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Dental research is part of the total health research effort
editorials
Dental research is part of the total health research effort
Hardly a month goes by without a number of significant research findings appearing in the dental literature. So rapid is progress being m ade these days that we have come to take it for granted. It is a good thing, therefore, for us to pause every now and then to take a' careful look at where we have been and where we are going. So it is that the ADA Council on Dental Research once each year invites the members of the profession to view from their various vantage points the ivory tower of dental research and to note its growth and the new banners which hang therefrom. And so it is that this issue of t h e j o u r n a l is devoting a good deal of its page space to research reviews. All of these articles make good reading. But there is one which should be of particular value to the reader who seeks an overall view of dental research, a view which allows the entire field to be seen in good perspective. This is the article by Francis A. Arnold, Jr., director, National Institute of Dental Research. Doctor Arnold describes the extremely broad scope of dental research, and makes the important observation that “ . . . dental research is part of the total health research effort. . . . While he looks for the answers to the problems of oral disease, the dental scientist is searching into the nature of disease itself and is finding that his work is related to the total concepts of the biomedical professions.” A recounting of some of the progress m ade in dental research over the years gives emphasis to Doctor Arnold’s observation. Consider, for example, water fluoridation and the events which led up to it and those which have followed. The finding that teeth with mottled enamel are resistant to decay was followed by the discovery of the dental benefits of fluoride and then by the widespread adoption of water fluorida tion, one of the truly significant advances in public health in this century. But research on the biological effects of fluoride is still being continued . . . and with some remarkably gratifying results, for fluoride appears to provide health bene fits other than decay prevention. Evidence is rapidly accumulating which indicates
136/904 • THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
that bone density is improved by fluoride. The incidence of bone fractures in the aged seems to be less in areas served by a fluoridated water supply than in those areas not so served. This is not all, however, for studies now underway indicate that fluoride is an effective agent in the treatment of two mystifying and troublesome pathological conditions: osteoporosis of the elderly and Paget’s disease. Although, as Arnold implies, it may be possible to predict the successful develop ment of a fundamental finding and thus “ buy” an end result, it is impossible to predict the fundamental finding itself or its cost. One can gain assurance from the past performances of researchers, however, and with some measure of confidence predict that, some day and at some unknown cost, more fundamental findings will be made. And once the fundamental finding has been reduced to practice and its benefits are widely felt, the cost— that unknown factor which initially may have frightened some people— is quickly forgotten. T o all but a few it becomes once more an unknown factor.
The color guard
A recent issue of a national news magazine tells of a dentist in one of the nation’s large cities who refused emergency treatment to a young Negro woman. The m aga zine stated that after the dentist told the woman, “ I don’t treat Negroes here,” she fled in tears and later was treated by a Negro dentist. No doubt this is not the first occurrence of such a sad and unfortunate incident, nor would it be too surprising were it not for the fact that the woman, new to the community, had been referred by a bureau of the dentist’s own local dental society. This agency, says an advertisement in the telephone directory, is “ . . . operated for the public’s welfare and convenience . . .” and, like its counterparts in other cities, is intended to inspire public confidence and enhance the availability of dental care. Such an action of discrimination legally, as well as professionally, is beyond the pale in at least two states, Illinois and New York. The state licensing agency for the profession in Illinois, for example, has a regulation which stipulates that any dentist who neglects, fails or refuses to render professional services to a person because of the person’s race, religion, color or national origin, shall be deemed guilty of improper, unprofessional or dishonorable conduct. At the time the regulation was adopted, the president of the American Dental Association said: “ This action is in full accord with the constitution and bylaws of the ADA which state that the Association’s object is to encourage the improvement of the health of the public.” These regulations are not only consistent with ADA policies but also are consistent with the behavior, beliefs and personal policies of most dentists. But for the health professions should such regulations be necessary at all? And should dentists provide reasons for their adoption?
Dental research is part of the total health research effort
Hardly a month goes by without a number of significant research findings appearing in the dental literature. So rapid is progress being m ade these days that we have come to take it for granted. It is a good thing, therefore, for us to pause every now and then to take a' careful look at where we have been and where we are going. So it is that the ADA Council on Dental Research once each year invites the members of the profession to view from their various vantage points the ivory tower of dental research and to note its growth and the new banners which hang therefrom. And so it is that this issue of t h e j o u r n a l is devoting a good deal of its page space to research reviews. All of these articles make good reading. But there is one which should be of particular value to the reader who seeks an overall view of dental research, a view which allows the entire field to be seen in good perspective. This is the article by Francis A. Arnold, Jr., director, National Institute of Dental Research. Doctor Arnold describes the extremely broad scope of dental research, and makes the important observation that “ . . . dental research is part of the total health research effort. . . . While he looks for the answers to the problems of oral disease, the dental scientist is searching into the nature of disease itself and is finding that his work is related to the total concepts of the biomedical professions.” A recounting of some of the progress m ade in dental research over the years gives emphasis to Doctor Arnold’s observation. Consider, for example, water fluoridation and the events which led up to it and those which have followed. The finding that teeth with mottled enamel are resistant to decay was followed by the discovery of the dental benefits of fluoride and then by the widespread adoption of water fluorida tion, one of the truly significant advances in public health in this century. But research on the biological effects of fluoride is still being continued . . . and with some remarkably gratifying results, for fluoride appears to provide health bene fits other than decay prevention. Evidence is rapidly accumulating which indicates
136/904 • THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
that bone density is improved by fluoride. The incidence of bone fractures in the aged seems to be less in areas served by a fluoridated water supply than in those areas not so served. This is not all, however, for studies now underway indicate that fluoride is an effective agent in the treatment of two mystifying and troublesome pathological conditions: osteoporosis of the elderly and Paget’s disease. Although, as Arnold implies, it may be possible to predict the successful develop ment of a fundamental finding and thus “ buy” an end result, it is impossible to predict the fundamental finding itself or its cost. One can gain assurance from the past performances of researchers, however, and with some measure of confidence predict that, some day and at some unknown cost, more fundamental findings will be made. And once the fundamental finding has been reduced to practice and its benefits are widely felt, the cost— that unknown factor which initially may have frightened some people— is quickly forgotten. T o all but a few it becomes once more an unknown factor.
The color guard
A recent issue of a national news magazine tells of a dentist in one of the nation’s large cities who refused emergency treatment to a young Negro woman. The m aga zine stated that after the dentist told the woman, “ I don’t treat Negroes here,” she fled in tears and later was treated by a Negro dentist. No doubt this is not the first occurrence of such a sad and unfortunate incident, nor would it be too surprising were it not for the fact that the woman, new to the community, had been referred by a bureau of the dentist’s own local dental society. This agency, says an advertisement in the telephone directory, is “ . . . operated for the public’s welfare and convenience . . .” and, like its counterparts in other cities, is intended to inspire public confidence and enhance the availability of dental care. Such an action of discrimination legally, as well as professionally, is beyond the pale in at least two states, Illinois and New York. The state licensing agency for the profession in Illinois, for example, has a regulation which stipulates that any dentist who neglects, fails or refuses to render professional services to a person because of the person’s race, religion, color or national origin, shall be deemed guilty of improper, unprofessional or dishonorable conduct. At the time the regulation was adopted, the president of the American Dental Association said: “ This action is in full accord with the constitution and bylaws of the ADA which state that the Association’s object is to encourage the improvement of the health of the public.” These regulations are not only consistent with ADA policies but also are consistent with the behavior, beliefs and personal policies of most dentists. But for the health professions should such regulations be necessary at all? And should dentists provide reasons for their adoption?