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The relation of dental health to general health
The
r e la tio n
of
d e n ta l
h e a lth
to
gen eral
h e a lth
Sh olom P e a r lm a n * D .D .S ., M .S ., Chicago
Early in 1960, the Commission on the tion. Any attempt to segment the total Survey of Dentistry asked a number of health status of the human body into leaders in different fields of health to ap anatomic areas or specific organ functions praise the importance of dental health is neither practical nor realistic. care in relation to sound health service. Health service, on the other hand, de The 32 responses varied in emphasis and mands segmentation as knowledge and extent, but certain considerations were understanding of disease, prevention and expressed with a high degree of accord. treatment continue to increase. Divisions Recognition of these basic features re develop within the health professions as flects thoughtful and courageous evalua a matter of course when the accumula tion of the matter on the part of dentists tion of facts grows beyond the capacity and nondentists alike. The following syn of any one individual to absorb them all thesis is based on the statements that were and far beyond the ability of a single submitted to the Commission on the Sur practitioner to apply them effectively and vey of Dentistry. efficiently. H EALTH
Health is the optimal condition of the whole human organism and it cannot exist if there is disease in any part of the body. Going beyond this axiom, the World Health Organization now con siders health as the state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This enlightened outlook underlies the activities of all the health professions, including dentistry. Recogni tion of the principle of total health repre sents a major advance in the philosophy of humanity and the progress of civiliza
D E N TIS T R Y AS A BR AN C H OF H E A L T H SERVICE
Dentistry evolved early as a distinct field of health service when it became evi dent that individuals who concentrated their attention on the diseases peculiar to the oral regions developed a degree of familiarity with these diseases which others could not hope to achieve without similarly restricting their interest and ac tivities. Intelligence and common sense indicate that problems in special areas of healing be referred to those who are best qualified to deal with them. The dental profession has reached its present position
PEARLMAN . . . VOLUME 61, OCTOBER I960 • 87/485
and stature by investigation and continual improvement of diagnostic, preventive and therapeutic information and pro cedures, directed toward maintaining health in areas of healing which have be come its acknowledged responsibility. Because a high degree of specialization has been necessary to achieve this end, dental health care has come erroneously to be looked upon, in some circles, as a service with little relationship to general health problems. Dentists have never lost sight of the vital contribution they make toward health maintenance, but the mere fact that the essentiality of dental service can be questioned at all indicates that the important role of dentistry has been ob scured to some extent. d e n t is t r y ’ s v it a l r o l e
IN H E A L T H
It must be recognized that, in this country and in other fortunate nations, dental disease is seldom a direct cause of death. This is not because diseases of the oral structures cannot result in death, for they do cause fatalities if they are not treated or arrested in their progress. Malignancies originating in the mouth and jaws still account for 5 to 10 per cent of all deaths from cancer; and infections of the teeth and oral tissues can lead to death in many parts of the world where health service is not adequate and espe cially where malnourishment and debili tation are common. In our society, dental disease rarely has a fatal outcome because dentistry has al ready attained a relatively high level of development. Moreover, the public is ac customed, by and large, to seek treatment at the first signs of distress and more peo ple are learning to have oral examinations at periodic intervals even in the absence of discomfort. As a result, it is almost al ways possible to detect and treat disease conditions long before they approach the life-threatening stage. Consequently, crit ically serious sequelae of dental disease
are seen infrequently. When they do oc cur, they receive as much attention in the dental profession as a case of smallpox or leprosy arouses in medical circles. Where advanced dental service is gen erally accessible, it is taken for granted that dental disease is of minor conse quence because death resulting from un treated dental abscesses, osteomyelitis of the jaws, monilial infection (“thrush” ) and other killing conditions is largely a thing of the past. Public health authori ties know that in regions where health is poor and care is not readily available the killing potential of dental diseases is very much a thing of the present. When dental disease progresses to the point where symptoms of general illness appear, they can be alleviated to varying degrees by procedures employed in the treatment of similar symptoms that arise from like conditions in other organs of the body. Abscesses can be drained ; infec tion can be stemmed with antibiotics; pain can be relieved with analgesics. But the sufferer cannot be restored to a sound state of health unless the offending con dition is eliminated, and it is the dentist, backed by the accumulated knowledge of his profession, who has the necessary in formation and . the carefully cultivated skill to perform this essential function. When the general physician strives to maintain health in the face of a disease condition that requires surgical interven tion which he himself is not prepared to perform, the service of the surgeon is re garded as essential. Although in a gener alized illness of dental origin the crisis may develop more gradually, and the relationship between physician and den tist is rarely so dramatically obvious as this, it is nevertheless apparent that in such situations the intervention of the dentist is likewise essential to the mainte nance of health. Dental health service contributes to the preservation of life by arresting the progress of infections that originate in the teeth, tongue, lips, jaws and associated
88/486 • THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
structures. These conditions include tooth cantly and sometimes completely hamper decay, gingivitis, periodontitis, pericoro the individual’s relationships with others nitis, abscesses, infected cysts and their and severely restrict his activities through sequelae. out his lifetime. Dentists perform essential health serv Dentistry meets this challenge in virtu ice in the early diagnosis of cancer, blood ally every phase of practice. Most spec diseases (leukemia, anemia), nutritional tacular and dramatic are the results deficiencies, arthritic disturbances, and achieved in the correction of cleft palate other conditions that may have far- and cleft lip, congenital defects which reaching effects on the human organism. occur in one out of every 800 persons In treating these conditions, other health born alive in this country. The emotional, professions may assume major responsi social and economic battles which vic bility, but early recognition by the dentist tims of this affliction must fight through often determines whether treatment will life cannot be comprehended fully by be instituted before it is too late. those who have not associated intimately with them. The dental specialist is the key member of teams that provide treat D E N TA L H E A L T H AND ment for these patients at cleft palate EFFECTIVE LIV IN G clinics in various parts of the world. Malocclusion, which includes “buck The saving and prolongation of life, although certainly the most critical con teeth,” “lantern jaw,” and less noticeable cern of all health professions, is only part but equally disturbing dental conditions, of the broad objective of health service. may create serious psychological prob Poor health, when it reduces productivity lems, especially in children and young and efficiency, diminishes the individual’s adults. Orthodontists perform a vital ability to contribute to society, his family, humanitarian service in restoring selfand his own well-being. Health service confidence and happiness which usually ideally is aimed at enabling everyone to are lost when the child becomes aware work at full capacity toward the fulfill of the esthetically undesirable facial ap ment of happy and purposeful living. pearance that accompanies this dental Because discomfort and pain disturb defect. living patterns, dental service is sought In adolescence, the appearance of the most often for removal of certain of the teeth and mouth assumes outstanding im interfering factors. Usually these symp portance in relation to social acceptance, toms appear only temporarily, as signs of particularly by the opposite sex. Inflamed acute dental disease conditions, and the or bleeding gums, decayed, misaligned, equanimity of the patient is restored after or discolored teeth are unsightly. Spaces successful treatment. Mental attitudes created through the loss of teeth by acci and emotional factors, however, are now dent or neglect present opportunities for universally recognized as highly impor comment and ridicule. Withdrawal from tant influences on the degree to which society, to different degrees, is the com the individual can achieve well-rounded, mon response to the situation unless the effectual living. In everyday life we com offending conditions of the mouth are municate with each other primarily with corrected through dental care. the mouth and face. Any disfigurement of Adults, no less than youth, are keenly these parts of the body that interferes sensitive about appearance, which is im however slightly with acceptable speech portant both in business and social rela or appearance may give rise to serious tionships. The psychological ramifications emotional problems and maladjustment associated with tooth loss and the pros of personality. These, in turn, can signifi pect of artificial dentures are extensive
PEARLMAN . . . VOLUME 61, OCTOBER I960 • 89/487
in middle-age and later life. Dental serv ice contributes immeasurably to the maintenance of emotional serenity in the face of aging. Prosthetic restorations and appliances of today often are considerably more attractive than the natural teeth they replace. Restoration of the vertical relationships of the jaws, accompanied by elimination of wrinkles, drooping lips and sagging cheeks, rejuvenates the ap pearance of the face at a time when appearance is important to personality and adjustment. The impact of prosthetic dental service on the physical and mental health of older individuals enables them to prolong the years of usefulness to the community and the enjoyment of life as a whole.
C O N C LU S IO N S
The foregoing broad considerations in dicate clearly that health service is not complete if the health of the oral struc tures and all they represent is excluded or glossed over. Any reflective appraisal is bound to establish incontrovertibly that dental care is an integral and essential part of sound health service. Moreover, it appears likely that dental health serv ice will continue to grow in importance when present concepts of health are mod ified by further enlightenment and the adoption of higher standards. *S e c r e ta r y ,t C o u n c il Den tal A sso cia tio n .
on
Dental
Research,
A m e ric a n
T he Fourth Dimension of D ental Education • I f dental education is going to assume its p art in providin g the necessary m anpow er requirem ents, it is going to have to do some self-analysis and initiate certain fundam ental changes. T h ese changes will affect all the other segments of the dental profession and w ill necessitate a change in the “ follow-the-leader” attitudes we seem to have ad opted in recent years. It m ay m ean that our greatest need in the future will be to break with the traditional dicta of today’s leaders. . . . G reat latitude should be allowed an d educational experim entation encouraged, not frow ned upon and actually opposed, as it has been in the past. A ttem pts to standardize and force into patterns should be avoided. Practically all of the dental schools are integral parts of universities and can be trusted to embark on legitim ate program s. Prescription of pre-dental subjects should be liberalized. ,. . . Selection of students m ust be reappraised. We have rath er good m easuring devices today to identify the student who has prom ise of developing as a com petent practitioner, but little or no w ay of identifying the applican t who has the potential to develop as a professional m an, with all of the intangible attributes and qualities of personality which we like to see in such people. Such identification will not be easy. A great m any program s to accom plish this objective will have to be tried. T h e time to start them is now. . . . I t is my belief that we, as dentists, have faced up to solving the problem of relating dentistry and den tal education to the w orld around us. We have com e to the realization that if we do not, non-dentists will do it for us, and history has shown th at when problem s are solved by legislatures it is only the quantitative aspects that are solved. We are strongly aw are that the people gran ted us, through licensure, a monopoly to practice dentistry and for this expect us to produce com petent dentists and to render good dental service. T h is we have done and are doing. F urth er than this, the people expect us to provide leadership and guidance in the field of our competency. T h is we recognize, even though it leads us out of the present dimensions of practice. We know that the m embers of a profes sion m ust be concerned with the total w elfare of the people, not a segment— particularly our own segment. When we think of ourselves only as a profession with isolated problem s to be solved, it is three dim ensional thinking. When we think of ourselves in relation to the w orld around us, we are approaching fourth dim ensional thinking, even if this means “ preceding our leaders behind us.” Willard C. Fleming. New D im ensions of Learning in a Free Society, 1958.
r e la tio n
of
d e n ta l
h e a lth
to
gen eral
h e a lth
Sh olom P e a r lm a n * D .D .S ., M .S ., Chicago
Early in 1960, the Commission on the tion. Any attempt to segment the total Survey of Dentistry asked a number of health status of the human body into leaders in different fields of health to ap anatomic areas or specific organ functions praise the importance of dental health is neither practical nor realistic. care in relation to sound health service. Health service, on the other hand, de The 32 responses varied in emphasis and mands segmentation as knowledge and extent, but certain considerations were understanding of disease, prevention and expressed with a high degree of accord. treatment continue to increase. Divisions Recognition of these basic features re develop within the health professions as flects thoughtful and courageous evalua a matter of course when the accumula tion of the matter on the part of dentists tion of facts grows beyond the capacity and nondentists alike. The following syn of any one individual to absorb them all thesis is based on the statements that were and far beyond the ability of a single submitted to the Commission on the Sur practitioner to apply them effectively and vey of Dentistry. efficiently. H EALTH
Health is the optimal condition of the whole human organism and it cannot exist if there is disease in any part of the body. Going beyond this axiom, the World Health Organization now con siders health as the state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This enlightened outlook underlies the activities of all the health professions, including dentistry. Recogni tion of the principle of total health repre sents a major advance in the philosophy of humanity and the progress of civiliza
D E N TIS T R Y AS A BR AN C H OF H E A L T H SERVICE
Dentistry evolved early as a distinct field of health service when it became evi dent that individuals who concentrated their attention on the diseases peculiar to the oral regions developed a degree of familiarity with these diseases which others could not hope to achieve without similarly restricting their interest and ac tivities. Intelligence and common sense indicate that problems in special areas of healing be referred to those who are best qualified to deal with them. The dental profession has reached its present position
PEARLMAN . . . VOLUME 61, OCTOBER I960 • 87/485
and stature by investigation and continual improvement of diagnostic, preventive and therapeutic information and pro cedures, directed toward maintaining health in areas of healing which have be come its acknowledged responsibility. Because a high degree of specialization has been necessary to achieve this end, dental health care has come erroneously to be looked upon, in some circles, as a service with little relationship to general health problems. Dentists have never lost sight of the vital contribution they make toward health maintenance, but the mere fact that the essentiality of dental service can be questioned at all indicates that the important role of dentistry has been ob scured to some extent. d e n t is t r y ’ s v it a l r o l e
IN H E A L T H
It must be recognized that, in this country and in other fortunate nations, dental disease is seldom a direct cause of death. This is not because diseases of the oral structures cannot result in death, for they do cause fatalities if they are not treated or arrested in their progress. Malignancies originating in the mouth and jaws still account for 5 to 10 per cent of all deaths from cancer; and infections of the teeth and oral tissues can lead to death in many parts of the world where health service is not adequate and espe cially where malnourishment and debili tation are common. In our society, dental disease rarely has a fatal outcome because dentistry has al ready attained a relatively high level of development. Moreover, the public is ac customed, by and large, to seek treatment at the first signs of distress and more peo ple are learning to have oral examinations at periodic intervals even in the absence of discomfort. As a result, it is almost al ways possible to detect and treat disease conditions long before they approach the life-threatening stage. Consequently, crit ically serious sequelae of dental disease
are seen infrequently. When they do oc cur, they receive as much attention in the dental profession as a case of smallpox or leprosy arouses in medical circles. Where advanced dental service is gen erally accessible, it is taken for granted that dental disease is of minor conse quence because death resulting from un treated dental abscesses, osteomyelitis of the jaws, monilial infection (“thrush” ) and other killing conditions is largely a thing of the past. Public health authori ties know that in regions where health is poor and care is not readily available the killing potential of dental diseases is very much a thing of the present. When dental disease progresses to the point where symptoms of general illness appear, they can be alleviated to varying degrees by procedures employed in the treatment of similar symptoms that arise from like conditions in other organs of the body. Abscesses can be drained ; infec tion can be stemmed with antibiotics; pain can be relieved with analgesics. But the sufferer cannot be restored to a sound state of health unless the offending con dition is eliminated, and it is the dentist, backed by the accumulated knowledge of his profession, who has the necessary in formation and . the carefully cultivated skill to perform this essential function. When the general physician strives to maintain health in the face of a disease condition that requires surgical interven tion which he himself is not prepared to perform, the service of the surgeon is re garded as essential. Although in a gener alized illness of dental origin the crisis may develop more gradually, and the relationship between physician and den tist is rarely so dramatically obvious as this, it is nevertheless apparent that in such situations the intervention of the dentist is likewise essential to the mainte nance of health. Dental health service contributes to the preservation of life by arresting the progress of infections that originate in the teeth, tongue, lips, jaws and associated
88/486 • THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
structures. These conditions include tooth cantly and sometimes completely hamper decay, gingivitis, periodontitis, pericoro the individual’s relationships with others nitis, abscesses, infected cysts and their and severely restrict his activities through sequelae. out his lifetime. Dentists perform essential health serv Dentistry meets this challenge in virtu ice in the early diagnosis of cancer, blood ally every phase of practice. Most spec diseases (leukemia, anemia), nutritional tacular and dramatic are the results deficiencies, arthritic disturbances, and achieved in the correction of cleft palate other conditions that may have far- and cleft lip, congenital defects which reaching effects on the human organism. occur in one out of every 800 persons In treating these conditions, other health born alive in this country. The emotional, professions may assume major responsi social and economic battles which vic bility, but early recognition by the dentist tims of this affliction must fight through often determines whether treatment will life cannot be comprehended fully by be instituted before it is too late. those who have not associated intimately with them. The dental specialist is the key member of teams that provide treat D E N TA L H E A L T H AND ment for these patients at cleft palate EFFECTIVE LIV IN G clinics in various parts of the world. Malocclusion, which includes “buck The saving and prolongation of life, although certainly the most critical con teeth,” “lantern jaw,” and less noticeable cern of all health professions, is only part but equally disturbing dental conditions, of the broad objective of health service. may create serious psychological prob Poor health, when it reduces productivity lems, especially in children and young and efficiency, diminishes the individual’s adults. Orthodontists perform a vital ability to contribute to society, his family, humanitarian service in restoring selfand his own well-being. Health service confidence and happiness which usually ideally is aimed at enabling everyone to are lost when the child becomes aware work at full capacity toward the fulfill of the esthetically undesirable facial ap ment of happy and purposeful living. pearance that accompanies this dental Because discomfort and pain disturb defect. living patterns, dental service is sought In adolescence, the appearance of the most often for removal of certain of the teeth and mouth assumes outstanding im interfering factors. Usually these symp portance in relation to social acceptance, toms appear only temporarily, as signs of particularly by the opposite sex. Inflamed acute dental disease conditions, and the or bleeding gums, decayed, misaligned, equanimity of the patient is restored after or discolored teeth are unsightly. Spaces successful treatment. Mental attitudes created through the loss of teeth by acci and emotional factors, however, are now dent or neglect present opportunities for universally recognized as highly impor comment and ridicule. Withdrawal from tant influences on the degree to which society, to different degrees, is the com the individual can achieve well-rounded, mon response to the situation unless the effectual living. In everyday life we com offending conditions of the mouth are municate with each other primarily with corrected through dental care. the mouth and face. Any disfigurement of Adults, no less than youth, are keenly these parts of the body that interferes sensitive about appearance, which is im however slightly with acceptable speech portant both in business and social rela or appearance may give rise to serious tionships. The psychological ramifications emotional problems and maladjustment associated with tooth loss and the pros of personality. These, in turn, can signifi pect of artificial dentures are extensive
PEARLMAN . . . VOLUME 61, OCTOBER I960 • 89/487
in middle-age and later life. Dental serv ice contributes immeasurably to the maintenance of emotional serenity in the face of aging. Prosthetic restorations and appliances of today often are considerably more attractive than the natural teeth they replace. Restoration of the vertical relationships of the jaws, accompanied by elimination of wrinkles, drooping lips and sagging cheeks, rejuvenates the ap pearance of the face at a time when appearance is important to personality and adjustment. The impact of prosthetic dental service on the physical and mental health of older individuals enables them to prolong the years of usefulness to the community and the enjoyment of life as a whole.
C O N C LU S IO N S
The foregoing broad considerations in dicate clearly that health service is not complete if the health of the oral struc tures and all they represent is excluded or glossed over. Any reflective appraisal is bound to establish incontrovertibly that dental care is an integral and essential part of sound health service. Moreover, it appears likely that dental health serv ice will continue to grow in importance when present concepts of health are mod ified by further enlightenment and the adoption of higher standards. *S e c r e ta r y ,t C o u n c il Den tal A sso cia tio n .
on
Dental
Research,
A m e ric a n
T he Fourth Dimension of D ental Education • I f dental education is going to assume its p art in providin g the necessary m anpow er requirem ents, it is going to have to do some self-analysis and initiate certain fundam ental changes. T h ese changes will affect all the other segments of the dental profession and w ill necessitate a change in the “ follow-the-leader” attitudes we seem to have ad opted in recent years. It m ay m ean that our greatest need in the future will be to break with the traditional dicta of today’s leaders. . . . G reat latitude should be allowed an d educational experim entation encouraged, not frow ned upon and actually opposed, as it has been in the past. A ttem pts to standardize and force into patterns should be avoided. Practically all of the dental schools are integral parts of universities and can be trusted to embark on legitim ate program s. Prescription of pre-dental subjects should be liberalized. ,. . . Selection of students m ust be reappraised. We have rath er good m easuring devices today to identify the student who has prom ise of developing as a com petent practitioner, but little or no w ay of identifying the applican t who has the potential to develop as a professional m an, with all of the intangible attributes and qualities of personality which we like to see in such people. Such identification will not be easy. A great m any program s to accom plish this objective will have to be tried. T h e time to start them is now. . . . I t is my belief that we, as dentists, have faced up to solving the problem of relating dentistry and den tal education to the w orld around us. We have com e to the realization that if we do not, non-dentists will do it for us, and history has shown th at when problem s are solved by legislatures it is only the quantitative aspects that are solved. We are strongly aw are that the people gran ted us, through licensure, a monopoly to practice dentistry and for this expect us to produce com petent dentists and to render good dental service. T h is we have done and are doing. F urth er than this, the people expect us to provide leadership and guidance in the field of our competency. T h is we recognize, even though it leads us out of the present dimensions of practice. We know that the m embers of a profes sion m ust be concerned with the total w elfare of the people, not a segment— particularly our own segment. When we think of ourselves only as a profession with isolated problem s to be solved, it is three dim ensional thinking. When we think of ourselves in relation to the w orld around us, we are approaching fourth dim ensional thinking, even if this means “ preceding our leaders behind us.” Willard C. Fleming. New D im ensions of Learning in a Free Society, 1958.