Exploring various types of dental practitioners in Taiwan based on dental-related laws and regulations during the Japanese colonial period (1895–1945)

Abstract

Background/purpose

During the Japanese colonial period in Taiwan (1895–1945), the medical management system included a complex set of laws and regulations governing dental practice. This study aimed to explore and classify the various types of dental practitioners in Taiwan during this era.

Materials and methods

Both direct and indirect historical materials related to medical and dental laws and regulations issued during the Japanese colonial period in Taiwan were collected and analyzed. Content regarding dental practitioners and their qualification requirements was extracted, compared, and categorized to reconstruct eight types of dental practitioners during this period.

Results

Analysis of legal documents revealed a series of regulations that shaped dental practice, beginning with the 1896 Taiwan Medical Practice Regulations and later including the Taiwan Dentists Order (1916), the Limited-location Physicians and Dentists Licensing Policies (1916–1918), and other regulations defining dental authority among physicians. Based on these regulations, eight types of dental practitioners were identified and grouped into three categories: (1) those with formal school education and training (dentists and three types of physicians with various dental licenses); (2) those who passed examinations based on experience or workplace training (e.g., traditional Chinese medicine practitioners, limited-location physicians/dentists); and (3) those granted special permission to continue specific dental work (denturists and tooth extractors).

Conclusion

Dental practice in Taiwan during the Japanese colonial period was diverse, shaped by evolving laws and practical needs. Eight distinct types of dental practitioners emerged, reflecting a multi-layered dental qualification system that integrated formal education, examinations, and special permissions.

Introduction

During the Japanese colonial period, the medical education system for training physicians was introduced to Taiwan for the first time. After several stages of development, Taiwan’s medical education system has become a crucial cornerstone of Taiwan’s medical and public health development.1 The earliest medical education institution in Taiwan was the Taiwan Government Taipei Hospital affiliated medical training institute, established in 1897. This institute specialized in training Taiwanese physicians and was a measure to rapidly replenish the physician workforce in the early stage of Japanese rule of Taiwan. In 1899, the Taiwan Government Medical School was established, becoming Taiwan’s earliest medical school. After several reforms in the medical education system, the school was renamed as the Taiwan Government Medical College in 1919, and again renamed as the Taiwan Government Taipei Medical College in 1927. Then, in 1936, the Taipei Imperial University established its Medical Faculty. The Taiwan Government Taipei Medical College was merged into the Taipei Imperial University at the same time, becoming the Affiliated Medical College of Taipei Imperial University. However, for 48 years from its establishment until the end of the World War II in 1945, this only medical education institution in Taiwan focused solely on training physicians.2

Throughout the Japanese colonial period, Taiwan did not establish its own dental school, nor did it directly implement a dental education system to train dentists. However, the modern medical system introduced to Taiwan during the Japanese colonial period included establishing the legal professional status of physicians and dentists and their practice management.3 In fact, the operation of this modern medical system also included measures to manage Taiwanese people who were already engaged in medical-related work before the Japanese rule of Taiwan, in order to meet the need to solve the shortage of medical personnel at that time. These people inevitably included dental practitioners, as we previously reported on traditional Chinese medicine (TCM) practitioners who made a living in dentistry.4 Although there was no dedicated dental education system to train dentists at that time, dentists were actually very active in Taiwan during the Japanese colonial period. They consisted of the Japanese dentists who immigrated to Taiwan, the Taiwanese dentists who went to Japan to study dentistry and returned to practice, and the limited-location dentists who were only allowed to practice in the remote areas.5 On the other hand, Taiwan medical education institution also provided dental education activities and clinical training for its medical students and graduates. In 1906, the Department of Surgery of Taiwan Government Taipei Hospital established a dental clinic, which became an independent dental department in 1910. In addition, the Taiwan Medical School added dental courses and a dental classroom in 1918. Besides medical students studying dentistry on campus, dentistry also became one of their postgraduate training options.2,6

Although Taiwan lacked dental schools during the Japanese colonial period, studies of the dentistry-related incidents and documents indicate that Taiwan medical education institution still conducted dental education and research activities and had a special dentist qualification system.7,8 This suggests that dental practitioners at that time may have presented a diverse range of forms. Therefore, this study aimed to collect and analyze historical materials from the Japanese occupation period, based on dental-related laws and regulations, to summarize and explore the various possible forms of dental practitioners during that time. We hope that the findings of this study can provide important references for studying the history of dentistry and dental education in Taiwan.

Materials and methods

This study adopted the historical research method, collecting medical and dental laws and regulations from the Japanese colonial period in Taiwan and extracting content related to dental practitioners. By analyzing the descriptions related to dental practitioner qualifications in these regulations, the various types of dental practitioners that might have existed at that time were categorized. The historical materials used in this study were divided into two types: direct historical materials (original historical materials) and indirect historical materials (second-hand historical materials). The direct historical materials were the Taiwan Governor-General’s Archives, which could be searched online through the Taiwan Historica database. The indirect historical materials included the compilations of regulations from the Japanese colonial period in Taiwan, which could be searched online from the Japanese National Diet Library. Through these historical materials, we confirmed the existence of various types of dental practitioners, reconstructing the diverse landscape of dental practitioners in Taiwan during the Japanese colonial period and summarizing the unique dental practitioner qualification system in Taiwan during that era.

Results

Based on medical and dental laws and regulations in Taiwan during the Japanese colonial period, this study summarized legal regulations concerning dental practitioners and identified eight types of dental practitioners under this medical management system, as shown in Tables 1 and 2.

Table 1.

The legal regulations concerning dental practitioners in Taiwan during the Japanese colonial period (1895–1945).

Time	Names and key contents of the laws and regulations
1896	Taiwan Medical Practice Regulations Only those who have undergone the formal school education and training and obtained a medical practice license issued by the Japanese Minister of Home Affairs or a medical practice license issued by the Governor-General of Taiwan are eligible to apply to engage in medical practice.
1899	Regulations for the continued operation of personnel offering dental prostheses, tooth extractions, and osteopathic treatment Before Japanese rule of Taiwan, Taiwanese people who had engaged in dental prostheses fabrication, tooth extractions, and osteopathic treatment were incorporated into the medical management system. They can apply to the local government and are granted special licenses to continue to engage in related work.
1901	Taiwan Medical Practitioners Licensing Regulations Before the Japanese rule of Taiwan, Taiwanese people who had worked in the medical field (mainly traditional Chinese medicine, TCM) were incorporated into the medical management system. They can apply to the local government, pass the examination, and obtain medical licenses, with their scope of practice also including dental treatment work.
1916	Taiwan Physicians Order Taiwan Dentists Order The qualifications for applying for a physician and a dentist are clearly defined to distinguish between general physicians and dentists. Those who do not have a dentist’s qualification are legally prohibited from practicing dentistry.
1916	Limited-location Physicians Licensing Policy Those with medical-related work experience or workplace training can apply to the Governor-General of Taiwan through the local government, pass the examination, obtain a physician license, and are allowed to practice in a certain area (the remote areas without physicians). They must renew their license every three years.
1918	Enforcement Rules for Taiwan Physicians Order The following 22 medical specialties can be claimed by the qualified physicians: internal medicine, gastroenterology, respiratory medicine, cardiology, endocrinology, nephrology, neurology, psychiatry, infectious diseases, surgery, oral surgery, visceral surgery, plastic surgery, proctology, urogenital medicine, dermatology, obstetrics and gynecology, pediatrics, ophthalmology, otolaryngology, radiology, and physical therapy. It should be noted that oral surgery is also among these medical specialties.
1918	Enforcement Rules for Taiwan Dentists Order The following 11 dental specialties can be claimed by the qualified dentists: conservative dentistry, alveolar dentistry, oral surgery, dental extraction, prosthodontics, fixed prosthodontics, jaw prosthodontics, oral palate prosthodontics, orthodontics, radiology, and pediatric dentistry.
1918	Limited-location Dentists Licensing Policy Those with dental-related work experience or workplace training can apply to the Governor-General of Taiwan through the local government, pass the examination, obtain a dentist license, and are allowed to practice in a certain area (the remote areas without dentists). They must renew their license every three years.
1918	Regulations on the Dental Profession of the Physicians The physicians with more than one year of dental training in the school or hospital can apply to the Governor-General of Taiwan through the local government to obtain a license to practice dentistry. The physicians with completed dental courses in the school can apply to the Governor-General of Taiwan through the local government to obtain a license to perform a certain part of dentistry, such as metal fillings, inlays, dentures, crowns and bridges, orthodontics, and palate obturators.

Table 2.

Eight types of dental practitioners in Taiwan during the Japanese colonial period (1895–1945).

Item	Types of dental practitioners
A	Those qualified through the formal school education and training
1	Dentists
2	Physicians with a license to practice dentistry
3	Physicians with a license to perform a certain part of dentistry
4	Physicians performing oral surgery
B	Those with previous relevant work experience or workplace training qualified through the examination
5	Traditional Chinese medicine (TCM) practitioners
6	Dentists in a restricted area
7	Physicians in a restricted area performing oral surgery
C	Those with previous relevant work experience or workplace training qualified through the special permission
8	Personnel offering dental prostheses (denturists) or tooth extractions (tooth extractors)

The legal regulations concerning dental practitioners in Taiwan during the Japanese colonial period

In 1896, the second year of Japanese rule of Taiwan, the “Taiwan Medical Practice Regulations” were promulgated. These regulations stipulated that only those who have undergone the formal school education and training and obtained a medical practice license issued by the Japanese Minister of Home Affairs or a medical practice license issued by the Governor-General of Taiwan are eligible to apply to engage in medical practice. Since neither Japan nor Taiwan had specific regulations defining what constituted a dentist at that time, Taiwan followed the Japan’s example, allowing anyone with a medical practice license issued by either the Minister of Home Affairs or the Governor-General of Taiwan to practice dentistry. Furthermore, given the shortage of modern medical professionals in Taiwan at that time, the Taiwan Government, based on practical needs, did not interfere with Taiwanese people practicing medicine without a license. In 1899, the Taiwan Government issued “Regulations for the continued operation of personnel offering dental prostheses, tooth extractions, and osteopathic treatment”, bringing Taiwanese people who had previously practiced dental prostheses fabrication, tooth extractions, and osteopathic treatment under its jurisdiction. They could apply to the local government and were granted special licenses to continue engaging in related work. It wasn’t until 1901, with the promulgation of the “Taiwan Medical Practitioners Licensing Regulations”, that Taiwanese medical practitioners were brought under regulation. They could apply to the local government, pass the examination, and obtain medical licenses, with their scope of practice also including dental treatment work. This typically involved relieving toothache with TCM and extracting teeth with metal instruments (Table 1).

In early 1916, the Governor-General of Taiwan simultaneously issued the “Taiwan Physicians Order” and the “Taiwan Dentists Order”, clearly defining the qualifications for applying to become a physician and a dentist, respectively, to distinguish between general practitioners and dentists. Those without a dentist license were legally prohibited from practicing dentistry. In the same year, the “Limited-location Physicians Licensing Policy” was also issued, addressing the medical needs of the remote areas. Those with medical-related work experience or workplace training could apply to the Governor-General of Taiwan through the local government. When they passed the examination, they could obtain a physician license and were allowed to practice in a certain area (the remote areas without physicians). They had to renew their license every three years. In addition, the “Limited-location Dentists Licensing Policy” was issued in 1918. Similar to the previous regulations, but the term “physician” was changed into “dentist” (Table 1).

On the other hand, in 1918, the Governor-General of Taiwan also issued the “Enforcement Rules for Taiwan Physicians Order” and the “Enforcement Rules for Taiwan Dentists Order”, which clearly defined the professional specialties that physicians and dentists could claim. Oral surgery was one of the 22 medical specialties listed. This meant that, according to the “Taiwan Physicians Order”, the physicians were authorized to perform oral surgery, with common procedures including tooth extraction and intraoral incision and drainage. Furthermore, in the same year, the “Regulations on the Dental Profession of the Physicians” were also issued, stipulating different levels of authority granted to physicians to perform dental services based on their levels of dental training. The physicians with more than one year of dental training in the school or hospital can apply to the Governor-General of Taiwan through the local government to obtain a license to practice dentistry, while the physicians with completed dental courses in the school can apply to the Governor-General of Taiwan through the local government to obtain a license to perform a certain part of dentistry, such as metal fillings, inlays, dentures, crowns and bridges, orthodontics, and palate obturators (Table 1).

Eight types of dental practitioners in Taiwan during the Japanese colonial period

According to dental-related laws and regulations for the definitions and qualifications of dental practitioners in various situations, we summarized eight types of dental practitioners in Taiwan during the Japanese colonial period. Based on the completeness of their dental training, they could be divided into three main categories (Table 2).

The first category consisted of those qualified through formal school education and training, including the dentists and the physicians with a license to practice dentistry, the physicians with a license to perform a certain part of dentistry, and the physicians performing oral surgery. Among them, the dentists received the most complete dental school education and obtained a government-granted dental license (Fig. 1A). They were licensed dentists with the most comprehensive scope of dental practice, covering 11 dental specialties as follows: conservative dentistry, alveolar dentistry, oral surgery, dental extraction, prosthodontics, fixed prosthodontics, jaw prosthodontics, oral palate prosthodontics, orthodontics, radiology, and pediatric dentistry. Some of them were Japanese dentists who immigrated to Taiwan, while others were Taiwanese dentists who studied dentistry in Japan and returned to practice in Taiwan (Table 1).

Figure 1.

Various types of licenses for different dental practitioners. (A) The dentist license issued by the Governor-General of Taiwan. (B) The physician license issued by the Japanese Minister of Home Affairs. (C) Dr. Ying-Fang Chen’s (graduating from the Taiwan Government Medical College) certificate of dental training from the Tokyo Imperial University Medical Faculty for the application of a license to practice dentistry (please see reference 9 for details). (D) Dr. Ying-Fang Chen’s certificate of dental courses from the Taiwan Government Medical College for the application of a license to practice metal fillings in dentistry (please see reference 9 for details). (E) The license of a traditional Chinese medicine (TCM) practitioner in dentistry published in the Taiwan Dental History (please see reference 5 for details). (F) The license format announced by the Taiwan government for the personnel offering dental prostheses, tooth extractions, and osteopathic treatment. The photographs in (A) and (B) were available from the personal collection of Feng-Chou Cheng, the first author of this article. The photographs in (C), (D) and (F) were available from the Taiwan Historica.

Furthermore, the physicians received the most complete medical school education and obtained a government-granted physician license (Fig. 1B). Based on the levels of their dental training, they were categorized into three types, each with different scopes of dental practice (Table 2). The physicians with more than one year of dental training in the school or hospital could obtain a license to practice dentistry, possessing the same scope of practice as regular dentists (Fig. 1C).9 The physicians who had completed dental courses in the school could obtain a license to perform certain parts of dentistry, such as metal fillings, inlays, dentures, crowns and bridges, orthodontics, and palate obturators (Fig. 1D).9 According to the “Enforcement Rules for Taiwan Physicians Order”, the physicians without additional dental training qualifications were still authorized by the government to perform oral surgery (Table 1).

The second category of dental practitioners consisted of those with previous relevant work experience or workplace training who passed the examination. Among them, the TCM practitioner examination was only held once, in 1901. Those who passed the examination and obtained a TCM practitioner license performed dental work using the TCM method, typically relieving toothache with Chinese medicine and performing simple tooth extractions (Fig. 1E).5 In addition, the examinations for limited-location physicians and dentists were held regularly to supplement medical personnel in the remote areas. They had the same scope of practice as licensed physicians and dentists. However, they must choose to serve in the areas without the licensed physicians or dentists and must undergo government examinations every three years to renew their licenses (Tables 1 and 2).

The third category of dental practitioners consisted of those with previous relevant work experience or workplace training who passed the special permission. They must apply for a special permission from the government within a certain period. Once approved, they received a special license to continue providing dental prostheses fabrication (denturists) or tooth extractions (tooth extractors) (Table 2 and Fig. 1F).

Discussion

During the Meiji Restoration (1868–1912), the Japanese government, in its pursuit of national modernization, promoted the modernization of medicine, replacing TCM with Western medicine. In 1883, the government promulgated the “Medical Practice Regulations”, completely westernizing the medical management system and establishing a modern medical management and education system based on Western medicine. Subsequently, through its colonial rule, Japan introduced its modern medical system to Taiwan and other Asian regions. Japan gradually transformed its public’s lifestyle from relying on TCM to relying on Western medicine.10 By the time of Japanese rule of Taiwan, it had accumulated nearly 30 years of experience in westernizing medicine. In the early stage of its rule, it transplanted the results of its Westernization reforms to Taiwan in one fell swoop, leading to a leapfrog development in Taiwan’s medical modernization and indirectly contributing to the coexistence of diverse types of dental practitioners in Taiwan during the Japanese colonial period.

Given the public’s need for medical care, the Japanese government, in the early stage of Japanese rule of Taiwan, did not drastically change the existing medical practices in Taiwan. Instead, it legislated to incorporate existing Taiwanese medical personnel into the medical management system, supplementing the medical manpower needed in the early stage of its rule.4 It retained existing TCM practitioners, denturists, and tooth extractors, issuing licenses for a limited period to allow them to continue providing services such as relieving toothache, fabrication of dentures, and tooth extractions in their original ways. No new licenses of these types were issued afterward, allowing them to gradually disappear over time, replaced by qualified medical personnel.

On the other hand, the limited-location physicians and limited-location dentists were expedient measures. These licenses were issued based on the needs of the remote areas. Typically, the apprentices from medical institutions took the examinations for these licenses. The limited-location dentists could provide comprehensive dental services in the remote areas, while in the areas inaccessible even to the limited-location dentists, the limited-location physicians could at least provide services such as relieving toothache, and performing simple oral surgery and tooth extractions.

In the early stage of Japanese rule of Taiwan, establishing a modern medical education system urgently required a school education system to train physicians. Given the scarcity of Japanese dentists who immigrated to Taiwan at that time, coupled with the public’s demand for oral health services, the physicians could serve as a potential alternative of dental practitioners.

For Taiwan, it was a suitable medical policy to grant the physicians different levels of dental practice authority after receiving varying degrees of dental training. Therefore, the dental education and training for medical students and physicians were particularly important. In 1918, the Taiwan Government Medical School added dental courses to medical education.2,7 At that time, not all medical schools in the mainland Japan offered dental courses. Before the end of the World War II, Japan had nine Imperial Universities, but only four of their medical faculties offered dental courses.11 The Medical Faculty of Taipei Imperial University offered both dentistry and oral surgery courses, making it one of the more prominent dental courses among the four Imperial Universities offering such courses.7 This was a distinctive feature of medical education in Taiwan at that time. In fact, people in those days habitually sought treatment from the physicians for toothaches. In addition, the physicians also needed to perform oral checkups during campus health examinations. 12 This clearly demonstrates the importance of dental training for medical students and physicians.

Although Taiwan did not establish an educational system for training dentists during the Japanese colonial period, the dental community in Taiwan still flourished due to the increasing number of the Japanese dentists practicing in Taiwan and the Taiwanese dentists returning to Taiwan to practice after studying dentistry in Japan. The island-wide Taiwan Dental Association and the Taiwan Academic Dental Association were established in 1916 and 1929, respectively. From the 1930s onward, the number of dentists in Taiwan continued to increase, becoming the mainstream of the dental service market, while the number of physicians who originally practiced dentistry as a sideline decreased year by year. By the end of the World War II in 1945, the number of dentists in Taiwan reached 738, including 493 Taiwanese dentists and 245 Japanese dentists.13

This study provided a new perspective, reconstructing the diverse forms of dental practitioners in Taiwan during the Japanese colonial period. Past research on dental history has been limited to the development history of formally educated dentists, neglecting the existence of other types of dental practitioners in the early stage of Japanese rule of Taiwan. Currently, our understanding of the actual practice of dental practitioners rather than the formal dentists is limited. For example, there are no data on their numbers and distribution. However, each type of dental practitioner played a crucial role in their respective historical period. For instance, how they maintained public oral health and their impact on the later development of dentistry are all potential important topics for further research on the dental history.