Staying healthy in Japan

Features Health - May 12th, 1989

by Elyse M. Rogers

THE KASUMIGASEKI DENTAL CLINIC

Imagine my surprise when I saw a notice in our own Tokyo Weekender about a new dental clinic that had English-speaking dentists and was eager to serve foreigners, particularly young foreigners. Usually new denial or medical services come to the pages of this paper via my column, but I was delighted to see this service actively reaching out to the foreign community.

Almost at the same time that the notice appeared, long-time Tokyo residents Kaz and Hal Drake wrote to tell me about this wonderful new dental clinic they’d discovered. So, it was with great delight and interest that I visited the Kasumigaseki Dental Clinic and talked with Osamu Toki­wa, D.D.S. Dr. Tokiwa is not only a competent dentist who speaks good English but he has the additional special qualifi­cation of being qualified by the American Board of Pedi­atric Dentistry, as a result of his course in pediatric dentistry at the University of Southern California.

HISTORY OF THE CLINIC

The clinic was started by Dr. Tetsuo Notomi who was graduated from Tokyo Dental College in 1955 and spent three years doing post-graduate work at the University of Southern California and the University of Washington. When the doctor returned to Japan he taught as a full-time instructor at Nihon University Dental School and tried to pass on the practices he had learn­ed. But he recognized that because of the dental-education system in Japan that new graduates needed additional training to practice good den­tistry.

In 1960 he began giving practical, post-graduate training, to private dentists, mainly in the area of prosthodontics, at his Kyobashi Clinic, In 1968 he opened the Kasumiga­seki Dental Postgraduate Cen­ter, to continue the post­graduate education of dentists in Japan. In May, 1970, he established a professional rela­tionship in science with the University of Southern Califor­nia and began the exchange of dental instructors.

In April of 1985 the post­graduate center was recognized and became The Kasumiga­seki Dental Postgraduate Cen­ter, authorized by the Ministry of Health and Welfare.

The Kasumi­gaseki Dental Clinic was opened in 1987 to pro­vide service to the public ant to help train the dentists studying in the postgraduate programs.

I was curious about the fact that the postgraduate center was established because Dr. Notomi had felt that “Japan­ese dentists needed more train­ing because of the educational system.” I asked Dr. Tokiwa to explain.

“In the United States den­tists are involved in clinical practice at the dental school-almost  for their entire  pro­gram. But that is not true in Japan. Most Japanese dentists complete dental school with much less practical experience; our programs are more re­search-oriented. Therefore, most newly graduated dentists need to hone their skills under the guidance of dental profes­sors.”

THE CLINIC & STAFF

At the Kasumigaseki Dental Clinic there are six dentists practicing regularly in the clinic (plus the 10 dentists studying in the full-time post­graduate program). The three dentists who speak English are probably of most interest to foreigners here: Dr. Tokiwa, the pediatric dentist. Dr. Maesumichi Notomi, the son of the clinic’s founder and a periodontist, and Dr. Hideki Hirayama, an endodontist.

Just to refresh your memory, pediodontists take care of children, periodontists special­ize in gum problems and endodontists do special pro­cedures such as root canals.

The clinic is a spacious one, with a comfortable waiting room, eight dental chairs in individual compartments, a private waiting room/office and examining room for the older Dr. Notomi, a private examining/treatment room for pediatric patients, and a large classroom and laboratory for the postgraduate medical students.

PEDIATRIC ROOM & PHILOSOPHY

The pediatric room may be of special interest to parents of young children under 14 years of age. Dr. Tokiwa takes his role of caregiver to children very seriously and has a room designed to put his small charges at ease. A grinning Snoopy with braces beams from the wall, stuffed animals sit in a basket nearby, and to make the walk down the nar­row corridor to the room less formidable, cheerful stuffed toys line the walls.

Dr. Tokiwa says his philo­sophy is to “tell, show and do.” In other words, he explains first, then shows what instru­ments he will use, and then docs the procedure. He also believes strongly in the “total oral” concept of dentistry, in that he does not just examine the young patient’s teeth for possible cavities, but looks at the whole mouth/jaw/ tooth structure relationship with the idea of making sure the patient winds up with the best possi­ble dental/mouth health as an adult.

For example, the practice of orthodonture, he believes, is a part of the whole dental health process and not simply a cosmetic specialty.

In regards to orthodonture, he feels that earlier orthodon­ture often makes sense for children and that it can con­siderably reduce the course of treatment. For example, he says that average boys reach the peak of their growth from 14-15 years and girls from 11-12 years. Often you can start braces two-three years before this peak and take ad­vantage of the rapid growth period to accelerate the course of treatment.

Dr. Tokiwa cautions that every child is different so that “accelerated treatment” is not always possible or wise: each child must be individually evaluated to see if she/he would benefit from that program.

I was pleased to hear Dr. Tokiwa talk about the prob­lems of total oral health in relation to orthodontics, since problems after braces can happen. “The child grows up and his face and mouth change with age. We must be very careful that we plan for this so that in later life the teeth remain healthy and functional.”

As you would expect, Dr. Tokiwa is very interested in preventive dentistry and advises his patients to come in for regular twice-yearly exami­nations. At that lime he gives fluoride treatments since there is no fluoridated water in Japan, Fluoride toothpastes are available here now, how­ever, and he recommends those also.

In order to make sure the children have a positive ex­perience, the doctor lets them look at and handle some of the equipment, and suggests that parents bring their child in early for a “friendly visit.” According to Dr. Tokiwa, if the children have a positive experience the first few times at the dentist, they are not fearful; however, if the initial experience or experiences are bad, the child will remain fearful of the dentist even as an adult.

HOURS & FEES

The clinic is open from 10 a.m. to 5 p.m. Monday, Tues­day, Wednesday and Friday. Sometimes weekend appoint­ments are possible. Call ahead for an appointment. Since the receptionist doesn’t speak much English, ask for Dr. Tokiwa or Dr. Notomi if you don’t speak Japanese. (Simply say, “Tokiwa-sensei onegai shima-su” or “Nihongo hanashimasen kara, Eigo hanasu sensei one­gai shimasu.”)

The clinic does accept Japa­nese national health insurance (kenko hoken) if you have it, or they will fill out forms for private insurance coverage. Even if you have national health insurance, some treatments are not covered, such as orthodonture. In addition, some materials used in treat­ment are not covered: for example, gold crowns or inlays are not reimbursed expenses, although crowns and inlays made with less expensive ma­terials usually are.

Fees vary according to the type of work needed, the materials used, etc. The dentists are happy to discuss fees before treatment is started, so be sure to ask if you’re worried about the total bill. Some ball­park figures are listed below:

  • Child or adult routine examination: ¥10,000.
  • Orthodontic examination and evaluation: ¥30,000.
  • X-rays:  ¥1,000  for one, ¥10,000 for full mouth.
  • Gold inlay:      ¥28,000-¥38,000.
  • Root canal therapy:  ¥22,000-¥48,000.

Remember—a lot depends on the situation. An anterior tooth root canal is the least expensive with a bicuspid root canal being more expensive and a molar the most expen­sive. Also, if it’s a root canal that has been done by another dentist and failed, that’s more expensive since it’s more dif­ficult to do.

LOCATION OF CLINIC

The clinic is conveniently located on the 12th floor of the Kasumigaseki Building. The building is not only near­by many foreigners’ homes, it’s also a well-known landmark so it’s easy to find. Presently there are no English-language signs downstairs, or even up­stairs (until you get to the waiting room) but Dr. Tokiwa promised to change that in the future.

For the present, go up the elevator to the 12th floor and proceed to the hallway that leads to Linguarama Executive Language Schools. Follow that sign until you pass the lan­guage school, and the next office is the clinic. It’s marked only (in romaji) as The Japan Postgraduate Dental Center, but that’s the clinic entrance as well.

Kasumigaseki Dental Clinic. Kasumigaseki Building 12th Floor. 2-5-3 Kasumieaseki, P.O. Box 30, Chiyoda-ku, To­kyo 100. Phone 581-9197.