It has all the elements of a nightmare. A masked person stands over you wielding a small mirror in one gloved hand and a needle-sharp probe in the other. A drill powerful enough to cut through bone in seconds sits idle on a table beside other implements of torture. You cannot see the masked face clearly because of dazzling lights above you, but your tormentor draws closer, eyes encased in goggles like a creature from outer space.

No, it’s not Leatherface from “The Texas Chainsaw Massacre,” just a regular visit to the dentist. But for many people that makes it worse. A visit to the dentist is, at best, one of life’s necessary evils, and it can be a painful experience, so much so that the unhappy memories lead people to stay away until the ache in a tooth becomes worse than the memory of what the last dentist did.

“It is a tragedy that people think this way,” says Mikako Hayashi, assistant professor at Osaka University’s Graduate School — a tragedy both for their teeth and their general health. “Treat the dentist as your friend, not your worst enemy,” she pleads.

This nation’s citizens get a bad rap for having some of the worst teeth in the world: Just think of the many caricatures of bucktoothed politicians or soldiers in decades past. But despite a seemingly endless procession of crooked smiles in Japan’s teeming cities, dentists here say huge strides have been made in dental care. Japan actually leads the world in the numbers of dentists per head of population. There are an astounding 95,000 dentists in this country, or one for every 1,340 people. The U.S. has one dentist per 1,700 people, and the U.K. has just one dentist in its crumbling national health service for each 3,000 Britons.

So, perhaps not surprisingly for a nation where dental clinics outnumber convenience stores, Japan is also a power in dental research. Japanese make up just below 20 percent of the 11,000-member International Association of Dental Research (IADR), the world’s leading body on dental research, but they provide between 25 and 30 percent of the association’s research papers.

Japanese research dentists are pioneers in a number of important areas, in part due to cooperation between university dental researchers and commercial companies like GC, Lion and J. Morita, which are known worldwide, especially in producing dental materials of the highest quality. In fact, IADR Executive Director Christopher Fox describes Japan as “the world leader” in that field. Japanese are also at the forefront in molecular research and microbiology.

Ahead in research

At Osaka University, professor Shigeyuki Ebisu leads pioneering research in microbiology, which has important implications for identifying and preventing gum disease, one of the main causes of tooth loss. Ebisu’s genius has been to understand the role of biofilm — the self-defence mechanism of bacteria, already known to medicine; his team is working to prevent accumulation of biofilm and thus stop it from causing caries (or tooth decay) and gum disease.

Hayashi, Ebisu’s colleague, has been praised by colleagues as “probably Japan’s best clinical conservative dentist,” in reference to caring for teeth and preventing decay rather than extracting them. She is about to be awarded a patent for a procedure to strengthen natural tooth structure. Potentially, this would make a decayed tooth actually stronger than the original pristine one.

Meanwhile, at Tokyo Medical and Dental University, professor Akira Yamaguchi is working to identify the molecular mechanisms of bone regeneration.

And at Nagoya University, professor Minoru Ueda’s stem-cell research with gingival tissue has, he says, produced a treatment for the wrinkles that come with age.

Not all smiles

Hayashi admits that Japanese teeth are not yet top of the global league in terms of sparkling whiteness, freedom from decay or their Hollywood aesthetic.

“I would put modern Japan at the same level as Europe, perhaps ahead of the U.K.,” says Hayashi, who spent 18 months doing research at Manchester University and has just completed a study of the U.K. system. “There, the national health service is facing big problems because dentists prefer private practice, which is more profitable.

“It is more difficult to compare Japan with the U.S. because the rich in the U.S. tend to spend heavily on making sure their teeth are both healthy and aesthetically pleasing, whereas the poor, who don’t have proper insurance cover, often have bad teeth.”

Good dental care also involves attention to what we eat, and Hayashi notes with some alarm unhealthy changes in Japan’s dietary habits, especially among young people. “The trend to junk food and softer food that does not need chewing is worrying,” she says, “since chewing helps to develop the jaw. A diet of junk food can lead to narrowing of the jaw and overcrowding of the teeth, the very reason for the Japanese goofy look of the past.”

Hayashi claims that having a full head of healthy teeth, especially molar or back teeth which are used for chewing, is important for maintaining brain functions and such basic physical movements as walking and standing.

“There is evidence that people with extensive tooth decay or with few teeth remaining are more susceptible to brain deterioration, as well as physical disabilities as they get older,” Hayashi says.

Among the hundreds of papers presented at a recent conference of the IADR in Brisbane, Australia, one asserted that regular dental checks have a key role in indicating the risk of strokes.

Even excluding such benefits, researchers put the global cost of dental disease at a staggering $60 billion, making it more costly than AIDS, cancer or any other much-feared medical malady.

Some lingering aches and pains

Japan has world-class dentists and researchers, but they aren’t always grinning from ear to ear.

Tensions exist over who owns patents produced by the top academic brains and the commercial money behind them.

Professor Minoru Ueda, of Nagoya University, meanwhile, complains that the health ministry is slow to approve new techniques or dental materials, and companies grumble that it is often easier to get a product approved through tough U.S. drug controls than in Japan.

Osaka University professor Mikako Hayashi says some research is too specialized. She wants more research to be relevant and applicable to ordinary dentists and ordinary patients, pointing out that the government permits insurance funds for checkups and teeth polishing, but not for vital preventative care.

“Major restoration work is needed on Japan’s health insurance scheme or it could collapse (just) as the British dental insurance system is crumbling,” Hayashi says.

The government says that it is difficult to track prevention work, and it fears that unscrupulous dentists would try to charge for work they have not done.

Hayashi, however, argues that the present system plays into the hands of greedy dentists. Expensive excavations and fillings with crowns may not be necessary, but can easily be done using health insurance money topped up with appeals to patients’ vanity to dig into their own pockets for a sparkling finish.

At the moment, the government allows a maximum of 15,200 yen per patient per year for a checkup once a month and quarterly polishings, and the patient pays 30 percent of the cost. To do quarterly preventative cleanups and checks would cost an extra 10,000 yen a year or 5,000 yen for half-yearly preventative care. Compare this with the 8,000 yen per tooth for a filling, or the 100,000 yen or more if you decide to get a gold crown.

“Stop unnecessary cutting and drilling is my message. It is painful, expensive and damages teeth,” she says.

Choosing a dentist

All dentists in Japan have to be licensed, but, like doctors, training in a good bedside or chairside manner is not part of the package. Here, without the risk of libel writs or a needle probe thrust down my throat, is a guide to finding a good dentist.

The best recommendation is probably that of a friend who has received good treatment.

Check whether the dentist has a Web site and see where he or she was trained and what his or her specialities are. Government universities like Osaka and Tokyo Dental and Medical and select private universities like Nippon Dental generally do a good job, but some private dental universities are so poor that they should probably be closed.

Membership in the Japanese Society of Conservative Dentistry is a plus (though the society’s English Web site www.soc.nii.ac.jp/jcd/hozon.html has not been updated since December 2005). Don’t be too impressed by membership in the Japan Dental Association, to which 72 percent of Japanese dentists belong and which this years was caught up in a political donations scandal. If you have special needs, a dentist who belongs to a scientific society, such as the Japanese Society of Oral Surgery (www.jsoms.or.jp) or the Japanese Society of Orthodontics (www.jcs.gr.jp), would be best — but their membership lists of qualified specialists are only in Japanese.

Be careful of anyone who qualified before 1980 — because he or she is probably heavily into expensive gold-digging excavations — or after 2002 — because they have not had time to really get to know their expensive equipment or how to handle the nervous quirks of real patients.

Ask what the dentist’s treatment plan is, which will give a clue to the way he or she will treat you.

If you cannot speak Japanese and have no Japanese friends to recommend a dentist, your best bet is to go to a national university in search of one who speaks your language.

Remember, a good dentist minimizes pain and uses a drill as a last resort, says professor Mikako Hayashi, who adds, ” ‘Drill with the touch of a feather,’ I tell my students.”


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