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Red Cross Activities in Dental Community Service*
DEPARTM EN T
OF
D EN TAL
HEALTH
E D U C A T IO N
RED CROSS ACTIVITIES IN DENTAL COMMUNITY SERVICE By JAMES L. FIESER,* Washington, D. C.
N 1919 the American Red Cross set to work intensively on a great national
provide such reparative work as is ab solutely essential in order that sickness peace-time program, some features of may be eliminated, children kept healthy which had been attempted in a limited and the physique of splendid adulthood way in the years immediately preceding. developed, has been a part of the chap On the surface apparently divergent, ter’s plan of work in countless places. each item of this plan was arranged to Through health teaching in schools and penetrate the different ramifications of homes by public health nurses and modern life and to accomplish one end, nutrition workers of the chapter, through the logical outcome of the Red Cross aim talks to the children in the schools and in wartime activities, which may be before mothers’ clubs and teachers’ as summed up as the preservation of life sociations given by dentists and arranged and the insuring of health through pre for by chapter workers, the public is vention and better public understanding. being aroused. Another factor in this Working at the main problem, but awakening of the community is that, in taking it from different angles, it has physical examinations in school, the been found in these five years of prac dentists examine the teeth while the phy tical effort that people generally do not sicians make the rest of the examination. realize the significance of several fac In the dental program of practically tors in public health. Dental care is cne; every chapter, the emphasis has been and to arouse the public to an appreci laid on work for children, with partic ation of its importance and value is a ular attention to the first graders and to necessity. Accordingly in many Red the preschool child; this, because school Cross chapters, the promotion of such inspections have revealed the fact that service has become a part of the regular the older child who visits the dentist has health program, and the workers are teeth too long-neglected to be saved. hammering away at the task of awaken Taking stock of the communities in ing their community to the need for den which propaganda for dental care is be tal care. An effort to stimulate people ing carried on, it is apparent that the to seek information regarding care of the chapter renders three types of service: teeth and value of oral hygiene, and to (1) in developing an appreciation of dental service in communities in which * V ice Chairm an o f D om estic Operations, it exists but is not properly valued; (2) A m erican R e d Cross.
I
1128
Department of Dental Health Education in supplying dental service in those com munities in which there is none; (3) in providing dental care for families who cannot afford it in whole or in part. An illustration of the first type of service may be given from Le Sueur County, Minn. Here, a dental exami nation was arranged at the county fair, and dentists came from various parts of the county to examine the children. For publicity, first, second and third prizes for the best cared-for teeth were offered for six groups, three for boys and three for girls from 3 to 6 years of age, from 6 to 12 and from 12 to 16. T o the mother bringing in the largest family of chil dren for examination, an additional prize was offered. Though the attend ance at the fair was not large, 220 adults and children visited the clinic. Inci dentally, in the attempt to awaken an appreciation of dental service, workers sometimes arouse dentists themselves to the need ior organization. In Le Sueur County, this need was so clearly demon strated in course of the preliminary ar rangements that the dentists are now planning such an organization. The effort of the Miner County, S. D., chapter to arouse public appreciation took the form of an eight-day dental clinic, which was arranged last August. There are 16 townships in the county and four dentists, so equalizing the work planned was an easy task. Each dentist worked in his own office, and in two days gave the dental care needed by the children of four townships. Altogether, 370 children took advantage of the clinic. With what results? They learned their way to the dentist’s office. Their fear of him was banished. Each had his or her teeth cleaned and necessary extractions made. An instructive talk was given by the dentist to every child. Incidentally, as a follow-up measure to the work done at the clinic, the schools have instituted toothbrush drills this year. In this case, the dentists were paid from a fund raised for the purpose.
1129
The effect that this kind of educative work is having on adults may be summed up in a story which comes from Fort Dodge, Iowa. A dentist there, not ing the fact that many men traveling about the country now called on him for attention to their teeth, commented on the fact to one of them. The latter re plied “ You know, the Red Cross put nurses in our schools to teach health to our children. We got our lesson on the importance of our teeth from our chil dren.” The matter of providing dental service where there is none is a problem very common to many of our rural chapters. In some states, it is simplified by the den tal resources of the state board of health, which can provide an itinerant dental clinic. But, more often, a great deal of work is involved. Actual instances can illustrate both points better than expla nation. In Buchanan County, W. Va., the De lano Red Cross nurse has spent much time and effort in endeavors to supply dental service to this country, which has none. The resources of the state board of health were tapped and a two months’ clinic was arranged, covering the need in five localities. T o stimulate interest, speaking engagements were arranged for the dentist, and that the opportunity might not be lost, in those engagements which the dentist could not fill, the nurse took his place. At Hurley, the clinic was attended by fifty-three pupils and lasted for three and a half days; at Matney, by seventyone pupils, for three and a half days; at Whitewood, by fifty-five pupils, for four and a half days; at Triangular Moun tain Institute, by thirty-nine pupils, for four days. At Council, the clinic sched uled for a week or more was still on when the report from which these facts are quoted was sent. This is the first time there has ever been anything of the kind in the whole county, and the re sponse was quite satisfactory. At the
1130
The Journal of the American Dental Association
first four towns mentioned, the payments made afforded $179 toward the cost of the clinic. In this connection, it must be remembered that, unlike the other nursing service maintained by chapters, Delano Red Cross nurses go only to isolated communities unable to make public health service self-supporting even though there is great need for the work. It is a special service made pos sible by that great hearted woman, Jane A. Delano, who, up to the time of her death in France, was head of the Red Cross Nursing Service, and who made provision in her will for this especially fine type of nursing work. The work of East Franklin County, Orange, Mass., is an instance of the sec ond point. After analyzing consider able material on dental equipment, prices and dental clinic costs, the work ers came to the conclusion that the stud ied plans were either too expensive or were unsuitable for local needs. They solved their problem by approaching a dentist in a nearby town in regard to a flat charge for dental work in rural schools. The plan as finally worked out was this: For $15 a day, guaranteed, the dentist promised to supply all the necessary materials, instruments and foot engine. The chapter arranged transportation and luncheon; and pur chased a portable dental chair; and, if the money received amounted to less than the $15 promised, because of the work done for children whose parents were unable to pay the full cost, was respon sible for any deficit. On a prearranged and well-announced schedule, three or four days was given to each school al though small, because no dental work had been done prior to this time. After school hours, any adults who cared to go to the school received attention. Now that the teeth are in good condition, it is estimated that a day in each school once every six months will probably suffice to continue the care. In eight months, the dentist earned approximately $500 of which only $15
was paid by the Red Cross, $15 by the grange and $15 by a civic improvement club. The parents themselves practically paid for the dental care their children received when it was provided in an ac cessible spot. So much interest has been aroused in many of the small towns that it is possible several will make an ap propriation for the work another year. The chapter is now trying to interest a dentist who recently graduated to locate in this newly awakened territory. Another illustration of the second type of service rendered comes from Ashland, Mass. The success of the nursing serv ice here led the committee in charge to attempt in 1921, the establishment of a dental clinic for the benefit of the 350 children of the three schools— high, grammar and primary. Careful esti mates indicated that its cost would be about $75 a week including supplies but not provision for quarters or equipment. The local Junior Red Cross contributed $65 to the experiment, and the public health nursing committee guaranteed the remainder. Permission to use one of the smaller rooms of the town hall rent free was obtained. The dentist engaged to take charge secured free the use of a suitable chair and a foot-power dental engine from a prominent firm dealing in dental supplies, the transportation of which from Boston was the contribution of a local business corporation. Printed circulars with an application card were sent to the parents, and when these were received, the Red Cross nurse sent out appointment notices. Considerable in genuity was needed to provide transpor tation for children living at a distance, but the system of consecutive appoint ments for children in the same district solved the problem and one automobile sufficed. The clinic, which was attended by 114 patients, was 70 per cent selfsupporting. It was interesting to the organizers to note that, contrary to tra dition, the children were impatient to visit the dentist, and the more general the attendance of children from any one
Department of Dental Health Education district, the more anxious were others in the same neighborhood to share the new experience. The problems of transportation and organization connected whh the central type of clinic, such as this one, form an eloquent plea for itinerant clinic service rather than a stationary service at just one center for each rural school. Not only is this the solution of the difficulties already mentioned, but it means a larger field for educational work that is also more effective. Each school is interested; many more teachers are educated when their cooperation is enlisted; the mothers are more interested because they have a kind of proprietary feeling toward truly local clinics in the schools that their children attend. Ih e instances of provision of dental care for families who cannot afford it in whole or in part, which is the third type of service the chapter renders, are in numerable. They cover the country from the Atlantic to the Pacific. What cooper ation between the Red Cross and the local dentists can achieve is splendidly illustrated in the following stories of actual work, selected with a view to showing the various types of arrange ments suggested by the ingenuity of dif ferent chapter workers. In April, 1921, the executive commit tee of the Hampshire County chapter in Massachusetts authorized the expendi ture of $2,000 for the holding of dental clinics for children in eight towns in the country. A committee was appointed to make the arrangements for the purchase of dental equipment, to engage a dentist and to appoint committees in each town to cooperate with the chapter committee. These committees provided a well-lighted room in which the equipment could be set up. They assisted and still assist the dentist by making appointments for him so that there is no loss o f his time. In several towns, the school nurse is a member of this committee, and her knowledge of family conditions is a great asset. A nominal charge is made if the
1131
parents can afford to pay a small sum. As there are a number of dependent chil dren in some of the towns they receive the benefit of the work at the expense of the state. In towns in which the homes are widely separated, the best way to in form the parents of the work is often through the schools, the churches and the grange. By more recent arrangement, the parents send in written requests for dental care for their children, so that there can be no misunderstanding. Emergency adult cases in towns half a day’s journey from a dentist have also been treated. The work in each town was thoroughly covered in the first year, usually, and the ground is gone over now for follow-up cases. There has been great interest in and a general de mand for the work. A member of the dental clinic committee says: “ In all of my volunteer work for the Red Cross during the last five years, I have never found anything that gives such satis factory returns for the amount of money expended.” Norristown, Penn., with a population of 32,319, in April, 1923, opened a den tal clinic for children from 6 to 10 years of age. The Red Cross chapter gave $500 to the Montgomery Council for Social Welfare to furnish the equipment and this year has been providing $50 a month for the payment of the services of two dentists two mornings each week. Thirteen Norristown dentists voluntarily maintained the work of the clinic last year by giving two mornings each week from 9 to 12 o’clock, and several still give free service. More than 500 chil dren have benefited by the dental care given in this clinic. A free dental program was planned by the Wabash County, Ind., chapter, in the spring of 1922. T o divide the work so that undue demands are not made on any one dentist, the eleven den tists (seven in Wabash and four in North Manchester) agreed to give half a day a month if they could work in their own offices rather than in a spe
1132
The Journal of the American Dental Association
cial clinic with unfamiliar arrangements. The children are allocated to dentists in alphabetical order. As the county is divided into a northern and a southern district, two children from Wabash and two from the southern part of the county go every week to a Wabash dentist and two from North Manchester and two from the northern part of the county to a North Manchester dentist. Eight chil dren, therefore, receive dental care each week. In some towns the school board or an other organization has been desirous that the children get the excellent habit of dental care early in life. What they learn when young, the}7 are likely to con tinue when older. There are three in stances in which this has been put into practical effect and approved by the local dental society; and because of the splen did work done in Portland, Ore., and Seattle and Tacoma, Wash., much of which is the result of the financial aid furnished by the local Junior Red Cross, community dental care has made excel lent progress on the Pacific Coast. In Portland, for instance, where the service was started in October, 1920, five paid dentists and five assistant nurses are em ployed on a part-time basis. Circulars, letters and talks were used to interest organizations and people in the clinic. A general educational and prophylactic program has been most strenuously car ried on, in addition to the reparative work. At first, the Junior Red Cross financed the program at a cost annually of about $10,000. Then it originated and successfully put through a campaign that secured the passage of an act by the state legislature enabling the school district to take over the work. In Tacoma, the dental service, which began as far back as 1909, was under the jurisdiction of the school board until the United States Supreme Court ruled that tax money could not be used fcr sucli a purpose. The Junior Red Cross then took over the responsibilicv of the health corrective work in the public
schools. A paid dentist is employed on part time, and he is on duty five morn ings a week. Only cases investigated by the five school nurses are treated. Seattle has two paid dentists and one dental hygienist in its clinic employed on full time. The Red Cross chapter in April, 1921, took over the work under its Junior Red Cross program from the school board which had conducted it un til the Supreme Court ruled that this was illegal. Last year about 6,000 dental cases were treated. The clinic costs about $14,500 yearly of which the school chil dren raise approximately $3,000. Preliminary steps taken are not with out interest. It should be emphasized that practically none of the work is planned without consultation with the local dental society or association, wher ever such exists, or in lieu of that with individual consultation. The chapter approaches the representative of the society. They jointly discuss local needs and together formulate the plan that seems most feasible. Then there is the question of dental equipment, on which an expert’s advice is infinitely more valu able than a layman’s. In those instances in which the state boards of health have a dental hygiene section, the chapter and the dental society confer with the state dentists as well. T o give examples of the way this works out in practice: In the case of the clinics arranged by the Hampshire, Mass., County chapter, to which refer ence has previously been made, the Northampton Dental Club was repre sented at every conference of the commit tee and materially helped in formulating the plans; while one dentist, who had at that time been in charge of the clinic in the public schools of the city for five years, not only gave the members the benefit of his practical experience but also selected the equipment, obtaining all of it at a very reasonable price. The dental clinic in Denton, Texas, was established in 1922 by the Denton County Dental Society and the Red
Department of Dental Health Education Cross, the former issuing all cards in connection with this free dental service for adults and for children unable to pay for it. The county Red Cross nurse in vestigates the cases so that the members of the dental society give aid to as many of the genuinely needy as is possible. C o n c l u s io n
N o discussion of the aims of the Amer ican Red Cross in regard to community dental service would be complete with out reference to the attitude of the den tists. Wherever this work has been at tempted, the chapters pay tribute to them. Their eagerness, their willing ness, their generosity are of material as sistance in enabling a great branch of health work to go forward. Local work
1133
ers commenting on their attitude say they are “ most interested and appreciative” or “ very friendly” or “ splendid.” Three things are required for any community dental service— professional skill, public interest and a modus oper andi. While this is just one phase of Red Cross work, the stories show how these factors have been supplied: the dentists contribute the necessary profes sional elements, the Red Cross chapter stimulates the public interest and sup port, and together the dentist and the chapter develop the plan of procedure. It is by such united effort that hun dreds of thousands of children, and adults, too, have learned and are learn ing the value of dental care.
THE PLACE OF DENTAL HYGIENE IN THE PUBLIC HEALTH PROGRAM By M E R R ILL C H A M P IO N ,* M .D ., C .P .H ., B oston, Massachusetts
HE subject of dental hygiene is a very important one and deserving of more intelligent consideration than is usually given to it. It is not ertough to say, “ Oh, yes, our children’s teeth do need attention, don’t they? Let us ask the town to appropriate money for a dental clinic.” That might prove to be the most unintelligent thing that could be done. I am going to give you my conclusions in serial form right here. Those who want to read farther will find out why I came to these conclusions:
T
Dental service of some sort is a necessity under modem con ditions. 2. Dental service is at present in sufficient to meet the needs of the • public.
3.
4.
1.
' ^Director, D ivision o f H ygiene, M assach u setts D epartm ent o f P u blic Health.
5.
Dentistry, as the term is ordi narily understood, is not essen tially a part of the public health program. The dental clinic is a necessary surgical convenience in all large communities and in many smaller ones. The traveling clinic is of the greatest assistance in isolated places. Both should be consid ered as essentially a means of furnishing surgical treatment and should be supported in the same way that any other medical or surgical clinics are supported, i.e., from private funds. Mouth hygiene is essentially a part of the public health prob lem. The dental hygienist is primarily a public health worker and may properly be supported by public funds.
OF
D EN TAL
HEALTH
E D U C A T IO N
RED CROSS ACTIVITIES IN DENTAL COMMUNITY SERVICE By JAMES L. FIESER,* Washington, D. C.
N 1919 the American Red Cross set to work intensively on a great national
provide such reparative work as is ab solutely essential in order that sickness peace-time program, some features of may be eliminated, children kept healthy which had been attempted in a limited and the physique of splendid adulthood way in the years immediately preceding. developed, has been a part of the chap On the surface apparently divergent, ter’s plan of work in countless places. each item of this plan was arranged to Through health teaching in schools and penetrate the different ramifications of homes by public health nurses and modern life and to accomplish one end, nutrition workers of the chapter, through the logical outcome of the Red Cross aim talks to the children in the schools and in wartime activities, which may be before mothers’ clubs and teachers’ as summed up as the preservation of life sociations given by dentists and arranged and the insuring of health through pre for by chapter workers, the public is vention and better public understanding. being aroused. Another factor in this Working at the main problem, but awakening of the community is that, in taking it from different angles, it has physical examinations in school, the been found in these five years of prac dentists examine the teeth while the phy tical effort that people generally do not sicians make the rest of the examination. realize the significance of several fac In the dental program of practically tors in public health. Dental care is cne; every chapter, the emphasis has been and to arouse the public to an appreci laid on work for children, with partic ation of its importance and value is a ular attention to the first graders and to necessity. Accordingly in many Red the preschool child; this, because school Cross chapters, the promotion of such inspections have revealed the fact that service has become a part of the regular the older child who visits the dentist has health program, and the workers are teeth too long-neglected to be saved. hammering away at the task of awaken Taking stock of the communities in ing their community to the need for den which propaganda for dental care is be tal care. An effort to stimulate people ing carried on, it is apparent that the to seek information regarding care of the chapter renders three types of service: teeth and value of oral hygiene, and to (1) in developing an appreciation of dental service in communities in which * V ice Chairm an o f D om estic Operations, it exists but is not properly valued; (2) A m erican R e d Cross.
I
1128
Department of Dental Health Education in supplying dental service in those com munities in which there is none; (3) in providing dental care for families who cannot afford it in whole or in part. An illustration of the first type of service may be given from Le Sueur County, Minn. Here, a dental exami nation was arranged at the county fair, and dentists came from various parts of the county to examine the children. For publicity, first, second and third prizes for the best cared-for teeth were offered for six groups, three for boys and three for girls from 3 to 6 years of age, from 6 to 12 and from 12 to 16. T o the mother bringing in the largest family of chil dren for examination, an additional prize was offered. Though the attend ance at the fair was not large, 220 adults and children visited the clinic. Inci dentally, in the attempt to awaken an appreciation of dental service, workers sometimes arouse dentists themselves to the need ior organization. In Le Sueur County, this need was so clearly demon strated in course of the preliminary ar rangements that the dentists are now planning such an organization. The effort of the Miner County, S. D., chapter to arouse public appreciation took the form of an eight-day dental clinic, which was arranged last August. There are 16 townships in the county and four dentists, so equalizing the work planned was an easy task. Each dentist worked in his own office, and in two days gave the dental care needed by the children of four townships. Altogether, 370 children took advantage of the clinic. With what results? They learned their way to the dentist’s office. Their fear of him was banished. Each had his or her teeth cleaned and necessary extractions made. An instructive talk was given by the dentist to every child. Incidentally, as a follow-up measure to the work done at the clinic, the schools have instituted toothbrush drills this year. In this case, the dentists were paid from a fund raised for the purpose.
1129
The effect that this kind of educative work is having on adults may be summed up in a story which comes from Fort Dodge, Iowa. A dentist there, not ing the fact that many men traveling about the country now called on him for attention to their teeth, commented on the fact to one of them. The latter re plied “ You know, the Red Cross put nurses in our schools to teach health to our children. We got our lesson on the importance of our teeth from our chil dren.” The matter of providing dental service where there is none is a problem very common to many of our rural chapters. In some states, it is simplified by the den tal resources of the state board of health, which can provide an itinerant dental clinic. But, more often, a great deal of work is involved. Actual instances can illustrate both points better than expla nation. In Buchanan County, W. Va., the De lano Red Cross nurse has spent much time and effort in endeavors to supply dental service to this country, which has none. The resources of the state board of health were tapped and a two months’ clinic was arranged, covering the need in five localities. T o stimulate interest, speaking engagements were arranged for the dentist, and that the opportunity might not be lost, in those engagements which the dentist could not fill, the nurse took his place. At Hurley, the clinic was attended by fifty-three pupils and lasted for three and a half days; at Matney, by seventyone pupils, for three and a half days; at Whitewood, by fifty-five pupils, for four and a half days; at Triangular Moun tain Institute, by thirty-nine pupils, for four days. At Council, the clinic sched uled for a week or more was still on when the report from which these facts are quoted was sent. This is the first time there has ever been anything of the kind in the whole county, and the re sponse was quite satisfactory. At the
1130
The Journal of the American Dental Association
first four towns mentioned, the payments made afforded $179 toward the cost of the clinic. In this connection, it must be remembered that, unlike the other nursing service maintained by chapters, Delano Red Cross nurses go only to isolated communities unable to make public health service self-supporting even though there is great need for the work. It is a special service made pos sible by that great hearted woman, Jane A. Delano, who, up to the time of her death in France, was head of the Red Cross Nursing Service, and who made provision in her will for this especially fine type of nursing work. The work of East Franklin County, Orange, Mass., is an instance of the sec ond point. After analyzing consider able material on dental equipment, prices and dental clinic costs, the work ers came to the conclusion that the stud ied plans were either too expensive or were unsuitable for local needs. They solved their problem by approaching a dentist in a nearby town in regard to a flat charge for dental work in rural schools. The plan as finally worked out was this: For $15 a day, guaranteed, the dentist promised to supply all the necessary materials, instruments and foot engine. The chapter arranged transportation and luncheon; and pur chased a portable dental chair; and, if the money received amounted to less than the $15 promised, because of the work done for children whose parents were unable to pay the full cost, was respon sible for any deficit. On a prearranged and well-announced schedule, three or four days was given to each school al though small, because no dental work had been done prior to this time. After school hours, any adults who cared to go to the school received attention. Now that the teeth are in good condition, it is estimated that a day in each school once every six months will probably suffice to continue the care. In eight months, the dentist earned approximately $500 of which only $15
was paid by the Red Cross, $15 by the grange and $15 by a civic improvement club. The parents themselves practically paid for the dental care their children received when it was provided in an ac cessible spot. So much interest has been aroused in many of the small towns that it is possible several will make an ap propriation for the work another year. The chapter is now trying to interest a dentist who recently graduated to locate in this newly awakened territory. Another illustration of the second type of service rendered comes from Ashland, Mass. The success of the nursing serv ice here led the committee in charge to attempt in 1921, the establishment of a dental clinic for the benefit of the 350 children of the three schools— high, grammar and primary. Careful esti mates indicated that its cost would be about $75 a week including supplies but not provision for quarters or equipment. The local Junior Red Cross contributed $65 to the experiment, and the public health nursing committee guaranteed the remainder. Permission to use one of the smaller rooms of the town hall rent free was obtained. The dentist engaged to take charge secured free the use of a suitable chair and a foot-power dental engine from a prominent firm dealing in dental supplies, the transportation of which from Boston was the contribution of a local business corporation. Printed circulars with an application card were sent to the parents, and when these were received, the Red Cross nurse sent out appointment notices. Considerable in genuity was needed to provide transpor tation for children living at a distance, but the system of consecutive appoint ments for children in the same district solved the problem and one automobile sufficed. The clinic, which was attended by 114 patients, was 70 per cent selfsupporting. It was interesting to the organizers to note that, contrary to tra dition, the children were impatient to visit the dentist, and the more general the attendance of children from any one
Department of Dental Health Education district, the more anxious were others in the same neighborhood to share the new experience. The problems of transportation and organization connected whh the central type of clinic, such as this one, form an eloquent plea for itinerant clinic service rather than a stationary service at just one center for each rural school. Not only is this the solution of the difficulties already mentioned, but it means a larger field for educational work that is also more effective. Each school is interested; many more teachers are educated when their cooperation is enlisted; the mothers are more interested because they have a kind of proprietary feeling toward truly local clinics in the schools that their children attend. Ih e instances of provision of dental care for families who cannot afford it in whole or in part, which is the third type of service the chapter renders, are in numerable. They cover the country from the Atlantic to the Pacific. What cooper ation between the Red Cross and the local dentists can achieve is splendidly illustrated in the following stories of actual work, selected with a view to showing the various types of arrange ments suggested by the ingenuity of dif ferent chapter workers. In April, 1921, the executive commit tee of the Hampshire County chapter in Massachusetts authorized the expendi ture of $2,000 for the holding of dental clinics for children in eight towns in the country. A committee was appointed to make the arrangements for the purchase of dental equipment, to engage a dentist and to appoint committees in each town to cooperate with the chapter committee. These committees provided a well-lighted room in which the equipment could be set up. They assisted and still assist the dentist by making appointments for him so that there is no loss o f his time. In several towns, the school nurse is a member of this committee, and her knowledge of family conditions is a great asset. A nominal charge is made if the
1131
parents can afford to pay a small sum. As there are a number of dependent chil dren in some of the towns they receive the benefit of the work at the expense of the state. In towns in which the homes are widely separated, the best way to in form the parents of the work is often through the schools, the churches and the grange. By more recent arrangement, the parents send in written requests for dental care for their children, so that there can be no misunderstanding. Emergency adult cases in towns half a day’s journey from a dentist have also been treated. The work in each town was thoroughly covered in the first year, usually, and the ground is gone over now for follow-up cases. There has been great interest in and a general de mand for the work. A member of the dental clinic committee says: “ In all of my volunteer work for the Red Cross during the last five years, I have never found anything that gives such satis factory returns for the amount of money expended.” Norristown, Penn., with a population of 32,319, in April, 1923, opened a den tal clinic for children from 6 to 10 years of age. The Red Cross chapter gave $500 to the Montgomery Council for Social Welfare to furnish the equipment and this year has been providing $50 a month for the payment of the services of two dentists two mornings each week. Thirteen Norristown dentists voluntarily maintained the work of the clinic last year by giving two mornings each week from 9 to 12 o’clock, and several still give free service. More than 500 chil dren have benefited by the dental care given in this clinic. A free dental program was planned by the Wabash County, Ind., chapter, in the spring of 1922. T o divide the work so that undue demands are not made on any one dentist, the eleven den tists (seven in Wabash and four in North Manchester) agreed to give half a day a month if they could work in their own offices rather than in a spe
1132
The Journal of the American Dental Association
cial clinic with unfamiliar arrangements. The children are allocated to dentists in alphabetical order. As the county is divided into a northern and a southern district, two children from Wabash and two from the southern part of the county go every week to a Wabash dentist and two from North Manchester and two from the northern part of the county to a North Manchester dentist. Eight chil dren, therefore, receive dental care each week. In some towns the school board or an other organization has been desirous that the children get the excellent habit of dental care early in life. What they learn when young, the}7 are likely to con tinue when older. There are three in stances in which this has been put into practical effect and approved by the local dental society; and because of the splen did work done in Portland, Ore., and Seattle and Tacoma, Wash., much of which is the result of the financial aid furnished by the local Junior Red Cross, community dental care has made excel lent progress on the Pacific Coast. In Portland, for instance, where the service was started in October, 1920, five paid dentists and five assistant nurses are em ployed on a part-time basis. Circulars, letters and talks were used to interest organizations and people in the clinic. A general educational and prophylactic program has been most strenuously car ried on, in addition to the reparative work. At first, the Junior Red Cross financed the program at a cost annually of about $10,000. Then it originated and successfully put through a campaign that secured the passage of an act by the state legislature enabling the school district to take over the work. In Tacoma, the dental service, which began as far back as 1909, was under the jurisdiction of the school board until the United States Supreme Court ruled that tax money could not be used fcr sucli a purpose. The Junior Red Cross then took over the responsibilicv of the health corrective work in the public
schools. A paid dentist is employed on part time, and he is on duty five morn ings a week. Only cases investigated by the five school nurses are treated. Seattle has two paid dentists and one dental hygienist in its clinic employed on full time. The Red Cross chapter in April, 1921, took over the work under its Junior Red Cross program from the school board which had conducted it un til the Supreme Court ruled that this was illegal. Last year about 6,000 dental cases were treated. The clinic costs about $14,500 yearly of which the school chil dren raise approximately $3,000. Preliminary steps taken are not with out interest. It should be emphasized that practically none of the work is planned without consultation with the local dental society or association, wher ever such exists, or in lieu of that with individual consultation. The chapter approaches the representative of the society. They jointly discuss local needs and together formulate the plan that seems most feasible. Then there is the question of dental equipment, on which an expert’s advice is infinitely more valu able than a layman’s. In those instances in which the state boards of health have a dental hygiene section, the chapter and the dental society confer with the state dentists as well. T o give examples of the way this works out in practice: In the case of the clinics arranged by the Hampshire, Mass., County chapter, to which refer ence has previously been made, the Northampton Dental Club was repre sented at every conference of the commit tee and materially helped in formulating the plans; while one dentist, who had at that time been in charge of the clinic in the public schools of the city for five years, not only gave the members the benefit of his practical experience but also selected the equipment, obtaining all of it at a very reasonable price. The dental clinic in Denton, Texas, was established in 1922 by the Denton County Dental Society and the Red
Department of Dental Health Education Cross, the former issuing all cards in connection with this free dental service for adults and for children unable to pay for it. The county Red Cross nurse in vestigates the cases so that the members of the dental society give aid to as many of the genuinely needy as is possible. C o n c l u s io n
N o discussion of the aims of the Amer ican Red Cross in regard to community dental service would be complete with out reference to the attitude of the den tists. Wherever this work has been at tempted, the chapters pay tribute to them. Their eagerness, their willing ness, their generosity are of material as sistance in enabling a great branch of health work to go forward. Local work
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ers commenting on their attitude say they are “ most interested and appreciative” or “ very friendly” or “ splendid.” Three things are required for any community dental service— professional skill, public interest and a modus oper andi. While this is just one phase of Red Cross work, the stories show how these factors have been supplied: the dentists contribute the necessary profes sional elements, the Red Cross chapter stimulates the public interest and sup port, and together the dentist and the chapter develop the plan of procedure. It is by such united effort that hun dreds of thousands of children, and adults, too, have learned and are learn ing the value of dental care.
THE PLACE OF DENTAL HYGIENE IN THE PUBLIC HEALTH PROGRAM By M E R R ILL C H A M P IO N ,* M .D ., C .P .H ., B oston, Massachusetts
HE subject of dental hygiene is a very important one and deserving of more intelligent consideration than is usually given to it. It is not ertough to say, “ Oh, yes, our children’s teeth do need attention, don’t they? Let us ask the town to appropriate money for a dental clinic.” That might prove to be the most unintelligent thing that could be done. I am going to give you my conclusions in serial form right here. Those who want to read farther will find out why I came to these conclusions:
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Dental service of some sort is a necessity under modem con ditions. 2. Dental service is at present in sufficient to meet the needs of the • public.
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' ^Director, D ivision o f H ygiene, M assach u setts D epartm ent o f P u blic Health.
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Dentistry, as the term is ordi narily understood, is not essen tially a part of the public health program. The dental clinic is a necessary surgical convenience in all large communities and in many smaller ones. The traveling clinic is of the greatest assistance in isolated places. Both should be consid ered as essentially a means of furnishing surgical treatment and should be supported in the same way that any other medical or surgical clinics are supported, i.e., from private funds. Mouth hygiene is essentially a part of the public health prob lem. The dental hygienist is primarily a public health worker and may properly be supported by public funds.