A Comparison of Oral Health in Japan and Germany and Its Cost Efficiency

Abstract

　Background：Both Germany and Japan have statutory health insurance systems which cover dental care to a large extent. Comparison of the oral health of the general populations as outcome offers the possibility to compare the performance of the systems. Both countries have repeated cross-sectional, representative oral health studies, on which these comparisons can be based.

　Materials and Methods：Deutsche Mundgesundheitsstudie（DMS III, DMS IV, and DMS V）studies are cross-sectional, multi-center, nationwide representative studies to investigate the oral health status of the German resident population. Study participants are adults（35- to 44-year-olds）and seniors（65- to 74-year-olds）. Surveys of Dental Diseases in Japan（SDD）are also cross-sectional, representative studies. We selected the 1999, 2005, 2011 and 2016 SDD waves and restricted our analysis to same age groups as in Germany.

　Results：German adults had 25.3 teeth in 1997 and 27.2 in 2014 and Japanese 27.2 in 1999 and 28.3 in 2016 and in German seniors the mean number of teeth increased from 10.1 to 15.5 and in Japanese seniors from 14.7 to 22.7 including wisdom teeth.

　Conclusion：Adult and senior Japanese citizens have more remaining teeth than their German counterparts. This may be dependent on a more favorable risk profile（education, smoking, metabolic factors）, informed decision making, a 30％ copayment of all treatment costs, a higher dental work force（more hygienists）, incentives for periodontal maintenance visits. For each German the expenditure for dentistry was 216 € in 1997 and 302 € in 2014, whereas for each Japanese the expenditure was 178 € in 1999 and 195 € in 2016. Overall it seems, that Japan uses the dental expenditure resources more efficient than Germany in terms of tooth retention.