5. Assigned to a clinical professor at Nihon University Dental School

I entered Nihon University in September 1958 expecting to teach dental students but the school founder, Dr Sato, had other plans at his age of 80+ years. At the age of 32 I became a professor and acting chief administrator of the dental hospital at Nihon (Japan) University. Dr. Sato wanted a report of my appraisal of the school within 6 months. It took 6 years of schooling to have the right to take a test to be a government licensed dentist in Japan. Each class had 200 students so 200 X 6 = 1200 undergraduate students. In addition we had 200 graduate students performing research for 4 more years to get a ‘hakase go’ (PHD). They were in the dental school for 4 (or more) years as professor’s slaves where professors got the credit for much of their work. We professors were well set.

My appraisal report to Dr Sato included the building, equipment, instruments, patient experience and policy on patient examinations, treatment plans, treatment method and treatment outcomes. In 1958-1960 Japan was still a poor country in technical resources for health care. I was frustrated with this mixed with the health ministry policy for patient care that was standardized from the 4 original deans who installed the system that existed in the Chicago Dental College in 1900!! Student requirements for patient care in all dental schools had never been changed until I arrived. The US army had issued orders to change the patient care pattern during the US occupation of Japan but they did not work daily in the schools so nothing changed.

My 1st year report on the building to Dr. Sato included- The building was well built but needed some repair that included broken windows from the USA bombings during world war II. Plaster flakes from the high ceiling were dropping on the clinic patients, students and floor so I proposed that a class of 200 students brush and clean the ceilings walls and windows to make them aware of cleaner environments. Sato OKed a clean-up day. The students and I were having a royal time until suddenly we were ordered out by a faculty committee chairman who felt it was beneath the dignity of university students to be working on the clinic environment. Fortunately we were ordered out late in the day so the job was almost done. A professor raised on a farm might assume that some heavy muscle work with students who only studied to enter a university is part of a good education. (I agreed with Mao’s move in China to ship university teachers to farms for a few years).

School clinic equipment was centered on patient seats with slightly tilting back rests for upright patients. This was the same as my school in Oregon. All dental students in Japan stood in front of the patient while stabilizing their operating hand with fingers on the soft cheeks and chin for all treatment. I asked Dr Sato why these unstable finger contacts were adopted for dental treatment. He answered that the biggest killer in Japan was tuberculosis, so dentists must avoid finger contacts in the mouth. When I arrived that was no longer true so I felt free to put student’s fingers in the mouth. At Oregon U we stood in front for lower teeth and behind the patient with use of mouth mirrors for upper teeth. I asked several international companies to donate some high speed handpieces if I bought some of them. (the school claimed they could not afford it). I had adopted treating flat patients while seated at the top of the patient heads with surgery tables at the Navy hospital with a finger contact adjacent to the instrument-tooth contact so I had no problem with this stabilized control of instruments. However we withdrew high speed for awhile at Japan (Nihon) University when we saw students cutting adjacent teeth and doing more harm than good to patients from wrong positions and no finger tooth contacts. Nothing could be done at that time to install equipment designed for better finger control with patients in a flat full rest (sleeping)  position and students seated at the top of horizontal patient’s’ heads. No company made such equipment, government ministry standards existed and most difficult are the resets of school faculty habits. Three years later they decided to make a new building when the Japan economy boomed from making western style buildings, good quality cars, good cameras, USA orders for the Vietnam war, the ‘bullet train’ and preparation for the Tokyo Olympics.

I was appointed as one of five members to the new building planning committee where 50% of the 2nd floor was allotted to a clinic for me and my graduate students. I learned a lot about building engineering and lost a lot of respect for architects in that role.

Patients in my existing school clinic were mostly embassy and international business people. I generally treated patients there from 3PM to midnight because I could not think of a better way to pass time. It also helped the school with the higher salary I was being paid. After a short time the school was making a profit from me so they updated and extended the clinic. People from other countries sometimes asked why I was working in such a poor country when financial conditions for dentists were much better in the US. The Minister of Economics in the US embassy was curious about where I lived so late one late snowy night after his dental appointment he took me home in his limousine. I invited him into my 1 room home in a carpenter’s house. It was typical Japanese with a hibachi pot containing charcoal over sand for warming the hands, making green tea and cooking. I was living with a dental hygienist who I later married. We had a few shelves for canned food and floor mats to sleep on and sit on. That was it. The Minister reported this to many in the multi-embassy party circuit about their embassy dentist. Jet plane airlines began to fly, so shortly patients were referred from many countries where I became exposed to worldwide dental treatment for wealthy people in the jet set. These rich people had been often sold on high risk treatment that required complicated replacements.

The embassy party circuit can keep a person occupied. After a few parties at ambassador and minister homes I sent my secretary as my representative to the parties. Her attractive personality and love of parties was a hit, so nobody missed me. I enjoyed the nights with my fingers in patient mouths.

My reports to Dr. Sato on school instruments, medicines, patient experience and treatment patterns resulted in appointments as committee chairman for school instruments, medicines and student treatment requirements.

Introduction of hygiene care :
The best I could do was to assign 10 students per day for 8 hours to my personal clinic where they saw recordings of examinations, full mouth treatment plans and consultation at a table, detailed mouth cleanings including selfcare with tooth brushing, fillings, surgery, patient appointments and dentist-patient positions that did not then exist in Japan. The daily patient for demonstrating tooth cleaning was a student selected as having the dirtiest mouth (unsaid) from 10 open dirty mouths while students stood at a wall on entry each morning. Students and faculty did not brush their teeth for good reason. Two companies had just started making tooth brushes and had not yet approached dental schools. The hygienist would clean one side of the mouth with tooth scrapers and fine sand called pumice which then contrasted sharply with the other side and gave self care instruction. It was up to the students to find a way to clean the other half but their half clean-half dirty mouths motivated them to get classmates to finish the job.. 200 students at 10 students per day took 20 days. We had no problem finding dirty mouths during the first week of 50 students. The second week we could find no dirty mouths!! The students had a class meeting and decided to clean their classmates’ teeth with scrapers and polishing before coming to my clinic! This is the way dental hygiene was introduced into the schools of Japan because the next year several students exposed to this became instructors in other schools with the added rule that 16 medicines on every student tray were removed and were replaced with a toothbrush.  The two tooth brush companies arranged big dinners for the hygienist (Yoko Mito) and me. Yoko later established the Japan Hygiene Association to reset hygiene school curriculums and clarify the duties of hygienists. Her classmates had learned to perform all procedures performed by dentists. Yoko filled teeth and performed extractions on her dentist teachers in hygiene school because they could see she had well controlled fingers. Two dentists started giving practice management courses on how to get rich by having hygienists do everything on patients while dentists filled out the paper records. At that time there were only 6 dental schools in Japan so that was one reason why rules were loose. Yoko succeeded in government rulings that reset hygiene school curriculums and reducing misuse of hygienists. I was the main speaker at the 1st meeting of Japan hygienists. I collected some detailed data on what hygienists were doing and reported it on a blackboard on the stage. Government officials were there who reported me to the Dean that I was not performing in the role of a professor.

Dr. Sato and the Vice Dean Dr. Nagai decided to appoint me as chairperson of the instrument, clinical treatment requirements and, pharmacy committees. As a result the school was placed on probation by the Health and Welfare Ministry because we changed so many things they could no longer renew periodic accreditation with the existing Japan standards. I had agreed to stay for 2 years but agreed to stay longer to help the school get off probation plus help settle some hot relations that split the faculty and students for and against the changes in patient treatment. High points in the split included a faculty planned strike of senior students against my changes and my bans on the use arsenic acid, shell crowns and 16 medicaments on the trays of all students. The student strike during the 1st year of my stay was averted by Shoji (Dr Shoji) who was a senior class director. He came to my office to announce a student strike scheduled one week later. The main reason was that my new clinic treatment requirements were not acceptable in the Japan culture and impossible to fulfill. They were a fraction of the Oregon requirements. I noticed that he had big cavities in his unclean mouth. I asked if he minded if I recorded the problems in his mouth. He consented. I then laid out 3 treatment plans. 1. What he would want as a patient. 2. What he would get in the school with my proposed student requirements 3. What he would get if the school reverted to the requirements established in 1900. He then accepted my proposal to fill 2 cavities in his mouth in one appointment instead of nerves being devitalized with arsenic acid and crowned with ready- made shells with the previous student requirements in at least 8 appointments. It was up to him to convince the class one way or the other. He returned later to say he was convinced about my proposed changes and he was going to cancel the strike. I felt that strong feelings existed in the class and apparently in the faculty so I proposed that he bring 10 well respected students to review what he experienced and perhaps some of them might prefer fillings with local anesthesia instead of arsenic acid. The additional students agreed and the students overruled the interest of the faculty members that I later found had planned the strike. The students decided whether I would stay longer in Japan for good or ill. At least 80+ years old Dr Sato was happy about the result.

These moves caught attention in all dental schools and the Health Ministry. I became the main speaker in the all-school professor meetings. A comparison of the student clinical requirements in 1958 and 1963—65 can indicate the impact of my activities with Japanese schools at that time.

Formation of dental study clubs:
In addition we established study clubs in several cities that were adopting my concepts of treatment plans based on 4 objectives of dental treatment, 3 scopes of analysis and other given numeric rules for patient care. I started placing everything in numeric orders because I found that the numbers were best remembered and saved a lot of translation especially with the unhandy terms we memorized in dental schools. The numeric orders per se led much to associative reasoning and made a good structure for problem based learning. One numeric set later caught the attention of WHO directors. The one-digit set provided a health oriented scale for health care records with 0 representing health. However the numeric order of 4 mouth treatment objectives anchored my reputation among Japanese dentists.  Objectives 1 (hygiene) 2 tissue resistance 3 favorable mouth forces 4 desired mouth appearance were highly defined in the course and dimly remembered. But decades later objectives 1,2,3,4 are clearly remembered.

In 2000 I was awarded a medal and sash from Japan’s Emperor titled ‘The Order of the Sacred Treasure’. The recipient’s background is extensively and secretly investigated beforehand. I was nominated by the Education Ministry, so I assumed that the award was granted for resetting the treatment pattern of Japanese schools during Nihon (Japan) university days. However my moves with students, study clubs and outside of school meetings were controversial as a professor, so I assume these were reasons for deleting that recognition from the award. My visa then was limited to only the role of a professor in a given school. A person involved in the investigation later said the medal was granted on my contribution to research and education in dentistry. I developed the way to collect data from linkage of body and environmental conditions for precise finger control in the 1970s-80s This data confirms a principle for finger centered skill with coordinated eye views of work points and everything used for procedure.

 

1962 Back to Alaska –
In 1962 I went to Alaska. An Oregon U school mate had made a medical-dental clinic and he wanted me there. He was a great salesman because I had no idea to go Alaska. He came to Japan claiming that dentistry was fast changing in the US and I had better go back to catch up. I found later that the ‘latest’ was based on invalid assumptions, but I had promised to go for one year. He assumed that I would stay because Alaska income was much higher than in Japan but climbing money and possession ladders were not central interests to me and I found the discussions in weekly meetings with Alaska dentists boring with their talk about their airplanes, money and other possessions so I returned to the Japan University through Hong Kong.

I stayed a few weeks in Hong Kong because of a Justice Ministry investigation about my unwarranted activities in Japan as a professor. I enjoyed working in Hong Kong with my Chinese classmate where fortunately I had a dental license there from a previous visit. This 3rd investigation again worked to my benefit because they concluded my activities were a net benefit to Japan, so I was given a visa that allowed much freedom outside of the university.

 

The party to celebrate decoration of the Emperor’s medal, 2000