BehindTheMedspeak: Why Japanese people smile with their mouths closed (they have terrible teeth)

You'd think people in a country as esthetically conscious and economically developed as Japan would have excellent teeth - and you'd be dead wrong.

I never noticed during my junior year abroad in college, when I lived and went to school in Tokyo, but it turns out Japan's a first-world country with third-world teeth.

Wait - did someone say intellectual arbitrage?

Didn't think so. Where was I?

Teeth. Focus on teeth.

Nobuko Juji and Mariko Sanchanta wrote about this surprising, unexpected phenomenon in this past Tuesday's Financial Times; the story follows.

Japan starts to get down in the mouth over its crooked teeth

Many Japanese women have the habit of demurely covering their mouth with one hand when they giggle.

To the casual observer, the gesture appears to be just another manifestation of the rigid politeness for which Japan is famed.

But peer behind the hand, and the reason becomes clear: it is often an attempt to conceal a mouthful of crooked teeth.

Despite Japan's economic clout and the technological prowess of its companies, experts contend the country's dental services - and the teeth of its people - have made little progress.

The Japanese, along with the British, share the ignominious distinction of having the worst teeth among G7 nationals.

Some experts contend that certain developing nations boast better dental services than those available in Japan.

"The Japanese have much poorer oral conditions than not only westerners but people in less economically developed nations," says Dr Kazumi Ikeda, an orthodontist who has practised in Tokyo for more than 20 years.

"You would be horrified if you examined the smiles of those who appear on TV or in magazines, all dressed up."

But in recent years, young Japanese have become more self-conscious about the appearance of their teeth, some influenced by the blinding white smiles of American pop and film stars who grace the covers of local magazines.

Teethart, which specialises in teeth whitening services (or "teeth manicure", in its parlance), opened its first office in 1995 in the posh Ginza district, and now has 12 salons in Japan.

The number of its patients has swelled from 1,000 in 1995 to 17,000 in fiscal 2003.

Capitalising on the Japanese habit of lightening and whitening their skin (known as bihaku, which literally means "beautiful white"), Teethart promises to whiten women's teeth to match their epidermis.

"Just as your skin is white, wouldn't you like to have white teeth?" asks a Teethart brochure.

Meanwhile, an increasing number of Japanese are opting for corrective orthodontic work later in life, often in their 20s and 30s.

Yuko Shinta, 27, who works at a call centre in Tokyo, was fitted with braces this summer.

Ms Shinta, petite and soft-spoken, is splitting the Y1m ($9,600, €7,300, £5,100) cost - not covered by Japanese national insurance - with her parents.

"I was actually more self-conscious about the thought of wearing braces as a child and didn't want them," she says.

"But now, at this age, there aren't too many things that can embarrass me any more."

But why are Japan's dental services so shoddy to begin with?

The answer is the country's healthcare system and the dental educational system.

The government sets dental fees, which promotes inefficiency.

There is little specialised postgraduate dental training in Japan, so general practitioners sometimes fit a patient with braces.

"Due to Japan's national healthcare system, dentists are not very enthusiastic about educating patients because there is no incentive," says one dentist who has been practising in Tokyo for more than 15 years.

"In the States, if you educate patients and they understand more about the products, they tend to buy the products. But in Japan, national health insurance covers everything and the fees are the same for every dentist, regardless of age or experience."

Traditionally, Japanese dentists have been one of the biggest financial supporters of the ruling Liberal Democratic party (LDP) over the years.

The JDA was the leading contributor to the LDP in 2002, according to local reports, donating about Y460m to the ruling party's operating fund.

Recently, a furore erupted over revelations that Ryutaro Hashimoto, a former prime minister, had received a cheque for Y100m on behalf of the powerful Japan Dental Association (JDA) in 2001, when he had dinner at a Tokyo restaurant with two former dental association executives, including its head, Sadao Usuda.

Younger dentists, disillusioned with JDA links with the LDP, are increasingly opting not to join the association.

Meanwhile, patients are starting to educate themselves via the internet.

Some are hoping that a more tooth-aware population will lead to better-quality Japanese dentists - but others argue that unless the system of payments and government subsidies is reworked, dentists will have no incentive to improve services and educate the public.

Slowly, however, the increasingly teeth-conscious Japanese are opting to fix their impacted incisors and crooked bicuspids.

And if Teethart has its way, all Japanese mouths will soon consist of nothing but gleaming, pearly whites.