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Dental Internship
THE JOURNAL of the AMERICAN DENTAL ASSOCIATION a n d THE DENTAL COSMOS* G. N . J o h n s o n , Editor** L . P ie r c e A
nth ony,
Associate Editor
Published b y the A m erican D e n tal Association a i2 East Superior St., C h ica go , 111. A ll expressions o f opinions and all statem ents o f supposed facts are published on the author ity o f the w riter over whose signature th ey appear, and are n ot to be regard ed as expressing the v iew o f the A m erican D e n tal Association, unless such statem ents o r opinions have been adopted b y the Association. C om m unications intended fo r p ublication in the scientific or litera ry pages o f T h e J ournal should be addressed to the Editor. A ll advertising or business m atter should be sent to the Business M an ager. Subscription is in clu ded in the annual membership dues. T h e subscription rate to non-m em bers is $5.00 a y e ar in advan ce, this rate ap plyin g to b o th dom estic and foreign subscriptions. A ll foreign subscriptions are to be p aid in U n ited States m oney. * I n deferen ce to the wish o f the dental profession to control its literatu re, T h e D ental Cosm os, fou n d ed in 1859, w as transferred b y the publishers as a g ift to the A m erican D ental Association, Jan u ary 1937. **D eceased.
N ovem ber
E d ito r ia l D e p a rtm e n t
19 3 8
DENTAL INTERNSHIP development of dentistry from its biologic aspect, as expressed in the relationship of dental disease to systemic disease, has been respon sible for a special effort toward cultivating a closer cooperation between medicine and dentistry. The present basis of dentistry is biologic; its mechanical procedures are not ends in themselves but are engineering problems in relation to a biologic field. If one were to seek for the main underlying cause of the revolutionary changes that have led up to the present-day conception of the purpose of dental science and art, it would undoubtedly be found to be the germ theory of the causation of disease. The researches of Miller and Black on the etiology of dental caries, T h e
Jour. A.D.A. & D. Cos., V ol. 25, November 1938
1848
Editorial Department
leading to our present-day knowledge of the bacterio-pathology of the oral cavity and the causal relation of mouth infection to systemic dis ease, have given to both the science and art of dentistry a new birth and a vigorous growth, with the result that the objectives of dental practice have become primarily vital rather than mechanical. In a fundamental sense, then, it is the recognition of the biologic fac tor and the new mental attitude of the dental profession resulting from this recognition of the vital importance of that factor that constitute the greatest forward step of dentistry. It is the motive power of that factor that has reorganized our educa tional curriculum, changed the entire system of dental technic and bred the multiplicity of specialties in dentistry. One of the principal factors in the further development of the clinical relation of dentistry to systemic diseases, and one that has not been de veloped to its full potentiality, is that of intern service preparatory to the practice of dentistry. The indispensability of internship as preparatory to intelligent med ical practice has long since been recognized in medicine to the extent that in some twenty-five states of the Union a two-year internship has become one of the basic requirements for licensure; nor is the prospec tive specialist in any phase of the healing arts exempt from the afore said preparational requirement. Furthermore, the intensive education demanded in any specialty of medicine has made it even more necessary that additional specialized education be gained through hospital intern ship. Dentistry, having become a recognized specialty of the healing art almost on a level with the other specialties, has also come to require the educational benefits that may be acquired from the clinical experience which the internship affords and has, within recent years, paid definite attention to its development. Clinical experience in, and study of, the cause and effect relation of dental disease to bodily disease has produced most convincing proof of the almost unlimited benefits to be gained in both medical and dental practice, so much so, that it is evident that the development of this rela tionship between medicine and dentistry is likely to be pursued to its finality— compulsory internship as a requisite for dental practice. A necessary preliminary, however, to intern experience being made compulsory is a broader recognition of the benefits in and to both med ical and dental practice. It seems that the hospitals, through exper
1850
The Journal of the American Dental Association and The Dental Cosmos
ience, are in a most receptive mood to applying the new, or dental, ancillary clinical aid in attaining a more complete medical service. There are many instances of individual dentists, groups of dentists and dental societies exerting their influence toward the employment of dental attendants and interns in various hospitals, mainly for the pur pose of demonstrating the value which the dental attendant or intern may be to hospital service. We are under the impression, however, that the favorable attitude which the hospitals have shown to the dental in tern is the result of a slowly evolving conviction of the value of the service demonstrated by the somewhat spectacular reactions in systemic diseases to proper attention to the dental causal condition; this as supplementary to the constant efforts on the part of the dental profession to convince the medical profession and the public that there are numerous systemic conditions that are related in a causal manner to dental disease. One of the primary purposes of the internship for the dental gradu ate is, of course, to supplement the education of both the dental intern and the medical intern, as it is quite generally recognized, and has been for many years, that the undergraduate medical student is not taught sufficient dentistry, nor is the undergraduate dental student taught suffi cient medicine. And this applies more acutely to the instruction of the dental student in the clinical aspects of disease. Among the benefits to be realized from dental attention to the hos pital patient is that the duration of disease is materially lessened and, too, the convalescent period is much shortened when the mouth is kept in a healthy condition. Then, also, the contact of the medical student with the dental student is a relation that has been shown to be of greatest benefit in the diagnosis and treatment of dental conditions which influ ence bodily health, and this particularly in cases in which the medical man has been too quick to condemn teeth to the forceps. On the other hand, the intern system establishes an association for the dental student that, in a measure, tends to relieve the stress which, in the nature of the case, he has been compelled to put upon technic; to the end that he may develop an appreciation of dental health values as related to systemic conditions and also a higher sense of moral responsibility to the com munity. For several years there has been, and, in fact, at the moment there is, a definite effort being made by the American Dental Association to enlarge the opportunities for dental internship, until at present there are one hundred and twenty hospitals throughout the country offering
Editorial Department
18 51
one hundred and eighty internships. In addition thereto, there are some fifty-four internships available in the Marine hospitals and in the peni tentiaries. While we do not consider it pertinent or timely as yet to suggest that internship be made a compulsory requisite to dental licensure, we do be lieve that the present period of trial of the system will so convincingly prove the benefits to be obtained therefrom that some day we may evolve to that educational status. Another phase of the intern’s activities that may lead to incalculable benefits to dentistry is that of aid in gathering statistics to prove the economic value of mouth health to patients of all classes. Many such statistics have been made by physicians and nurses, but the lack of un derstanding and appreciation of the dental point of view is such as to make statistics gathered under such circumstances practically useless. We have in mind an instance in which mouth examinations were made by physicians and nurses in a group of hospital patients, the same group being reexamined later by dental interns. The physicians and nurses reported 67 per cent of those examined as having no decay, whereas the dental interns reported a percentage of only 2.7 of the same group as having no decay. This quite graphically illustrates the necessity of examination of mouth conditions being conducted by those dentally qualified and, incidentally, it shows the valuelessness of many of the den tal data that have been gathered by some of the social welfare groups. Another benefit that undoubtedly will come to the graduate dental student from such a hospital association as the internship affords is the development of an appreciation of the value of making and studying case records— a phase of clinical dental practice that has not yet been developed to its full possibilities. And in the light of the constantly increasing demand for a higher efficiency in dental practice, it behooves us to cultivate and develop every facility for meeting the new require ments. It has been pertinently suggested that, in our present state of educa tional transition, what we need is evolution more than revolution, and our earnest hope is that the internship may be instrumental in evolving the dental graduate into an efficient unit in the community health serv ice. L. P. A.
nth ony,
Associate Editor
Published b y the A m erican D e n tal Association a i2 East Superior St., C h ica go , 111. A ll expressions o f opinions and all statem ents o f supposed facts are published on the author ity o f the w riter over whose signature th ey appear, and are n ot to be regard ed as expressing the v iew o f the A m erican D e n tal Association, unless such statem ents o r opinions have been adopted b y the Association. C om m unications intended fo r p ublication in the scientific or litera ry pages o f T h e J ournal should be addressed to the Editor. A ll advertising or business m atter should be sent to the Business M an ager. Subscription is in clu ded in the annual membership dues. T h e subscription rate to non-m em bers is $5.00 a y e ar in advan ce, this rate ap plyin g to b o th dom estic and foreign subscriptions. A ll foreign subscriptions are to be p aid in U n ited States m oney. * I n deferen ce to the wish o f the dental profession to control its literatu re, T h e D ental Cosm os, fou n d ed in 1859, w as transferred b y the publishers as a g ift to the A m erican D ental Association, Jan u ary 1937. **D eceased.
N ovem ber
E d ito r ia l D e p a rtm e n t
19 3 8
DENTAL INTERNSHIP development of dentistry from its biologic aspect, as expressed in the relationship of dental disease to systemic disease, has been respon sible for a special effort toward cultivating a closer cooperation between medicine and dentistry. The present basis of dentistry is biologic; its mechanical procedures are not ends in themselves but are engineering problems in relation to a biologic field. If one were to seek for the main underlying cause of the revolutionary changes that have led up to the present-day conception of the purpose of dental science and art, it would undoubtedly be found to be the germ theory of the causation of disease. The researches of Miller and Black on the etiology of dental caries, T h e
Jour. A.D.A. & D. Cos., V ol. 25, November 1938
1848
Editorial Department
leading to our present-day knowledge of the bacterio-pathology of the oral cavity and the causal relation of mouth infection to systemic dis ease, have given to both the science and art of dentistry a new birth and a vigorous growth, with the result that the objectives of dental practice have become primarily vital rather than mechanical. In a fundamental sense, then, it is the recognition of the biologic fac tor and the new mental attitude of the dental profession resulting from this recognition of the vital importance of that factor that constitute the greatest forward step of dentistry. It is the motive power of that factor that has reorganized our educa tional curriculum, changed the entire system of dental technic and bred the multiplicity of specialties in dentistry. One of the principal factors in the further development of the clinical relation of dentistry to systemic diseases, and one that has not been de veloped to its full potentiality, is that of intern service preparatory to the practice of dentistry. The indispensability of internship as preparatory to intelligent med ical practice has long since been recognized in medicine to the extent that in some twenty-five states of the Union a two-year internship has become one of the basic requirements for licensure; nor is the prospec tive specialist in any phase of the healing arts exempt from the afore said preparational requirement. Furthermore, the intensive education demanded in any specialty of medicine has made it even more necessary that additional specialized education be gained through hospital intern ship. Dentistry, having become a recognized specialty of the healing art almost on a level with the other specialties, has also come to require the educational benefits that may be acquired from the clinical experience which the internship affords and has, within recent years, paid definite attention to its development. Clinical experience in, and study of, the cause and effect relation of dental disease to bodily disease has produced most convincing proof of the almost unlimited benefits to be gained in both medical and dental practice, so much so, that it is evident that the development of this rela tionship between medicine and dentistry is likely to be pursued to its finality— compulsory internship as a requisite for dental practice. A necessary preliminary, however, to intern experience being made compulsory is a broader recognition of the benefits in and to both med ical and dental practice. It seems that the hospitals, through exper
1850
The Journal of the American Dental Association and The Dental Cosmos
ience, are in a most receptive mood to applying the new, or dental, ancillary clinical aid in attaining a more complete medical service. There are many instances of individual dentists, groups of dentists and dental societies exerting their influence toward the employment of dental attendants and interns in various hospitals, mainly for the pur pose of demonstrating the value which the dental attendant or intern may be to hospital service. We are under the impression, however, that the favorable attitude which the hospitals have shown to the dental in tern is the result of a slowly evolving conviction of the value of the service demonstrated by the somewhat spectacular reactions in systemic diseases to proper attention to the dental causal condition; this as supplementary to the constant efforts on the part of the dental profession to convince the medical profession and the public that there are numerous systemic conditions that are related in a causal manner to dental disease. One of the primary purposes of the internship for the dental gradu ate is, of course, to supplement the education of both the dental intern and the medical intern, as it is quite generally recognized, and has been for many years, that the undergraduate medical student is not taught sufficient dentistry, nor is the undergraduate dental student taught suffi cient medicine. And this applies more acutely to the instruction of the dental student in the clinical aspects of disease. Among the benefits to be realized from dental attention to the hos pital patient is that the duration of disease is materially lessened and, too, the convalescent period is much shortened when the mouth is kept in a healthy condition. Then, also, the contact of the medical student with the dental student is a relation that has been shown to be of greatest benefit in the diagnosis and treatment of dental conditions which influ ence bodily health, and this particularly in cases in which the medical man has been too quick to condemn teeth to the forceps. On the other hand, the intern system establishes an association for the dental student that, in a measure, tends to relieve the stress which, in the nature of the case, he has been compelled to put upon technic; to the end that he may develop an appreciation of dental health values as related to systemic conditions and also a higher sense of moral responsibility to the com munity. For several years there has been, and, in fact, at the moment there is, a definite effort being made by the American Dental Association to enlarge the opportunities for dental internship, until at present there are one hundred and twenty hospitals throughout the country offering
Editorial Department
18 51
one hundred and eighty internships. In addition thereto, there are some fifty-four internships available in the Marine hospitals and in the peni tentiaries. While we do not consider it pertinent or timely as yet to suggest that internship be made a compulsory requisite to dental licensure, we do be lieve that the present period of trial of the system will so convincingly prove the benefits to be obtained therefrom that some day we may evolve to that educational status. Another phase of the intern’s activities that may lead to incalculable benefits to dentistry is that of aid in gathering statistics to prove the economic value of mouth health to patients of all classes. Many such statistics have been made by physicians and nurses, but the lack of un derstanding and appreciation of the dental point of view is such as to make statistics gathered under such circumstances practically useless. We have in mind an instance in which mouth examinations were made by physicians and nurses in a group of hospital patients, the same group being reexamined later by dental interns. The physicians and nurses reported 67 per cent of those examined as having no decay, whereas the dental interns reported a percentage of only 2.7 of the same group as having no decay. This quite graphically illustrates the necessity of examination of mouth conditions being conducted by those dentally qualified and, incidentally, it shows the valuelessness of many of the den tal data that have been gathered by some of the social welfare groups. Another benefit that undoubtedly will come to the graduate dental student from such a hospital association as the internship affords is the development of an appreciation of the value of making and studying case records— a phase of clinical dental practice that has not yet been developed to its full possibilities. And in the light of the constantly increasing demand for a higher efficiency in dental practice, it behooves us to cultivate and develop every facility for meeting the new require ments. It has been pertinently suggested that, in our present state of educa tional transition, what we need is evolution more than revolution, and our earnest hope is that the internship may be instrumental in evolving the dental graduate into an efficient unit in the community health serv ice. L. P. A.