Dr. Robert Nara: Freedom from Dental Disease

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PLOWBOY: The National Health Federation Bulletin recently cited a 1974 study in which a group of dentists were asked whether they felt that they had an effective preventive dentistry program in their offices. If the answer was "no", the study requested the reasons for this lack. Some 88% of the dentists questioned explained the absence of such a program by saying that they were uncertain about the financial aspects of disease prevention. Do you feel that this sort of "office economics" is behind some of the opposition to your "Oramedics" approach to preventive dentistry?

NARA: Oh, I'm sure it is! For example, did you realize that there's a $30-million-a-year business going on in denture teeth alone ... I don't mean full dentures, just the little white beans that dentists stick into the plastic form that they call a denture. And that figure only represents one small item. If you multiply it by all of the filling materials, bridges, inlays, and so forth, you can see that there is a tremendous amount of financial interest in maintaining the disease process.

There's another angle to this economic concern, too. When we all but eliminated polio we didn't put physicians out of business ... in fact, we couldn't ever do without M.D.'s . . . because we seem to replace every disease that we are able to eliminate with another that was almost unheard of before. But dentistry is—for all intents and purposes—based on one disease. If you can eliminate that disease—and you can!—the job market for dentists would eventually be limited to cosmetic work and regular preventive checkups. The future simply wouldn't hold enough work for the number of dentists that we have today.

I've tried to discuss this possibility in my lectures, to calm the fears that it creates among my cohorts. After all. those people that are practicing today don't have a thing to worry about There's so much dental disease in this country right now that we could all spend the rest of our lives just trying to correct the existing problems! I feel however, that we are morally obligated to prevent disease whenever and wherever we can . . and that the focal point of our efforts has to come in children's dentistry, where the damage can be stopped before it starts.

Of course, the ADA would claim that it does concentrate on prevention for children . . . with things like the Children's Dental Health Week. But the fact is that those programs have been totally ineffective.

For example, our dental establishment constantly assures us that we have the finest system of dental care in the world. Yet a study was recently done in New Zealand to determine how many school children—out of a random sampling of 10,000—were missing any permanent teeth. That study turned up students up 18 students who had already lost one or more. In a similar study made in the U.S., however, 6,000 out of a random group of 10,000 were already missing one or more permanent teeth. And the discrepancy shown by these two studies—the difference between 18 children and 6,000 who have lost irreplaceable teeth—is attributable to the fact that New Zealand has a dental nurse program for its schoolchildren. Of course, we have children's dental programs too . . . and the evidence damns them worthless.

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