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OUTLOOK FOR DENTISTRY
334 to be in the respiratory centre.3 Rodman and Close4reporting a further case, adduced more evidence of the unresponsiveness of the respiratory centre. In most hypoventilatory conditions, the breathing of oxygenenriched air is followed by a prompt though transient decrease in pulmonary ventilation. This is attributed to the cessation of hypoxic " impulses from the carotidbody chemoreceptors. Failure of the hypoventilatory response to physiological denervation "5 of the carotid chemoreceptors indicates a lesion of the chemoreceptors, of the medullary centres, or of their neural connections. Patients presenting with polycythxmia and disordered pulmonary ventilation without obvious heart or lung disease need careful investigation. Primary polycythxtnia can be excluded by studies of arterial oxygen saturation, which is normal in polycythsemia vera. If the polycythxmia is secondary, the response to breathing 100% oxygen may give valuable information: lack of an initial hypoventilatory response indicates unresponsiveness of the medullary centres, while failure to relieve cyanosis 6 may indicate an occult right-to-left shunts Similarly arterial carbon-dioxide estimations are valuable. Primary hypoventilation syndromes are marked by retention of carbon dioxide, but this hypercapnia is not found with right-to-left shunts or diffusion defects. Now that pulmonary function is more often estimated, disturbances of pulmonary ventilation are more likely to come to light.
is held
"
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Plainly, the situation will deteriorate further before any improvement can be expected from policy decisions taken now, however radical these may be. The experimental scheme for training dental ancillaries, which might have brought some relief to the dental profession by relieving the dentist of some of his simpler and routine tasks, seems to make little progress; and, though the findings of the Royal Commission on the Remuneration of Doctors and Dentists, when eventually these are known, may make dentistry more attractive as a career, their effect on the number of practising dentists could not be felt for a long time. Additional difficulties arise from the uneven geographical distribution of dentists. While some parts of the country have more than their fair share, the situation in other, less favoured areas already fully justifies the alarm expressed by the dental profession in discussions on public-health policy. To give one recently reported example, the Shetland Isles havehad no dentist at all in the past year except the school dental officer.9 MENTAL HEALTH OF THE ELDERLY
THIS disturbed world is not an easy place in which to old, and in the post-war battle for priority the social services which should support the elderly have never caught up with their needs. Hence what might be merely an emergency often grows into a crisis or a catastrophe, and for lack of the right help many an old man (or woman) OUTLOOK FOR DENTISTRY becomes a reluctant, and often inappropriate, occupant THE Central Youth Employment Executive has added of a bed in one of our overcrowded mental hospitals. The strain which old people are imposing on the social a booklet on dentistry to its Choice of Careers series.’ Discussing the opportunities open to the qualified dentist, and health services suggests that, though we have lengthened life a little, we have not yet learnt to put’the few the booklet says: extra years to the best use. The expansion of the geriatric There is at present a shortage of dentists, which it is expected will increase, because the number of students in services, research into the physiological process of ageing, training is not sufficient to replace the large number of dentists and various expert reports are signs of the community’s who will be retiring from practice during the next few years. growing concern. The latest of these reports,lO from the Newly qualified dentists, women as well as men, have therefore World Health Organisation, nominally deals with the a wide choice of opportunities." mental health of the aged; but, since mental and physical We must all hope that this shortage will be an attraction health are interdependent, and both are influenced by to entrants; but it is certainly going to be an inconvenience, social circumstances, it- inevitably surveys most of the or worse, to the public. Pointing out that last year the difficulties of old people. number of names on the Dentists Register fell by 191, All over the world the old have to face the common and that no less than 27% of dentists engaged in the difficulties of dwindling resources of money, health, General Dental Service were 60 years of age or over, the resilience, and friends; but these difficulties are often less British Dental Journal S urges the Government to provide in the traditional cultures, now found chiefly in what are called the less-developed countries. The W.H.O. commoney for a national campaign of dental health education and to give priority for the extension of the dental schools, mittee believe, however, that, as industrialisation thickens, so as to increase the number of students in training. the traditional pattern will have to change and that only Since it is generally agreed that dental disease is increasing careful advance planning will protect old people in these the a of the foresees breakdown countries. Certainly in our part of the world urbanisation rapidly, journal complete nation’s dental services unless the Ministry of Health and industrialisation have often increased their troubles. does more to instruct the public in positive dental health Though there may be savings and pensions, their real the work of the -perhaps by liberally supporting Standing value is apt to fall; younger members of the family have Committee on Dental Health Education, which at present been drawn away from their old homes to new centres of gets no financial help whatever from the Government. employment, and daughters and other forms of domestic In addition, the expansion of the dental schools must be help are working all day in factory or office. The old treated as a metter of urgency, since seven or eight years person easily becomes bewildered by the pace and commust elapse between the commencement of a building plexity of modern life, especially as exemplified by traffic and the the Dentists on programme Register and income-tax forms. appearance of the name of the first additional dentist. The W.H.O. committee, not unexpectedly, agree that the best prophylaxis against ageing (as distinct from old 3. Richter, T., West, J. R., Fishman, A. P. New Engl. J. Med. 1957, 256, 1165. age) is independence and activity. One of the easiest ways 4. Rodman, T., Close, H. P. Amer. J. Med. 1959, 26, 808. 5. Dripps, R. D., Comroe, J. H., Jr. Amer. J. Physiol. 1947, 149, 277. of achieving this is to postpone retirement as long as 6. Friedlich, A. L., Bing, R. J., Blount, S. G. Bull. Johns Hosp. grow
"
86,
Hopk.
20.
7. Choice of Careers: new series. no. 96. 1959. 9d. 8. Brit. dent. J. Aug. 4, 1959, p. 47.
Dentistry.
H.M.
Stationery
1950,
Office.
9. Scotsman, Aug. 12, 1959. 10. Mental Health Problems of Aging and the Aged. Wld Hlth Org. rech. Rep. Ser. no. 171. Geneva; 1959. Pp. 51. 3s. 6d. (Obtainable from H.M. Stationery Office, P.O. Box 569, London, S.E.1.)
is held
"
"
Plainly, the situation will deteriorate further before any improvement can be expected from policy decisions taken now, however radical these may be. The experimental scheme for training dental ancillaries, which might have brought some relief to the dental profession by relieving the dentist of some of his simpler and routine tasks, seems to make little progress; and, though the findings of the Royal Commission on the Remuneration of Doctors and Dentists, when eventually these are known, may make dentistry more attractive as a career, their effect on the number of practising dentists could not be felt for a long time. Additional difficulties arise from the uneven geographical distribution of dentists. While some parts of the country have more than their fair share, the situation in other, less favoured areas already fully justifies the alarm expressed by the dental profession in discussions on public-health policy. To give one recently reported example, the Shetland Isles havehad no dentist at all in the past year except the school dental officer.9 MENTAL HEALTH OF THE ELDERLY
THIS disturbed world is not an easy place in which to old, and in the post-war battle for priority the social services which should support the elderly have never caught up with their needs. Hence what might be merely an emergency often grows into a crisis or a catastrophe, and for lack of the right help many an old man (or woman) OUTLOOK FOR DENTISTRY becomes a reluctant, and often inappropriate, occupant THE Central Youth Employment Executive has added of a bed in one of our overcrowded mental hospitals. The strain which old people are imposing on the social a booklet on dentistry to its Choice of Careers series.’ Discussing the opportunities open to the qualified dentist, and health services suggests that, though we have lengthened life a little, we have not yet learnt to put’the few the booklet says: extra years to the best use. The expansion of the geriatric There is at present a shortage of dentists, which it is expected will increase, because the number of students in services, research into the physiological process of ageing, training is not sufficient to replace the large number of dentists and various expert reports are signs of the community’s who will be retiring from practice during the next few years. growing concern. The latest of these reports,lO from the Newly qualified dentists, women as well as men, have therefore World Health Organisation, nominally deals with the a wide choice of opportunities." mental health of the aged; but, since mental and physical We must all hope that this shortage will be an attraction health are interdependent, and both are influenced by to entrants; but it is certainly going to be an inconvenience, social circumstances, it- inevitably surveys most of the or worse, to the public. Pointing out that last year the difficulties of old people. number of names on the Dentists Register fell by 191, All over the world the old have to face the common and that no less than 27% of dentists engaged in the difficulties of dwindling resources of money, health, General Dental Service were 60 years of age or over, the resilience, and friends; but these difficulties are often less British Dental Journal S urges the Government to provide in the traditional cultures, now found chiefly in what are called the less-developed countries. The W.H.O. commoney for a national campaign of dental health education and to give priority for the extension of the dental schools, mittee believe, however, that, as industrialisation thickens, so as to increase the number of students in training. the traditional pattern will have to change and that only Since it is generally agreed that dental disease is increasing careful advance planning will protect old people in these the a of the foresees breakdown countries. Certainly in our part of the world urbanisation rapidly, journal complete nation’s dental services unless the Ministry of Health and industrialisation have often increased their troubles. does more to instruct the public in positive dental health Though there may be savings and pensions, their real the work of the -perhaps by liberally supporting Standing value is apt to fall; younger members of the family have Committee on Dental Health Education, which at present been drawn away from their old homes to new centres of gets no financial help whatever from the Government. employment, and daughters and other forms of domestic In addition, the expansion of the dental schools must be help are working all day in factory or office. The old treated as a metter of urgency, since seven or eight years person easily becomes bewildered by the pace and commust elapse between the commencement of a building plexity of modern life, especially as exemplified by traffic and the the Dentists on programme Register and income-tax forms. appearance of the name of the first additional dentist. The W.H.O. committee, not unexpectedly, agree that the best prophylaxis against ageing (as distinct from old 3. Richter, T., West, J. R., Fishman, A. P. New Engl. J. Med. 1957, 256, 1165. age) is independence and activity. One of the easiest ways 4. Rodman, T., Close, H. P. Amer. J. Med. 1959, 26, 808. 5. Dripps, R. D., Comroe, J. H., Jr. Amer. J. Physiol. 1947, 149, 277. of achieving this is to postpone retirement as long as 6. Friedlich, A. L., Bing, R. J., Blount, S. G. Bull. Johns Hosp. grow
"
86,
Hopk.
20.
7. Choice of Careers: new series. no. 96. 1959. 9d. 8. Brit. dent. J. Aug. 4, 1959, p. 47.
Dentistry.
H.M.
Stationery
1950,
Office.
9. Scotsman, Aug. 12, 1959. 10. Mental Health Problems of Aging and the Aged. Wld Hlth Org. rech. Rep. Ser. no. 171. Geneva; 1959. Pp. 51. 3s. 6d. (Obtainable from H.M. Stationery Office, P.O. Box 569, London, S.E.1.)