OSAKA - Japan’s cities appear filled with dental clinics, yet experts warn that their numbers may soon decline, raising concerns that the country could eventually face a shortage. Tooth decay has decreased in recent years while periodontal disease has become more common, and as these trends reshape the market, the operating environment for dental practices is deteriorating.
What exactly is happening? Nakai Daisuke, a dentist who runs Nakai Dental Office in Kishiwada, Osaka, explains the latest situation.
Last year, the number of dental clinics that went bankrupt, suspended operations, or dissolved reached 145, the highest on record. Several factors are driving this trend, beginning with the aging of the dental workforce. In 2002, dentists in their 60s accounted for 8.1% and those 70 or older for 7.8% of the total, but by 2022 these shares had climbed to 23.1% and 12.5%. Today, roughly 35% of dentists are aged 60 or above. According to Nakai, dentistry has gained a reputation among medical students as a field that does not generate sufficient earnings, and declining popularity is leaving fewer young dentists to replace retirees.
Nakai notes that dental clinics have become polarized. Practices that rely primarily on insurance-covered treatments operate on a low-margin, high-volume business model, which has become increasingly difficult to sustain as labor costs, material prices, and utility expenses rise. He explains that unless clinics expand their non-insurance services, maintaining stable operations will remain challenging. This financial pressure is discouraging young people from entering the field, and some dental schools are unable to fill their enrollment quotas.
Oversupply is another issue shaping the industry. There are now about 66,000 dental clinics in Japan, far exceeding the roughly 57,000 convenience stores nationwide. With so many clinics competing for a shrinking pool of patients, profits per clinic are inevitably squeezed. The roots of this oversupply go back to Japan’s rapid economic growth in the 1960s and 1970s, when increased sugar consumption led to what was dubbed a “flood of cavities,” prompting the government to increase the number of dentists.
However, cavities have sharply declined. Around 30 years ago, nearly 90% of children aged six to eight had tooth decay, but by 2022 the share had dropped to below 30%. Widespread dental checkups, improved brushing habits, and fluoride application have all contributed to the decrease. Nakai adds that the declining population of children is further reducing the number of young patients.
Although cavities have decreased, periodontal disease is becoming more widespread. This inflammatory condition is caused by bacterial infection and damages the gums and the bone supporting the teeth, eventually leading to tooth looseness and loss. It is recognized by Guinness World Records as the most common infectious disease globally, and the WHO estimates that roughly one billion people suffer from severe periodontal disease. Softer diets, reduced saliva production, and the rise of unconscious mouth breathing— which dries the oral cavity and weakens natural antibacterial defenses—are believed to be contributing factors. Nakai warns that unlike cavities, periodontal disease causes little pain and often remains unnoticed until significant damage has occurred. He notes that half of tooth loss cases are caused by periodontal disease, and because tartar cannot be removed by brushing, professional cleaning should ideally be done at least once every six months.
Dental technicians, who fabricate and repair dentures and fillings under dentists’ instructions, are also declining in number, raising concerns that dentures may become harder to obtain. The workforce shrank from about 35,000 in 2020 to around 31,700 in 2024, a sharp drop in just four years. Nakai believes that reduced dentist visits during the COVID-19 pandemic played a role, but the longer-term issue is aging among technicians, more than half of whom are now in their 50s or older. Young people tend to avoid the profession because of long working hours and low pay, with one female technician lamenting that her hourly wage amounted to about 600 yen. Nakai points out that because technicians must work extremely long hours to earn a livable income, many quit, resulting in a turnover rate of about 70%.
This shortage is already affecting patients. While it typically takes about one month to complete a set of dentures under insurance coverage, one man reported that a remake took two months, forcing him to continue using an ill-fitting set that eventually led to stomach ulcers. Nakai explains that prolonged difficulty chewing reduces saliva and burdens the digestive system; in elderly patients, it may also contribute to cognitive decline.
Looking ahead, Nakai believes dental clinics must shift from being places people visit only when a cavity appears to facilities that support regular maintenance, which is essential for preventing periodontal disease. He predicts that although the current oversupply will ease as clinic numbers decline, shortages are likely to develop in regional areas within the next five to ten years.
Source: ABCTVnews
