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Community Obligation of the Dentist
Department of Denial Health Education tained in these schools in from sixty to ninety days, according to the statistics, were marvelous, demonstrating what may be accomplished by the dental hygienist as a health inspector and teacher. The dental hygienist and her work is attracting attention throughout the country. The message is being carried by the daily press, in professional jour nals and in magazines, by the medical and the dental professions, nurses, den tal hygienists and teachers. The public has accepted the service and the de mand for the dental hygienist in public work is now beyond the supply. The dental profession has created the de mand. It is now up to the profession to supply it, or to assist in every way possible. i While a study of the efforts being put forth throughout the country for mouth hygiene shows a widespread in terest, it also shows a lack of uniform
727
ity, which is evidence that it is yet, to some extent, in the experimental stage. Therefore, there should be an effort made by the dental profession to stand ardize the training of dental hygienists for public school work. If the name, “ public school hygien ist,” and the work suggested for her by Dr. Fones should prove to be the most acceptable, beneficial, and economical to the public, then that plan should be followed. /W hen the question of standardized training is settled, there should be little difficulty in securing uniform legislation in the several states, regulating the serv ices of such hygienists and making pro vision for their training through the educational system of each state. The American Dental Association should assist in solving these problems through its Council on Mouth Hygiene and Public Instruction. A
COMMUNITY OBLIGATION OF THE DENTIST By C. J. HOLLISTER, D.D.S., Harrisburg, Pennsylvania (R ead before the American Dental Association, Dallas, Texas, November 10-14, 1924)
N TH IS day of great technical and re search development by the dental pro fession, there is a line of activity that has been sadly neglected by the majority of dentists of the nation and that is pre ventive dentistry by education of the laity to the value of proper nutrition, mouth hygiene and periodic examination by the dentist. The purpose of this paper is to show the individual dentist what he owes to the community in which he lives and how he can fulfil that obligation. The progress of the profession in the past generation has furnished a real oppor tunity for the dentist to be a source of information on proper diet. The results of investigations by McCollum, Grieves,
I
Howe, Toverud, the Mellanbys, Wiley and many others have shown conclu sively that what we eat has much to do with our physical well-being. Animals do not have toothbrushes, nor do they have toothache; and, further, animals living in their natural environment do not suffer from disease; they die a death of violence or of normal old age, and when they die of old age, they do not fail in any one part or function, but rather fail in toto, passing like the “ one horse shay.” We, in our present high state of civili zation, look on statements of nutrition research investigators with little or no concern, classifying them as alarmists or extremists until, in individual cases,
728
The Journal of the American Dental Association
we are forced by lowered vitality or loss of function to adopt their doctrines, and after a period of strict adherence to their advice, we find ourselves benefited almost beyond belief. Then, because of our personal experience, we become ar dent disciples of the truth of proper and balanced dietary. Nutrition is beyond question the foundation for health, men tal and moral development, and with these undisputed facts before us, why should we not prepare ourselves, in a capable manner, to do our part toward educating the lay public to the impor tance of proper foods? The value of prophylaxis and dental correction was first brought to our at tention by the experiment made by Ebersole and his associates in Cleveland, in 1913, and substantiated wherever this type of work has been established. This experiment proved conclusively the rela tion of a well cared for dental apparatus to physical and mental ability. Here I want to call your attention to the fact that the twenty-seven children who took part in this experiment were also in structed in proper diet, and their mode of living was kept up under supervision by frequent home visitation. This brings out a point that applies to the majority of educational dental programs. The activities with which I have come in contact are not confined to prophylaxis or correction of dental defects but are a part of the general health program. The Bridgeport plan is a fine example of the broadness of application of the serv ices of the dental hygienist. There they augment the work of all other health and hygiene agencies in the schools. In Hanover, Pa., during a four months’ campaign for correction of den tal defects among the children attend ing one school of that borough, 315 were examined, and those needing dental service were urged to have necessary work done by local dentists, of which there are four. The checkup at the end of four months gave the following re
sult: 230 children returned certificates signed by their dentist; forty-eight had work not quite completed; thirty-seven, chiefly in the primary grade, did not visit a dentist. This result was accom plished by following the plan of Miss Gladys Eyrich, who obtained 100 per cent perfect teeth certificates from 1,674 children of Jackson, Miss. May I call your attention to the fact that 278 chil dren out of 315 received treatment by dentists as private pay patients. It cost the dentists of the community nothing. In fact, they were beneficiaries of the activity. In Chambersburg, Pa., last year, among 2,000 school children there were 650 perfect teeth certificates signed by local dentists, and this year indications are that the number will go well over 1,000, owing almost entirely to the activ ities of the hygienist employed by the school board. In Allentown, where four dental hygienists have been employed for the past three years by the school board, I have it on authority of school officials that retardation has been reduced from 18 to 25 per cent. We do not say that this reduction is due entirely to the work of the dental hygienist, but it is significant that no other changes were made in the curriculum during that time. There are about seventy-five school districts in Pennsylvania employing den tal hygienists, and, without exception, the superintendents of these districts en thusiastically endorse the work. U. L. Gordy, superintendent of the Chambers burg schools, says, “ Of all non-curricular activities in our schools, dental hy giene would be the last to go in any policy of retrenchment.” Joseph F. Noonan, superintendent of schools of Mahanoy Township, in closing a recent letter to me, says, “ Believing that the in troduction of dental hygiene here will be productive of splendid results in connec tion with the general health of our school children, and extending heartiest good wishes, I remain, very truly yours.”
Department of Dental Health Education The foregoing statements are endorsed by all school men in our state who have had any opportunity to observe the den tal hygienist in school work. Constant contact with members of the profession in many parts of the country is my authority for the statement that the majority of dentists dislike to work for children, and under past conditions the aversion to this work was natural, for a number of reasons. The child has rarely, if ever, looked forward to his first experience in a dental office with pleas ure. Except among those of you who are confining your work exclusively to children, it is the usual experience to have the child brought to you actually suffering pain and also under great ap prehension. Another reason is that it takes more nervous energy on the part of a dentist to operate on a child in this state of mind, and in most communities the child is taken to the dentist after school hours, which means that the oper ator is called on to do work that demands the best he has in him, at the ragged end of his busy day. Again, there is the profession’s apathy toward children’s work, and the old impression that com pensation for this work should be at half fare as on railroad trains. If a child enters the dental office of its own voli tion seeking service on the advice of the school dental hygienist or for any similar reason, it gives the operator an opportu nity to practice real preventive dentistry, and here might be added a long discourse on the subject. By this early and pre ventive service, the child is impressed w'ith the value of frequent examination by his dentist, which means that, through regular periodic examination, the neces sity for dental correction is reduced to a minimum. I find that the regular ex amination procedure is being adopted in a great many offices, which is, of course, a step in the right direction. Now as to methods, which local dentists can ethically apply at home. Coudersport, Pa., has a population of 2,900 and a school population of 800. Two den
729
tists are practicing there. The town is too small to make it practical to employ a dental hygienist and it is isolated so that it is not possible to employ such a worker in cooperation with some other community, as is frequently done; so these two dentists voluntarily suggested to the school board that they give pro phylactic care to the school children of the district in their offices without com pensation. This offer was accepted, and the plan is in operation. The dentists set aside one morning each week during which the school authorities, assisted by a community nurse, send fifteen or twenty children to each office for prophy lactic treatment. In addition to this service, these dentists have taken it on themselves to give classroom talks in all the rooms of the borough. The prin cipal of this school, who was in my office at the time this article was being prepared, reported that already there was a marked improvement in appear ance and attitude of the entire school enrolment. This, to my mind, is an ideal plan by which members of the profession located in small communities can accomplish a bit of real service. In larger places, their activity should be directed toward stimulating local author ities toward the establishment of paid service of like nature using the dental hygienist or dentists, depending on personal opinion and local conditions. We are not exploiting the services of the dental hygienist as a panacea for all dental ills. We know of a number of dental service plans in operation in various parts of the country that are accomplishing admirable results without the dental hygienist. Notably, there is one in operation in the rural schools of Virginia. Another fine program is being carried out in the schools of North Dakota by the training of all school teachers in the principles of dental hygiene, they, in turn, passing it on to their pupils. The dentist in private practice can
730
The Journal of the American Dental Association
wield a great influence in molding pub lic opinion as regards public dental serv ice. Examples of the results of this in fluence are: The Rochester'Dental In firmary, The Forsyth Dental Infirmary and many other similar activities where the philanthropically inclined wealthy citizens willingly supplied sufficient funds to work of this kind, as a result of their contact with some member of the profession. The obligation of all local dentists, then, is to seek a local Eastman or Forsyth, and win him to the idea of community dentistry. In Pennsylvania, we have a volun teer organization made up of ethical practitioners of the state, which has been described. This plan is functioning beyond the expectations of its originators, and, by means of this group, it is planned to hold a state-wide dental health week, beginning February 22, 1925. The suc cess of dental health weeks in Milwaukee and Detroit in previous years, and also in Reading and York, Pa., last year, has been our incentive to try to put over such a plan in every city, borough and hamlet in the state. W e believe that the
time has passed when it should be con sidered unethical for members of the profession to broadcast the importance of mouth hygiene, and we believe that every dentist in the community, both in groups and individually, should do everything in his power to disseminate proper in formation to the public. In Pennsylvania this year, there are more than 100 dental hygienists serving, in seventy-five communities, and about as many more dentists engaged in school clinic work. There are, in round num bers, 1,800,000 children of school age in Pennsylvania, and it is estimated that approximately 300,000 of these children are receiving preventive and corrective service at the hands of these workers. The adopted slogan of the state dental society and the state department of health is “ A clean mouth for every inhabitant of the commonwealth.” Actually, this slogan will never be realized, but, within a very few years, it will not be the fault of the health department authorities or the dental profession if there is an un clean mouth in the state, for the message will have reached the remotest corner.
THE DENTAL HYGIENIST By ANNA V. HUGHES,* D.M.D., New York City TRAN G E as it may seem, there are many people, including dentists, who do not understand the special field of the dental hygienist. Many of them think she is a highly trained office assistant, while, in reality, she is pri marily an educator. Conservative statistics show that 95 per cent of the adult population have
S
^Professor of Preventive Dentistry, Colum bia University.
carious teeth. Such teeth are not only potential sources of pain and discomfort, but are also sources of disease, and with every mouthful of food they send into the system a supply of dangerous bac teria. Decayed teeth, moreover, are not able to do the work of biting, chewing, thoroughly masticating and preparing the food for the intestinal tract, and thus they are instrumental in bringing about the digestive troubles with which so many people are afflicted.
727
ity, which is evidence that it is yet, to some extent, in the experimental stage. Therefore, there should be an effort made by the dental profession to stand ardize the training of dental hygienists for public school work. If the name, “ public school hygien ist,” and the work suggested for her by Dr. Fones should prove to be the most acceptable, beneficial, and economical to the public, then that plan should be followed. /W hen the question of standardized training is settled, there should be little difficulty in securing uniform legislation in the several states, regulating the serv ices of such hygienists and making pro vision for their training through the educational system of each state. The American Dental Association should assist in solving these problems through its Council on Mouth Hygiene and Public Instruction. A
COMMUNITY OBLIGATION OF THE DENTIST By C. J. HOLLISTER, D.D.S., Harrisburg, Pennsylvania (R ead before the American Dental Association, Dallas, Texas, November 10-14, 1924)
N TH IS day of great technical and re search development by the dental pro fession, there is a line of activity that has been sadly neglected by the majority of dentists of the nation and that is pre ventive dentistry by education of the laity to the value of proper nutrition, mouth hygiene and periodic examination by the dentist. The purpose of this paper is to show the individual dentist what he owes to the community in which he lives and how he can fulfil that obligation. The progress of the profession in the past generation has furnished a real oppor tunity for the dentist to be a source of information on proper diet. The results of investigations by McCollum, Grieves,
I
Howe, Toverud, the Mellanbys, Wiley and many others have shown conclu sively that what we eat has much to do with our physical well-being. Animals do not have toothbrushes, nor do they have toothache; and, further, animals living in their natural environment do not suffer from disease; they die a death of violence or of normal old age, and when they die of old age, they do not fail in any one part or function, but rather fail in toto, passing like the “ one horse shay.” We, in our present high state of civili zation, look on statements of nutrition research investigators with little or no concern, classifying them as alarmists or extremists until, in individual cases,
728
The Journal of the American Dental Association
we are forced by lowered vitality or loss of function to adopt their doctrines, and after a period of strict adherence to their advice, we find ourselves benefited almost beyond belief. Then, because of our personal experience, we become ar dent disciples of the truth of proper and balanced dietary. Nutrition is beyond question the foundation for health, men tal and moral development, and with these undisputed facts before us, why should we not prepare ourselves, in a capable manner, to do our part toward educating the lay public to the impor tance of proper foods? The value of prophylaxis and dental correction was first brought to our at tention by the experiment made by Ebersole and his associates in Cleveland, in 1913, and substantiated wherever this type of work has been established. This experiment proved conclusively the rela tion of a well cared for dental apparatus to physical and mental ability. Here I want to call your attention to the fact that the twenty-seven children who took part in this experiment were also in structed in proper diet, and their mode of living was kept up under supervision by frequent home visitation. This brings out a point that applies to the majority of educational dental programs. The activities with which I have come in contact are not confined to prophylaxis or correction of dental defects but are a part of the general health program. The Bridgeport plan is a fine example of the broadness of application of the serv ices of the dental hygienist. There they augment the work of all other health and hygiene agencies in the schools. In Hanover, Pa., during a four months’ campaign for correction of den tal defects among the children attend ing one school of that borough, 315 were examined, and those needing dental service were urged to have necessary work done by local dentists, of which there are four. The checkup at the end of four months gave the following re
sult: 230 children returned certificates signed by their dentist; forty-eight had work not quite completed; thirty-seven, chiefly in the primary grade, did not visit a dentist. This result was accom plished by following the plan of Miss Gladys Eyrich, who obtained 100 per cent perfect teeth certificates from 1,674 children of Jackson, Miss. May I call your attention to the fact that 278 chil dren out of 315 received treatment by dentists as private pay patients. It cost the dentists of the community nothing. In fact, they were beneficiaries of the activity. In Chambersburg, Pa., last year, among 2,000 school children there were 650 perfect teeth certificates signed by local dentists, and this year indications are that the number will go well over 1,000, owing almost entirely to the activ ities of the hygienist employed by the school board. In Allentown, where four dental hygienists have been employed for the past three years by the school board, I have it on authority of school officials that retardation has been reduced from 18 to 25 per cent. We do not say that this reduction is due entirely to the work of the dental hygienist, but it is significant that no other changes were made in the curriculum during that time. There are about seventy-five school districts in Pennsylvania employing den tal hygienists, and, without exception, the superintendents of these districts en thusiastically endorse the work. U. L. Gordy, superintendent of the Chambers burg schools, says, “ Of all non-curricular activities in our schools, dental hy giene would be the last to go in any policy of retrenchment.” Joseph F. Noonan, superintendent of schools of Mahanoy Township, in closing a recent letter to me, says, “ Believing that the in troduction of dental hygiene here will be productive of splendid results in connec tion with the general health of our school children, and extending heartiest good wishes, I remain, very truly yours.”
Department of Dental Health Education The foregoing statements are endorsed by all school men in our state who have had any opportunity to observe the den tal hygienist in school work. Constant contact with members of the profession in many parts of the country is my authority for the statement that the majority of dentists dislike to work for children, and under past conditions the aversion to this work was natural, for a number of reasons. The child has rarely, if ever, looked forward to his first experience in a dental office with pleas ure. Except among those of you who are confining your work exclusively to children, it is the usual experience to have the child brought to you actually suffering pain and also under great ap prehension. Another reason is that it takes more nervous energy on the part of a dentist to operate on a child in this state of mind, and in most communities the child is taken to the dentist after school hours, which means that the oper ator is called on to do work that demands the best he has in him, at the ragged end of his busy day. Again, there is the profession’s apathy toward children’s work, and the old impression that com pensation for this work should be at half fare as on railroad trains. If a child enters the dental office of its own voli tion seeking service on the advice of the school dental hygienist or for any similar reason, it gives the operator an opportu nity to practice real preventive dentistry, and here might be added a long discourse on the subject. By this early and pre ventive service, the child is impressed w'ith the value of frequent examination by his dentist, which means that, through regular periodic examination, the neces sity for dental correction is reduced to a minimum. I find that the regular ex amination procedure is being adopted in a great many offices, which is, of course, a step in the right direction. Now as to methods, which local dentists can ethically apply at home. Coudersport, Pa., has a population of 2,900 and a school population of 800. Two den
729
tists are practicing there. The town is too small to make it practical to employ a dental hygienist and it is isolated so that it is not possible to employ such a worker in cooperation with some other community, as is frequently done; so these two dentists voluntarily suggested to the school board that they give pro phylactic care to the school children of the district in their offices without com pensation. This offer was accepted, and the plan is in operation. The dentists set aside one morning each week during which the school authorities, assisted by a community nurse, send fifteen or twenty children to each office for prophy lactic treatment. In addition to this service, these dentists have taken it on themselves to give classroom talks in all the rooms of the borough. The prin cipal of this school, who was in my office at the time this article was being prepared, reported that already there was a marked improvement in appear ance and attitude of the entire school enrolment. This, to my mind, is an ideal plan by which members of the profession located in small communities can accomplish a bit of real service. In larger places, their activity should be directed toward stimulating local author ities toward the establishment of paid service of like nature using the dental hygienist or dentists, depending on personal opinion and local conditions. We are not exploiting the services of the dental hygienist as a panacea for all dental ills. We know of a number of dental service plans in operation in various parts of the country that are accomplishing admirable results without the dental hygienist. Notably, there is one in operation in the rural schools of Virginia. Another fine program is being carried out in the schools of North Dakota by the training of all school teachers in the principles of dental hygiene, they, in turn, passing it on to their pupils. The dentist in private practice can
730
The Journal of the American Dental Association
wield a great influence in molding pub lic opinion as regards public dental serv ice. Examples of the results of this in fluence are: The Rochester'Dental In firmary, The Forsyth Dental Infirmary and many other similar activities where the philanthropically inclined wealthy citizens willingly supplied sufficient funds to work of this kind, as a result of their contact with some member of the profession. The obligation of all local dentists, then, is to seek a local Eastman or Forsyth, and win him to the idea of community dentistry. In Pennsylvania, we have a volun teer organization made up of ethical practitioners of the state, which has been described. This plan is functioning beyond the expectations of its originators, and, by means of this group, it is planned to hold a state-wide dental health week, beginning February 22, 1925. The suc cess of dental health weeks in Milwaukee and Detroit in previous years, and also in Reading and York, Pa., last year, has been our incentive to try to put over such a plan in every city, borough and hamlet in the state. W e believe that the
time has passed when it should be con sidered unethical for members of the profession to broadcast the importance of mouth hygiene, and we believe that every dentist in the community, both in groups and individually, should do everything in his power to disseminate proper in formation to the public. In Pennsylvania this year, there are more than 100 dental hygienists serving, in seventy-five communities, and about as many more dentists engaged in school clinic work. There are, in round num bers, 1,800,000 children of school age in Pennsylvania, and it is estimated that approximately 300,000 of these children are receiving preventive and corrective service at the hands of these workers. The adopted slogan of the state dental society and the state department of health is “ A clean mouth for every inhabitant of the commonwealth.” Actually, this slogan will never be realized, but, within a very few years, it will not be the fault of the health department authorities or the dental profession if there is an un clean mouth in the state, for the message will have reached the remotest corner.
THE DENTAL HYGIENIST By ANNA V. HUGHES,* D.M.D., New York City TRAN G E as it may seem, there are many people, including dentists, who do not understand the special field of the dental hygienist. Many of them think she is a highly trained office assistant, while, in reality, she is pri marily an educator. Conservative statistics show that 95 per cent of the adult population have
S
^Professor of Preventive Dentistry, Colum bia University.
carious teeth. Such teeth are not only potential sources of pain and discomfort, but are also sources of disease, and with every mouthful of food they send into the system a supply of dangerous bac teria. Decayed teeth, moreover, are not able to do the work of biting, chewing, thoroughly masticating and preparing the food for the intestinal tract, and thus they are instrumental in bringing about the digestive troubles with which so many people are afflicted.