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Dental health officers for local health units
Dental health officers for local health units D. M . Hadjimarkos, D.D.S., M .S.D., M .P.H ., Portland, Ore.
sired because the local health department is responsible for the preservation of health, including dental health, of the people o f its area.
The field of dental public health is con cerned with “ those organized community health services which cannot be rendered by the private practitioner alone.” 1 From this definition, adopted by the American Dental Association, the great importance placed on the development of local or community dental health programs is ap parent. The establishment of such pro grams as a means o f improving the dental health o f the nation has been urged by the American Dental Association for years. Today there are numerous methods and technics for combating dental dis ease on a mass scale, thus improving the dental health of the population. Promo tion of dental health can only be accom plished, however, by the successful appli cation of the available methods. Hence, the main efforts in the field o f dental public health are, or should be, directed toward persuading the community to ac cept and utilize the newer knowledge of dental health. This means changing longestablished habits and modes o f living, which is not too easy to accomplish, (par ticularly in undramatic diseases such as dental caries and periodontal disease), without a thorough understanding and appreciation of the different factors and conditions (cultural, economic, and so cial) peculiar to each community. As a dental health aid, a study was made among the health officers o f Oregon to ascertain their attitudes, reactions and comments regarding the employment of dental health officers (public health den tists) on the regular staff o f community health units. This information was de
M E T H O D
A N D
R E S U L T S
The state o f Oregon is composed of 36 counties. O f these, 19 are served by full time health departments (14 single county units and 2 district units). The remaining 17 counties are classified as unorganized, without full-time health services. For the purpose of the study, a ques tionnaire and an explanatory letter were sent to every full-time and part-time health officer of the state, 33 in all. R e plies were received from 31. None o f the community health depart ments o f Oregon employs a dental health officer (public health dentist) on a regular staff on a full-time basis. Only Multnomah county, which is one o f the state’s most populous counties, reported that a public health dentist is on the staff on a half-time basis, together with a full time dental hygienist. From the returned questionnaires it was noted that some of the health officers were aware o f the magnitude o f the den tal health problem in their counties, and also indicated that it would be desirable to have a dental health officer on the
Professor and head, Department of Public Health, the Dental School of the University of Oregon. I. Am erican Dental Association. Transactions 1952.
241
242 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SS O C IA T IO N
staff of the local health unit. Some ex planations were given as to why the crea tion of such a position on the local health unit has not materialized or is not con sidered essential. The two most frequently cited reasons were budgetary limitations, and sparsity o f population. Other comments offered by the officers included: “ D o not think an effort has been made to acquire a dental health officer.” “ The general public would have to be sold on this program.” “ W e have needs with greater priority.” “ At present time not practical because too many pro grams— fluoridation on agenda.” “ Num ber of dentists available for population of the county seems sufficient.” “ W e have only two dentists in the county and they arc so overworked I feel that neither of them would be willing to undertake any additional duties. They have been ex amining the school children under a minimal fee basis and everyone seems satisfied with the arrangement.” “ A pro gram o f dental examinations would only make people more unhappy than they are because they cannot get the treatment needed. If such a person did treatment, the cry of ‘socialized dentistry’ would be raised and he could only do a very small part o f the treatment needed anyway.” The suggestion was made by some offi cers that in view of budgetary limitations and sparsity of population it might be possible to make arrangements between neighboring counties for the employment of dental health officers on a district level. The possibility of employing dental hygienists and the need for more dental health education were also proposed for consideration. D IS C U S S IO N
The results of the study not only indicate the existing situation in one state re garding the employment of dental health officers on the local health unit, but also parallel similar conditions prevailing in the rest o f the country. From a recent re
port on the number of personnel em ployed by the nation’s 1,389 full-time health departments which serve 2,229 counties and include 89 per cent of the population, it was shown that only 236 dental health officers are employed on a full-time basis at the local level.2 The remaining 11 per cent of the population is not covered by full-time local health services. O f these 236 dental health offi cers, 145 are on the staff of city health departments and the remaining 91 are employed by single county health units and local and state health districts. A c cording to the same report, only 367 den tal hygienists are on the staff of local health units. Commenting on the importance of de veloping local or community dental health programs, Phair3 stated: It has been recognized, through both tradi tion and experience, that it is in the com munity where health needs can best be de termined, where resources can be utilized to the fullest extent, where the desires and inter ests o f the people can be made known and, in the final analysis, where the actual health services are perform ed.
In general, the impetus or initiative for developing community dental health programs comes from two main sources: ( 1 ) the dental health division of the state department o f health and (2) the local dental practitioners. The participation and cooperation of the local dentists is an absolute essential for the successful estab lishment of such a program. Today, however, the number of organized community dental health pro grams is extremely small. From a survey conducted a few years ago by the Coun cil on Dental Health o f the American Dental Association it was revealed that out of 40,000 communities in the country
2. Greve, C. H., and Cam pbell, J. R. Organization and staffing for full-time local health services. Pub. 441. W ashington, D.C., U.S. Department of Health, Educa tion, and Welfare, Public Health Service, 1953. 3. Phair, W. P. American Dental Association program for community dental health. J.A.D.A. 46:438 A p ril 1953.
H A D JIM A R K O S . . . VO LUM E 55, AUG UST 1957 • 243
only 5,000 had some type of community dental health program.4 Although there are reasons for the scarcity o f community dental health pro grams in the country, undoubtedly some important ones stem directly from the dental practitioners. In a recent study it was indicated that some of the difficulties arise from lack o f knowledge and under standing on the part of dentists regarding the scope and nature of community den tal health programs.3,5 Another contribu tory factor is that dentists in the past have not received adequate instruction in public health during their under graduate dental education and, as a re sult, they are not well prepared'to exer cise leadership in the development of dental health programs.6 The dental health divisions of state departments of health are contributing a great deal o f time and effort to promote and motivate the development o f com munity dental health programs. A num ber o f state dental health divisions are handicapped in their efforts, however, by inadequate personnel and also by the great size of the state. In the case of Oregon, for example, the dental health division of the state board of health is composed o f only the director and one dental hygienist, yet the state of Oregon occupies an area o f 96,981 square miles. In view of these facts, it is necessary to consider and explore new approaches for the fulfillment o f dentistry’s objective; that is, the establishment of successful dental health programs in every com munity o f the United States. In line with this, the employment o f dental health officers by the local health department or unit is certainly a step in the right direction. Although some progress has been made in the number o f dental health officers employed on the staff of local health departments, much remains to be done.7 The advantages o f such a system or approach are obvious. At the present time, the successful operation o f com
munity dental health programs depends to a great extent on the continuous and enthusiastic participation and interest of local dental practitioners. In view o f the complexities, multiplicity of activities, and time involved in conducting such programs, however, this is not always easy to accomplish and many promising beginnings fail to reach full fruition. On the other hand, a dental health officer on the staff o f the community health unit will have the opportunity to acquire a thorough knowledge and understanding of the problems, resources, and potential ities o f his area. As a result of this, he will be in a better position to exercise effective leadership not only for initiating ap propriate dental health programs but also for sustaining and expanding their opera tion. He will be able to coordinate the activities and give expert guidance to the different lay and professional groups in terested in dental health improvement. T he main difficulties encountered in Oregon regarding the employment of dental health officers by the local health unit or department may reasonably be assumed to be also applicable to the rest of the country. One o f the obstacles most frequently cited in the study seems to be lack o f sufficient funds. The suggestion that neighboring counties combine forces for employing a dental health officer on a district level should be explored vigor ously. Such an approach is promising and seems particularly advantageous for coun ties with small population and limited resources. O n the basis of comments contained in the questionnaires returned, however, it would seem that other important factors are also responsible for this situation. It
4. Phair, W . P. Com munity dental health programs in the United States: results of a Purvey. J.A.D.A. 43:722 Dec. 1951. 5. Skinner, M . L. Report of the pilot study on heaith education for dental health. Albany, N.Y., Bureau of Dental Health, N.Y. State Health Dept., 1952 (Mim eo.). 6. Hadjimarkos, D. M . Teaching public health to dental students. Am . J. Pub. Health 44:1352 Oct. 1954. 7. Trends in public health dentistry. A Committee Report. Am. J. Public Health, 46:353 March 1956.
244 • TH EJO U R N A L OF T H E A M E R IC A N DENTAL A SSO C IA T IO N
appears that no concerted effort has been made to create a position for a dental health officer on the staff of the local health unit. This in turn may stem, in part, from lack o f understanding o f the magnitude of the dental health problem by those responsible for the appropriation of funds for the operation of the health unit. It may be that the local dental prac titioners have not exercised the leadership expected o f them in promoting the crea tion of such a position. As one health officer stated, in discussing the steps to be taken for creating such a post, “ we would need the consent and cooperation of the local dental society.” Furthermore, from the remarks made by the health officers participating in the study, the impression has been gained that some o f them might not have a clear picture of the objectives o f dental public health and o f the role, responsibili ties, and duties of a dental health officer. It is apparent that there are major obstacles to be overcome before positions for dental health officers at the local health unit are created. The responsibility for this rests to a great extent on the dental profession, and in the final analy sis it is one o f education. The dental practitioner, by virtue of his professional standing, is a highly influential member o f his community and often occupies a position o f public and civic importance which enables him to exercise effective leadership. Thus, the state and local den tal societies should exert every effort among lay and professional people to: (1) convey to them an understanding of the basic objectives and philosophy of dental public health, (2) present infor mation regarding the seriousness o f the dental health problem and (3) explain the value and the necessity o f having a dental health officer, either full or parttime, on the local health team. When all the facts are presented and explained, there is every reason to believe that satisfactory arrangements, budgetary and other, can be made in the majority
o f instances. Clearly, the expenditure of over 1.5 billion dollars by the American public in the course o f one year for den tal care, and also the magnitude of the nation’s unmet dental needs indicate that dental health constitutes a major health problem that merits serious consideration, both by the health professions and lay groups o f every community. It is gratifying to note in this connec tion that recent trends in dental educa tion indicate that the dentist of the future will have a more adequate background o f dental public health objectives and practices, thus increasing his potential contribution to the community in the improvement of dental health.8-12 S U M M A R Y
A study was conducted among the health officers of Oregon to ascertain their atti tudes, reactions, and comments regarding the employment of dental health officers on the regular staff of the local health de partments o f the state. The results showed that none of the local health units of the state employs a dental health officer on a full-time basis, and also revealed important reasons re sponsible for this situation. The findings in Oregon parallel similar conditions pre vailing in the rest of the country. The value of employing dental health officers on the regular staff of local health departments as a means of improving the dental health of the people is dis cussed and a plan toward realization of this end is suggested.
8. Hadjîmarkos, D. M. Field training in public health for undergraduate dental students. J. D. Educ. 19:223 Nov. 1955. 9. Peterson, Shailer. Current status of public health dentistry courses for undergraduate dental students. J. D. Educ. 20:95 March 1956. 10. Gruebbel, A. O . Ob[ectives of a course in public health dentistry. J. D. Educ. 20:114 March 1956. 11. Easlick, K. A . Qualifications and training of the teacher of dental public health. J. D. Educ. 20:119 March 1956. 12. Galagan, D. J, Proposed ideal curriculum for a productive course in public health dentistry. J. D. Educ. 20:127 March 1956.
sired because the local health department is responsible for the preservation of health, including dental health, of the people o f its area.
The field of dental public health is con cerned with “ those organized community health services which cannot be rendered by the private practitioner alone.” 1 From this definition, adopted by the American Dental Association, the great importance placed on the development of local or community dental health programs is ap parent. The establishment of such pro grams as a means o f improving the dental health o f the nation has been urged by the American Dental Association for years. Today there are numerous methods and technics for combating dental dis ease on a mass scale, thus improving the dental health of the population. Promo tion of dental health can only be accom plished, however, by the successful appli cation of the available methods. Hence, the main efforts in the field o f dental public health are, or should be, directed toward persuading the community to ac cept and utilize the newer knowledge of dental health. This means changing longestablished habits and modes o f living, which is not too easy to accomplish, (par ticularly in undramatic diseases such as dental caries and periodontal disease), without a thorough understanding and appreciation of the different factors and conditions (cultural, economic, and so cial) peculiar to each community. As a dental health aid, a study was made among the health officers o f Oregon to ascertain their attitudes, reactions and comments regarding the employment of dental health officers (public health den tists) on the regular staff o f community health units. This information was de
M E T H O D
A N D
R E S U L T S
The state o f Oregon is composed of 36 counties. O f these, 19 are served by full time health departments (14 single county units and 2 district units). The remaining 17 counties are classified as unorganized, without full-time health services. For the purpose of the study, a ques tionnaire and an explanatory letter were sent to every full-time and part-time health officer of the state, 33 in all. R e plies were received from 31. None o f the community health depart ments o f Oregon employs a dental health officer (public health dentist) on a regular staff on a full-time basis. Only Multnomah county, which is one o f the state’s most populous counties, reported that a public health dentist is on the staff on a half-time basis, together with a full time dental hygienist. From the returned questionnaires it was noted that some of the health officers were aware o f the magnitude o f the den tal health problem in their counties, and also indicated that it would be desirable to have a dental health officer on the
Professor and head, Department of Public Health, the Dental School of the University of Oregon. I. Am erican Dental Association. Transactions 1952.
241
242 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SS O C IA T IO N
staff of the local health unit. Some ex planations were given as to why the crea tion of such a position on the local health unit has not materialized or is not con sidered essential. The two most frequently cited reasons were budgetary limitations, and sparsity o f population. Other comments offered by the officers included: “ D o not think an effort has been made to acquire a dental health officer.” “ The general public would have to be sold on this program.” “ W e have needs with greater priority.” “ At present time not practical because too many pro grams— fluoridation on agenda.” “ Num ber of dentists available for population of the county seems sufficient.” “ W e have only two dentists in the county and they arc so overworked I feel that neither of them would be willing to undertake any additional duties. They have been ex amining the school children under a minimal fee basis and everyone seems satisfied with the arrangement.” “ A pro gram o f dental examinations would only make people more unhappy than they are because they cannot get the treatment needed. If such a person did treatment, the cry of ‘socialized dentistry’ would be raised and he could only do a very small part o f the treatment needed anyway.” The suggestion was made by some offi cers that in view of budgetary limitations and sparsity of population it might be possible to make arrangements between neighboring counties for the employment of dental health officers on a district level. The possibility of employing dental hygienists and the need for more dental health education were also proposed for consideration. D IS C U S S IO N
The results of the study not only indicate the existing situation in one state re garding the employment of dental health officers on the local health unit, but also parallel similar conditions prevailing in the rest o f the country. From a recent re
port on the number of personnel em ployed by the nation’s 1,389 full-time health departments which serve 2,229 counties and include 89 per cent of the population, it was shown that only 236 dental health officers are employed on a full-time basis at the local level.2 The remaining 11 per cent of the population is not covered by full-time local health services. O f these 236 dental health offi cers, 145 are on the staff of city health departments and the remaining 91 are employed by single county health units and local and state health districts. A c cording to the same report, only 367 den tal hygienists are on the staff of local health units. Commenting on the importance of de veloping local or community dental health programs, Phair3 stated: It has been recognized, through both tradi tion and experience, that it is in the com munity where health needs can best be de termined, where resources can be utilized to the fullest extent, where the desires and inter ests o f the people can be made known and, in the final analysis, where the actual health services are perform ed.
In general, the impetus or initiative for developing community dental health programs comes from two main sources: ( 1 ) the dental health division of the state department o f health and (2) the local dental practitioners. The participation and cooperation of the local dentists is an absolute essential for the successful estab lishment of such a program. Today, however, the number of organized community dental health pro grams is extremely small. From a survey conducted a few years ago by the Coun cil on Dental Health o f the American Dental Association it was revealed that out of 40,000 communities in the country
2. Greve, C. H., and Cam pbell, J. R. Organization and staffing for full-time local health services. Pub. 441. W ashington, D.C., U.S. Department of Health, Educa tion, and Welfare, Public Health Service, 1953. 3. Phair, W. P. American Dental Association program for community dental health. J.A.D.A. 46:438 A p ril 1953.
H A D JIM A R K O S . . . VO LUM E 55, AUG UST 1957 • 243
only 5,000 had some type of community dental health program.4 Although there are reasons for the scarcity o f community dental health pro grams in the country, undoubtedly some important ones stem directly from the dental practitioners. In a recent study it was indicated that some of the difficulties arise from lack o f knowledge and under standing on the part of dentists regarding the scope and nature of community den tal health programs.3,5 Another contribu tory factor is that dentists in the past have not received adequate instruction in public health during their under graduate dental education and, as a re sult, they are not well prepared'to exer cise leadership in the development of dental health programs.6 The dental health divisions of state departments of health are contributing a great deal o f time and effort to promote and motivate the development o f com munity dental health programs. A num ber o f state dental health divisions are handicapped in their efforts, however, by inadequate personnel and also by the great size of the state. In the case of Oregon, for example, the dental health division of the state board of health is composed o f only the director and one dental hygienist, yet the state of Oregon occupies an area o f 96,981 square miles. In view of these facts, it is necessary to consider and explore new approaches for the fulfillment o f dentistry’s objective; that is, the establishment of successful dental health programs in every com munity o f the United States. In line with this, the employment o f dental health officers by the local health department or unit is certainly a step in the right direction. Although some progress has been made in the number o f dental health officers employed on the staff of local health departments, much remains to be done.7 The advantages o f such a system or approach are obvious. At the present time, the successful operation o f com
munity dental health programs depends to a great extent on the continuous and enthusiastic participation and interest of local dental practitioners. In view o f the complexities, multiplicity of activities, and time involved in conducting such programs, however, this is not always easy to accomplish and many promising beginnings fail to reach full fruition. On the other hand, a dental health officer on the staff o f the community health unit will have the opportunity to acquire a thorough knowledge and understanding of the problems, resources, and potential ities o f his area. As a result of this, he will be in a better position to exercise effective leadership not only for initiating ap propriate dental health programs but also for sustaining and expanding their opera tion. He will be able to coordinate the activities and give expert guidance to the different lay and professional groups in terested in dental health improvement. T he main difficulties encountered in Oregon regarding the employment of dental health officers by the local health unit or department may reasonably be assumed to be also applicable to the rest of the country. One o f the obstacles most frequently cited in the study seems to be lack o f sufficient funds. The suggestion that neighboring counties combine forces for employing a dental health officer on a district level should be explored vigor ously. Such an approach is promising and seems particularly advantageous for coun ties with small population and limited resources. O n the basis of comments contained in the questionnaires returned, however, it would seem that other important factors are also responsible for this situation. It
4. Phair, W . P. Com munity dental health programs in the United States: results of a Purvey. J.A.D.A. 43:722 Dec. 1951. 5. Skinner, M . L. Report of the pilot study on heaith education for dental health. Albany, N.Y., Bureau of Dental Health, N.Y. State Health Dept., 1952 (Mim eo.). 6. Hadjimarkos, D. M . Teaching public health to dental students. Am . J. Pub. Health 44:1352 Oct. 1954. 7. Trends in public health dentistry. A Committee Report. Am. J. Public Health, 46:353 March 1956.
244 • TH EJO U R N A L OF T H E A M E R IC A N DENTAL A SSO C IA T IO N
appears that no concerted effort has been made to create a position for a dental health officer on the staff of the local health unit. This in turn may stem, in part, from lack o f understanding o f the magnitude of the dental health problem by those responsible for the appropriation of funds for the operation of the health unit. It may be that the local dental prac titioners have not exercised the leadership expected o f them in promoting the crea tion of such a position. As one health officer stated, in discussing the steps to be taken for creating such a post, “ we would need the consent and cooperation of the local dental society.” Furthermore, from the remarks made by the health officers participating in the study, the impression has been gained that some o f them might not have a clear picture of the objectives o f dental public health and o f the role, responsibili ties, and duties of a dental health officer. It is apparent that there are major obstacles to be overcome before positions for dental health officers at the local health unit are created. The responsibility for this rests to a great extent on the dental profession, and in the final analy sis it is one o f education. The dental practitioner, by virtue of his professional standing, is a highly influential member o f his community and often occupies a position o f public and civic importance which enables him to exercise effective leadership. Thus, the state and local den tal societies should exert every effort among lay and professional people to: (1) convey to them an understanding of the basic objectives and philosophy of dental public health, (2) present infor mation regarding the seriousness o f the dental health problem and (3) explain the value and the necessity o f having a dental health officer, either full or parttime, on the local health team. When all the facts are presented and explained, there is every reason to believe that satisfactory arrangements, budgetary and other, can be made in the majority
o f instances. Clearly, the expenditure of over 1.5 billion dollars by the American public in the course o f one year for den tal care, and also the magnitude of the nation’s unmet dental needs indicate that dental health constitutes a major health problem that merits serious consideration, both by the health professions and lay groups o f every community. It is gratifying to note in this connec tion that recent trends in dental educa tion indicate that the dentist of the future will have a more adequate background o f dental public health objectives and practices, thus increasing his potential contribution to the community in the improvement of dental health.8-12 S U M M A R Y
A study was conducted among the health officers of Oregon to ascertain their atti tudes, reactions, and comments regarding the employment of dental health officers on the regular staff of the local health de partments o f the state. The results showed that none of the local health units of the state employs a dental health officer on a full-time basis, and also revealed important reasons re sponsible for this situation. The findings in Oregon parallel similar conditions pre vailing in the rest of the country. The value of employing dental health officers on the regular staff of local health departments as a means of improving the dental health of the people is dis cussed and a plan toward realization of this end is suggested.
8. Hadjîmarkos, D. M. Field training in public health for undergraduate dental students. J. D. Educ. 19:223 Nov. 1955. 9. Peterson, Shailer. Current status of public health dentistry courses for undergraduate dental students. J. D. Educ. 20:95 March 1956. 10. Gruebbel, A. O . Ob[ectives of a course in public health dentistry. J. D. Educ. 20:114 March 1956. 11. Easlick, K. A . Qualifications and training of the teacher of dental public health. J. D. Educ. 20:119 March 1956. 12. Galagan, D. J, Proposed ideal curriculum for a productive course in public health dentistry. J. D. Educ. 20:127 March 1956.