Regional inequalities in accessing dental care in Japan

Iveta Ramonaite, Dental Tribune International

Wed. 14. July 2021

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TSUKUBA, Japan: Healthcare can be considered a right or a luxury, depending on one’s location. Although essential for maintaining good health, healthcare is not readily accessible to all as certain barriers might greatly hinder access to certain healthcare services, including dentistry. For example, researchers in Japan have recently found that, although the country is economically developed and has a large dental workforce, there exist socio-economic inequalities that discourage patients from actively seeking preventive dental treatment.

“In the 1960s, Japanese society experienced a shortage of dentists, and the government adopted a policy of increasing the number of dentists in the country. As a result, Japan now has one of the largest numbers of dentists in the world, ranking eighth among Organisation for Economic Co-operation and Development member countries,” first author Kento Taira, a researcher in the Department of Health Services Research at the University of Tsukuba, told Dental Tribune International (DTI).

First author Kento Taira. (Image: Takahiro Mori)

“Nevertheless, in recent years, government sample surveys have indicated that inequalities have appeared in dental and oral health in Japan, and dental care supply and socio-economic factors have been mentioned as possible causes. Despite this, there has been little research on the utilisation of dental care at the nationwide level. In addition, there has been a lack of the public surveys that would allow for a national-level study,” he continued.

According to Taira, the incidence of dental caries has been steadily decreasing in the country. However, the ageing of society and the subsequent increase in the number of remaining teeth in the elderly population has led to an increase in the incidence of periodontal disease and has altered the demand for dental care in the country. As a result, the provision of home dental care for the elderly population and oral function management for hospitalised patients have become important in Japanese society.

Accessing dental care in Japan

To learn how people access dental care and what type of treatments they seek, the researchers used 216 million pieces of data that spanned almost a year, from April 2017 to March 2018, and included indicators such as outpatient visits, use of outreach services and seeking treatments such as dental fillings and dentures. The data was examined in different regions in Japan, and the researchers sought to understand whether certain socio-economic factors, such as income and education, influenced the results.

Co-author Takahiro Mori, associate professor in the Faculty of Medicine at the University of Tsukuba in Japan. (Image: Takahiro Mori)

“This study is the first national-level analysis of differences in dental care utilisation using information from a medical insurance claims database that covers almost the entire population,” Taira noted. “The current study showed that there is large regional inequality in the utilisation of dental care in Japan for periodontal treatment and outreach services,” he commented and told DTI that he was taken aback by the findings since Japan boasts numerous dental institutions and has a large dental workforce.

“However, this regional inequality was less noticeable in urgent and essential dental treatments such as tooth extraction, pulp extraction for severe caries, and occlusal restoration treatment such as dental bridges and dentures,” he noted.

The researchers also found that income and educational level had a direct correlation with seeking preventive dental treatment. Namely, those people who lived in areas that showed lower income and education level were less likely to seek dental care such as treatment for periodontal disease or calculus removal. The researchers noted that in those poorer areas, dental diseases may have already reached an advanced stage by the time the patient visits a dental clinic. Subsequently, such patients often require occlusal rehabilitation and find it difficult or even impossible to preserve teeth.

Implications for dentistry

The findings carry considerable implications for dental care in Japan. According to co-author Prof. Nanako Tamiya, chair of the Department of Health Services Research at the university, failing to seek dental treatment could make it more difficult for people to preserve teeth and could eventually lead patients to require more severe treatment. “Knowing these inequalities is a key first step in righting them,” she said in a press release.

Co-author Prof. Nanako Tamiya. (Image: Takahiro Mori)

“We believe that the current dental system in Japan needs to change to maintain the balance between supply and demand by foreseeing the future changes in the disease structure, such as the increase in periodontal needs among adults and elderly people, and the needs of patients who have difficulty accessing dental care,” Taira noted.

“The results of our study provide essential and fundamental information for the consideration of a dental care system that is adapted to future social needs. We believe that the results of our study will have an important influence on policymakers in terms of reducing regional and socio-economic inequalities in order to change and construct an appropriate dental care system for Japanese society in the future,” he concluded.

The study, titled “Regional inequality in dental care utilization in Japan: An ecological study using the National Database of Health Insurance Claims”, was published online on 13 June 2021 in the Lancet Regional Health, ahead of inclusion in an issue.

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