourself. You’re in your dentist’s hands. What he or she says is true. What he or she recommends is best. But what if the dentist is a profiteer? Or not even that – what if soaring costs are driving him or her to bankruptcy? Dentistry is science, dentistry is healing – but it’s also business. Economics – cost-cutting – inevitably comes into it. 

Be advised, warns Shukan Post (March 22).

 Patients, too, of course, are cost-conscious. If the dentist says a certain kind of filling or crown is significantly cheaper than, but more or less as good as, another, most patients will go along with the implicit suggestion. Better not, the magazine says.

At one time the standard ingredients of a filling or crown were gold and platinum, mixed in a standardly-recognized proportion. When the cost of platinum rose, Japanese dentists developed an alternative: a blend of gold (12 percent), palladium (20) and silver. Palladium was a good cheap substitute for platinum. It’s still good, but no longer cheap. Its use in mobile phones and car exhaust scrubbers put such a strain on demand, in fact, that Russia and South Africa, its main supply sources, now treat it as a precious metal – as do speculators, propelling costs still higher. In 1990 its going price was roughly 500 yen per gram. Now it’s  6,000 yen.

“Every treatment,” complains one dentist, “brings me closer to bankruptcy.”

So perhaps dentists can’t be too harshly blamed for seeking substitutes. Maybe they can be blamed for saying or implying to patients that the substitutes are just as good. They know better.

Shukan Post’s report was written by journalist and author Michihiko Iwasawa. The two principal alternatives to the gold-silver-palladium mix, he explains, are a nickel-chrome alloy and a silver alloy. Gold-silver-palladium is least cost-effective: the dentist's fee, in the case of a crown, is 9,670 yen, minus 5,130 yen for the metal. For the silver alloy, the respective figures are 5,030 yen and 490 yen; for nickel-chrome, the most economical from the dentist’s point of view, 4,640 yen and 100 yen.

One trouble with nickel-chrome, Iwasawa says, is its hardness. It’s so hard, in fact, that it damages the tooth against which it bites. Worse still, it’s an allergen – possibly even a carcinogen. It has a peculiar effect, moreover: saliva mixes it with other metals in other teeth, generating a weak electric current in the mouth which may produce, besides headaches, sensations you have no immediate name for. You may tell yourself – or the people you complain to may tell you – that it’s your imagination. It’s not.

The silver alloy, on the other hand, is too soft. It can wear out, or blacken.

Strangely enough, all three choices are covered by Japan’s national health insurance. Maybe that’s where the root problem lies. If humans were morally perfect, dentists no doubt would put their patients’ well-being ahead of their own economic survival. Would you, if you were a dentist?

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There aren’t many poor dentists in Japan...

1 ( +1 / -0 )

“Every treatment,” complains one dentist, “brings me closer to bankruptcy.

Then charge more for your services.

1 ( +1 / -0 )

Thank god for Bangkok. When I get treatment there, my fillings and crowns are composite or resin materials, matched precisely to the color of the surrounding tooth. At a better price, too.

Why don't Japanese dentists use modern materials instead of ones from a century ago? Who wants to pay more for "metal mouth," anyway?

4 ( +4 / -0 )


actually they do, at least my dentist.

Guess it all depends who you choose and trust!

1 ( +1 / -0 )

Technology is progressing quickly and people will soon be able to grow their missing teeth back. This is great news, not only for people with missing teeth but also for people with root canals since they are known to cause severe health problems if the tissue in the dead tooth becomes infected.

“A new technique pioneered at the Tissue Engineering, and Regenerative Medicine Laboratory of Dr. Jeremy Mao, Edward V. Zegarelli Professor of Dental Medicine, and a professor of biomedical engineering at Columbia University can orchestrate the body’s stem cells to migrate to three-dimensional scaffold that is infused with the growth factor. This can yield an anatomically correct tooth in as soon as nine weeks once implanted in the mouth.”

“Dr. Mao’s technique not only eliminates the need to grow teeth in a Petri dish, but it is the first to achieve regeneration of anatomically correct teeth by using the body’s own resources. Factor in the faster recovery time and the comparatively natural process of regrowth (as opposed to implantation), and you have a massively appealing dental treatment.”

Therefore, this university has already filed patent applications in regard to the technology ...

0 ( +0 / -0 )

Perhaps, that explains why a filling requires so many visits and so much time in Japan. The dentist loses on the filing, so he makes up for it by charging for a check on the first visit, drilling out and inserting a temporary filling on the second, and then doing the filling on the third visit.

In Thailand it is all done in one visit.

0 ( +0 / -0 )

Every treatment,” complains one dentist, “brings me closer to bankruptcy.”

But the figures given above show that the dentist's fee is Y4540, regardless of the alloy used.

0 ( +0 / -0 )

Beware. I recently went to a dental office where I trusted the father for many years but he asked me to let his daughter be my dentist. She advised to replace a very small filling between the teeth and she literally ended up drilling out 50 percent of my healthy tooth to replace the small filling and cap it. I am thoroughly disgusted that I agreed.

0 ( +0 / -0 )

I recently saw a dentist in the US when a filling I had done by a Japanese dentist broke while I was on a trip. It cost me $600 to get my tooth rebuilt. The dentist there told me I should get my other fillings redone in the future, as the alloy they use is only used in Japan, and is considered to be crap in the dentistry world.

This dentist rebuilt my tooth, there in the office, and it's white instead of the silver alloy the Japanese dentist used, and unlike in Japan, they did the whole filling right then and there, without having to take a cast, send it away, and then come back another day to get it inserted.

It cost me about 8x as much in the US. But this tooth feels like it's a lot better than what I had done in Japan.

1 ( +1 / -0 )

As I told you folks:

it all depends on the dentist. Maybe you should come down here, "inaka" and get with my dentist"?

Maybe worth the long drive? But I can only highly recommend him!

0 ( +0 / -0 )

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