Japan Oral Health Association — Oral Disaster Preparedness Project
People survive the disaster — and pneumonia becomes the largest single cause of the deaths that follow.It begins in the mouth. It is preventable.
Japan, one of the world's most disaster-prone and most aged societies, has learned this lesson repeatedly since 1995. This page presents the evidence, the model we are building, and an invitation to adapt it — in disaster response, and in humanitarian settings worldwide.
The Problem
People survive the disaster — and die in the weeks that follow
Japan distinguishes between direct deaths — caused by the hazard itself — and disaster-related deaths (saigai kanren-shi): deaths caused by the deterioration of health during evacuation and shelter life. The trend across three decades is unambiguous.
- Great Hanshin-Awaji Earthquake (1995): 6,434 deaths in total, of which 921 were initially certified as disaster-related (a count that later exceeded 1,840). Pneumonia was the largest single cause group, at 24%. Roughly 90% of related deaths were among people aged 60 and over, and about 80% occurred within two months of the disaster.
- Great East Japan Earthquake (2011): in Ishinomaki City, pneumonia accounted for 26.9% of certified disaster-related deaths — an incidence roughly three times the pre-disaster norm.
- Kumamoto Earthquake (2016): 50 direct deaths; approximately 220 disaster-related deaths. Deaths after the disaster exceeded deaths during it — by more than four to one.
- Noto Peninsula Earthquake (2024): 229 direct deaths; more than 261 disaster-related deaths certified as of December 2024.
Why the mouth? In evacuation shelters, water is scarce, toothbrushes are missing from relief supplies, dentures are lost or cannot be cleaned, and stress reduces saliva. Oral bacteria multiply; in older adults with weakened swallowing function, they are aspirated into the lungs. Among pneumonia patients aged 70 and over, approximately 80% of cases are aspiration pneumonia. The chain — poor oral hygiene, aspiration, pneumonia, death — is well documented, and each link is preventable.
The Evidence
Oral care is a life-saving intervention. The evidence is not new.
The founding trial
In a two-year randomized controlled trial across Japanese nursing homes, professional oral care reduced the incidence of pneumonia by 39% and pneumonia mortality by 53%. (Yoneyama T. et al., “Oral care and pneumonia,” The Lancet, 1999;354:515.)
The mechanism
Approximately 80% of pneumonia in patients aged 70 and over is aspiration pneumonia — caused by oral and pharyngeal bacteria entering the lungs. Controlling oral bacteria is upstream prevention of a leading cause of death. (Teramoto S. et al., J Am Geriatr Soc, 2008;56:577-579.)
The field data
After the 2011 Great East Japan Earthquake, pneumonia accounted for 26.9% of certified disaster-related deaths in Ishinomaki City, at roughly three times the usual incidence. What the RCT showed in institutions, the disaster record confirms in shelters.
All statistics on this site are maintained under the continuous review of our Chief Academic Officer, Dr. Koichi Nakakuki, DDS, PhD (Specially Appointed Lecturer, Center for Disaster and Environmental Dentistry, Tohoku University Graduate School of Dentistry; principal investigator of Japan's national research program on dental public health in large-scale disasters, 2007–2009; co-editor of the standard Japanese textbook Disaster Dental Medicine). Citation accuracy is reviewed independently of the Association's management and of all sponsors.
The Japanese Model
Not a campaign. A system.
The Oral Disaster Preparedness Project, operated by the Japan Oral Health Association, is building a replicable social implementation model — turning oral care from an act of individual goodwill into institutional infrastructure. It rests on five pillars:
01
EDUCATION
A structured curriculum in disaster oral care, open to both citizens and health professionals, delivered through e-learning and in-person training.
02
CERTIFICATION
A three-tier certification scheme (basic / professional / instructor) to build a distributed workforce of local advisers. (Under development.)
03
STOCKPILING
Standardized oral care kits for households and evacuation shelters, with quantity standards by shelter size, so that “what to stockpile” is no longer left to guesswork.
04
GOVERNMENT ADOPTION
Support for municipalities to embed oral care into local disaster management plans, shelter operation manuals, drills, and registries of persons requiring special care.
05
EVIDENCE
Continuous outcome measurement and publication, so that every element of the model remains open to scrutiny and improvement.
A methodology tested in the field: stay, hand over, institutionalize
- Niigata Chuetsu Earthquake (2004): from day 5, a 25-day rotation across 115 shelters delivered oral care to 1,226 evacuees — early proof that shelter-based oral care can be organized at scale.
- Onagawa, after the 2011 tsunami: eight years of support for a town that lost both of its dental clinics — from emergency triage, to temporary clinics, to prefabricated-housing outreach, until the activities were handed over to the town itself as funded local programs.
- Minami-Aso, after the 2016 Kumamoto Earthquake: 927 dental assessments in the first month by rotating regional teams, followed by three years of continuing support in temporary housing and care facilities, ending with a structured handover to local practitioners.
This methodology was developed through two decades of field work by Japan's disaster dental community, in which our Chief Academic Officer has played a central role. Its lessons were institutionalized in 2022 as JDAT — the Japan Dental Alliance Team — a nationwide disaster dental support system positioned in Japan's Basic Disaster Management Plan, whose training program our Chief Academic Officer helped design and lead. In the 2024 Noto Peninsula Earthquake, 127 JDAT teams were deployed.
What Japan can offer is not equipment. It is a tested sequence: educate, stockpile, embed in government plans, stay after the cameras leave, and hand over to the community.
Beyond Japan
Wherever people are displaced, the same chain of risk follows them
The conditions that make oral care a matter of life and death — crowded shelters, scarce water, interrupted routines, lost dentures, exhausted and grieving people — are not unique to earthquakes, and not unique to Japan.
Disasters
Earthquakes, floods, cyclones. Any country with an ageing population faces the same epidemiology Japan documented: survival of the event, followed by preventable respiratory death in shelters. The model's shelter protocols, stockpile standards, and training curricula are designed to be adapted, not copied.
Conflict and displacement
People displaced by armed conflict often live in collective shelters for months or years — far longer than most natural-disaster evacuations. Older people, people with disabilities, and people who have lost caregivers carry the highest risk. We believe that keeping one's mouth clean, being able to eat, and being able to speak are quiet but fundamental parts of human dignity in displacement. We seek partners with humanitarian field experience to adapt this model responsibly; we do not claim expertise we do not yet have.
Ageing societies
Japan is the world's most aged society; many countries are one or two decades behind on the same curve. Building oral care into emergency preparedness now is less costly than discovering its absence after the next crisis.
International humanitarian and health frameworks already acknowledge this territory. The Sphere Handbook's guidance on hygiene items lists toothbrushes and toothpaste as additional items — beyond the first-phase essentials — to be provided to affected populations. The World Health Assembly's 2021 resolution on oral health (WHA74.5) and the WHO Global Oral Health Action Plan 2023–2030 call for oral health to be included in national emergency preparedness and response plans. What remains globally underdeveloped — as it was in Japan — is operational implementation in emergency settings: who acts, with what supplies, under which procedures. That is precisely the layer this model addresses.
Partner With Us
We are looking for the first partners outside Japan
This project is young, and we say so plainly: our track record is being built now, in the open, with every design document and data source published. What we offer partners is not a finished product but a tested methodology, a verified evidence base, and an academic governance structure — and the willingness to adapt all three to your context.
Government agencies and municipalities
We can share our municipal adoption toolkit — model wording for disaster management plans, shelter operation checklists, stockpile quantity standards, and drill formats — and discuss adaptation to your legal and administrative framework. We work with governments of any political composition; the Association is strictly non-partisan.
International organizations
We seek dialogue on how shelter-based oral care can be operationalized within existing humanitarian coordination structures and standards, and how Japan's disaster-related death certification data can inform global guidance.
NGOs and humanitarian operators
If your teams work in displacement or post-disaster settings, we are interested in co-designing pilot adaptations of our training and kit standards — with your field expertise leading on context, protection, and delivery.
Researchers
Our evidence base, reference list, and outcome frameworks are public. We welcome collaboration on shelter-based oral health outcomes, implementation science, and comparative disaster epidemiology.
Write to us in English or Japanese via the contact form.
Contact usJapan Oral Health Association (registered general incorporated association, corporate number 3010405019730), Tokyo, Japan.
Governance, funding independence, and conflict-of-interest policies: /about/governance
Sources and data notes
- Yoneyama T., Yoshida M., Matsui T., Sasaki H. "Oral care and pneumonia." The Lancet, 1999;354(9177):515.
- Teramoto S. et al. J Am Geriatr Soc, 2008;56:577-579.
- Adachi R. An Official Journal of the Japan Primary Care Association, 2011;34:245-248 (Great Hanshin-Awaji Earthquake related-death analysis).
- Official disaster-related death certifications: Fire and Disaster Management Agency; Reconstruction Agency; Kumamoto Prefecture; Ishikawa Prefecture (Noto figures as of December 2024; certified totals are revised over time; the Hanshin-Awaji total of 6,434 includes disaster-related deaths).
- Nakakuki K. (principal investigator). National research program on dental health crisis management in large-scale disasters, Health and Labour Sciences Research Grants, 2007–2009.
- Sphere Association. The Sphere Handbook, 2018 edition (hygiene items guidance; toothbrushes and toothpaste are listed among additional items).
- WHO. Resolution WHA74.5 on oral health (2021); Global Oral Health Action Plan 2023–2030 （who.int）.
Japanese-language primary sources and the full reference list: /evidence. Disaster-related death figures are official certified counts and change as certifications proceed; this page states the as-of date wherever figures are cited.
The Association is non-partisan and does not endorse or affiliate with any political party, in Japan or elsewhere. Partnerships are governed by written agreements approved by the Association's board.