Dr. Robert Nara: Freedom from Dental Disease

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NARA: Of course. I took my undergraduate degree at Michigan State University—in East Lansing, Michigan—in 1955. Immediately thereafter, I enrolled in the University of Michigan's dental school. After graduation, I served in the Navy for two years . . . during which time I practiced dentistry at the Pacific missile range headquarters in California.

I returned to Houghton, Michigan when my hitch was up and set myself up in private practice in 1961.

PLOWBOY: How did it happen that your work turned toward preventive, rather than reparative, dentistry?

NARA: Well, first of all. I was taught enough microbiology, oral physiology, and biochemistry in dental school to get a pretty fair understanding of the processes that contribute to dental disease. This "medical" material, however, was presented to us in a rather hit-or-miss pattern . . . with bits of information dribbling in during one class or another.
What my schooling really prepared me for, however—and what any student in dental school is actually trained to do— was mechanics . . . drilling and filling.

PLOWBOY:Don't the dental schools encourage preventive care?

NARA: No, they don't encourage it at all! And there's another factor that contributes to the lack of preventive dentistry in the United States, too. You see, most young dentists—upon graduation—have a very substantial educational debt to take care of. Then, in order to get a practice started, these men and women have to go out and buy more than $50,000 worth of equipment! So there is, as you can see. tremendous pressure put upon the beginning dentist to get going and bring in some money. I believe that many of these people would like to be able to start their practices by teaching folks how to clean their mouths, but the simple truth is that the big money is in reparative work. So, the new dentist—who, as I've said, is really under the economic gun—puts off his or her ideas about prevention until after the bills are paid . . . and once that pattern is established, it never really gets broken.

PLOWBOY: Can you be more specific about that "pattern"?

NARA: Certainly. You see, after a beginning practitioner has become convinced that mechanical repair is the only way to get out of debt, he or she will usually spend a long period of time doing little else. Now, reparative dentistry is, for the most part, dull, tedious, and—in all but a financial sense—unrewarding work. It doesn't take much of this sort of drudgery to kill off any idealism that might have motivated the dentist to try prevention in the first place.

It seems that many of these doctors eventually come to regard dental health from the same frame of reference as most of the American public does . . . that dental disease is inevitable and that everyone will lose his or her teeth sooner or later. Naturally, once this attitude takes over—and it may be a "gut feeling" that's never actually spoken about or even consciously thought—the dentist begins to feel that prevention is a waste of time . . . and so the status quo perpetuates itself.

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