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Evanston, Illinois, fluoridation program Thirteenth Anniversary progress report
Evanston, Illinois, fluoridation program Thirteenth Anniversary progress report
On February 11, 1960, the Evanston Health Department observed the thirteenth anniversary of water fluoridation. A luncheon was held in the large dining hall of the First Methodist Church. A group of 125 which included members of the local medical, dental and nursing professions, local, state and national public health officials, and city and school administrators and citizens gathered to celebrate the occasion. Certificates of good dental health were presented by Herman Wenger, president of the Illinois State Dental Society, to a set of twins who were born in Evanston on November 11, 1947. Francis A. Arnold, Jr., director of the National Institute of Dental Research, spoke on the national aspect of water fluoridation. J. Roy Blayney, director of the Evanston Dental Caries Study, presented a report to the Evanston citizens on the accomplish ments of the 15 year program to date. The talks given by Drs. Arnold and Blayney are reported in the following pages.
A S A L U T E T O T H E E V A N S T O N F L U O R ID A T IO N S T U D Y
Francis A . A rnold, J r .* D .D .S ., Bethesda, M d .
It is not often that one in research, such as myself, sees some of his hopes brought to fruition. About 20 years ago, Evanston, 111. was using fluorine-free water and was what was called a “ control-city” in a crucial study to show that fluoridated water would reduce tooth decay. A few years later, H . Trendley Dean was invited to discuss the benefits of fluoridation before a joint gathering of the physicians and dentists of the Evanston area. After that meeting, both professional groups enthusiastically recommended to the Evanston Commissioner of Health that a carefully controlled fluoridation pro-
gram be developed. Later, an advisory committee appointed by the Commissioner of Health solicited the help of J. Roy Blayney and his colleagues at the Zoller Memorial Dental Clinic in designing a cooperative long-range study of such a program. As a result the Evanston City Council passed a resolution authorizing the study and the purchase of equipment for the addition of sodium fluoride to the city water. The public and parochial school officials pledged their support and the medical and dental professions endorsed the project.1 Thus, a rewarding fluoridation program was
88/74 • THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
launched 13 years ago in Evanston. Since that time, I have been periodically in formed on the progress of the study through close association with Dr. Blay ney and his staff. The success of the Evanston study, along with that of other comparable studies at Grand Rapids, Mich., New burgh, N. Y ., and Brantford, Ontario, Canada, are responsible for the gradual transition of the theory of fluoridation into a scientific fact. Indeed, what was once only a hope of many researchers is now a truism of preventive dentistry. On any anniversary there are either candles on the cake or there are certain persons or groups who deserve special consideration. In this instance I feel somewhat qualified to select the recipients of congratulations because I have had some 15 years experience in administer ing the Grand Rapids study, which is similar to yours. T o this end, and on be half of the Surgeon General of the Pub lic Health Service, I wish first, to con gratulate Dr. Blayney and his colleagues for the precise design and visionary leadership of this outstanding research program. Second, I wish to commend the city and school officials and particularly, the school teachers of the community for their interest and cooperation. I recog nize the many “time-taking” disturbances that this 13 year study has injected into the midst of a full and active school pro gram. Third, I wish to congratulate the citi zens of Evanston for their cooperation and participation in this study. This ap plies not only for those who had children to be examined and to benefit, but also for those who really had nothing per sonal to gain from fluoridation. T o these individuals I pay special tribute because their unwavering faith in the integrity of local officials and scientists, even in the face of scare propaganda by oppo nents, has made an indelible mark in the history of this successful study.
And finally, in every well-designed re search study the importance of a control group cannot be overemphasized. The Evanston study is, of course, no excep tion, and for this reason the citizens of Oak Park deserve our special recognition and gratitude for the equally significant role they have played in the success story we celebrate here today. The broader extension of the protec tion which fluoridation provides continues to be a major goal for all who are in terested in improving the oral health of our nation. However, the old cliche, “easier said than done” seems to describe appropriately the challenge at hand. A l though a majority of the cities with populations of a half million or more now use fluoridated water, only 6 per cent of the communities with popula tions under 2,500 are doing so. Although more than 35 million people in over 1,850 communities served by public water sup plies are now receiving the benefits of fluoridated water, more than a third of the population of the United States may never be able to enjoy these benefits be cause they consume water obtained from individual home water supplies. Despite this acknowledged shortcoming today, the striking success of the studies on fluorides and their use in caries con trol has had broader significance than one would imagine. For example, when these studies started, back in the early thirties, we had just a meager handful of research scientists devoting their thoughts to the cause of oral diseases. The success of this early work on fluorides stimulated wider interest in many quar ters and finally resulted in substantial appropriations by Congress for the ex pansion of dental research throughout the nation. Today dental scientists in this country are concerned not only with the cause and control of caries, but also with a variety of other conditions and malfor mations of the mouth and adjacent struc tures including periodontal disease (a most formidable opponent), oral cancer,
A R N O L D ... VOLUME 61, JULY I960 • 89/75
cleft lip and palate, oral manifestations of systemic disease and the influence of oral diseases on other organ systems of the body. To meet the special needs of those who do not have access to communal water supplies, a new approach to the control of dental caries is currently being ex plored by scientists in various research centers throughout the country. For ex ample, a study at the National Institute of Dental Research, which is utilizing the cooperation of several other federal and private agencies, is testing the recently acquired evidence that dental decay in experimental animals is drastically re duced by adding dibasic calcium phos phate to th e Hour used to prepare ex perimental diets. Under way in a number of selected boarding schools in North and South Dakota is a study where half of the children are receiving phosphated bread, while the others are serving as controls. It is expected that annual examinations of the two groups for the next several years will provide an indication of pos sible benefits to caries control. Representative of another type of in vestigation aimed at the prevention of oral disease are a series of studies in the Institute’s Laboratory of Histology and Pathology. In this work the so-called re sistance factor to tooth decay has been directly related to the absence of a par ticular type of bacteria. Moreover, it has been found that certain kinds of bacteria isolated from carious teeth in hamsters can be implanted so as to cause caries in previously “caries-resistant hamsters.” Since the infecting organisms were made resistant to antibiotics prior to experi mentation, it has been possible to isolate and positively identify them during and after the test periods. When caries-resistant animals were experimentally in fected with a variety of other types of bacteria from the mouth, no dental decay
occurred. Thus, the results of these im portant investigations have clearly estab lished caries in animals as a transmis sible disease and have stimulated new interest in the search for a specific bac terial agent that may be responsible for human caries. The work I have just cited is but a part of a rapidly expanding program aimed at the prevention of oral disease. Although growth in basic biologic re search at our Bethesda Laboratories has been extensive, it is a small part of the explosive growth of federally supported research and training in dental schools throughout this country and abroad. In the area of research project grants alone, we experienced an increase in activity of almost 30-fold during the 1950’s. Com parable progress in the area of training is expected in the immediate years ahead. This will provide more practitioners for an expanding population, as well as vital manpower trained in teaching and re search methods. Dentistry as a health service now stands on the threshold of change. Measurable relief from the endless repair of decayed teeth is now assured by fluoridation. Fur thermore, we have reason to believe that other equally effective control measures will- soon be added to our armamen tarium. In the meantime, as scientists continue their methodical probing for an understanding of the etiology of oral dis ease, each and every citizen of Evanston, 111., can be justly proud of the unique contribution they have made to their families, their community and the dental health status of the entire nation.
Presented as an address at the celebration of the thirteenth anniversary o f flu orid a tion in Evanston, Evanston, III., February II , I960. *D irector, National Institute of Dental Research, Na tional Institutes of Health, U. S. Public Health Service, Department o f Health, Education, and W elfare. I. Blayney, J. R., and Tucker, W , H. The Evanston dental caries study. J.D. Res. 27:279 June 1948.
On February 11, 1960, the Evanston Health Department observed the thirteenth anniversary of water fluoridation. A luncheon was held in the large dining hall of the First Methodist Church. A group of 125 which included members of the local medical, dental and nursing professions, local, state and national public health officials, and city and school administrators and citizens gathered to celebrate the occasion. Certificates of good dental health were presented by Herman Wenger, president of the Illinois State Dental Society, to a set of twins who were born in Evanston on November 11, 1947. Francis A. Arnold, Jr., director of the National Institute of Dental Research, spoke on the national aspect of water fluoridation. J. Roy Blayney, director of the Evanston Dental Caries Study, presented a report to the Evanston citizens on the accomplish ments of the 15 year program to date. The talks given by Drs. Arnold and Blayney are reported in the following pages.
A S A L U T E T O T H E E V A N S T O N F L U O R ID A T IO N S T U D Y
Francis A . A rnold, J r .* D .D .S ., Bethesda, M d .
It is not often that one in research, such as myself, sees some of his hopes brought to fruition. About 20 years ago, Evanston, 111. was using fluorine-free water and was what was called a “ control-city” in a crucial study to show that fluoridated water would reduce tooth decay. A few years later, H . Trendley Dean was invited to discuss the benefits of fluoridation before a joint gathering of the physicians and dentists of the Evanston area. After that meeting, both professional groups enthusiastically recommended to the Evanston Commissioner of Health that a carefully controlled fluoridation pro-
gram be developed. Later, an advisory committee appointed by the Commissioner of Health solicited the help of J. Roy Blayney and his colleagues at the Zoller Memorial Dental Clinic in designing a cooperative long-range study of such a program. As a result the Evanston City Council passed a resolution authorizing the study and the purchase of equipment for the addition of sodium fluoride to the city water. The public and parochial school officials pledged their support and the medical and dental professions endorsed the project.1 Thus, a rewarding fluoridation program was
88/74 • THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
launched 13 years ago in Evanston. Since that time, I have been periodically in formed on the progress of the study through close association with Dr. Blay ney and his staff. The success of the Evanston study, along with that of other comparable studies at Grand Rapids, Mich., New burgh, N. Y ., and Brantford, Ontario, Canada, are responsible for the gradual transition of the theory of fluoridation into a scientific fact. Indeed, what was once only a hope of many researchers is now a truism of preventive dentistry. On any anniversary there are either candles on the cake or there are certain persons or groups who deserve special consideration. In this instance I feel somewhat qualified to select the recipients of congratulations because I have had some 15 years experience in administer ing the Grand Rapids study, which is similar to yours. T o this end, and on be half of the Surgeon General of the Pub lic Health Service, I wish first, to con gratulate Dr. Blayney and his colleagues for the precise design and visionary leadership of this outstanding research program. Second, I wish to commend the city and school officials and particularly, the school teachers of the community for their interest and cooperation. I recog nize the many “time-taking” disturbances that this 13 year study has injected into the midst of a full and active school pro gram. Third, I wish to congratulate the citi zens of Evanston for their cooperation and participation in this study. This ap plies not only for those who had children to be examined and to benefit, but also for those who really had nothing per sonal to gain from fluoridation. T o these individuals I pay special tribute because their unwavering faith in the integrity of local officials and scientists, even in the face of scare propaganda by oppo nents, has made an indelible mark in the history of this successful study.
And finally, in every well-designed re search study the importance of a control group cannot be overemphasized. The Evanston study is, of course, no excep tion, and for this reason the citizens of Oak Park deserve our special recognition and gratitude for the equally significant role they have played in the success story we celebrate here today. The broader extension of the protec tion which fluoridation provides continues to be a major goal for all who are in terested in improving the oral health of our nation. However, the old cliche, “easier said than done” seems to describe appropriately the challenge at hand. A l though a majority of the cities with populations of a half million or more now use fluoridated water, only 6 per cent of the communities with popula tions under 2,500 are doing so. Although more than 35 million people in over 1,850 communities served by public water sup plies are now receiving the benefits of fluoridated water, more than a third of the population of the United States may never be able to enjoy these benefits be cause they consume water obtained from individual home water supplies. Despite this acknowledged shortcoming today, the striking success of the studies on fluorides and their use in caries con trol has had broader significance than one would imagine. For example, when these studies started, back in the early thirties, we had just a meager handful of research scientists devoting their thoughts to the cause of oral diseases. The success of this early work on fluorides stimulated wider interest in many quar ters and finally resulted in substantial appropriations by Congress for the ex pansion of dental research throughout the nation. Today dental scientists in this country are concerned not only with the cause and control of caries, but also with a variety of other conditions and malfor mations of the mouth and adjacent struc tures including periodontal disease (a most formidable opponent), oral cancer,
A R N O L D ... VOLUME 61, JULY I960 • 89/75
cleft lip and palate, oral manifestations of systemic disease and the influence of oral diseases on other organ systems of the body. To meet the special needs of those who do not have access to communal water supplies, a new approach to the control of dental caries is currently being ex plored by scientists in various research centers throughout the country. For ex ample, a study at the National Institute of Dental Research, which is utilizing the cooperation of several other federal and private agencies, is testing the recently acquired evidence that dental decay in experimental animals is drastically re duced by adding dibasic calcium phos phate to th e Hour used to prepare ex perimental diets. Under way in a number of selected boarding schools in North and South Dakota is a study where half of the children are receiving phosphated bread, while the others are serving as controls. It is expected that annual examinations of the two groups for the next several years will provide an indication of pos sible benefits to caries control. Representative of another type of in vestigation aimed at the prevention of oral disease are a series of studies in the Institute’s Laboratory of Histology and Pathology. In this work the so-called re sistance factor to tooth decay has been directly related to the absence of a par ticular type of bacteria. Moreover, it has been found that certain kinds of bacteria isolated from carious teeth in hamsters can be implanted so as to cause caries in previously “caries-resistant hamsters.” Since the infecting organisms were made resistant to antibiotics prior to experi mentation, it has been possible to isolate and positively identify them during and after the test periods. When caries-resistant animals were experimentally in fected with a variety of other types of bacteria from the mouth, no dental decay
occurred. Thus, the results of these im portant investigations have clearly estab lished caries in animals as a transmis sible disease and have stimulated new interest in the search for a specific bac terial agent that may be responsible for human caries. The work I have just cited is but a part of a rapidly expanding program aimed at the prevention of oral disease. Although growth in basic biologic re search at our Bethesda Laboratories has been extensive, it is a small part of the explosive growth of federally supported research and training in dental schools throughout this country and abroad. In the area of research project grants alone, we experienced an increase in activity of almost 30-fold during the 1950’s. Com parable progress in the area of training is expected in the immediate years ahead. This will provide more practitioners for an expanding population, as well as vital manpower trained in teaching and re search methods. Dentistry as a health service now stands on the threshold of change. Measurable relief from the endless repair of decayed teeth is now assured by fluoridation. Fur thermore, we have reason to believe that other equally effective control measures will- soon be added to our armamen tarium. In the meantime, as scientists continue their methodical probing for an understanding of the etiology of oral dis ease, each and every citizen of Evanston, 111., can be justly proud of the unique contribution they have made to their families, their community and the dental health status of the entire nation.
Presented as an address at the celebration of the thirteenth anniversary o f flu orid a tion in Evanston, Evanston, III., February II , I960. *D irector, National Institute of Dental Research, Na tional Institutes of Health, U. S. Public Health Service, Department o f Health, Education, and W elfare. I. Blayney, J. R., and Tucker, W , H. The Evanston dental caries study. J.D. Res. 27:279 June 1948.