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The Type of Dentistry Available for High School Students in New York*
Bureau of Public Relations their time and energy to their particular branch of dentistry and who are always available with their experience, advice and skill. O ften, patients from neighboring towns drop in unexpectedly. Usually, we can find one or two among us who can rearrange appointments and take care of them promptly. O r if there is much to be done and in various departments, we cooperate in giving these patients non conflicting appointments, making it pos sible to get considerable work done in a short time. T his also reflects in a saving of hotel expense for the patients. In a group, there is some advantage in buying certain supplies in quantity lots. W e effect quite a saving by purchasing sufficient stationery, appointment books, drugs, etc., to last for a year or so in ad vance. T h en too, the supply houses offer attractive discounts. W e make a 20 per cent plus 2 per cent saving on teeth bought in $300 lots, w ith the privilege of exchange. Purchase of alloys in 10ounce lots saves 15 per cent. And so w ith burs, cements, etc., all in addition to
1703
the 2 per cent allowed for cash deposits. O u r collection of roentgenograms, records of Vincent’s smears, photographs, study models, etc., furnish data for papers, clinics or study clubs. In a group, if one is away from the office either for recreation or on account of sickness, there is always someone ready and willing to look after any emergency th at may arise. I am confident that should any of my patients need attention while I am attending this meeting, they w ill be cared for promptly by my part ners. T o us, group practice is the ideal way to practice dentistry, and w hat a wonder ful thing it would be if all dentistry could be organized into groups, each comprising a complete unit fully equipped to include all branches of dentistry w ith every mem ber prompted by the highest standards of service to his fellow m a n ; and each unit w ith an efficient business management to relieve the operators of all business rou tine and responsibility, that he may con centrate his efforts in the branch of den tistry for which he is best suited.
TH E TYPE OF DENTISTRY AVAILABLE FOR HIGH SCHOOL STUDENTS IN NEW YORK By IRWIN WALTER SCOPP,* B.S., D.D.S., New York City
PURPOSE O F T H E
S TU D Y
H IS study was undertaken because of the fact that there is no unified system under the N ew Y ork board of education of meeting the dental needs of the students. As a m atter of fact, there are no dentists in the employ of the board of education who receive their salary
T
*Licensed teacher of biology, High School Division.
solely for the dental service they may render. T here are two dentists, to my knowledge, who receive a salary from the board of education, but not because they serve as dentists. Rather, they are teachers of academic subjects, and in cidentally are dentists. These men are D r. Sabin, serving now under the license of teacher-in-training in biology at M o r ris H igh School, and I. Such being the case, we have before
1704
T he Journal of the American D ental Association
us the following problem ; forty-two high schools in the C ity of N ew York, having 172,000 pupils, w ith no unified dental organization caring for the needs or see ing th a t the needs of these adolescents are cared for. T h e dental program of each high school, if there is to be one at all, depends on the principal of the school. Ju st so far as he is impressed w ith the necessity of a dental program is the dental organization of his school effective. As w ill be seen in our study, the degree of care given ranges from no care whatso ever to one system where advancement from one class to another is withheld each term until the teeth are cared for and a fund is available for indigent students. M E T H O D O F IN V E S T IG A T IO N
Letters requesting certain information were sent out to each of the forty-two high schools in the city. In view of the fact th at dental care is usually under the supervision of either the biology or the health education department, the letters were addressed specifically to the heads of these departments. Before analyzing the data presented, it would be well to consider the back ground of high school students in N ew Y ork. T h e ages of 92 per cent range from 14 to 18 years. M any come from very poor homes, especially during de pression times. T h e only reason many are in high school is that the N ew Y ork State law prohibits them from working full time until they have reached the age of 17. H aving such a group in school com plicates the problem, not only the work of the classroom teacher, but also any plans for carrying out an oral health program. T h e great majority of pupils have two interests in life: the girls idolize the movie stars; the boys, professional ath letes. A nything else, no m atter w hat it is, is considered of little or no significance. I t is quite evident that anyone attem pting
to introduce an oral health program must dynamite his way through such lethargy and unconcern. ANALYSIS O F FIN D IN G S
O f the forty-two schools, only twentythree returned the questionnaire. In all of the forty-two high schools of this city, we find that there are no dentists paid by the board of education for dental service. O nly eight high schools have a dentist who volunteers his services; fifteen have teachers examine the pupils. In only one school (C urtis H igh School) is provision made for pupils who cannot afford to go to private dentists or even dental clinics. H ere we have a teacher’s fund. H ow effectively this works out and how large the fund is I have not had time to ascertain. In short, a student may go through high school and even graduate w ith a m outh full of cavities and infected teeth merely by in sisting th at he cannot afford dental treat ment. H e may be threatened w ith failure to graduate or be promoted, but if the threat fails, there is no other recourse— and the students know th at graduation or promotion cannot be withheld. T hey may fail in their course in hygiene, but since this is a minor course (one forty minute period per week), failure does not prevent promotion or graduation. A fairly good oral health program was found at M orris H igh School, a school of 7,000 students. D r. Sabin, a dentist, is a member of the biology staff. A l though he is employed to teach biology, he has done much to advance this dental program. A t the head of the biology de partm ent is Miss E dith Read, who is directly responsible for this fine work. D r. Sabin, with the assistance of some of the teachers, examines the entire school each semester. T h e difficult cases are sub mitted to D r. Sabin. W hen students are not cooperative, there are conferences
Bureau of Public Relations w ith parents and the students are sent to the office as a m atter of discipline and be cause of failing in hygiene. As part of the instruction in hygiene and biology, moving pictures demonstrating dental pathology and the structure of the teeth and lectures on diet in relation to teeth and the causes of caries are presented. Miss Elizabeth T . Fitzpatrick, chair man of health education at Ju lia Richman H igh School, gives her version of the situation as follow s: The dental situation is a very difficult one. As far as I understand it, there are two contributing causes. Many parents send their children to clinics because they say they cannot afford to consult private dentists or they think hospitals do better work than private dentists. Many of these people can afford good clothes, food, etc., but think dental care is an expense for which there is not adequate return. Such situations crowd the clinics and keep the deserving poor from receiving proper at tention. On the other hand, clinical den tistry is too expensive for the poor person. My solution is to have the board of health start an educational campaign with the pre school child just as has been done in con trolling diphtheria. Educate the mothers to take children to the dentist when they reach the age of 3 years. Then have teachers in elementary schools require dental certifi cates each term. If this is done, the mouths of the children will not get into such con dition that the work is very expensive, the mouth unsightly and the health impaired. Education in dental hygiene should begin with the kindergarten and continue all through school. For the present situation, the only solution is an endowed clinic of some kind for the deserving poor. D E N T IST R Y FO R H IG H SC H O O L TEA CH ERS
Although the dental condition of students is very bad, one would expect to find that of the teacher fairly good. W hile at T extile H igh School, where I taught biology, I undertook an examina tion one afternoon of the teachers in biol
1705
ogy, chemistry and physics. O ut of a group of twelve, I found only two w ith no cavities. O f these two, one had a full upper and lower denture. “T in can” crowns flourished and nearly all the fill ings disregarded the anatomic structure of the tooth. None of the teachers had all four first molars. Periodontoclasia was rampant. T h e board of education has a staff of six or seven physicians to examine pro spective applicants for teachers’ positions. Before a teacher is granted a license, the physician checks up on the heart, lungs, hearing, eyesight, weight, vaccination, etc., and license to teach is denied if all examinations are not negative. T his rule is rigidly enforced. T here is no examina tion of the teeth. I t is my suggestion th at two or three dentists be similarly employed by the board of education to check up on the dental needs of the teacher applicants. Licenses should be denied, if a healthy oral condition is not found. ESSENTIALS F O R A GO O D O RAL H Y G IE N E PRO G RA M IN T H E SCHOOLS
T o carry out a dental program, it is m andatory to provide for the following: 1. Examination of pupils only by li censed and capable dentists or oral hygienists rather than school teachers. . 2. Dentists on an annual salary basis so that they can spend sufficient time and energy in this type of work. 3. Full-time dental administrators for all schools on a yearly salary basis. 4. D ental service for indigent pupils. 5. A n enforceable rule whereby all students are required to present a healthy oral condition each semester. This may be secured only by rigorously enforcing a rule whereby students may be suspended from classes until such work is at least started. 6. A careful follow-up system by
1706
The Journal of the American D ental Association
which those careless about oral hygiene missing teeth, etc., to be given in con nection w ith the regular course in hy are given special urging. 7. A series of lectures interestingly giene. 8. W ithholding of a teacher’s license presented on diet, toothbrushing, gingi val care, caries, oral hygiene and effects until all needed work is completed. of prem ature extraction and unsupplied 1455 W alton Avenue.
CURRENT LITERATURE Care and Treatment of Teeth in Child hood ( G. Fischer, München, med. Wchnschr., April 14, 1933; abstr. Am. J. Dis. Child., M ay, 1934): Dental prophylaxis is most important and should be begun by the mother in the antepartum period. The diet during pregnancy should contain plenty of calcium and vitamins. The child should be gin to brush the teeth at 3 years of age. His diet should be well balanced and con tain an abundance of calcium and vitamins. Infections injure the teeth, and therefore it is important to increase the child’s resist ance as much as possible. H oof and M outh Disease: Von Scheitz (Klin. Wchnschr., April 28, 1934) states that human subjects are most readily in fected by raw milk. Another mode of in fection is contact with a diseased animal. Transmission from man to man is still somewhat doubtful. The incubation period is fairly short in human subjects, lasting as a rule two or three days. This is followed by the primary blisters and higher fever with general debility. In the second phase, the secondary blisters and aphthae develop. This phase may assume widely different as pects. In typical cases, grayish white aph thae about the size of a pinhead or blisters of the same size appear on the buccal mu cous membrane, tongue and gums. The mucous membrane is swollen and painful, and salivation occurs. The food intake is difficult. The vesicles may appear on the fingers and toes, aphthae may develop on the nostrils and lips and the conjunctiva may become inflamed. The vesicles and aphthae burst after one or two days and the temperature decreases. The secondary
symptoms may take the form of an inflam mation of the nails, and cutaneous erup tions may appear on any part of the body, producing a generalized maculopapulous exanthem, which may become hemorrhagic. In many instances, the secondary symptoms are rather mild and hardly noticeable. For this reason, the diagnosis must be based mainly on the primary blisters and the typi cal fever curve. The most frequent com plication of hoof and mouth disease is an involvement of the cardiac muscle. The disorder has been mistaken for milker’s nodules, erythema exudativum multiforme and herpes. The author gives a history of one case which showed the typical double phase and the beneficial effect of intra venous injection of neo-arsphenamine. Electrocardiography revealed a temporary involvement of the cardiac muscle. Vac cination of guinea-pigs with extract of the aphthae gave positive results and passage likewise was accomplished. One investiga tor vaccinated himself with a highly viru lent strain four months after an infection and he did not contract the disease again. The author stresses the beneficial effects of neo-arsphenamine. He also found that the application of nupercaine ointment counteracts the pain of the mucous mem brane for six or seven hours. Irrigations with a 2 per cent boric acid solution or with camomile tea are helpful in the treatment of the oral symptoms.—Abstr. J.A.M .A., June 23, 1934. Congenital Epulis (Its Histogenesis) (P. Moulonguet and Genevieve De Lambert, Ann. d’anat. path., 9:887, 1932; abstr. Am. J. Dis. Child., M ay, 1934): In studying
1703
the 2 per cent allowed for cash deposits. O u r collection of roentgenograms, records of Vincent’s smears, photographs, study models, etc., furnish data for papers, clinics or study clubs. In a group, if one is away from the office either for recreation or on account of sickness, there is always someone ready and willing to look after any emergency th at may arise. I am confident that should any of my patients need attention while I am attending this meeting, they w ill be cared for promptly by my part ners. T o us, group practice is the ideal way to practice dentistry, and w hat a wonder ful thing it would be if all dentistry could be organized into groups, each comprising a complete unit fully equipped to include all branches of dentistry w ith every mem ber prompted by the highest standards of service to his fellow m a n ; and each unit w ith an efficient business management to relieve the operators of all business rou tine and responsibility, that he may con centrate his efforts in the branch of den tistry for which he is best suited.
TH E TYPE OF DENTISTRY AVAILABLE FOR HIGH SCHOOL STUDENTS IN NEW YORK By IRWIN WALTER SCOPP,* B.S., D.D.S., New York City
PURPOSE O F T H E
S TU D Y
H IS study was undertaken because of the fact that there is no unified system under the N ew Y ork board of education of meeting the dental needs of the students. As a m atter of fact, there are no dentists in the employ of the board of education who receive their salary
T
*Licensed teacher of biology, High School Division.
solely for the dental service they may render. T here are two dentists, to my knowledge, who receive a salary from the board of education, but not because they serve as dentists. Rather, they are teachers of academic subjects, and in cidentally are dentists. These men are D r. Sabin, serving now under the license of teacher-in-training in biology at M o r ris H igh School, and I. Such being the case, we have before
1704
T he Journal of the American D ental Association
us the following problem ; forty-two high schools in the C ity of N ew York, having 172,000 pupils, w ith no unified dental organization caring for the needs or see ing th a t the needs of these adolescents are cared for. T h e dental program of each high school, if there is to be one at all, depends on the principal of the school. Ju st so far as he is impressed w ith the necessity of a dental program is the dental organization of his school effective. As w ill be seen in our study, the degree of care given ranges from no care whatso ever to one system where advancement from one class to another is withheld each term until the teeth are cared for and a fund is available for indigent students. M E T H O D O F IN V E S T IG A T IO N
Letters requesting certain information were sent out to each of the forty-two high schools in the city. In view of the fact th at dental care is usually under the supervision of either the biology or the health education department, the letters were addressed specifically to the heads of these departments. Before analyzing the data presented, it would be well to consider the back ground of high school students in N ew Y ork. T h e ages of 92 per cent range from 14 to 18 years. M any come from very poor homes, especially during de pression times. T h e only reason many are in high school is that the N ew Y ork State law prohibits them from working full time until they have reached the age of 17. H aving such a group in school com plicates the problem, not only the work of the classroom teacher, but also any plans for carrying out an oral health program. T h e great majority of pupils have two interests in life: the girls idolize the movie stars; the boys, professional ath letes. A nything else, no m atter w hat it is, is considered of little or no significance. I t is quite evident that anyone attem pting
to introduce an oral health program must dynamite his way through such lethargy and unconcern. ANALYSIS O F FIN D IN G S
O f the forty-two schools, only twentythree returned the questionnaire. In all of the forty-two high schools of this city, we find that there are no dentists paid by the board of education for dental service. O nly eight high schools have a dentist who volunteers his services; fifteen have teachers examine the pupils. In only one school (C urtis H igh School) is provision made for pupils who cannot afford to go to private dentists or even dental clinics. H ere we have a teacher’s fund. H ow effectively this works out and how large the fund is I have not had time to ascertain. In short, a student may go through high school and even graduate w ith a m outh full of cavities and infected teeth merely by in sisting th at he cannot afford dental treat ment. H e may be threatened w ith failure to graduate or be promoted, but if the threat fails, there is no other recourse— and the students know th at graduation or promotion cannot be withheld. T hey may fail in their course in hygiene, but since this is a minor course (one forty minute period per week), failure does not prevent promotion or graduation. A fairly good oral health program was found at M orris H igh School, a school of 7,000 students. D r. Sabin, a dentist, is a member of the biology staff. A l though he is employed to teach biology, he has done much to advance this dental program. A t the head of the biology de partm ent is Miss E dith Read, who is directly responsible for this fine work. D r. Sabin, with the assistance of some of the teachers, examines the entire school each semester. T h e difficult cases are sub mitted to D r. Sabin. W hen students are not cooperative, there are conferences
Bureau of Public Relations w ith parents and the students are sent to the office as a m atter of discipline and be cause of failing in hygiene. As part of the instruction in hygiene and biology, moving pictures demonstrating dental pathology and the structure of the teeth and lectures on diet in relation to teeth and the causes of caries are presented. Miss Elizabeth T . Fitzpatrick, chair man of health education at Ju lia Richman H igh School, gives her version of the situation as follow s: The dental situation is a very difficult one. As far as I understand it, there are two contributing causes. Many parents send their children to clinics because they say they cannot afford to consult private dentists or they think hospitals do better work than private dentists. Many of these people can afford good clothes, food, etc., but think dental care is an expense for which there is not adequate return. Such situations crowd the clinics and keep the deserving poor from receiving proper at tention. On the other hand, clinical den tistry is too expensive for the poor person. My solution is to have the board of health start an educational campaign with the pre school child just as has been done in con trolling diphtheria. Educate the mothers to take children to the dentist when they reach the age of 3 years. Then have teachers in elementary schools require dental certifi cates each term. If this is done, the mouths of the children will not get into such con dition that the work is very expensive, the mouth unsightly and the health impaired. Education in dental hygiene should begin with the kindergarten and continue all through school. For the present situation, the only solution is an endowed clinic of some kind for the deserving poor. D E N T IST R Y FO R H IG H SC H O O L TEA CH ERS
Although the dental condition of students is very bad, one would expect to find that of the teacher fairly good. W hile at T extile H igh School, where I taught biology, I undertook an examina tion one afternoon of the teachers in biol
1705
ogy, chemistry and physics. O ut of a group of twelve, I found only two w ith no cavities. O f these two, one had a full upper and lower denture. “T in can” crowns flourished and nearly all the fill ings disregarded the anatomic structure of the tooth. None of the teachers had all four first molars. Periodontoclasia was rampant. T h e board of education has a staff of six or seven physicians to examine pro spective applicants for teachers’ positions. Before a teacher is granted a license, the physician checks up on the heart, lungs, hearing, eyesight, weight, vaccination, etc., and license to teach is denied if all examinations are not negative. T his rule is rigidly enforced. T here is no examina tion of the teeth. I t is my suggestion th at two or three dentists be similarly employed by the board of education to check up on the dental needs of the teacher applicants. Licenses should be denied, if a healthy oral condition is not found. ESSENTIALS F O R A GO O D O RAL H Y G IE N E PRO G RA M IN T H E SCHOOLS
T o carry out a dental program, it is m andatory to provide for the following: 1. Examination of pupils only by li censed and capable dentists or oral hygienists rather than school teachers. . 2. Dentists on an annual salary basis so that they can spend sufficient time and energy in this type of work. 3. Full-time dental administrators for all schools on a yearly salary basis. 4. D ental service for indigent pupils. 5. A n enforceable rule whereby all students are required to present a healthy oral condition each semester. This may be secured only by rigorously enforcing a rule whereby students may be suspended from classes until such work is at least started. 6. A careful follow-up system by
1706
The Journal of the American D ental Association
which those careless about oral hygiene missing teeth, etc., to be given in con nection w ith the regular course in hy are given special urging. 7. A series of lectures interestingly giene. 8. W ithholding of a teacher’s license presented on diet, toothbrushing, gingi val care, caries, oral hygiene and effects until all needed work is completed. of prem ature extraction and unsupplied 1455 W alton Avenue.
CURRENT LITERATURE Care and Treatment of Teeth in Child hood ( G. Fischer, München, med. Wchnschr., April 14, 1933; abstr. Am. J. Dis. Child., M ay, 1934): Dental prophylaxis is most important and should be begun by the mother in the antepartum period. The diet during pregnancy should contain plenty of calcium and vitamins. The child should be gin to brush the teeth at 3 years of age. His diet should be well balanced and con tain an abundance of calcium and vitamins. Infections injure the teeth, and therefore it is important to increase the child’s resist ance as much as possible. H oof and M outh Disease: Von Scheitz (Klin. Wchnschr., April 28, 1934) states that human subjects are most readily in fected by raw milk. Another mode of in fection is contact with a diseased animal. Transmission from man to man is still somewhat doubtful. The incubation period is fairly short in human subjects, lasting as a rule two or three days. This is followed by the primary blisters and higher fever with general debility. In the second phase, the secondary blisters and aphthae develop. This phase may assume widely different as pects. In typical cases, grayish white aph thae about the size of a pinhead or blisters of the same size appear on the buccal mu cous membrane, tongue and gums. The mucous membrane is swollen and painful, and salivation occurs. The food intake is difficult. The vesicles may appear on the fingers and toes, aphthae may develop on the nostrils and lips and the conjunctiva may become inflamed. The vesicles and aphthae burst after one or two days and the temperature decreases. The secondary
symptoms may take the form of an inflam mation of the nails, and cutaneous erup tions may appear on any part of the body, producing a generalized maculopapulous exanthem, which may become hemorrhagic. In many instances, the secondary symptoms are rather mild and hardly noticeable. For this reason, the diagnosis must be based mainly on the primary blisters and the typi cal fever curve. The most frequent com plication of hoof and mouth disease is an involvement of the cardiac muscle. The disorder has been mistaken for milker’s nodules, erythema exudativum multiforme and herpes. The author gives a history of one case which showed the typical double phase and the beneficial effect of intra venous injection of neo-arsphenamine. Electrocardiography revealed a temporary involvement of the cardiac muscle. Vac cination of guinea-pigs with extract of the aphthae gave positive results and passage likewise was accomplished. One investiga tor vaccinated himself with a highly viru lent strain four months after an infection and he did not contract the disease again. The author stresses the beneficial effects of neo-arsphenamine. He also found that the application of nupercaine ointment counteracts the pain of the mucous mem brane for six or seven hours. Irrigations with a 2 per cent boric acid solution or with camomile tea are helpful in the treatment of the oral symptoms.—Abstr. J.A.M .A., June 23, 1934. Congenital Epulis (Its Histogenesis) (P. Moulonguet and Genevieve De Lambert, Ann. d’anat. path., 9:887, 1932; abstr. Am. J. Dis. Child., M ay, 1934): In studying