In the following interview, Dr. Robert Nara discusses the protracted battle he has had to fight with the dental care establishment to advance public awareness of and support for preventive dentistry.
Dr. Robert Nara has paid a heavy price for trying to move the practice of oral care to a preventative dentistry model.
In 1819 a dentist named Levi S. Parmly wrote a book called A Practical Guide to the Management of the Teeth ... Comprising a Discovery of the Origin of Caries, or Decay of the Teeth, with its Prevention and Cure.
Some 77 years later. Dr. G. V. Black closed his address to a group of dental school graduates with these words: "The day is coming, and perhaps within the lifetime of you young men, when we will be engaged in practicing preventive dentistry rather than reparative dentistry."
Yet the U.S. Public Health Service tells us that 98 out of every 100 men, women, and children in the United States still suffer from some form of dental disease. And American Dental Association figures indicate that the average American has 14 teeth decayed, filled, or missing by the time he or she reaches 20 years of age! Just what has happened to the dream of preventive dentistry?
"It isn't a dream anymore, it's a reality!" says Dr. Robert Nara of Houghton, Michigan, who adds, "Dental disease—tooth decay and bad gums—can be eliminated. I've been doing it for almost 20 years!"
These are pretty strong words, especially to those of us who are suffering from the pain and financial losses caused by conventional reparative dentistry. But Bob Nara is sure of his message. So sure, in fact, that he has put his means of earning a living on the line in a bitter struggle with the dental establishment (those professional organizations which, Nara claims, condition this country's dentists to do no more than "help the patient's mouth rest comfortably while the teeth die").
MOTHER EARTH NEWS was curious about Nara's claims and about the system of preventive care, called Oramedics, that the Michigan dentist has designed to help "spread the word" that dental disease can be eradicated.
And so staffer Bruce Woods flew up to the Wolverine state for a talk with Nara, who had—not long before—had his license suspended by the Michigan State Dental Association. This transcript of their conversation contains some statements that—if true—paint a shocking picture of a "medical" profession that has the means to insure dental health but, instead, allows political and economic pressures to limit its practice to treating symptoms while it completely ignores the causes of tooth and gum disease.
Whether you finish this interview as a believer in Oramedics or not, we think you owe it to your mouth to read what Bob Nara has to say.
PLOWBOY: Dr. Nara, your ideas about preventive dentistry have, so far, cost you your license to practice, gotten you kicked out of the county, state, and national dental organizations, and forced you to face criminal charges. I know this situation didn't develop overnight, so why don't we begin at the beginning. Can you tell me about your training and professional background?
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. 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.
PLOWBOY: But this common attitude didn't keep you from practicing preventive therapy?
NARA: No, it didn't, and I think there are several reasons why I was able to maintain my interest in prevention. For one thing, I'm a pretty stubborn individual. For another, I dislike even trying to treat a mouth that isn't clean. I mean, why go through the time and effort necessary to really remove decay and place nice fillings when you know—because the mouth itself is not being cared for—that the new work is going to be decayed all around its margins in six months or a year? There's simply not much job satisfaction in enlarging the same filling time after time until the tooth has to come out.
So, early in my practice I tried to put together a plan that would motivate my patients, to help them establish an effective oral hygiene program. I failed miserably—as I should have known I would—because nobody wanted to listen.
My patients, at that time, shared the common attitude: "Come on, Doc, just get that tooth filled, or get this one pulled, and let me out of here." Because most folks don't want to spend any more time than is absolutely necessary in a dentist's office, they want to get away from that chair and away from those drills as quickly as possible.
PLOWBOY: This "fear" would seem to be related to the frame of reference you spoke of earlier.
NARA: Right, it's part of the same attitude. And, because of that frame of reference, a dentist can talk till he or she's blue in the face about keeping the mouth healthy and so forth. Nobody wants to hear about it. Nobody even believes it!
PLOWBOY: Do people actually doubt that prevention can be effective, or do they simply feel that they lack the willpower to follow through with such a program?
NARA: I think that—in most cases—a combination of both these beliefs is at work, because the concept of a really effective oral health program is simply beyond the scope of most people's experience. For example, note the toothpaste ads that are run on television: "Look, Mom, only one cavity!" Now, that ad is claiming—and the manufacturers of that product are claiming—that really good prevention will result in only one cavity every six months! At that rate, a person could have more than 32 fillings by the time he or she reaches 21 years of age! It's crazy, and this kind of advertising contributes to our national indifference toward the prevention of dental disease.
Another problem with the traditional approach to oral hygiene is that it's all ''teach, teach, teach." Now adults, especially—and even children to a large degree—don't really appreciate being told that someone is going to teach them something. Most folks consider the very suggestion that they need education to be an insult, a put-down. Yet, many "modern" dental offices have a room with a big sign on the door that says, "Patient Education Room." The sign might as well say. "This Way, Dummy", because that's exactly the feeling that's conveyed.
PLOWBOY: How did you manage to communicate the necessary information without insulting your patients, then?
NARA: Well, I knew that most people avoid the dentist's office until they need work done, usually either a filling or an extraction. And people in pain aren't likely to be receptive to a cute story about preventing the disease. So, I had to design a system that would penetrate, first, the preoccupation with money worries and physical discomfort that most folks bring to the office with them. And I also had to figure out a way to change the preconception that nothing can be done about tooth decay and gum disease anyway.
With all of these cards stacked against me, I knew that I needed a very effective psychological delivery system. So, I spent a lot of time thinking about it, saying to myself, "How can I do this?"
My goal was to stop disease, and I was sure that I could stop it—I had all of the scientific evidence in the world to back me up— if could get the patients' help and cooperation.
And that's what the "method" that I came to call Oramedics does: It enables me to get the patients to cooperate, to take the control of their own oral environment into their own hands. And the system works!
PLOWBOY: But as soon as you started practicing this form of prevention, you began to encounter resistance from the dental establishment. When did the first signs of your coming "war" with organized dentistry show up?
NARA: I began working, in 1968, to bring about some changes in the outmoded dental laws that still exist in much of the U.S. At that point I was mainly concerned with setting up a system that would help the dentist to be more effective in his or her job. Part of the problem, as I saw it. was that most dentists simply didn't have the time to handle health education effectively. I felt that this situation could be remedied if the doctors were able to delegate some of the more routine dental tasks to paradental personnel. After all, there are many new types of paramedical jobs and paralegal jobs today, but we really don't have any new paradental positions. There haven't been any "new kids on the team" for years.
So, I started lecturing that dental assistants should be trained to polish teeth, to give fluoride treatments, and so forth in order to allow these people to become really worthwhile members of the dental health team. I pushed pretty hard to get new laws passed that would help bring about these changes. For instance, I got myself elected to the American Dental Association's House of Delegates in 1971 and spent four years pushing for modern laws.
Unfortunately, dental laws fall under the category of state's rights, so—even though the House of Delegates did vote to recommend liberalized legislation—direct action could only be taken at the state level. And it just so happens that my home state of Michigan is one of the most backward places—in terms of dental progress—in the Union. This is because we have a network of long-entrenched "dental politicians" in Michigan. In many states, on the other hand, there is a regular turnover among professional politicians, because many people compete for these positions. Michigan, however, lacks that healthy competition, and old dental ideas are seldom challenged here. In fact, just as an example, we had two men—father and son— who ran the Michigan State Board of Dentistry for 40 years!
Anyway, I went to work, through the appropriate political channels, and helped to get rid of some of these people who were—I thought—standing in the way of necessary change. And, in the process of fighting the entrenched hierarchy, I did make some enemies ... enemies who are still "haunting" me today.
The first real sign of the troubles to come, however, showed up in April of 1968. I was called, at that time, before the State Board of Dentistry and told by one of the Board's members that I'd lose my license if I continued to rock the boat. I replied that I believed myself to be in the right, that I was acting in the public interest, and that I would continue to do so regardless of whatever he was tempted to do in retaliation. The board member responded by saying, "We'll get you." And it took him 10 years, 10 long years of battles in the professional organizations and in the courts, to finally take my license away from me.
The State Board chose to attack me on the ground that I was training my assistants to perform the routine tasks I described above. They tried to force me to stop doing this, and I, of course, refused. Then, in 1972, one of my assistants—while following my instructions—placed a medicated piece of cotton in a patient's cavity ... and the man returned the next day with warrants for my assistant's and my arrest. He was actually the attorney who served as chief investigator for the Dental Board's Department of Licensing and Regulations.
PLOWBOY: And what was the outcome of that 1972 arrest?
NARA: Well, it eventually led to an arraignment. And, at the hearing, the judge explained to me that—if I were found guilty as charged—I could spend a year in jail and be fined up to $500.
He then asked me how I intended to plead, and I told him "guilty."
The judge was upset by this. "You're putting me in a rough spot here, Doctor," he said. I asked him what he meant, and he explained that if I didn't plead "not guilty" he'd have to sentence me. I replied that I was at fault, that I had allowed my assistants to polish teeth and so forth. So, the judge turned off his tape recorder, leaned over the bench, and advised me to get myself a lawyer and to give the matter some serious thought before I came to trial. Well, I didn't hire an attorney. I didn't want one, because my attitude was that the laws themselves were wrong. And I figured that I might just as well be the person who challenged them.
At any rate, it took another six months for the case to actually come to trial, and the State Dental Board must have gotten a bit worried by that time. It looked pretty certain that the judge was going to have to throw me in the slammer for a year, and the Board must have decided that they'd get a lot of bad press if they sent a dentist to jail for letting his assistants perform routine tasks, so they dropped the charges.
PLOWBOY: Was that the end of your troubles?
NARA: Everything did settle down for a while. I was, at the time, writing research proposals for Michigan Technological University. And, about a year after the trial, I came up with a really unique proposal that seemed to have a very good chance of being accepted. While I was out of town lecturing, however, the president of the Copper County District Dental Society went to the dean of the university's School of Business—who was in charge of the grant proposal program—and told him that the college should take my name off the proposal and put the Dental Society president's name on it! The president threatened that—If this wasn't done—the Society's members would write letters to the Department of Health, Education, and Welfare saying that they did not want this research done in their area. Of course, HEW isn't likely to try to conduct research in any given area if the local doctors oppose that study because the project would become a terrible mess.
PLOWBOY: Are you referring to the peer pressure that could be put on the researchers?
NARA: Correct. Anyway, the dean was upset—he didn't want to lose the grant that might mean several million dollars to his university—and, as he was unable to reach me, he gave in. My name was taken off the proposal and the name of the president of the County District Dental Society was put on.
I was, of course, very angry when I heard about this, because the proposal was my work! So—since I had no other course of action available—I filed a complaint with the Dental Society against its own president! In retaliation, the Society simply disbanded and then reorganized itself, thereby clearing the records of all former complaints!
But, although those local dental politicians had effectively swept my charges under the table, they were really riled that I'd had the gall to attack them. Soon after they had reorganized their little club, Society dentists sent a series of letters to the Department of Licensing and Regulation. These documents charged me with unethical conduct on the grounds that I was still training my dental assistants to polish teeth and perform other such routine chores.
Ironically, while I was being hassled for training my assistants to polish teeth, the major dental journals were carrying ads for a portable device that would allow patients to polish their own teeth at home!
And, to make the situation even more ludicrous, I was then—and still am—qualified to teach in any dental school in the country. I don't need a single additional credit to train young people to become dentists, and yet my profession attacked me for teaching dental assistants to polish teeth!
PLOWBOY: The charge is almost identical to that made in 1972. How were the members of the Dental Society able to make it stick in this case?
NARA: In 1972 they had tried to "get" me in the civil courts and had let those charges drop for fear of bad publicity. In this instance, however, they decided to handle the matter themselves and stay out of the courts. So I was charged, before the Michigan State Board of Dentistry, with letting an unlicensed assistant polish teeth and with ''advertising an unrecognized specialty." The latter accusation refers to an ad that I had placed in the local yellow pages. The advertisement read: "Specializing in Oramedics ... for people with teeth who want to keep them." You should know, too, that it is not illegal for a dentist to advertise in Michigan. For instance, dentists have run ads saying that they specialized in dentures, or root canals, or something like that, and they have had no problems. Oramedics, however, is not a term that the American Dental Association or the Michigan State Dental Association recognizes. And, on the basis of those two charges, they were ultimately able to suspend my license for 15 months.
PLOWBOY: When did this suspension take effect?
NARA: On February 15, 1978.
PLOWBOY: Did you then make any effort to appeal the Board's action?
NARA: Yes, I did. As a first step, I filed an appeal, based on what I felt was the unconstitutionality of Michigan's dental codes. And charging, also, that the board was guilty of misconduct because of the manner in which the proceedings were held and the findings reached.
You see, the Board had, as usual, hired a hearing examiner—in this instance he was an administrative judge named Wayne Lusk—to rule on the case. But Lusk found me innocent: He said that the Oramedics-related charges "failed to establish a violation"! The Board, however, threw Lusk's report out, upheld the charges against me, and then also voted never to use Mr. Lusk—who had 35 years' experience as a hearing examiner—again!
At any rate, I filed an appeal—based upon the discrepancies in the dental codes and on this "irregularity"—with the state appeals court.
PLOWBOY: And did the appeals court give you any help?
NARA: No, the court was also presented with a "counterstatement of facts" from the State Board of Dentistry, and it denied my appeal for "lack of merit and grounds presented."
PLOWBOY: Have you taken any further steps to clear yourself?
NARA: I've appealed to the Michigan State Supreme Court. They've had my appeal for some 10 months now and have yet to decide if they'll even hear the case! This delay is curious, as I was assured—by Mr. Bruce Lindstrom, who was then the aide in charge of Upper Peninsula affairs for Governor Milliken—that my appeal would be handled quickly and that a stay of my license suspension would be granted, automatically, while the appeal was in progress. Lindstrom told me this when the appeal was first filed. He has since resigned, and I've still gotten no word from the Supreme Court.
PLOWBOY: It does seem as if you're being singled out for "special treatment". Do you have any theories that could explain this apparent vendetta?
NARA: In my opinion the whole thing boils down to one simple fact: The dental establishment is scared to death that the public is going to realize that the entire profession has been making a living by repairing the results of a disease they could have been curing all along! I just happen to be, at the present time, the person who is in the best position to expose organized dentistry.
Nothing was resolved in my prior encounters with the county and state dental associations, because they dropped their charges and swept mine under the table. This time, however, I think there's going to be a winner and a loser, and my opponents are pulling out all the stops to keep me under wraps. They're soliciting a lot of support, too—by using loaded terms like "unethical conduct"—among those indoctrinated dentists who don't want anyone upsetting their very lucrative apple carts.
PLOWBOY: Why do you refer to "unethical conduct" as a loaded term?
NARA: I think many people would feel that the phrase has an almost "dirty" ring to it. It sounds like it has something to do with morality. This is not really the case, however, because—in medical jargon—the functional meaning of "ethics" is usually "not squealing on another doctor." If the other guy makes a mistake, you are expected—because of your professional ethics— not to expose him. You can imagine, then, why the dental establishment has come so unglued about my case—I haven't discriminated, I haven't singled out any individuals, I'm exposing the whole profession's lack of concern about disease prevention! And, of course, if there weren't anything there to expose, it's unlikely that I would have drawn such a violent reaction.
Strangely enough, however, the whole battle could have been avoided. I wouldn't have had anything to expose if the dental establishment had allowed me to continue to practice and develop my methods. It would have been easy—and mutually beneficial—for all of us to work together and share each other's ideas for the good of the patients and of the profession. But, when they took my license away and threw me out of their associations, they left me no recourse but to fight, and that's what I'm doing.
PLOWBOY: And how are you striking back at the associations that have attacked you?
NARA: I've filed a suit against the American Dental Association, the Michigan State Dental Association, and the Copper County District Dental Society for eight million dollars in damages. I didn't want to sue, and I still don't, but I have no other way to defend myself at this point.
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. The evidence damns them as worthless.
PLOWBOY: You touched upon the subject of dentures while we were discussing the financial pressures that may cause dentists to resist preventive programs. Yet you yourself do not make dentures. Can you tell me the reason that you don't?
NARA: Because I'm not motivated to provide that service. Dentures are the end of the road, and—in my opinion—a dentist selling dentures is akin to a physician peddling coffins. It seems to me that it's almost immoral for a healer to spend too much time and effort cleaning up after a preventable illness that has run its course. Naturally, someone has to make these prosthetic devices, but I choose not to.
PLOWBOY: Would you say that American dentistry places a heavy emphasis on dentures?
NARA: Very much so. Dentures are, for one thing, about the most profitable service that a dentist can provide. You might not know this, but dental laboratories often don't charge more than $25 a plate to prepare a set of dentures for a dentist. And the finished product—$50 worth of work for both upper and lower plates—might cost the patient as much as seven or eight hundred dollars! In fact, the lab costs on most dental services are usually less than 20% of the fee charged to the patient. The profits are tremendous! I feel that, because of this huge profit potential, dentures should be taken out of the hands of the dentists!
In fact, a dentist named Dr. W.W. Alport tried—back in 1877—to have denture-making removed from the curriculum in dental schools. Alport was ahead of his time, but I think this change will have to come about. After all, if our profession is supposed to be trying to save teeth, doesn't it constitute a kind of conflict of interest to have this tremendous economic return for selling "crutches"?
PLOWBOY: I think many people will see it that way. But your Oramedics program, on the other hand, does concentrate upon saving teeth. Could you tell me precisely how Oramedics works, and what facts and figures you can cite to prove that it has been successful in your nearly 20 years of practice?
NARA: First and foremost, Oramedics is a method of reaching the patient. It's a kind of consumer-protection dentistry. To put it another way, Oramedics is a combination of scientific tests and a psychological delivery system. The tests show the ecology of the mouth and can monitor the improvement or degeneration of that ecology, while the delivery system motivates the patient to continually improve the health of his or teeth and gums. Now, it might sound egotistical to say that our message reaches people better than the traditional "patient education programs" do, but egotistical or not, that statement is true. And our success is based upon the logic inherent in the program, not on my charming personality!
When a patient comes into my Oramedics office, he or she is given—as a part of the routine examination—a U.S. Navy plaque index test. Now, most people will be curious about this test, because it's unfamiliar to them. The staff then explains what the test is: that it was developed and is in constant use by the Navy, and that it is a means of measuring the amount of plaque—a film made up of bacteria, food particles, and saliva —which is adhering to the teeth. From that point, most folks want to know how the test relates to them and how they can improve their "score."
Similarly, when we ask the patient to spit into a little bottle, he or she will usually ask why we're doing this. The question is a logical one, and we answer that the saliva sample will be tested to let us know the amount of bacteria that the mouth contains.
And, once the person understands the reasons for the tests, he or she is told that—if we all work together—we can eradicate most of the plaque and bacteria and thus create an oral ecology that will no longer support tooth decay or gum disease!
Of course, most folks become a bit suspicious upon hearing this. But, we go on to explain that their suspicion is a product of an "old" frame of reference, and that the frame of reference will have to be changed because Oramedics doesn't accept tooth decay or bad gums.
The two tests, then, help the dentist understand whatever problems are present. But. more important, they also help the patient see the problems. And, once you let someone understand his or her disease—and then convince that person that the disease can be simply and inexpensively cured—you can expect that he or she will cooperate with you to get the illness cleared up.
Over a period of almost 20 years of using these methods, we have never failed to eliminate dental disease from the mouth of anyone who has cooperated with us. Of course, we have had some folks say, "Dr. Nara, you're some kind of a nut," and just get up and go out the door.
PLOWBOY: What percentage of your patients have refused to follow the program and left your practice?
NARA: We've kept careful records on that. Over the years we've lost between three and five percent of our patients because they weren't willing to try—or stick with—the program.
PLOWBOY: That leaves you with quite an impressive "success ratio."
NARA: And the people who do stay to listen get our message, and once they get the message, it stands to reason that they'll follow through. I mean, who really wants to have bad teeth? Then, of course, once the results begin to show up—which is usually in a matter of weeks—these patients feel very proud of themselves, and rightly so, because Oramedics is self-help dentistry. The dentist's office becomes a place where the patient can check the progress that he or she is making toward having a completely disease-free mouth!
You could say that Oramedics is to dental health as Dr. Kenneth H. Cooper's "aerobics" is to physical fitness. When Cooper wanted to bring his running program to the people he said, in effect, "Look, you clowns, your blood vessels are going to hell, you need to get some oxygen pumping around in there, and the only way you can do that is with exercise!'' And Cooper designed a simple test: All you had to do was to see how far you could run, walk, and crawl in 12 minutes, then check your distance against the figures in the Aerobics book to find out what kind of shape you were in.
And, the book also described methods to improve your score. If you follow Cooper's recommendations, you will almost certainly improve your physical fitness. It's the same with Oramedics ... if you follow the instructions contained in our books and material, you will almost certainly improve your oral health. Now, before Aerobics was published people knew that exercise was good, but how many folks did you see out jogging then? Today, of course, there are millions of people who have personal running programs. I jog myself, every morning, but I didn't until somebody reached me! That's what Oramedics does: It allows the dentist to reach his or her patients, and those people do start cleaning their mouths. Clean teeth do not decay and they do not foster gum disease. It's really that simple.
PLOWBOY: Dr. Nara, many people are going to read this interview, and I'd suspect that a number of them will want to try Oramedics for themselves. Is there any way that these people can locate an Oramedics practitioner in their areas?
NARA: Not at this time ... at least not without great difficulty. There are some 600 practicing Oramedics Fellows in the world today, but—because of the tremendous confrontation that's going on—those who live in the U.S. have to "keep a low profile." If someone were to call one of these practitioners and ask, " Doctor, do you do Oramedics?" the dentist might well be afraid to say yes, for fear of reprisals from the dental associations.
PLOWBOY: Because your yellow pages ad simply said that you practiced Oramedics, and that was one of the factors that led to your loss of license.
NARA: Exactly, for the simple reason that the dental profession doesn't recognize Oramedics—or any form of preventive dentistry—as a specialty.
PLOWBOY: Well, since Oramedics dentists are not readily available, can you describe an "aerobics" kind of oral hygiene program that could be followed at home ... or even on a remote farmstead?
NARA: The first thing that I would recommend—to any persons interested in having a healthy mouth—is much like the first step in the aerobics program: that is, they should take a test to find out where they stand. This sort of evaluation is necessary before a course of action can be planned.
Now, the best of these tests is the saliva examination that I mentioned before, the "lactobacillus test." And that examination is within reach of anyone who has access to the postal system. People can mail in a saliva sample, have the laboratory work performed, and receive a very specific report which will detail their oral health problems and tell them what to do in order to cure those problems.
PLOWBOY: Tell me how and where these samples can be sent.
NARA: We are offering this service through Oramedics International. If someone writes to us saying that he/she would like to have an Oramedics evaluation, we will mail back a sample jar and a series of forms to fill out. The forms detail both dental and medical histories. Then, we'll report our findings—based upon the lactobacillus count and the patient's case history—and recommend a home care, self-help program which will enable the person to improve his or her oral ecology while spending as little as five minutes a day on dental hygiene. We also will ask that another saliva sample be submitted after the patient has followed our recommendations for a month. Most people will be well on the way to dental health by then, and we can put them on a "maintenance program" which—if followed—will almost insure a lifetime of freedom from dental disease!
In addition to these services, anyone requesting an evaluation will receive a 20-page booklet and a tape cassette explaining the background of the Oramedics program. The total cost for both tests, plus the evaluation, the recommendations, and so forth is $24.
PLOWBOY: That sounds quite reasonable.
NARA: This system is something that we've devised since my license was suspended. When the dental associations stopped me from drilling and filling, I decided to find another way to help the public understand their mouths and keep their teeth and gums healthy. I don't need a license to perform this service; anyone who understands oral physiology and microbiology could do the same thing.
PLOWBOY: Are most of the materials that you would recommend available without a prescription?
NARA: Yes. In fact, we describe all of the items that are needed, and the patient can then either procure them in a drugstore or order the materials directly from Oramedics International.
PLOWBOY: It sounds as if we may well be entering an era of do-it-yourself dentistry! How might this trend—assuming that the Oramedics approach gains public acceptance—change the American dental care system?
NARA: The major change I foresee is that organized dentistry will be forced—by public opinion—to create a special field for preventive dentists. There are over 15,000 physicians in this country who are board-certified in preventive medicine, but not one dentist who is so recognized.
Therefore, I feel that the dental associations will have to develop some form of certification for those dentists who wish to specialize in treating the cause of the disease rather than simply repairing the damage that the illness does.
When this recognition becomes available, there will probably be a split between those people who are interested in prevention and those men and women who are more concerned with prosthesis—dentures, partials, that sort of thing. In fact, I wouldn't be at all surprised to see a violent parting of the ways occur, a split that would—in effect—create two specific professions.
Another, although less significant, change will take place on the legislative level: Dentists will be allowed to advertise in all parts of the country. Some states, of course, already allow medical advertising, but almost every dental ad that's placed today is denture related: "Plates: In by 10, Out by 5", that sort of thing. You'd have to look long and hard to find a dentist who advertises him- or herself to be a proponent of curing the disease!
PLOWBOY: Is this lack of "preventive" advertising due to the fact that the profession doesn't certify prevention as a specialty?
NARA: That's one of the reasons. Primarily, however, our shortage of dentists who practice prevention is due to the fact that the "system" places an economic premium on the repair and replacement of teeth. Even the insurance companies that are now involved in dentistry are mainly offering assistance in getting fillings, bridges, and repairs in general. Most dental policies will cover little if any preventive care. They are only an aid in cleaning up the mess left by the disease.
PLOWBOY: Dr. Nara. the very fact that you've held up in the face of 10 years of harassment proves that you believe in what you're doing. Can you tell me why you've stuck with it? What do you hope to accomplish in your career?
NARA: The principles that I'm operating on today are based on the belief that one person with the truth can constitute a majority. I believe the truth is that dental disease can be eradicated. Of course, this will only happen if the "healers" are able to reach the public. The message must be presented in such a way that people find it valuable. Sadly enough, though, we can't—at this time—count on the dental profession to relay that message.
So, one of my immediate goals is to solicit the aid of allied health professions. There are for example, several chiropractors who are, already, practicing Oramedics, and I plan to take the whole concept of preventive dentistry out of the hands of the dental profession if that's what's necessary to get the job done.
PLOWBOY: Why did you choose to go to the chiropractors?
NARA: Well, as you may know, chiropractic medicine has come a long way in the past few years. The "back crackers" of old are probably better versed in wholistic and nutritional health care than any other medical profession in America. They have moved forward while all the rest have stood still.
And, along those same lines, I have written a book that should be available in January 1979. It's called Money by the Mouthful: Everything That You Need to Know About the Health of Your Mouth and Body That No Doctor's Going to Tell You. The volume will be available in bookstores and through Oramedics International for $4.95, plus $1.00 postage and handling. I'm so sure of the value of this book that it is completely guaranteed. Anyone who doesn't find Money by the Mouthful worth the price can simply send in a post card, get the purchase price back, and keep the book.
PLOWBOY: Will this volume take the Oramedics case directly to the people?
NARA: Yes, and I expect many of them will be surprised at what they read. Oramedics is nothing new, you see. We aren't claiming to have come up with a revolutionary system. We're not pushing any "miracle" drugs or anything like that. We are simply offering a commonsense approach to dental health, and the likes of that has never been available to the American people before. Oramedics is nothing more—and nothing less—than the simplest route to a disease-free oral ecology. And I think that anyone who is interested in regaining control over his or her life and body will surely want to know about it.
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