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Dental, Medical, Nursing and Hospital Services for Rural Areas
TH E
l O
t
i r
i l c
AMERICAN MAY I, 1947
•
VOLUME 34
l j L
1
OENTAL •
OF
THE
ASSOCIATION
NUMBER 9
L o n W . M o r r e y , d.d.s.. Editor Published by the American Dental Association • 222 East Superior St. • Chicago 11, III.
EDITORIALS
T H E N E E D F O R U N IF O R M IT Y IN D E N T A L N O M E N C L A T U R E
recent adoption by the Committee on Nomenclature of the American Dental Association of a standardized method for the symbolic designation of teeth is to be commended. The simplicity and practicability of the method warrant its early acceptance by the dental profession. At least seven methods of designating teeth are now in use, including one rec ommended by the Committee on Nomenclature in 1933. For years, this lack of uniformity has resulted in confusion, irritation and wasted effort. It is hoped that the Committee’s latest recommendation, which appears on page 647 of this issue of t h e j o u r n a l , will be put into operation as standard procedure as rapidly as possible. The method recommended is neither new nor complicated. It consists of dividing the dental field into quadrants by vertical and horizontal lines. The per manent teeth in each quadrant are designated numerically in relation to these lines. The deciduous teeth are designated similarly by letters. Thus, [3 indicates the lower left permanent cuspid, and b] indicates the upper right deciduous lateral incisor. The adoption of this standard method of tooth designation is particularly timely. An increasing number of hospitals are establishing dental departments and dental internships. An increasing number of communities are establishing health centers and dental health programs for children. Forensic dentistry is better understood now than previously, and the use of teeth as a means of identification is becoming common practice. For these as well as other reasons a uniform method of desig nating teeth should be universally adopted. The standardization of tooth designation, although important, is but a small facet of the larger subject of nomenclature. A correct nomenclature is just as essential to the progress of dentistry as it is to the development of any other science. h e
T
616
Editorials
J.A.D.A., Vol. 34, May I, 1947 . . . 617
T h e f ir s t n o t a b l e e f f o r t t o s t a n d a r d i z e A m e r i c a n d e n t a l t e r m s w a s m a d e b y C h a p i n A . H a r r i s i n 1 8 4 9 . H i s Dictionary of Dental Science s e r v e d a s a s t a n d a r d u n t il G . V . B la c k ’s r e p o r t t o t h e C o lu m b ia n D e n t a l C o n g re s s in 1 8 9 3 . B la c k ’s r e p o r t s e rv e d as a f o u n d a t io n o n w h ic h t h e p ro fe s s io n ’s p re s e n t n o m e n c la t u r e w a s b u ilt . I n 1 9 2 1 , th e N a t io n a l D e n t a l A s s o c ia tio n a p p o in t e d a s t a n d in g c o m m it t e e o n d e n t a l n o m e n c la t u r e w h ic h , w it h c h a n g e s i n p e r s o n n e l, s e rv e d f a it h f u lly a n d w e ll f o r m a n y y e a rs . H o w e v e r , t h e la s t c o m p r e h e n s iv e r e p o r t o f t h e C o m m i t t e e o n N o m e n c la t u r e w a s m a d e in 1 9 3 7 . S in c e t h e n , o n ly t w o o r th r e e m i n o r re p o rts h a v e b e e n s u b m itte d . U n f o r t u n a t e ly , p ro g re s s in d e n ta l te rm in o lo g y h a s n o t k e p t p a c e w it h p ro g re s s i n d e n t a l t e c h n o l o g y o r d e n t a l r e s e a r c h . I n d e e d t h e r e is a t e n d e n c y f o r s o m e le a d in g d e n t a l w r it e r s t o d is r e g a r d c e r t a in t e r m s a n d s y m b o ls w h i c h , a f t e r c a r e f u l d e lib e r a tio n , h a v e b e e n a d o p t e d b y th e C o m m it t e e o n N o m e n c la t u r e . I n s o m e in s ta n c e s , t h e o b je c t io n s r a is e d t o c e r t a in t e r m s a r e b a s e d o n p e r s o n a l p r e ju d ic e o r p r id e o f a u th o r s h ip . A n o t h e r d i f f i c u l t y t o b e o v e r c o m e is t h e i n c l i n a t i o n o n t h e p a r t o f c e r t a i n s p e - c i a l t i e s w i t h i n t h e p r o f e s s i o n t o a d o p t t e r m s w i t h o u t f ir s t s u b m i t t i n g t h e m f o r a p p r o v a l t o th e C o m m it t e e o n N o m e n c la t u r e o f t h e A m e r ic a n D e n t a l A s s o c ia tio n . C e r t a i n l y , e a c h d e n t a l s p e c i a l t y s h o u l d e n d e a v o r t o i m p r o v e it s o w n t e r m i n o l o g y , b u t th e r e s h o u ld b e o n e s u p re m e c o u r t w i t h i n t h e p ro fe s s io n w h ic h w p u ld p a s s f in a l ju d g m e n t o n a ll s c ie n t if ic d e n t a l t e r m s . U n d e r t h e p r e s e n t C o n s t it u t io n a l a n d A d m i n i s t r a t i v e B y l a w s , t h a t c o u r t is t h e C o m m i t t e e o n N o m e n c l a t u r e . I f a n d w h e n t h e p r o p o s e d n e w c o n s t i t u t i o n is a d o p t e d , t h is f u n c t i o n w i l l b e t r a n s f e r r e d t o t h e B u r e a u o f L i b r a r y a n d I n d e x in g S e r v ic e . R e g a r d le s s o f w h i c h c o m m it t e e o r b u r e a u is a s s ig n e d t h is r e s p o n s i b i l i t y , t h e t a s k m u s t b e u n d e r t a k e n s e r io u s ly . I t is h i g h t i m e f o r r e e x a m i n a t i o n o f d e n t i s t r y ’ s n o m e n c l a t u r e , d e f i n i t i o n o f n e w t e r m s a n d t h e m o d e r n i z a t io n o f t h e d e n t a l g lo s s a ry .
DENTAL, MEDICAL, N U R SIN G A N D HOSPITAL SERVICES FOR RURAL AREA S
t h e second s o re d b y th e w h ic h w o u ld r u r a l a re a s w e re
A
t
a n n u a l N a tio n a l C o n fe re n c e o n R u r a l H e a lt h in F e b ru a ry , s p o n A m e r ic a n M e d i c a l A s s o c ia t io n , t h e f o llo w in g r e c o m m e n d a t io n s a i d i n b r i n g i n g p h y s i c i a n s a n d d e n t is t s t o , a n d h o l d i n g t h e m i n , m ade:
1 . T h a t s t a t e a n d c o u n t y h e a l t h c o u n c i l s b e e s t a b l is h e d , t o b e c o m p o s e d o f r e p r e s e n t a t iv e s o f m e d i c a l , d e n t a l , f a r m a n d o t h e r o r g a n i z a t i o n s c o n c e r n e d w i t h t h e r u r a l h e a lt h p r o b le m . T h e s e c p u n c ils s h o u ld s t u d y th e h e a lt h n e e d s a n d d e v e lo p p la n s a n d p r o g r a m s f o r im p r o v e m e n t o f r u r a l h e a lt h in e a c h a re a . 2 . T h a t a d e q u a te h e a lt h f a c ilitie s b e d e v e lo p e d in r u r a l a re a s w h e r e a c o m p e t e n t s u r v e y h a s s h o w n t h a t th e s e f a c ilit ie s a r e n e e d e d . I n o r d e r t o a t t r a c t a n d r e t a i n p h y s i c i a n s a n d d e n t is t s i n r u r a l a r e a s , c e r t a i n f u n d a m e n t a l s s e e m n e c e s s a r y :
6 18
The Journal of the American Dental Association
( a ) t h e p r o v is io n o f a d e q u a te m e d ic a l f a c ilitie s ; ( b ) th e p r o v is io n o f a re a s o n a b l e i n c o m e f o r p h y s i c i a n s a n d d e n t is t s i n t h e s e a r e a s ; ( c ) s t i m u l a t i o n o f p r a c tic e i n g r o u p s ; ( d ) a c o n c o m it a n t im p r o v e m e n t o f c o m m u n it y e d u c a t io n a l a n d c u l t u r a l f a c ilit ie s ; ( e ) e x t e n s io n o f g o o d r o a d s , a n d ( f ) t h e d e v e lo p m e n t o f u n d e r s t a n d i n g o n t h e p a r t o f t h e c o m m u n i t y o f it s r e s p o n s i b i l i t i e s w i t h r e f e r e n c e t o a l l h e a lth m a tte rs . 3 . T h a t a p r o g r a m o f p r e v e n t iv e m e d ic a l a n d d e n t a l c a re b e d e v e lo p e d t h r o u g h p r o v is io n o f f u n d s i n th e v a r io u s s ta te s . T h i s p r o g r a m c o u ld b e b e s t im p le m e n t e d b y a s o u n d s y s t e m o f h e a l t h e d u c a t i o n i n t h e s c h o o ls . 4 . T h a t m o r e e m p h a s is b e p l a c e d o n t h e e c o n o m i c p r o b l e m s o f m e d i c i n e i n th e m e d ic a l s c h o o l c u r r ic u lu m . O n e o f t h e g r e a t e s t p r o b l e m s t h a t c o n f r o n t s t h e h e a l t h p r o f e s s i o n t o d a y is t h a t o f s u p p l y i n g d e n t a l , m e d i c a l , n u r s i n g a n d h o s p i t a l s e r v ic e s f o r r u r a l a r e a s . A c c o r d i n g t o a 1 9 4 0 r e p o r t , a p p r o x im a t e ly 2 0 ,0 0 0 ,0 0 0 p e o p le liv e in r u r a l c o m m u n it ie s . E l e v e n t h o u s a n d c o m m u n i t i e s w i t h le s s t h a n 1 ,0 0 0 p o p u l a t i o n h a v e o n l y 1 5 1 h o s p i t a l s , 8 5 p e r c e n t o f w h i c h h a v e a c a p a c i t y o f le s s t h a n f i f t y b e d s . I n t h e e n t i r e c o u n t r y , r u r a l a re a s o u ts id e o f t h e v illa g e s h a v e b u t 9 0 h o s p ita ls a n d m o r e t h a n 5 0 p e r c e n t o f t h e s e h a v e a c a p a c i t y o f le s s t h a n f i f t y b e d s . S m a l l h o s p ita ls u s u a lly m e a n in a d e q u a t e m e d ic a l a n d n u r s in g s ta ffs a n d in a d e q u a t e f a c ilit ie s . T h e d if f ic u lt y e n c o u n t e r e d b y m a n y r u r a l c o m m u n it ie s in a t t r a c t i n g a n d h o l d i n g c o m p e t e n t p h y s i c i a n s a n d n u r s e s is w e l l k n o w n . T h e s c a r c i t y o f d e n t is t s i n r u r a l a r e a s h a s f r e q u e n t l y b e e n r e p o r t e d . I n 1 9 4 2 , ' 2 1 5 c o u n tie s h a d n o d e n t is t . O n e h u n d r e d a n d f o r t y -n in e c o u n tie s h a d a r a t io o f 1 0 ,0 0 0 t o 5 5 , 0 0 0 p e r s o n s t o 1 d e n t i s t ; 4 9 7 c o u n t i e s h a d a r a t i o o f 5 , 0 0 0 t o 1 0 ,0 0 0 p e r s o n s t o 1 d e n t i s t , a n d 1 ,3 0 2 c o u n t i e s h a d a r a t i o o f 2 ,0 0 0 t o 5 , 0 0 0 p e r s o n s p e r d e n tis t. P e o p le w h o liv e i n r u r a l c o m m u n it i e s d o n o t le a d c h a r m e d liv e s . L i k e t h e u r b a n d w e lle r s , t h e y n e e d a n d s h o u ld h a v e a d e q u a t e m e d ic a l a n d d e n t a l s e rv ic e . P r a c t ic a l m e t h o d s o f s u p p ly in g t h a t s e rv ic e h a v e n o t as y e t b e e n d e v e lo p e d , a lt h o u g h t h e s u b j e c t h a s r e c e i v e d c o n s i d e r a b l e t h o u g h t a n d d is c u s s i o n . I t b e c o m e s in c r e a s in g ly a p p a r e n t t h a t f u r n is h in g a d e q u a t e h e a lt h s e rv ic e s t o p e o p l e r e s i d i n g i n r u r a l a r e a s is n o s i m p l e m a t t e r . I t i n v o l v e s m o r e t h a n i n c r e a s i n g th e n u m b e r o f d e n t a l a n d m e d ic a l g r a d u a t e s . I t in v o lv e s m o r e t h a n th e e r e c t io n o f h e a l t h c e n t e r s o r th 'e p r o c u r e m e n t o f o f f ic e s p a c e a n d f a c i l i t i e s . I t w a s t h e c o n s e n s u s o f th o s e in a tte n d a n c e a t th e C o n fe re n c e t h a t “ t h e p r o b le m o f s u p p ly in g h e a l t h s e r v ic e s t o t h o s e i n s p a r s e ly s e t t l e d r e g i o n s is i n t i m a t e l y t i e d i n w i t h t h e w h o le s o c ia l a n d e c o n o m ic s ta tu s in r u r a l a re a s , a n d t h e m a in t e n a n c e o f a r e a s o n a b l e a n d s t a b l e i n c o m e o f r u r a l p e o p l e is t h e u n d e r l y i n g f a c t o r i n t h e a c h i e v e m e n t o f th e s e o b je c t iv e s .”
l O
t
i r
i l c
AMERICAN MAY I, 1947
•
VOLUME 34
l j L
1
OENTAL •
OF
THE
ASSOCIATION
NUMBER 9
L o n W . M o r r e y , d.d.s.. Editor Published by the American Dental Association • 222 East Superior St. • Chicago 11, III.
EDITORIALS
T H E N E E D F O R U N IF O R M IT Y IN D E N T A L N O M E N C L A T U R E
recent adoption by the Committee on Nomenclature of the American Dental Association of a standardized method for the symbolic designation of teeth is to be commended. The simplicity and practicability of the method warrant its early acceptance by the dental profession. At least seven methods of designating teeth are now in use, including one rec ommended by the Committee on Nomenclature in 1933. For years, this lack of uniformity has resulted in confusion, irritation and wasted effort. It is hoped that the Committee’s latest recommendation, which appears on page 647 of this issue of t h e j o u r n a l , will be put into operation as standard procedure as rapidly as possible. The method recommended is neither new nor complicated. It consists of dividing the dental field into quadrants by vertical and horizontal lines. The per manent teeth in each quadrant are designated numerically in relation to these lines. The deciduous teeth are designated similarly by letters. Thus, [3 indicates the lower left permanent cuspid, and b] indicates the upper right deciduous lateral incisor. The adoption of this standard method of tooth designation is particularly timely. An increasing number of hospitals are establishing dental departments and dental internships. An increasing number of communities are establishing health centers and dental health programs for children. Forensic dentistry is better understood now than previously, and the use of teeth as a means of identification is becoming common practice. For these as well as other reasons a uniform method of desig nating teeth should be universally adopted. The standardization of tooth designation, although important, is but a small facet of the larger subject of nomenclature. A correct nomenclature is just as essential to the progress of dentistry as it is to the development of any other science. h e
T
616
Editorials
J.A.D.A., Vol. 34, May I, 1947 . . . 617
T h e f ir s t n o t a b l e e f f o r t t o s t a n d a r d i z e A m e r i c a n d e n t a l t e r m s w a s m a d e b y C h a p i n A . H a r r i s i n 1 8 4 9 . H i s Dictionary of Dental Science s e r v e d a s a s t a n d a r d u n t il G . V . B la c k ’s r e p o r t t o t h e C o lu m b ia n D e n t a l C o n g re s s in 1 8 9 3 . B la c k ’s r e p o r t s e rv e d as a f o u n d a t io n o n w h ic h t h e p ro fe s s io n ’s p re s e n t n o m e n c la t u r e w a s b u ilt . I n 1 9 2 1 , th e N a t io n a l D e n t a l A s s o c ia tio n a p p o in t e d a s t a n d in g c o m m it t e e o n d e n t a l n o m e n c la t u r e w h ic h , w it h c h a n g e s i n p e r s o n n e l, s e rv e d f a it h f u lly a n d w e ll f o r m a n y y e a rs . H o w e v e r , t h e la s t c o m p r e h e n s iv e r e p o r t o f t h e C o m m i t t e e o n N o m e n c la t u r e w a s m a d e in 1 9 3 7 . S in c e t h e n , o n ly t w o o r th r e e m i n o r re p o rts h a v e b e e n s u b m itte d . U n f o r t u n a t e ly , p ro g re s s in d e n ta l te rm in o lo g y h a s n o t k e p t p a c e w it h p ro g re s s i n d e n t a l t e c h n o l o g y o r d e n t a l r e s e a r c h . I n d e e d t h e r e is a t e n d e n c y f o r s o m e le a d in g d e n t a l w r it e r s t o d is r e g a r d c e r t a in t e r m s a n d s y m b o ls w h i c h , a f t e r c a r e f u l d e lib e r a tio n , h a v e b e e n a d o p t e d b y th e C o m m it t e e o n N o m e n c la t u r e . I n s o m e in s ta n c e s , t h e o b je c t io n s r a is e d t o c e r t a in t e r m s a r e b a s e d o n p e r s o n a l p r e ju d ic e o r p r id e o f a u th o r s h ip . A n o t h e r d i f f i c u l t y t o b e o v e r c o m e is t h e i n c l i n a t i o n o n t h e p a r t o f c e r t a i n s p e - c i a l t i e s w i t h i n t h e p r o f e s s i o n t o a d o p t t e r m s w i t h o u t f ir s t s u b m i t t i n g t h e m f o r a p p r o v a l t o th e C o m m it t e e o n N o m e n c la t u r e o f t h e A m e r ic a n D e n t a l A s s o c ia tio n . C e r t a i n l y , e a c h d e n t a l s p e c i a l t y s h o u l d e n d e a v o r t o i m p r o v e it s o w n t e r m i n o l o g y , b u t th e r e s h o u ld b e o n e s u p re m e c o u r t w i t h i n t h e p ro fe s s io n w h ic h w p u ld p a s s f in a l ju d g m e n t o n a ll s c ie n t if ic d e n t a l t e r m s . U n d e r t h e p r e s e n t C o n s t it u t io n a l a n d A d m i n i s t r a t i v e B y l a w s , t h a t c o u r t is t h e C o m m i t t e e o n N o m e n c l a t u r e . I f a n d w h e n t h e p r o p o s e d n e w c o n s t i t u t i o n is a d o p t e d , t h is f u n c t i o n w i l l b e t r a n s f e r r e d t o t h e B u r e a u o f L i b r a r y a n d I n d e x in g S e r v ic e . R e g a r d le s s o f w h i c h c o m m it t e e o r b u r e a u is a s s ig n e d t h is r e s p o n s i b i l i t y , t h e t a s k m u s t b e u n d e r t a k e n s e r io u s ly . I t is h i g h t i m e f o r r e e x a m i n a t i o n o f d e n t i s t r y ’ s n o m e n c l a t u r e , d e f i n i t i o n o f n e w t e r m s a n d t h e m o d e r n i z a t io n o f t h e d e n t a l g lo s s a ry .
DENTAL, MEDICAL, N U R SIN G A N D HOSPITAL SERVICES FOR RURAL AREA S
t h e second s o re d b y th e w h ic h w o u ld r u r a l a re a s w e re
A
t
a n n u a l N a tio n a l C o n fe re n c e o n R u r a l H e a lt h in F e b ru a ry , s p o n A m e r ic a n M e d i c a l A s s o c ia t io n , t h e f o llo w in g r e c o m m e n d a t io n s a i d i n b r i n g i n g p h y s i c i a n s a n d d e n t is t s t o , a n d h o l d i n g t h e m i n , m ade:
1 . T h a t s t a t e a n d c o u n t y h e a l t h c o u n c i l s b e e s t a b l is h e d , t o b e c o m p o s e d o f r e p r e s e n t a t iv e s o f m e d i c a l , d e n t a l , f a r m a n d o t h e r o r g a n i z a t i o n s c o n c e r n e d w i t h t h e r u r a l h e a lt h p r o b le m . T h e s e c p u n c ils s h o u ld s t u d y th e h e a lt h n e e d s a n d d e v e lo p p la n s a n d p r o g r a m s f o r im p r o v e m e n t o f r u r a l h e a lt h in e a c h a re a . 2 . T h a t a d e q u a te h e a lt h f a c ilitie s b e d e v e lo p e d in r u r a l a re a s w h e r e a c o m p e t e n t s u r v e y h a s s h o w n t h a t th e s e f a c ilit ie s a r e n e e d e d . I n o r d e r t o a t t r a c t a n d r e t a i n p h y s i c i a n s a n d d e n t is t s i n r u r a l a r e a s , c e r t a i n f u n d a m e n t a l s s e e m n e c e s s a r y :
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The Journal of the American Dental Association
( a ) t h e p r o v is io n o f a d e q u a te m e d ic a l f a c ilitie s ; ( b ) th e p r o v is io n o f a re a s o n a b l e i n c o m e f o r p h y s i c i a n s a n d d e n t is t s i n t h e s e a r e a s ; ( c ) s t i m u l a t i o n o f p r a c tic e i n g r o u p s ; ( d ) a c o n c o m it a n t im p r o v e m e n t o f c o m m u n it y e d u c a t io n a l a n d c u l t u r a l f a c ilit ie s ; ( e ) e x t e n s io n o f g o o d r o a d s , a n d ( f ) t h e d e v e lo p m e n t o f u n d e r s t a n d i n g o n t h e p a r t o f t h e c o m m u n i t y o f it s r e s p o n s i b i l i t i e s w i t h r e f e r e n c e t o a l l h e a lth m a tte rs . 3 . T h a t a p r o g r a m o f p r e v e n t iv e m e d ic a l a n d d e n t a l c a re b e d e v e lo p e d t h r o u g h p r o v is io n o f f u n d s i n th e v a r io u s s ta te s . T h i s p r o g r a m c o u ld b e b e s t im p le m e n t e d b y a s o u n d s y s t e m o f h e a l t h e d u c a t i o n i n t h e s c h o o ls . 4 . T h a t m o r e e m p h a s is b e p l a c e d o n t h e e c o n o m i c p r o b l e m s o f m e d i c i n e i n th e m e d ic a l s c h o o l c u r r ic u lu m . O n e o f t h e g r e a t e s t p r o b l e m s t h a t c o n f r o n t s t h e h e a l t h p r o f e s s i o n t o d a y is t h a t o f s u p p l y i n g d e n t a l , m e d i c a l , n u r s i n g a n d h o s p i t a l s e r v ic e s f o r r u r a l a r e a s . A c c o r d i n g t o a 1 9 4 0 r e p o r t , a p p r o x im a t e ly 2 0 ,0 0 0 ,0 0 0 p e o p le liv e in r u r a l c o m m u n it ie s . E l e v e n t h o u s a n d c o m m u n i t i e s w i t h le s s t h a n 1 ,0 0 0 p o p u l a t i o n h a v e o n l y 1 5 1 h o s p i t a l s , 8 5 p e r c e n t o f w h i c h h a v e a c a p a c i t y o f le s s t h a n f i f t y b e d s . I n t h e e n t i r e c o u n t r y , r u r a l a re a s o u ts id e o f t h e v illa g e s h a v e b u t 9 0 h o s p ita ls a n d m o r e t h a n 5 0 p e r c e n t o f t h e s e h a v e a c a p a c i t y o f le s s t h a n f i f t y b e d s . S m a l l h o s p ita ls u s u a lly m e a n in a d e q u a t e m e d ic a l a n d n u r s in g s ta ffs a n d in a d e q u a t e f a c ilit ie s . T h e d if f ic u lt y e n c o u n t e r e d b y m a n y r u r a l c o m m u n it ie s in a t t r a c t i n g a n d h o l d i n g c o m p e t e n t p h y s i c i a n s a n d n u r s e s is w e l l k n o w n . T h e s c a r c i t y o f d e n t is t s i n r u r a l a r e a s h a s f r e q u e n t l y b e e n r e p o r t e d . I n 1 9 4 2 , ' 2 1 5 c o u n tie s h a d n o d e n t is t . O n e h u n d r e d a n d f o r t y -n in e c o u n tie s h a d a r a t io o f 1 0 ,0 0 0 t o 5 5 , 0 0 0 p e r s o n s t o 1 d e n t i s t ; 4 9 7 c o u n t i e s h a d a r a t i o o f 5 , 0 0 0 t o 1 0 ,0 0 0 p e r s o n s t o 1 d e n t i s t , a n d 1 ,3 0 2 c o u n t i e s h a d a r a t i o o f 2 ,0 0 0 t o 5 , 0 0 0 p e r s o n s p e r d e n tis t. P e o p le w h o liv e i n r u r a l c o m m u n it i e s d o n o t le a d c h a r m e d liv e s . L i k e t h e u r b a n d w e lle r s , t h e y n e e d a n d s h o u ld h a v e a d e q u a t e m e d ic a l a n d d e n t a l s e rv ic e . P r a c t ic a l m e t h o d s o f s u p p ly in g t h a t s e rv ic e h a v e n o t as y e t b e e n d e v e lo p e d , a lt h o u g h t h e s u b j e c t h a s r e c e i v e d c o n s i d e r a b l e t h o u g h t a n d d is c u s s i o n . I t b e c o m e s in c r e a s in g ly a p p a r e n t t h a t f u r n is h in g a d e q u a t e h e a lt h s e rv ic e s t o p e o p l e r e s i d i n g i n r u r a l a r e a s is n o s i m p l e m a t t e r . I t i n v o l v e s m o r e t h a n i n c r e a s i n g th e n u m b e r o f d e n t a l a n d m e d ic a l g r a d u a t e s . I t in v o lv e s m o r e t h a n th e e r e c t io n o f h e a l t h c e n t e r s o r th 'e p r o c u r e m e n t o f o f f ic e s p a c e a n d f a c i l i t i e s . I t w a s t h e c o n s e n s u s o f th o s e in a tte n d a n c e a t th e C o n fe re n c e t h a t “ t h e p r o b le m o f s u p p ly in g h e a l t h s e r v ic e s t o t h o s e i n s p a r s e ly s e t t l e d r e g i o n s is i n t i m a t e l y t i e d i n w i t h t h e w h o le s o c ia l a n d e c o n o m ic s ta tu s in r u r a l a re a s , a n d t h e m a in t e n a n c e o f a r e a s o n a b l e a n d s t a b l e i n c o m e o f r u r a l p e o p l e is t h e u n d e r l y i n g f a c t o r i n t h e a c h i e v e m e n t o f th e s e o b je c t iv e s .”