Brace yourself.

Orthodontist Yuki Miyajima believes that Japanese have long been too tolerant of the sometimes crooked ways of teeth.

The good news? He says more and more Japanese are seeking out that winning smile achieved by straightening up — and can improve their health and even English pronunciation by doing so.

Miyajima, 39, who calls himself a freelance orthodontist, has written a Japanese-language book on the subject under the English-language title: “‘Polish’ your teeth rather than your English to become cosmopolitan! Dental care for being active globally.”

The Nagoya native, whose parents are both dentists, says he has made it his “life’s work” to get more Japanese adults and children to straighten their crooked teeth through orthodontic treatment.

Instead of awkwardly covering their mouths when laughing or displaying bashful grins that might be mistaken for timidness, he wants Japanese to radiate big, confident smiles.

“In general, Japanese really don’t want to show their teeth to other people, but this has more to do with culture than whether their teeth are bad or good,” Miyajima, who has business tie-ups with 11 dental clinics around Japan, said in a recent interview.

“What’s interesting, though, is that once their teeth are straightened, the patients I have treated want to laugh more. They tell me they want people to see their smiles. When their teeth are straight, their personalities also become brighter.”

Miyajima, who lives in Tokyo, vividly remembers the dazzling smiles of the people he saw when visiting Saint Louis University in the United States, where his father was teaching orthodontics as a visiting professor.

He recalls having chosen his career path as early as elementary school. Although he was born into the home of an orthodontist father and dentist mother, both parents encouraged him to become a doctor, not a dentist, he says.

“But my parents’ dental clinic was right next to my home, and I’d see how patients would leave with these bright smiles on their faces. I saw that I could help make people happy and also earn a respectable living, and chose this path.”

In his book, published in 2017, Miyajima lists the results of a 2012 survey carried out on expatriates by the U.S. affiliate of a Japanese maker of 3D scanners and mouthpieces used in orthodontics. Three-quarters of the respondents said they had bad impressions of Japanese teeth. What’s more, 83 percent thought having straight teeth contributed to a winning smile.

In one section where respondents could give more wide-ranging opinions, an American man in his 30s marveled at how bad Japanese teeth are, despite the high level of health consciousness typically observed among the people. He also said he was shocked to see many celebrities on TV with “badly crooked teeth.”

In a 2010 nationwide survey by the Japanese Association of Orthodontists covering 1,000 men and women between 10 and 50, about half lacked confidence in their teeth. But despite a reluctance to get braces, a majority said teeth determine first impressions, and that those with straight teeth exude a sense of cleanliness, health and good upbringing.

As Miyajima writes in his book, there is historical context for Japan’s lack of awareness about dental care. He cites the custom of ohaguro (teeth blackening), which was seen as a status symbol among aristocrats until the end of the Meiji Era (1868-1912).

Ohaguro, the dye for which was made by dissolving iron filings in vinegar, was widely used by married women in the Edo Period (1603 to 1868) as it was considered beautiful and modest to mask one’s teeth.

Brushing teeth using a powder containing salt — mainly to keep teeth white and prevent bad breath — came into vogue among Tokyoites in the early 19th century, “but people were surprisingly tolerant of bad teeth alignment,” Miyajima writes. In fact, the Japanese word for snaggletooth — ranguiba — literally means “disorderly tooth stakes” and appears as a description in a comic book of the times.

“Because of this cultural history, no one really cared much about whether teeth were bad or good or what people thought about their teeth. That’s one of the reasons why Japanese haven’t taken the trouble to fix their teeth until recently,” Miyajima says.

Dr. Sayo Shimizu, director of a dental clinic in Tokyo’s Setagaya Ward that specializes in children’s orthodontics, has recently seen a remarkable increase in child patients, she says.

Shimizu, who is not associated with Miyajima, says the reasons parents give for bringing their children to her clinic include other kids getting braces or because their kids were found to have malocclusions during school health checkups.

Demand for tooth correction in Japan started around the time of a health ministry survey in 2011 in which 44 percent of dental patients between 12 and 20 complained of crowding, Shimizu says.

Yaeba, the fang-like upper canine teeth men have considered appealing in Japanese women, are caused by crowding, according to Miyajima, who says the problem has been exacerbated by small jaws and a change in eating habits.

“Japanese jaws are naturally smaller than Western jaws, but eating softer foods in childhood, such as school lunches, has also led to underdeveloped jaws,” he said. Also, since baby food has become more nutricious, “teeth have also become larger. When these canines come in, there isn’t enough space for them to emerge.”

Even though there was a fashion trend around 2013 that saw teenage girls paying to have fake yaeba artificially attached to their real teeth, Miyajima believes that in the West, yaeba are considered “vampiresque” and infantile.

“At a bare minimum, Japanese should understand good tooth alignment as a global standard for personal grooming and social etiquette to engage with people from abroad,” he said.

Miyajima says children benefit from braces because the bones in their upper and lower jaw are more pliable. He applies a pre-orthodontic mouthguard called Myobrace, which trains the mouth muscles and tongue and promotes correct swallowing and breathing through the nose, often without the need to use braces.

“There is an excellent chance of getting ideal tooth alignment without having to remove any adult teeth. Correcting teeth that jut out allows kids to close their mouths and breathe properly through their nose to receive more oxygen and enhance physical and mental fitness,” he said.

Miyajima lists several reasons why bad teeth cause health issues — tooth decay, for example, because of the tendency for people to develop cavities and gum disease, susceptibility to sleep apnea, and problems with foul breath from bacteria persisting between crooked teeth. They can also negatively impact self-esteem, he says.

He even points out that enunciation in general, particularly the “s” and “th” sounds in English, becomes more challenging if teeth are knotted or gapped.

Miyajima has been treating Kaho Yamaguchi, a 12-year-old patient at Kalmia Dental Clinic run by Ryosuke Sugihira in Tokyo’s Sumida Ward, for about two years.

Keiko Yamaguchi, Kaho’s mother, says she decided to bring her daughter to the clinic because there was an orthodontist on-site.

Kaho, who wears a clear mouthpiece brace instead of conventional silver wires, says she feels more confident about smiling since correcting her protruding bottom teeth. “I wanted to have straight teeth. My smile has become more natural now,” said Kaho, who hopes to become a dancer when she gets older.

Miyajima and Sugihira, 41, describe their work routine as team medicine.

“In Japan, when patients have a problem with their teeth, they usually go to a general practitioner dentist, no matter what the problem is, including for orthodontic work,” Sugihira says. “But all dentists have their strong and weak points, so there is a tendency for treatments to be half-baked and unsatisfactory in such cases. Since Miyajima is an orthodontic specialist, he can provide the highest level of treatment in his field. This way, we don’t have a situation where we perform treatments we aren’t good at.”

That is also why Miyajima chooses “freelance” work, he says. If he were to open his own clinic, their specialized team would not be in place.

“I get teeth to their ideal alignment before other specialists do procedures like crowns or dentures. If your teeth last long, your body’s overall health also lasts. I chose freelance since I can go to various locations to perform team medicine,” Miyajima said.

The cost of his treatments, however, is not covered by national health insurance and can range anywhere from ¥400,000 ($3,650) for elementary school students to upwards of ¥1 million for junior high school students and adults. There are also separate costs for follow-up visits.

Though patients in Japan are required to bear only 30 percent of the costs of general dental work under national health insurance, unlike many other countries, the coverage options for cosmetic dentistry are limited.

Contrary to the long-held belief in Japan that personality is more important than looks, Miyajima thinks that appearance, including tooth alignment, can influence a person’s life or career.

In his book, he cites several economic studies that conclude that, generally speaking, people considered attractive earn more or are more successful than those who are not. But the evidence is unclear when it comes to teeth.

Shimizu, the orthodontist from Setagaya Ward, said demand for corrective work is picking up.

“There are perspectives from abroad about the bad teeth alignment of Japanese people,” she said. “Although yaeba were seen as attractive long ago, these days, even celebrities with yaeba and other malalignments are getting their teeth corrected, and more of my patients want to get braces.”

Miyajima concurs. Although Japanese have largely ignored their misaligned teeth, more people, especially millennials, are starting to take notice, he said.

Miyajima, who has appeared on TV to promote his Bright Orthodontics brand to make people aware of how alignment can affect overall health, blogs about how glad he is when he sees movements on social media promoting improved teeth, including over 10,500 Instagram posts with the hashtag #shiretsukyoseijoshi (girls with straightened teeth).

Young Japanese women often share before-and-after photos of their orthodontic work, and in most cases the difference is striking. Miyajima hopes to see many more ear-to ear-smiles splashed across the faces of more Japanese.

“This really makes me happy that these women are proud to show off their teeth. My dream is to get Japanese people to have the same level of awareness about tooth alignment as people in America and the West. Providing people with the proper information on dental care is how I will continue to work toward this goal.”

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