Despite the fact that we clean them at least once or twice a day and use them more often than that, do we really think about our teeth? The truth is, we tend to ignore our pearly whites unless they cause us trouble, like coming loose or hurting.

This is clearly proven in the results of the latest National Oral Health Survey for Adults (Nohsa) 2010, where the most common reason for visiting the dentist over the previous two years was “something wrong” (56.6%), with the second most common reason, “time for cleaning/examination”, trailing far behind at 15.9%.

Similarly, the most common reason for not visiting the dentist over the previous two years was “no problem” (67.7%), followed by “too busy” (9.3%) and “no teeth” (6.9%). It is hardly surprising then, that despite the general recommendation that we all visit the dentist once a year to check our teeth, only 27.4% of Malaysian adults had done so, according to Nohsa 2010.

The survey also found that just over one-third (34.5%) of Malaysians aged 60 and above had no teeth left at all, with just over one-fifth (21.7%) having 20 or more teeth left. Going by the results of the survey, we Malaysians can expect to have an average of 9.8 teeth left by the time we hit 60.

This poses a problem as the number of teeth you have is tied to the general state of your health.

Teeth, elderly, dental care, oral health, 8020 campaign, Dr Kakuhiro Fukai, Star2.com

Dr Fukai, who is also the director of the 8020 Promotion Foundation, shares that oral health is a specific part of programmes to prevent dementia, diabetes and cardiovascular disease. — Photo: The Star/Faihan Ghani

Poor teeth, poor health

Japan is well-known as an ageing nation, with 27.7% of their population currently aged 65 and above, and an average life expectancy of 83 years. According to Fukai Institute of Health Science director Dr Kakuhiro Fukai,

“The goal of the Japanese government and health professionals is to not only expand life expectancy, but also to expand healthy life expectancy.”

Health life expectancy includes life expectancy, activities of daily living, social participation, healthy ageing and quality of life. “The main cause of decreased healthy life expectancy is disease,” he says.

“As you know, the major killer of human beings is non-communicable disease, so the most important thing is prevention of non-communicable disease. And the other is addressing the causes of long-term care, e.g. dementia and stroke.”

As it turns out, research has shown that maintaining good oral health is associated with increased life expectancy, as well as prevention of diseases such as dementia, diabetes and cardiovascular disease.

In fact, dental and oral health are not only some of the basic elements of initiatives to promote Japanese national health policies, but are also specifically included in national programmes to manage cancer, dementia and diabetic nephropathy.

There are also discussions to include oral health in the programme to prevent and manage metabolic syndrome.

Dr Fukai adds that many of the risk factors for non-communicable diseases like obesity and diabetes are the same as the risk factors for dental disease, so health education for dental disease also helps to prevent those diseases.

The dentist says: “If people lose their teeth, there is a change in nutritional intake. Those who have lost many teeth hesitate to take vegetables or fruits, and nutritional balance is destroyed. In addition, in people with poor oral status, the dietary pattern is very simple and poor; a healthy dietary pattern is difficult for those with poor oral health status.”

So, Dr Fukai explains, it was due to these factors that the 8020 campaign was started in Japan in 1989.

Easy access to care

Dentist Dr Makiyo Iwata notes: “If you have good oral health when you are young, you will retain more teeth when you get old. So we set the target 8020 to promote keeping more than 20 teeth at the age of 80. The reason for this number is that if you have 20 teeth at least, you can bite, chew and enjoy almost all foods, regardless of the texture.”

The Japanese Ministry of Health, Labour and Welfare Dental Health Division deputy director says that as of 2016, 51.2% of Japanese aged 80 have accomplished the goal of retaining 20 or more teeth. She suggests three keys to the success of this campaign in Japan. “First of all, we provide easy access to professional care and self-care.”

With Japan’s universal healthcare system, citizens can go to any dental clinic and receive treatment, while co-paying only 30% of the cost, which is also controlled by the government.

In addition, Dr Iwata says that local authorities provide dental check-ups for those aged 18 months and three years, school children, pregnant women and those over 75, as well as periodontal disease examinations for those aged 40, 50, 60 and 70 years.

Malaysia, according to Health Ministry Oral Health Division deputy director Dr Zainab Shamdol, has public dental health programmes covering toddlers, kindergarten pupils, school students, pregnant women, the elderly and those with special needs.

Malaysia has also achieved universal healthcare, and at public dental clinics, costs are subsidised up to 98% by the Government, with most standard outpatient dental procedures like scaling, crowning, filling and extraction only costing between RM1 to RM4.

Dr Iwata adds that self-care products like toothpaste, toothbrushes, mouthwash, dental floss, and even sweets, chewing gum and chocolates that contain the sugar substitute xylitol, which helps prevent tooth decay, are commonly available in drugstores around Japan.

Teeth, elderly, dental care, oral health, 8020 campaign, Dr Makiyo Iwata, Star2.com

According to Dr Iwata, the easy-to-remember catchphrase 8020 plays an important role in the success of the national Japanese oral health campaign.

Public buy-in

The second key is an evidence-based population approach.

Dr Iwata explains that Japan has introduced many of the recommendations for prevention of caries given by health bodies like the World Health Organisation (WHO) and the FDI World Dental Federation.

“For example, thanks to the cooperation of Japanese oral care companies, almost all toothpaste available in Japan contains fluoride. So clearly, this has contributed to the prevention of caries effectively,” she says, showing a graph that displayed an inverse relationship between the increase in the market share of fluoride toothpaste and the number of decayed teeth in 12-year-old Japanese children.

She adds: “Also, many schools have introduced fluoride mouthwash after lunch. As this approach targets all the students, this helps diminish health disparities for those from socially-disadvantaged families.”

In Malaysia, about three-quarters of the treated water supply has fluorides added to it to help prevent tooth decay in the population. Fluoridated toothpaste and mouthwashes are also widely available on the market.

Dr Zainab adds that the Oral Health Division also runs oral health promotion initiatives targeting specific groups like trainee teachers, smokers, universities and non-governmental organisations, as well as the general public. The last key, Dr Iwata says, is the easy catchphrase 8020.

“It is important to use a catchphrase that is easy to remember, easy to understand and easy to work on. 8020 is well-known among many Japanese because it fulfils all the criteria,” she says.

For example, school students regularly create 8020 campaign posters in art class and local Japanese authorities give awards to students with the best oral health.

“So you see that many people enjoy this campaign and try to join this national health movement by themselves. I think this component is very important as we need to involve all the people and make them step forward (to join the campaign). At the same time, the government enacts the overall promotion goals, and set other targets and details for the next step,” she explains.

While Malaysia does not have an overarching oral health campaign, initiatives like Ikon Gigi (iGG) and Transformation With 1Smile Together (TW1ST) target specific groups, as mentioned above.

Dr Fukai adds that another component to the success of the campaign is the attitude of the Japanese towards oral healthcare. For example, the number of Japanese who brush their teeth at least twice a day increased from 16.9% in 1969 to 77% in 2016, and more than half of Japanese (52.9%) aged 20 and above reported going for a dental check-up in the past year, in the 2016 Survey of Dental Diseases.

Teeth, elderly, dental care, oral health, 8020 campaign, Dr Zainab Shamdol, Star2.com

According to Dr Zainab, dental healthcare is provided by the Ministries of Health, Defence and Higher Education respectively in the public sector, while 36 of Malaysian dentists are in the private sector.

Areas to improve

However, Dr Iwata notes that they need to improve on delivering oral healthcare to the elderly.

“Now, one out of four people is over 65 in Japan and this rate is estimated to increase in the future. Therefore, we need to think how to provide oral healthcare services to the elderly. Even if they become bedridden or inpatients at the hospital, we have to deliver appropriate care to improve their quality of life.

“So now, we are working on providing oral healthcare efficiently and effectively to them, and also, to find a way to collaborate with other healthcare providers such as medical doctors, nutritionists and other allied health specialists.”

Another issue she says, is to decrease the healthcare disparity, especially among the younger generation.

Dr Iwata, Dr Fukai and Dr Zainab were all speaking at the recent Oral Healthcare Seminar 2018 held at the residence of the Japanese Ambassador to Malaysia, and organised by the Malaysian Association of Dental Public Health Specialists, Embassy of Japan in Malaysia and Japan’s Ministry of Economy, Trade and Industry, in cooperation with the Association for Overseas Technical Cooperation and Sustainable Partnerships, Japan.