An Effective Dental Health Care Agency for a Dental Society

SEVEN T H N A T IO N A L D E N T A L H EA LT H C O N F E R E N C E . . . V O L U M E 54, FEBR U A RY 1957 • 167

cern of the dental profession. Although some of these things may be partially or wholly true, the fact remains that a changing social order now confronts the dental profession with more insistent re­ quests for expanding its health services. No profession conscious of its obligation to societycan ignore or frustrate such re­ quests coming from larger and larger groups of the population. Whatever hap­ pens in this changing society, it is clear

to me, personally and officially, that the Americanpeopledeservetohaveahigher level of health care, including dental health care, as a part of their increasing standard of living. It seems obvious, also, that theAmericanstandardof livingcan­ not goonincreasing, asithasdonealmost for the last generation, without makinga real part of that better standard of life a better standard of dental health care for all the people.

A N E F F E C T IV E D E N T A L H E A L T H C A R E A G E N C Y F O R A D E N T A L S O C IE T Y

Albert L. Borish, D.D.S., Philadelphia

The dental health problems in Philadel­ phia are enormous. Activity in this im­ portant area of health is spread over the public and parochial schools, the many outpatient departmentsinhospitalsof the city and in health centers of the Depart­ ment of PublicHealth, eachof whichhas its individual dental head or authority. To makeeachcognizant of the other and coordinate their efforts and programs so that they will performmaximum service withthese resources was the major prob­ lem of the council on dental health of the Philadelphia County Dental Society. This is beingdone. The keynote of the entire policy is co­ ordination. Coordination has been prac­ ticedwithout lossof oneiotaof autonomy to any of the units. The Council usurps the prerogatives of no individual group representedin it. The organization of the Council is re­ vealed in the illustration. The president of the Philadelphia County Dental So­ ciety appoints the chairman of the coun­ cil on dental health with the approval of the board of governors. The council on dental health consists of individuals representing the Philadelphia Mouth Hygiene Association; dental service,

Board of Public Education; dental serv­ ice, parochial schools; hospital dental de­ partments; the two dental colleges; dental health section, Department of Public Health; members-at-large, Phila­ delphia County Dental Society; Phila­ delphia dental hygienists; Philadelphia Societyof Periodontology, andtheHealth and Welfare Council of the Community Chest. The Council functions as a whole and also through its ten subcommittees: (1) coordination, (2) work conferences, (3) standardization and evaluation, (4) den­ tal agency administrators, (5) Health Fair, (6) televisioneducational programs, (7) handicapped children, (8) Child Dental Health Week, (9) exhibits and (10) periodontology. The over-all objectives of the Council are as follows: 1. To have all agencies with dental programs represented on the Council with voting privileges. 2. To have all policies approved by the board of governors of the Philadel­ phia County Dental Society. C h a irm a n , c o u n c il on C o u n ty Dental S o ciety.

d e n ta l

hea lth ,

P h ila d e lp h ia

168 • T H E J O U R N A L O F THE A M E R IC A N D E N T A L A S S O C IA T IO N

COUNCIL O N DENTAL HEALTH

TABLE OF ORGANIZATION

Philadelphia Mouth Hygiene Association

- Coordination

Dental Service, Board of Education

. Work Conferences

Dental Service, Parochial Schools

— Standardization and Evaluation

Hospitals, Dental Departments Philadelphia Council

County

— Dental Agency Administrators

Dental Colleges, University of Pennsylvania and Temple University

— Health Fair

on

Dental

Dental

Society (Board of Governors)

Subcommittee — Department Public Health, Dental Health Section

— TV Educational Programs

Philadelphia County Dental Society (members-at-large)

_

Philadelphia Dental Hygienists

— Child Dental Health Week

Health

Handicapped Children

Health and Welfare Council of Community Chest

Philadelphia Society of Periodontology

•Periodontology

Organization of the council on dental health of the Philadelphia County Dental Society

3. To be the informational center for community dental needs and resources. 4. To help coordinate all community dental programs so that maximumserv­ icewill begivenwiththese resources. 5. To help each agency obtain com­ munity support. 6. To help evaluate programs and in­ duce improvements. The subcommittees aredynamic. They are fully aware of their responsibilities, and they meet and function. The sub­ committee on coordination may do the following: 1. Recommend to the Council: a. Policies andprocedures for com­ munity agencies.

b. Action to be takenon reports of community programs. 2. Act as reference committee for the Council. 3. Act onrequestsof communityagen­ cies. 4. Studynewprograms. 5. Evaluate actitivies of subcommit­ tees. 6. Report totheCouncil regardingthe activities of various community dental programs. Thesubcommitteeonworkconferences has successfully completed one of the most fruitful projects attempted locally, the Work Conference on Dental Health for Preschool Age Children. Ninety au­

SEVENTH N A T IO N A L D EN T A L H EA LT H C O N F E R E N C E

thorities representingdentistry, medicine, nursing, education, public health and in­ formed and interested laymen partici­ pated. Some findings have already stimu­ lated action. City dental health clinics utilizedtheirtimeduringJulyandAugust on these preschool age youngsters, and two hospital dental staffs sponsored fullday programs on children’s dentistry for general practitioners in the immediate community. The presentation of all phases of pedodontics, presented by the staff, and an impressive luncheon, given by the women’s auxiliary of the hospital, made up a model programto which all dentists inthevicinity (100 inattendance at each) were invited. The desired aim of the project was to impress further on a selected community the latest thera­ peutic and technical skills employed in the handling of the child patient and the needfor theseskills. The full storyof this workconference, with its findings and its 16 points or recommendations, has been accepted for publication in The Journal of the American Dental Association.

Presently, the Work Conference on Dental Programs in Hospitals is being planned for March of 1957. Dentists, physicians, hospital administrators and others will consider the scopeof dentistry in hospitals. It is hoped that these hos­ pital administrators will be made more aware of their dental problems. The subcommittee on standardization and evaluation, inApril of 1956, revised the “Dental Standards for Treating the Children in Community Programs.” The first really great stride toward bringing organizeddentistryintoworking arrange­ ment with dental public health came withthe arrival of J. M. Wisan as dental public health administrator in the De­ partment of Public Health in 1953. He made his moves and changes inharmony with organized dentistry. It was the first time in the history of public health den­ tistry in this city that the Philadelphia CountyDental Societywasinvitedtocol­ laborateinsolvingthecity’sdental health

. V O L U M E 54, FEBR U A RY 1957 • 169

problems. In January of 1954, the board of governors formally endorsed a new Health Department program of public health dentistry and approved a set of standards comparable to the highest in the nation and drawn up by the council on dental health. Subsequently, voluntary agencies re­ questedthat standards bedesignatedthat would be feasible for hospital outpatient clinics. The following “Standards for Dental Procedures for the Child” (re­ vised) is being sent to every public and privatedental agencyinPhiladelphiaand will be published in the local and state journals: It is recommended that all treatment be provided in accordance with high standards enunciated by dental authorities. Attempts to attain short cuts at the expense of fundamental requirements o f scientific treatment will result in faulty teeth and endangered health. D en­ tists should be cognizant of the cooperation available from the medical profession. It is further recommended that the stand­ ard examination and treatment record forms as devised by the subcommittee on dental health agencies be used in all clinics. In order to enhance the usefulness of den­ tists, auxiliary personnel (dental hygienists and dental assistants) should be provided in all clinics. T he objective of any program should be “ complete dental treatment” and implies the following: a. Prophylaxis and fluoride therapy. b. Dental examinations, including roent­ genograms and treatment planning. c. A ll restorations. d. Removal of inoperable and infected teeth after adequate roentgenographic diag­ nosis. e. Treatment of all oral soft tissue lesions. f. Referral and follow-up of cases requir­ ing a type of treatment not performed in the clinic. g. Arrangement for subsequent mainte­ nance treatment. h. Referral of patients requiring medical attention to a physician. Recommended Techniques: 1. A complete oral examination that will include the teeth, supporting tissues and oral mucosa should be given. External palpation for pathologic conditions should be included. T h e occlusion should be examined and any malocclusions noted.

170 • THE J O U R N A L O F T HE A M E R IC A N D EN T A L A S S O C IA T IO N

2. R oentgenographic diagnosis should be an integral phase o f dental exam inations and treatment planning. 3. W hen a sharp explorer catches in an occlusal pit or fissure, the tooth should be pre­ pared for a restoration. I f the roentgenogram discloses an interproxim al carious lesion, that tooth should be restored im mediately. N o cavity is too small to fill. W hen planning treatment, consideration should be given to the possibility o f treating systematically by m outh quadrants. For exam ple, when treat­ ment o f the lower right first deciduous molar, low er right second deciduous m olar and lower right first permanent m olar is required, m an­ dibular conductive anesthesia w ill enable the dentist to perform extractions a n d /o r cavity preparations of all three teeth at one sitting. 4. U ntil further scientific data indicate otherwise, topical fluoride application should be an integral part o f com plete dental care. 5.

Operative procedures: a. A chieve “ extension for prevention” in all cavity preparations. b. M ake occlusal locks w ide enough for maximum retention in Class I I cavities. c. In all deep cavities, protect the pulp by a suitable lining. d. Use matrices and gingival wedges in the filling o f all Class I I cavities. e. W hen inserting am algam for restora­ tions, obtain thorough condensation. f. Polish all fillings at a subsequent visit. 6.

R edu ce tem porary fillings to a minimum.

7.

Utilize anesthesia when indicated.

8.

Exodontia procedu res: a. Every infected tooth, deciduous or permanent, that cannot be successfully treated, should be extracted. b. Before extractions for children w ith a history o f rheum atic fever or w ith acute dental infection, antibiotics should be provided. c. A fter extractions, patients should be given written instructions concerning post­ operative attention. 9.

Precedence should be given to: a. R elief o f pain. b. Restoration o f the perm anent incisors, and the second deciduous m olar for children up to 10 years o f age. c. Preventive treatment o f permanent molars. Restoration is recom m ended for the occlusal surfaces o f all first perm anent molars and the buccal surfaces of low er molars and the lingual surfaces o f upper m olars whenever a sharp explorer sticks in the p it or fissure. d. Filling o f pits and fissures before the tenth year is recom m ended for the second de­ ciduous molars.

e. Pulpotom y fo r “ vital” pulp exposures is suggested in order to prevent premature loss o f teeth. f. R o o t canal therapy is recom m ended for all treatable teeth. 10. Patients should be referred to a suitable agency if the follow ing treatments are not available: a. Space maintenance for the deciduous dentition. b. Prosthodontic. c. C row n and bridge. d. E ndodontic. e. Treatm ent o f traumatized incisors. f. C om plicated surgical procedures. g. O rthodon tic consultation. 11. Efforts should be m ade to im part perti­ nent and authentic inform ation to parents and children in order to influence desirable dietary and dental habits. T h e im portance o f brushing the teeth after every meal and before retiring should be stressed. Particular emphasis should be placed on the necessity o f beginning dental care for the child at the age of two and m ainte­ nance treatment given routinely thereafter.

Evidence of the fact that the council ondental healthhasbeenacceptedbythe communityas theauthoritativesourcefor dental health education was the recent request of one of Philadelphia’s large voluntary agencies to have the Council undertake evaluation of its program. The Council isdevelopingfeasiblepro­ cedures for helping community agencies to maintain high standards of treatment in their programs. The subcommittee on dental agency administrators consists of the dental heads of the hospitals of Philadelphia. Great strides have been made by this group. Understanding and cooperation never before realized are nowappearing. Plans to standardize programs, records, interchange of ideas and even a move toward offering refresher courses to hos­ pital staff dentists by those institutions stressing one phase more than another is nowonthe calendar. For example, the Children’s Hospital, which has one of the most thorough dental health pro­ grams for the child, is offering a course limited to all members of affiliated hos­ pitals.

SEVENTH N A T IO N A L D EN T A L H EA LT H C O N F E R E N C E . . . V O L U M E 54, FEBR U A RY 1957 • 171

The subcommittee on Health Fair handles the dental section of the Phila­ delphia Health Fair. Last year, the sec­ ond annual Fair drew 81,000 persons. The Council’s exhibit, one of the most attractive and best attended, was equippedwithtwo complete dental units, with dentists and hygienists always on duty examining children, giving tooth­ brush drills and puppet shows and dis­ tributing kits and literature. The dental service of the Board of Public Education prepared a series of telecasts on dentistry that will be used as a format by the subcommittee on tele­ vision educational programs. Present plans call for study of financial resources for extendedprograms inthenearfuture. The subcommittee on handicapped children made a thorough study of the treatment problemfaced by dentistry in regard to handicapped children. The child who shows some form of central neurological disturbance and who be­ cause of this injury would require special training, care and schooling is included in the category. The results of the sub­ committee’s extensive survey was pub­ lished in the March issue of the Bulletin of the Philadelphia County Dental So­ ciety. Questionnairesweresent to all den­

tists in the city as well as social service agencies. The aimwas to register a com­ plete report of various comments re­ corded by dentists, compile a list of pro­ fessional personnel andinstitutions doing dental work for the handicapped child, collect all of theoral observationsof prac­ ticing dentists and determine the need for additional clinics and hospital facili­ ties. The subcommittee on child dental healthweekpresentedan11point project for 1956. Coordinating the efforts of the Department of Public Health dental sec­ tion, Philadelphia public school system, Philadelphiaparochial schools andPhila­ delphia hospitals, it was instrumental in planning the following activities during Children’s Dental Health Week:

1. Winning Smile contest—finals on WFIL-TV. Council ondental healthand the Board of Public Education. 2. Poster contest. Parochial schools of Philadelphia. 3. Public health meeting, Greater Philadelphia Annual Meeting. A sym­ posium entitled “Why Fill Deciduous Teeth” was given. 4. Leaflets (50,000) “Now Is the Time for the Child of Two to Five” by the council on dental health and the Philadelphia Dairy Council. Distributed by the women’s auxiliary of Philadelphia County Dental Society to drug stores, healthcenters andchild carecenters. The Philadelphia Boardof Health was responsible for 25,000 leaflets, “Two Birthdays to Remember.” 5. Evaluation 1955 Work Conference on Dental Health of Preschool Children. 6. Poster, “Protect ‘First’ TeethFirst.” Published by the Philadelphia Depart­ ment of Public Health for display on public buses, trolley cars, subway and elevated trains. 7. Televisionprograms. 8. Radio skits. 9. Newspaper items. 10. Children’s dentistry symposium, Kensington Hospital. 11. Distribution of A.D.A. posters, “For Better Dental Health—It’s the Brushing That Counts.” The Winning Smile contest, inaugu­ rated this year, was highlysuccessful and well received by the community. For the climax to be reached during Children’s Dental Health Week, the contest was be­ gun four weeks earlier. Abram Cohen, supervisorof dental services of the Phila­ delphia public schools, requested the ap­ proval of the board of superintendents. The event was limited to the 41,000 students in the 25 junior high schools. The school dental examiners, teachers and dental hygienists selected a boy and girl winner in each school. The next round of judging took place in the audi­ toriumof the Boardof Education Build­

172 • THE J O U R N A L O F T H E A M E R IC A N D EN T A L A S S O C IA T IO N

ing where these 50 contestants were reduced to 16, a boy and girl selected in each of the eight school districts. The district choices were further reduced to six, three boys and three girls, during Public Health Day activities of the Greater Philadelphia Annual Meeting. Thesesixfinalists, thefourjudges andthe station moderator were gathered before the television cameras of WFIL-TV where the winning boy and girl were named. Each child received a beautiful plaque for his and her possession and duplicates were delivered to the schools of the recipients for their archives. The judges consisted of a former dean of a dental school, president-elect of the Philadelphia County Dental Society and the dental head of the Department of Public Health. For the semifinal round of the contest, the president of the So­ ciety, the president of the women’s auxiliary, the president of the dental as­ sistants’ association and the professor of pedodontics of one of the colleges ac­ cepted the assignment; for the final round, the superintendent of public schools, both the medical director and the dental supervisor of themedical serv­ ices of the public schools and the chair­ man of the council on dental health. The subcommittee on exhibits pre­ paredits first exhibit for the 1956 session of the American Dental Association in Atlantic City. It depicted the objectives, organizational theme andcoordinationof the Council. Other scenes for the exhibit will be prepared for the next Greater Philadelphia Annual Meeting and other local and state gatherings. The subcommittee on periodontology is the most recent addition to the Coun­ cil family. It is now engaged in the fol­ lowing projects: (1) poll of dentists’ opinion of periodontal disease; (2) poll of laypersons’ opinionof periodontal dis­ ease; (3) survey using Russell’s index; (4) publicationof aleaflet onperiodontal disease; (5) courses in periodontology to be presented inhospitals for practitioners

in the vicinity of the respective institu­ tion. This subcommittee has been pre­ senting ten weekly radio programs for which the starting date of February 3, 1956, was agreedon, becauseit coincided with the Greater Philadelphia Annual Meetingand fit inwell withthepublicity attendant to the annual show. The Council’s relationship with the various groups inthe community may be revealed in this manner. The chairman of the Council presented a one hour paper on the “Council onDental Health at Work” at the annual two day session of theHealthInstituteof thePhiladelphia Board of Public Education. This meeting was attended by 500 men and women consisting of the medical and dental staffs, nurses, hygienists and interested lay health educators of both the public and parochial schools. The Council, through authority given it by the board of governors, presents a scholarship annually to a Philadelphia hygienist to attend the Workshop of the Committee on Health Education at Temple University, one of five universi­ ties in the state of Pennsylvania giving the course. Desiring to stimulate ormotivate other groups to develop dental health educa­ tion projects, the council on dental health, collaborating with the Philadel­ phiaDairyCouncil, preparedandprinted an excellent leaflet, “Now Is the Time for the Child of Two to Five,” for dis­ tribution to the dentists of Philadelphia for redistribution to their patients. Re­ quests have come infromall parts of the United States. The latest request, from California, has asked for permission to reprint it for allotting to the dentists of their state, with full credit to be given to the Council and the Philadelphia Dairy Council. During Children’sDental Health Week, this folder was inserted in the weekly publication of the Phila­ delphia County Medical Society. This issue included also an editorial on Chil­ dren’s Dental Health Week.

S EVENTH N A T IO N A L D EN T A L H EA LT H C O N F E R E N C E . . . V O L U M E 54, F EB R U A RY 1957 • 173

Education projects are planned by the Philadelphia Mouth Hygiene Association and the United Cerebral Palsy Associa­ tion of Philadelphia. Anovel andeffectivemethodforstudy­ ing a problem was conceived by Dr. Wisan. A Mock Trial Investigation of PhiladelphiaDental Health Programs for Children was given by the Philadelphia Society of Dentistry for Children in col­ laborationwiththeCouncil. It was set up in courtroom fashion, with a presiding judge, attorney for the commonwealth, attorney for the advisory committee and a jury representing a home and school association, the Health and Welfare Council, a high school principal, the di­ rector of medical services of the Board of Public Education, a pediatrician, and deans of bothPhiladelphiadental schools, among others. Also, there were witnesses, representative authorities in hospital, school and public health dental agencies and even a clerk of the court. Excellent newspaper reviews were ob­ servedonthefollowingday—“Panel calls dental programs for city children inade­ quate” and“aninquiryintodental health programs was heldlast night and a‘jury’ found them grossly inadequate.” The linage securedwas about thebest todate. This presentation has enumerated many activities which normally should

require abudget of $5,000. However, be­ causeof thecoordinationandcooperation of the various agencies, this has been ac­ complished with $300 for the first year andwith anincrease to $720 for the sec­ ond year. Some few of the projects and the sums required are: the Health Fair —$200 (an amount which will have to be increased) ; summer-session scholar­ ship for the Workshop on CommunitySchool HealthEducationat TempleUni­ versity—$70; aspecial printingof Views, publication of the Philadelphia Depart­ ment of Health and dedicated to Phila­ delphia dentistry—close to $300, includ­ ing mailing to the county membership; publicity expenses incidental to hospital seminars—$75 (this, too, must require more money as the plandevelops) ; mail­ ing of minutes to Council members— $100; funds for sending Council repre­ sentatives to study hospital facilities and programs in other cities—to be de­ termined, and fund for a television edu­ cation project—to be determined. It is unfair to expect individuals to give of their time, energy andfinances to subsidize so worthy a program as that which dentistry has accepted as its re­ sponsibility. Adequate budgetary allow­ ances shouldbeprovidedbythe local and state dental societies for this most im­ portant phase of dental health activities.

A N E F F E C T IV E D E N T A L D IV IS IO N IN T H E P U B L IC H E A L T H D E P A R T M E N T

John W. Stone, D.D.S., M .P.H ., Austin, Texas

The first dental programestablishedby a health department on a state-wide basis was in North Carolina in 19I8.1 Un­ fortunately, other states were slowto fol­ lowthepatternthus created. Most of the early programs arose as the direct result of theinterest andactivityof dental prac­ titioners and dental societies who recog­

nized the urgent need for broad, state­ wideprograms directedtowardthe eradi­ cation, or at least theamelioration, of the dental diseases andtheir sequelae. Form erly, p u b lic health d e n tis try section, M ic h ig a n D e p a rtm e n t o f H e a lth ; a t present, d ire c to r, d e n ta l d iv is io n , Texas D e p a rtm e n t o f H e a lth . I. G e rrie , N . F. Dental p u b lic hea lth. J .A .D .A . 40:750 June 1950.