OPINION: Dentistry -- from Cinderella to Belle of healthcare ball

Japan's education, health and finance ministries must urgently get together to plan radical reforms to the national health insurance system and to the way that medicine is taught and practiced.

Otherwise Japan is likely to run into an immense crisis before too long, which will threaten some of our most cherished goals.

We need to move away from a curative system -- basically one of fixing, by drugs and operations, problems that have happened -- to a preventative scheme -- of helping people to lead healthier lives.

It will not be easy. The curative way has spawned multizillion yen interests and powerful pressure groups. But a preventative way of life will be healthier for everyone, and cheaper too, especially for the government, bureaucrats please note.

I write this with more than 25 years experience as a teaching and clinical dentist.

Dentistry is the forgotten Cinderella of the healthcare system. We neglect our teeth until we have a sudden pain, usually a sign of a problem, which may be difficult, possibly painful and probably expensive to fix.

It is unwise to forget about our oral health or about healthy folk wisdom. "Down in the mouth" means unwell. If a plan "has bite" or "has teeth," it is a good one.

This folk wisdom is indeed wise. The mouth is the sentinel to the whole body, and is an indicator of many diseases. We forget this at our peril.

I am sometimes astonished at the lack of oral understanding by my medical colleagues. Doctors and dentists should understand each other better.

Decades of detailed research in Sweden suggest that people who have healthy lifestyles, brush their teeth twice a day, get regular checkups, and follow the advice of their dentists, may lose at most a single tooth in 30 years.

My clinical colleagues and I are doing research in the Osaka region that says the same thing: tooth loss can be avoided by regular preventative care.

Another of my colleagues has also found that old people who retain their natural teeth are livelier and have sharper brains than the edentulous.

Yet Japan's health scheme rewards drilling and filling of teeth, which is the dental highway to hell of tooth loss, and does not reward either dentists or patients who try to safeguard their teeth.

In Japan's case, it is also no help that the dental education system means that most students graduate without adequate clinical training or skills. In other countries dental students treat actual patients at least from their third year or training.

It is time to change, or Japan's admirable 80:20 goal (at 80 the average Japanese will have 20 natural teeth) will never be achieved and the health insurance scheme will go bankrupt from increasingly expensive treatment of the elderly population.

At birth, every Japanese should be given a unique national insurance number with the requirement to register with a doctor and dentist who will be required to maintain records on the patient.

Until high school at 18, dental and medical treatment should be free. After that, those who have regular checkups and follow healthy diets and lifestyles will qualify for cheap health insurance treatment. Those who smoke or don't take care of themselves will have to pay more.

We cannot prevent aging, which may bring inevitable diseases. But we can try to be healthy as long as possible for our own benefit and the good of society and the government budget.

(Mikako Hayashi is professor of Restorative Dentistry and Endodontology in the Graduate School of Dentistry at Osaka University.)

==Kyodo