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British Dental Association Reports on Insurance Plan
2302
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A s s o c ia t io n
M cI n t ir e R e a p p o in t e d Navy S urgeon G en eral
R e a r A d m r. Ross T . M c ln tir e was sworn in on D ecem b er 1 fo r a second fou r-year term as ch ief o f the B u reau of M ed icin e an d S u rgery o f the U n ited States N av y . B y this reappointm ent, the President in d icated that, fo r the d u ra tion, h e w ill not observe the one-term ru le fo r chiefs o f bureaus an d branches, w h ich he applied in tim es o f peace. T h e S enate confirm ation o f A d m iral M o In tire’s reappointm ent cam e rapidly, in recognition o f outstanding service per form ed in exp an d in g the M ed ica l C orps o f the N avy. O r d e r S ix te e n O f f i c e r s
To N a v y
D e n ta l S ch o o l
Sixteen n ew ly com m issioned dental officers, a ll lieutenants (ju n ior grade) h ave b een ordered to the N av a l D en ta l School a t B ethesda, M d ., fo r ind octrina tion. T h e y a r e : P h illip R . Z eitsoff, T h a d deus H . W illiam s, W arren E . T h orn b u rg, W ilb u r J. Sunderm an, G len n R . R ich a rd son, Benson N . R ed d in g, C harles C . P ruitt, Jr., W ilb ert G . M an ke, E u gen e C . L ytle , John F . C h im ien ti, D o n ald R . B ragg, F ra n k C . B lair, Jr., F ra n k J. Losee, F red L . Losee, W illiam P. Jones and F red eric S. H ill.
COMMITTEE ON ECONOMICS
B r it is h D e n t a l A R eports
on
ss o c ia t io n
I n su ran ce P lan
A review o f the R e p o rt o f the B rit ish D en ta l Association to the In terd ep art m en tal C om m ittee on Social Insurance an d A llied Services w as prep ared by R aym on d M . W alls, ch airm an , an d M . L . D o llar, secretary, o f the C om m ittee
on E conom ics o f the A m erican D en ta l Association. T h e im plications o f the re port fo r dentistry in this country w ill be discussed in a second article in Jan u ary. How to make available adequate dental care for all sections of the population, the perplexing problem which has for many years plagued organized dentistry in the United States, has been quite as much of a prob lem to the British Dental Association. Re search has not yet revealed the basic cause of, or the cure for, caries, but experience has shown that, through early treatment, caries can be arrested and the loss of teeth through extraction be postponed for many years. Thus, while the knowledge of how caries can be controlled is at hand, a prac tical means of financing the dental treatment necessary to effect such control remains an unsolved problem. The British Dental As sociation is not waiting for the miracle of a simple cure or preventive of dental disease or for a period of prosperity that will enable every one to afford complete dental care. It is facing the issue squarely and planning realistically a program designed to alleviate the serious dental condition now existing in Great Britain. Over a long period of years, the British Dental Association has kept in touch with developments in the field of public dental service. There has been a growing convic tion on the part of the association that the lack of coordination between the numerous branches of public dental service has led to confusion, economic loss and failure to meet the dental health needs of the nation. Recently, the association decided that the time was ripe for a thorough-going study of public dental service. Accordingly, a special committee was appointed and charged with the responsibility of making a study and re porting on the provision of dental treatment for the industrial classes. A program was to be planned with a view to securing com plete dental service by the coordination of existing arrangements and by their extension where necessary. A report was prepared and submitted to the Interdepartmental Com mittee on Social Insurance with the request that the sections of the report having to do with aspects of dental health services that were not under its jurisdiction be passed on to the appropriate governmental agency.
M id - M o n t h l y I s s u e
The report, while recognizing the impor tance of diet in a long range program for dental health, emphasizes the need for reg ular examination and treatment in order to meet present need. T he report traces the development of dental deterioration chrono logically, starting with the effects of care of the expectant mother and continuing through preschool age, nursery school age, school age, adolescence and adulthood. The dental care available to each of these groups is reviewed and criticized and suggestions are made for improvement. With reference to programs for dental care for expectant and nursing mothers and for the preschool age group, the report states, various statutes assert that such care may be given by the local health authorities, but that there is no compulsion. As a result, the few services that are available are very in adequate. It is recommended that the ma ternal and child welfare dental program be brought under central control and that a dental staff be organized and given the re sponsibility for organizing a program to meet the need. This agency should be charged with ensuring that the child enter school with sound teeth. The expansion of the nursery school system will greatly facilitate the pro gram. Through such a program, the deplor able condition of the teeth of the children entering school could be remedied, and the emphasis of the school program could be placed on preventive rather than on restor ative dentistry as heretofore. The report calls attention to the fact that the school program formerly had the same status that the maternal and infant welfare programs now have. That is to say, prior to 1921, local authorities were granted permis sion to give medical examinations to chil dren in the schools, but, with the passage of the Education Act of 1921, it became com pulsory that facilities be provided for medi cal examination and treatment. On the basis of this authority, the Board of Education is making every effort to encourage, develop and control programs for dental care in the schools. Statistics on dental conditions among school children vouch for the growing effec tiveness of this program. However, there is still much room for improvement in the school program, since, on the average, only 75 per cent of the student body is examined each year. Seventy-four per cent of all those
2303
examined are found to need dental care. O f those who need care, only 64 per cent actually receive treatment, and in many of these cases, restoration is not complete. It is recommended that the school pro gram be organized on a regional basis, in preference to the present local basis. T he staff should be increased to allow for a bi annual examination, of every child. T he dental staff should be organized with various ranks under the direction of the regional den tal officer. Such a system would provide an incentive to the dentist to give his best efforts in order to receive promotion. Supervision would ensure the high quality of the work done. It is pointed out that the salaries of the dentists now participating in the pro gram equals less than 1 per cent of the total salaries paid to teachers. Should the pro gram be expanded as recommended, the sal aries of the dentists would still amount to only 3 per cent of the total salaries paid to teachers. The age group most neglected under the present system, according to the report, are the adolescents who have just graduated from school and have entered industry. While these young people immediately be come eligible for medical care under the compulsory insurance plan, they do not re ceive dental care at all in many communi ties, and not until after a waiting period of two or three years even in those areas where the approved society does offer dental care as an additional benefit. The British Dental Association recommends that the local au thorities make dental service available to this group during the waiting period and institute a program to encourage the use of the service. Presumably, the worker in industry who is protected by health insurance has his health needs cared for. However, the report charges that dental health needs are woefully neg lected. Dental care is not included as a regular benefit of the plan, and many of the approved societies do not have it even as an additional benefit. Those societies that do give dental care as an additional service usually are so hampered by lack of funds that they are able to offer only very limited dental care. In most instances, the approved society pays but 50 per cent of the dental bill. Since there are many people who can( Continued on page 231a)
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A s s o c ia t io n
M cI n t ir e R e a p p o in t e d Navy S urgeon G en eral
R e a r A d m r. Ross T . M c ln tir e was sworn in on D ecem b er 1 fo r a second fou r-year term as ch ief o f the B u reau of M ed icin e an d S u rgery o f the U n ited States N av y . B y this reappointm ent, the President in d icated that, fo r the d u ra tion, h e w ill not observe the one-term ru le fo r chiefs o f bureaus an d branches, w h ich he applied in tim es o f peace. T h e S enate confirm ation o f A d m iral M o In tire’s reappointm ent cam e rapidly, in recognition o f outstanding service per form ed in exp an d in g the M ed ica l C orps o f the N avy. O r d e r S ix te e n O f f i c e r s
To N a v y
D e n ta l S ch o o l
Sixteen n ew ly com m issioned dental officers, a ll lieutenants (ju n ior grade) h ave b een ordered to the N av a l D en ta l School a t B ethesda, M d ., fo r ind octrina tion. T h e y a r e : P h illip R . Z eitsoff, T h a d deus H . W illiam s, W arren E . T h orn b u rg, W ilb u r J. Sunderm an, G len n R . R ich a rd son, Benson N . R ed d in g, C harles C . P ruitt, Jr., W ilb ert G . M an ke, E u gen e C . L ytle , John F . C h im ien ti, D o n ald R . B ragg, F ra n k C . B lair, Jr., F ra n k J. Losee, F red L . Losee, W illiam P. Jones and F red eric S. H ill.
COMMITTEE ON ECONOMICS
B r it is h D e n t a l A R eports
on
ss o c ia t io n
I n su ran ce P lan
A review o f the R e p o rt o f the B rit ish D en ta l Association to the In terd ep art m en tal C om m ittee on Social Insurance an d A llied Services w as prep ared by R aym on d M . W alls, ch airm an , an d M . L . D o llar, secretary, o f the C om m ittee
on E conom ics o f the A m erican D en ta l Association. T h e im plications o f the re port fo r dentistry in this country w ill be discussed in a second article in Jan u ary. How to make available adequate dental care for all sections of the population, the perplexing problem which has for many years plagued organized dentistry in the United States, has been quite as much of a prob lem to the British Dental Association. Re search has not yet revealed the basic cause of, or the cure for, caries, but experience has shown that, through early treatment, caries can be arrested and the loss of teeth through extraction be postponed for many years. Thus, while the knowledge of how caries can be controlled is at hand, a prac tical means of financing the dental treatment necessary to effect such control remains an unsolved problem. The British Dental As sociation is not waiting for the miracle of a simple cure or preventive of dental disease or for a period of prosperity that will enable every one to afford complete dental care. It is facing the issue squarely and planning realistically a program designed to alleviate the serious dental condition now existing in Great Britain. Over a long period of years, the British Dental Association has kept in touch with developments in the field of public dental service. There has been a growing convic tion on the part of the association that the lack of coordination between the numerous branches of public dental service has led to confusion, economic loss and failure to meet the dental health needs of the nation. Recently, the association decided that the time was ripe for a thorough-going study of public dental service. Accordingly, a special committee was appointed and charged with the responsibility of making a study and re porting on the provision of dental treatment for the industrial classes. A program was to be planned with a view to securing com plete dental service by the coordination of existing arrangements and by their extension where necessary. A report was prepared and submitted to the Interdepartmental Com mittee on Social Insurance with the request that the sections of the report having to do with aspects of dental health services that were not under its jurisdiction be passed on to the appropriate governmental agency.
M id - M o n t h l y I s s u e
The report, while recognizing the impor tance of diet in a long range program for dental health, emphasizes the need for reg ular examination and treatment in order to meet present need. T he report traces the development of dental deterioration chrono logically, starting with the effects of care of the expectant mother and continuing through preschool age, nursery school age, school age, adolescence and adulthood. The dental care available to each of these groups is reviewed and criticized and suggestions are made for improvement. With reference to programs for dental care for expectant and nursing mothers and for the preschool age group, the report states, various statutes assert that such care may be given by the local health authorities, but that there is no compulsion. As a result, the few services that are available are very in adequate. It is recommended that the ma ternal and child welfare dental program be brought under central control and that a dental staff be organized and given the re sponsibility for organizing a program to meet the need. This agency should be charged with ensuring that the child enter school with sound teeth. The expansion of the nursery school system will greatly facilitate the pro gram. Through such a program, the deplor able condition of the teeth of the children entering school could be remedied, and the emphasis of the school program could be placed on preventive rather than on restor ative dentistry as heretofore. The report calls attention to the fact that the school program formerly had the same status that the maternal and infant welfare programs now have. That is to say, prior to 1921, local authorities were granted permis sion to give medical examinations to chil dren in the schools, but, with the passage of the Education Act of 1921, it became com pulsory that facilities be provided for medi cal examination and treatment. On the basis of this authority, the Board of Education is making every effort to encourage, develop and control programs for dental care in the schools. Statistics on dental conditions among school children vouch for the growing effec tiveness of this program. However, there is still much room for improvement in the school program, since, on the average, only 75 per cent of the student body is examined each year. Seventy-four per cent of all those
2303
examined are found to need dental care. O f those who need care, only 64 per cent actually receive treatment, and in many of these cases, restoration is not complete. It is recommended that the school pro gram be organized on a regional basis, in preference to the present local basis. T he staff should be increased to allow for a bi annual examination, of every child. T he dental staff should be organized with various ranks under the direction of the regional den tal officer. Such a system would provide an incentive to the dentist to give his best efforts in order to receive promotion. Supervision would ensure the high quality of the work done. It is pointed out that the salaries of the dentists now participating in the pro gram equals less than 1 per cent of the total salaries paid to teachers. Should the pro gram be expanded as recommended, the sal aries of the dentists would still amount to only 3 per cent of the total salaries paid to teachers. The age group most neglected under the present system, according to the report, are the adolescents who have just graduated from school and have entered industry. While these young people immediately be come eligible for medical care under the compulsory insurance plan, they do not re ceive dental care at all in many communi ties, and not until after a waiting period of two or three years even in those areas where the approved society does offer dental care as an additional benefit. The British Dental Association recommends that the local au thorities make dental service available to this group during the waiting period and institute a program to encourage the use of the service. Presumably, the worker in industry who is protected by health insurance has his health needs cared for. However, the report charges that dental health needs are woefully neg lected. Dental care is not included as a regular benefit of the plan, and many of the approved societies do not have it even as an additional benefit. Those societies that do give dental care as an additional service usually are so hampered by lack of funds that they are able to offer only very limited dental care. In most instances, the approved society pays but 50 per cent of the dental bill. Since there are many people who can( Continued on page 231a)