Will Technology Change the Dentistry? -The reality and its backgrounds-

Outline of this feature

When was the last time you saw a dentist? If you visit a dentist for the first time in a while, you might feel the evolution of technology. In dentistry, various treatments are provided for oral health, from prevention to treatment depending on the situation. It includes treatment of cavities to oral diseases relating with general status, preparation, and adjustment of dentures (artificial teeth), regular checkups, and cleaning. To understand technological progress related with dentistry, we need to broaden our perspective even its social aspects, such as the cases in which self-pay treatment is required due to restrictions of public health insurance and the application of technology from industries and medicine.

Processing of prosthetics essential in dentistry
If you have ever undergone dental treatment, you might have had a missing tooth fixed with a “crown” or denture. What are used for this are called prosthetics, which are essential parts of dental practice. Prosthetics can be said to be artificial organs, artificial limbs, and artificial legs in the medical field. Prosthetics are fabricated by nationally licensed dental technicians.

Prosthetics is not just to look like a tooth but also is a functional form supporting the bite force, which is said to be as much as your body weight and assuming the movement of the jaw joint. This requires a high level of skill. Some of you might remember taking a tooth mold at the dentist's office using clay-like paste called impression material that hardens in your mouth. In many cases, prosthetics are made using dental plaster replicas based on this tooth mold with a lot of time and effort. You would feel uncomfortable even if you chew a single hair in your mouth, but prosthetics can require even more precision than that.

As a dentist myself, I have practiced cutting wax into various tooth shapes when I was an undergraduate. Also, when a resident, I was trained to make fillings by casting metal and produce dentures based on the theory with advice from my advisor. In consideration of these experiences, prosthetic fabrication is an artisanal skill that requires academic knowledge and years of experience. Currently, I have outsourced production to a dental technical workshop, but I do my best to provide treatment that allows for smooth communication with them.

Impact of Changes in Workforce and Global Economy on Prosthetic Processing

Nowadays, the world of dental prosthetics is undergoing a digital transformation. One of the techniques that have been particularly popular in dentistry in recent years is CAD/CAM (Computer-Aided Design / Computer-Aided Manufacturing). CAD/CAM is a technology that designs prosthetics using computer software and processes them using a control program, which used to be done by hand. Another new technology rapidly being adopted is 3D printing. This technology widely used in architecture, aerospace, and other fields, has also become a new player in dental processing, which requires custom-made products.

One of the reasons behind this is the decrease in the number of dental technicians. The age group of over 50 accounts for 50% of all dental technicians that support dentistry with their craftsmanship skills. There is also a problem of early turnover of qualified employees. Further, due to the declining birthrate, there are indications of a shortage of workers in the future. *¹

Another issue is the soaring prices of metal materials. In particular, the recent rise in the cost of palladium, which is one of the metals used in so-called silver teeth and has long been used in insurance treatment, has attracted much attention. The reasons are said to be the increased demand for palladium, which is used in catalysts to purify automobile exhaust, due to strengthened regulations from the global decarbonization movement. Furthermore, the economic uncertainty caused by the Covid-19 pandemic has led to a concentration of speculation on metals as a safe asset. *²

Some view that the problem of the backwardation of material costs relative to treatment fees caused by palladium issue has influenced the easing of the insurance coverage conditions prosthetics designed with CAD/CAM using non-metallic materials. In addition, it is said that white teeth are preferred, and metal is not used much in dental treatment in countries other than Japan.

The Cost of Dental Treatment in Other Countries
Some say that the cost of dental treatment is high, but how is it worldwide? According to the Consulate-General of Japan in New York, it costs about $1000 per tooth in the U.S.*³ On the other hand, under the NHS (National Health Service) in the UK, where most treatments are free, 1,000 dentists enrolled left it last year due to a lack of financial resources and other problems.*⁴ When I treat patients living abroad who are temporarily back in Japan and patients from abroad, I realize that dental treatment varies depending on the circumstance of the country.

Dental treatment is influenced by technology and the economy. In 2020, the Japan Dental Association also published a proposal as a vision, looking at the use of information and communication technology (ICT), diagnosis by AI, and new technologies in dental practice. *¹ Now, it seems that the dental industry is undergoing a significant transformation from manual to digital work, but what is the reality? In this series, I would like to share the changing dental technologies from the eyes of a clinician.

(To be continued to the next article)

【Source】

*1    Japan Dental Association, 「2040年を見据えた歯科ビジョンー令和における歯科医療の姿ー」 October 2020, https://www.jda.or.jp/dentist/vision/pdf/vision-all.pdf, Last Accessed 26 January 2022.
*2    Hyogo Medical Practitioners Association, 「2020年3月15日（1936号） ピックアップニュース」　兵庫保険医新聞, 15 March 2020, http://www.hhk.jp/hyogo-hokeni-shinbun/backnumber/2020/0315/070001.php, Last Accessed January 26 2022. 
*3    Consulate-General of Japan in New York, "Medical Overview," https://www.ny.us.emb-japan.go.jp/jp/g/01.html, Last Accessed 26 January 2022.
*4    Gaby Bissett, "Almost 1,000 dentists left the NHS last year," 20th Jan 2022, Dentistry Online, https://dentistry.co.uk/2022/01/20/almost-1000-dentists-left-the-nhs-last-year/, Last Accessed 26 January 2022

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