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Year 2000: Community Dentistry
COMMUNITY DENTISTRY
Clifton 0. Dummett, DDS, Los Angeles D ra w in g s by
Twenty-three years ago I became interested in the integration of human behavior and mental health principles in dental education. It was recognized that the physical, mental, emotional, and social characteristics of an individual were indivisible constituents of a dynamic aggregate, and their com plexities made it difficult to solve the problems of countless human adjustments. Subsequently, the dental schools in thè United States were surveyed to determine the amount of instruction they were giving in mental health.1 It was found that some specific mental health principles were being taught in 7 schools, but none whatever in 30 schools. The majority of American dental schools had not found a place for mental health, even at the bot tom of the list of possible essential subjects in the dental school curriculum. In a formal report on the subject,2 1 pointed out that dental educational institutions needed to pro mote experiments in curriculum construction, in teaching methods, and in subject matter. That re port said, It is impossible to fill dental students minds with all the dental knowledge they will need for the remain der of their professional careers; therefore, relative values should be considered and dental educators
either sacrifice some of the less important subjects now offered, or proportionately reduce some o f the time now devoted to a continual repetition of vaunt ed technics of aged dental pedagogues and bygone professional eras. Rigid, inflexible and inadequate patterns should not endure, especially when they fail to meet existing requirements. Is dentistry too com placent and self-satisfied to encourage and give pro fessional sanction, if not financial assistance, to some revolutionary experiments in dental education? Sim ilar experiments are being fostered by medical schools and other institutions o f higher education, and dentistry might do well to stop and reconsider. The inclusion of mental health in the dental curricu lum is not revolutionary by any means, but rather it is an important and long overdue assignment.
Another regional milestone in the development of community dentistry was reached in 1952 with the presentation of the widely heralded First In stitute of Public Health emphasizing health prob lems in rural areas of the South. ’'-4 This institute was sponsored by the dental service of the Veter ans Administration Hospital, Tuskegee, Ala. Besides creating an unusual amount of favora ble publicity for dentistry, this community health program served to sensitize individuals at the lo cal level to the presence of needs, disparities, and
K /T 6
e o tija u r ttc e A ,
+ e c k ^ ic fu e s
¿ K zs> \aJi.
to work with people and with other professions for the achievement of health. Eight years later, in 1960, Philip Black erby5 de livered his catalytic paper entitled “Why Not a Department of Social Dentistry.” His suggestions stimulated vigorous activity in this direction, and the first department of community dentistry was established at the University of Kentucky in 1963. During the ensuing seven years, practically every dental school in the United States has inaugurated a department, or at least some teaching, in this special field. Population, political power, poverty, and pol lution are among the most significant issues which were widely examined in the sixties, and will be directional determinants of the seventies. The com munity components of these vital matters have af fected every realm of modem activity, especially the health professions.
oV c 5
p -zd ^
inequalities, pointing out the role of health— phys ical, mental, and social— in helping to solve many of the problems that create tensions, encourage separatism, and perpetuate weaknesses which jeo pardize happiness and prosperity. One of the im mediate objectives attained was an appreciation of the role played by dentistry in public health. Point ing out that public health afforded one of the best opportunities for experience in interprofessional cooperation and human relations, the conclave demonstrated the inappropriateness of profession al isolation, and emphasized the need for dentistry
a . o / » O c * p | f ) r o p r ic r f r e / o e s s |0 r o £ * e s s / o / o < x i _
Population Dentistry in general and community dentistry in particular are very much concerned with popula tion. The 1970 census placed the population of the United States at approximately 205 million, and it is estimated that in the year 2000 the figure will be in excess of 300 million. What the ethnic com position of that population will be is a subject for conjecture. Proponents of the elimination of class and social
ôV
• »
281
strife insist that our land abounds quantitatively in human as well as natural resources, and these must be conserved and developed if the desirable goal of a prospering people in a beautiful land is to be reached. The powerful influence and strategic position of the United States have been evidenced by the fact that its population, a mere 6% of that of the world, has accounted for as much as half the an nual consumption of the world’s resources. The need for more dental professional m an power is dire and imminent. The current estimate of dentists in the United States has been placed in excess of 100,000. Even though the number of ap proved dental schools has increased during the past 30 years, the production of dentists has not been sufficient to keep pace with the general pop ulation growth. Available data indicate that an estimated 56 million teeth were extracted by dentists in private practice in 1969; that more than 80% of the na tion’s adolescents are suffering from varying de grees of periodontal disease; that there are 25 m il lion persons with just 50% of their natural denti tion, and 30 million people without any of their own teeth; that there are nearly 1 billion dental carious lesions in the American population and only 82 million persons using fluoridated water. Statisticians have pointed out that there are to day fewer dentists per unit population than there were 30 years ago. When the uneven distribution of dentists is considered, the disparity becomes greater. It is not likely that we will catch up with this disparity in the next 30 years. The costs of dental education, the time required to produce a dentist, the relatively inadequate number of persons in terested in dentistry as a career are all critical fac tors to which leaders in the profession have been devoting increased attention. Solutions to the 282 ■ JADA, Vol. 82, February 1971
problems of quantitative deficiency of dental pro fessional manpower have included shortening the time of preparation, creation of professional hier archies, experimentation with character of prac tice and the delivery of dental services, and many other intelligent innovations. As yet, none of these has been completely successful in satisfying pro jected health needs, and so the search continues. Because community dentistry has been con cerned with thé availability of oral health care for more people, it has been supporting extensions in the use of auxiliary personnel and will probably do so more intensively in the near future. The insistent dissatisfactions of dental hygiene organizations indicate that pressures will be brought to bear on the profession to have the den tal hygienist effectuate a number o f procedures in addition to those she may legally accomplish at the present time. There have been suggestions that she perform routine operative procedures, admin ister general anesthesia, and render needed peri odontal care. It is not too difficult to imagine that the dental hygienist of the future will be the dental health education specialist with responsibilities for in forming the public and extraprofessional person nel about dentistry, its philosophies, and its func tions. O f specific benefit to dental practice would be the prophylactic technician whose training is accelerated and more and more clinically orient ed, and who is better utilized by the dentist. There have also been suggestions about new duties that the dental assistant would perform. These include intraoral procedures, such as m ak ing study casts and radiographs, polishing restora tions, placing rubber dams, and inserting tempo rary filling materials and periodontal dressings. Another member of the auxiliary team who will emerge as quite an asset is the dental health aide who would work especially, but not exclusively,
in the disadvantaged communities. These aides, as I saw them in Watts, were indigenous to the community and acted as intermediaries between the community and the health center. They can help bridge the communications gap and explain to community residents the why, what, how, when, and where of oral health procedures, not to men tion the relationship of oral health to general health.
P o litic a l p o w e r
By the year 2000, there is a great likelihood that even more power will be vested in the federal gov ernment. It has been confidently predicted that the nation’s economy will be directed by the trade unions, management, and the government, with the government assuming the most powerful role. This means that we must understand existing and future government relations. It should be observed that the philosophies of community dentistry have been responsible to a great extent for publicizing and stimulating an appreciation of these relations. During the next 30 years there will be complete acceptance o f the fact that these subject matter areas are all-important facets of the dental curric ulum: social welfare, political science, American culture, economics, human values and motivation, personality development, government organiza tion, health legislation, methods of financing den tal care, systems for the delivery of health care, bio metrics, and epidemiology. This will mean a com
plete repudiation of dentistry’s formerly self-imposed insularity. As an important part of dental educational curriculums, community dentistry will have been given the opportunity to help immea surably in the preparation of dental leaders intent on solving many of the problems that confront the health professions. One of the difficulties will be getting the peo ple to recognize those dental enigmas that are amenable to their political actions after they have become informed about the scientific facts. A num ber o f failures in getting community water supplies fluoridated have been due to dentists’ lack of po litical astuteness. The recognition of political re lationships will serve as the prelude to an in creased utilization of the experts in psychology and government organization to promote forms of po litical action to bring about desired goals.
P o v e rty
In the year 2000, the chances are that poverty and its accompaniments will still be here. It is hoped, however, that there will be a substantial change in the attitudes of health personnel toward prevent ing sickness among the population in general and the poor in particular. Preventing illness will be fi nancially rewarding to private practitioners as it is not now under either private or federal health plans. There have been discussions concerning federal aid for physical examinations of which oral examinations are an integral part. In actuality this is a first step in preventive and community health.
Dummett: COMMUNITY DENTISTRY ■ 283
As an integer in the provision of health, dentists will have to become competent in providing com prehensive, high quality, preventive and curative health treatment on the basis of need. This means care for special groups in clinics, hospitals, and neighborhood health centers. It means group and specialty practices. Realistic assessments indicate that the next 30 years will probably bring stricter government rules and regulations designed to proctor more adequately the quality of health ser vices. Increased federal input in medical care will dictate an even higher degree of federal interven tion. In 1969 the nation’s health bill of 60 billion dollars (6.7 % of the gross national product) was ex ceeded only by the 81 billion dollars spent for military purposes. In 1950, the figure was 12.1 billion or 4.2% of the gross national product. Health costs for the average American went from $128 a year in 1960 to $328 in 1969, representing an increase of more than 80% during a period when the consumer price index rose less than 25% . It is probable that there will be a commensurate rise in the next 30 years. Both disadvantaged and advantaged are unconvinced that they are getting corresponding amounts of good health care. The rise in dentists’ and physicians’ fees, and the in finitely greater increase in hospital costs are con ditions with which the public has been unsympa thetic. Attention has been called to the fact that many more Americans are demanding dental care today than in 1940. The current figure of 40% who seek 284 ■ JADA, Vol. 82, February 1971
dental care is larger than that of 20 or 30 years ago, but undoubtedly much smaller than that of 30 years hence. Even though the various types of oral health services now being rendered are like ly to change somewhat in the future, the new de mands for mainstream dentistry will have added significantly to costs that have already been esca lating. Compelled to increase their patient loads, dentists, like other health personnel, have in creased the costs of care. There will be a prodigious growth in the num ber of plans and programs designed to help peo ple withstand the costs of health care. Prepaid den tal programs are most popular at present, and are all designed to assist families in carrying the eco nomic burden of their dental care more easily. N a tional health insurance programs have been pro moted. Future programs will probably cover all citizens, without individual limit, for the entire range of health services, including dental services, nursing home care, psychiatric treatment, and pharmaceuticals. The fault with many existing pro grams and legislative provisions is that dentistry has been excluded. The Committee of 100 for N a tional Health Insurance recently proposed a new health plan to cover all Americans and this plan did include dental care for children up to age 15 at the start of the plan, with an increasing eligibil ity age each year until all age groups are included. A further prediction is that if a national health insurance program is activated, then health care will become the nation’s largest industry. It is to be hoped that the professions will be stimulated to prepare for such an eventuality.
P o llu tio n
People are becoming more and more aware that clean air, water, land, and general environment are the sine qua non of urban existence. Because interest and knowledge are on the increase, it is predictable that the next 30 years will bring about significant solutions to some pollution problems. For instance, there is a good chance that electric automobiles and the artificial conversion of ali phatic compounds to aromatic hydrocarbons will eliminate gasoline exhaust. Moreover, it is essen tial to point out that even though pollution prob lems may be mainly urban in nature, there is a significant number of rural problems that need just as precise attention. Much publicity has been given to the use of pesticides and their effects on the soil, the plants, the streams; the polluting ef
fects of tractors and other farm equipm ent; and the inadequate disposal o f anim al debris. With the interest and real determ ination to do som ething about them , m any o f the problem s as sociated with waste disposal, je t aircraft emissions, dental office contam inants, sanitation, defoliation, and beautification will probably have been solved in the next 30 years. A nd com m unity dentistry will have m ade its contribution to the problem -solving process because it was busy in 1970 educating den tists to cope with the problem s of practice in the tw enty-first century. D entists will be less sensitive about t'ee-for-service and free choice of dentist, and m ore concerned with their responsibilities as citizens o f com m unities in which they practice, and with w hat they do as com m unity m em bers to iden tify and am eliorate pollution problem s. These lat ter contributions will be ju st as im portant as their professional services and their support o f research on specific ecologic problem s associated with den tal offices and clinics. If com m unity dentistry can add to the dental cu r riculum that substance which will kindle in the
dentist an acute awareness of him self as a vital, dy nam ic participant in the com m unity at large, sub je ct to its pressures, influenced by its needs, and eager to becom e involved in its concerns— then indeed dentistry will be able to m ake the kinds of creative, im aginative, and innovative changes that are necessary to fulfill its com m itm ent o f providing first rate dental care to all people.
Presented at the Indiana University Sesquicentennial cele bration, Indianapolis, Oct 14, 1970. Doctor Dummett is associate dean for extramural affairs and chairman, departm ent of community dentistry, Univer sity of Southern California, 925 W 34th St, Los Angeles, 90007. 1. Questionnaire prepared by author and mailed to 37 US dental schools, September 1947. 2. Dummett, C.O. Mental health principles in dental edu cation. Bull Ala DentAssn 34:15 Oct 1950. 3. Veterans Administration. Dentists sponsor Rural Health Institute. Public Health Rep 69 (no. 2): 151 Feb 1954. 4. Dummett, C.O. Dentistry contributes to public health by sponsoring its first public health institute in the South. J N at Med Assn 46:168 May 1954. 5. Blackerby, P.E. Why not a Departm ent of Social Den tistry? J Dent Educ 24:197 Sept 1960.
Dummett: C O M M U N ITY DENTISTRY ■ 285
Clifton 0. Dummett, DDS, Los Angeles D ra w in g s by
Twenty-three years ago I became interested in the integration of human behavior and mental health principles in dental education. It was recognized that the physical, mental, emotional, and social characteristics of an individual were indivisible constituents of a dynamic aggregate, and their com plexities made it difficult to solve the problems of countless human adjustments. Subsequently, the dental schools in thè United States were surveyed to determine the amount of instruction they were giving in mental health.1 It was found that some specific mental health principles were being taught in 7 schools, but none whatever in 30 schools. The majority of American dental schools had not found a place for mental health, even at the bot tom of the list of possible essential subjects in the dental school curriculum. In a formal report on the subject,2 1 pointed out that dental educational institutions needed to pro mote experiments in curriculum construction, in teaching methods, and in subject matter. That re port said, It is impossible to fill dental students minds with all the dental knowledge they will need for the remain der of their professional careers; therefore, relative values should be considered and dental educators
either sacrifice some of the less important subjects now offered, or proportionately reduce some o f the time now devoted to a continual repetition of vaunt ed technics of aged dental pedagogues and bygone professional eras. Rigid, inflexible and inadequate patterns should not endure, especially when they fail to meet existing requirements. Is dentistry too com placent and self-satisfied to encourage and give pro fessional sanction, if not financial assistance, to some revolutionary experiments in dental education? Sim ilar experiments are being fostered by medical schools and other institutions o f higher education, and dentistry might do well to stop and reconsider. The inclusion of mental health in the dental curricu lum is not revolutionary by any means, but rather it is an important and long overdue assignment.
Another regional milestone in the development of community dentistry was reached in 1952 with the presentation of the widely heralded First In stitute of Public Health emphasizing health prob lems in rural areas of the South. ’'-4 This institute was sponsored by the dental service of the Veter ans Administration Hospital, Tuskegee, Ala. Besides creating an unusual amount of favora ble publicity for dentistry, this community health program served to sensitize individuals at the lo cal level to the presence of needs, disparities, and
K /T 6
e o tija u r ttc e A ,
+ e c k ^ ic fu e s
¿ K zs> \aJi.
to work with people and with other professions for the achievement of health. Eight years later, in 1960, Philip Black erby5 de livered his catalytic paper entitled “Why Not a Department of Social Dentistry.” His suggestions stimulated vigorous activity in this direction, and the first department of community dentistry was established at the University of Kentucky in 1963. During the ensuing seven years, practically every dental school in the United States has inaugurated a department, or at least some teaching, in this special field. Population, political power, poverty, and pol lution are among the most significant issues which were widely examined in the sixties, and will be directional determinants of the seventies. The com munity components of these vital matters have af fected every realm of modem activity, especially the health professions.
oV c 5
p -zd ^
inequalities, pointing out the role of health— phys ical, mental, and social— in helping to solve many of the problems that create tensions, encourage separatism, and perpetuate weaknesses which jeo pardize happiness and prosperity. One of the im mediate objectives attained was an appreciation of the role played by dentistry in public health. Point ing out that public health afforded one of the best opportunities for experience in interprofessional cooperation and human relations, the conclave demonstrated the inappropriateness of profession al isolation, and emphasized the need for dentistry
a . o / » O c * p | f ) r o p r ic r f r e / o e s s |0 r o £ * e s s / o / o < x i _
Population Dentistry in general and community dentistry in particular are very much concerned with popula tion. The 1970 census placed the population of the United States at approximately 205 million, and it is estimated that in the year 2000 the figure will be in excess of 300 million. What the ethnic com position of that population will be is a subject for conjecture. Proponents of the elimination of class and social
ôV
• »
281
strife insist that our land abounds quantitatively in human as well as natural resources, and these must be conserved and developed if the desirable goal of a prospering people in a beautiful land is to be reached. The powerful influence and strategic position of the United States have been evidenced by the fact that its population, a mere 6% of that of the world, has accounted for as much as half the an nual consumption of the world’s resources. The need for more dental professional m an power is dire and imminent. The current estimate of dentists in the United States has been placed in excess of 100,000. Even though the number of ap proved dental schools has increased during the past 30 years, the production of dentists has not been sufficient to keep pace with the general pop ulation growth. Available data indicate that an estimated 56 million teeth were extracted by dentists in private practice in 1969; that more than 80% of the na tion’s adolescents are suffering from varying de grees of periodontal disease; that there are 25 m il lion persons with just 50% of their natural denti tion, and 30 million people without any of their own teeth; that there are nearly 1 billion dental carious lesions in the American population and only 82 million persons using fluoridated water. Statisticians have pointed out that there are to day fewer dentists per unit population than there were 30 years ago. When the uneven distribution of dentists is considered, the disparity becomes greater. It is not likely that we will catch up with this disparity in the next 30 years. The costs of dental education, the time required to produce a dentist, the relatively inadequate number of persons in terested in dentistry as a career are all critical fac tors to which leaders in the profession have been devoting increased attention. Solutions to the 282 ■ JADA, Vol. 82, February 1971
problems of quantitative deficiency of dental pro fessional manpower have included shortening the time of preparation, creation of professional hier archies, experimentation with character of prac tice and the delivery of dental services, and many other intelligent innovations. As yet, none of these has been completely successful in satisfying pro jected health needs, and so the search continues. Because community dentistry has been con cerned with thé availability of oral health care for more people, it has been supporting extensions in the use of auxiliary personnel and will probably do so more intensively in the near future. The insistent dissatisfactions of dental hygiene organizations indicate that pressures will be brought to bear on the profession to have the den tal hygienist effectuate a number o f procedures in addition to those she may legally accomplish at the present time. There have been suggestions that she perform routine operative procedures, admin ister general anesthesia, and render needed peri odontal care. It is not too difficult to imagine that the dental hygienist of the future will be the dental health education specialist with responsibilities for in forming the public and extraprofessional person nel about dentistry, its philosophies, and its func tions. O f specific benefit to dental practice would be the prophylactic technician whose training is accelerated and more and more clinically orient ed, and who is better utilized by the dentist. There have also been suggestions about new duties that the dental assistant would perform. These include intraoral procedures, such as m ak ing study casts and radiographs, polishing restora tions, placing rubber dams, and inserting tempo rary filling materials and periodontal dressings. Another member of the auxiliary team who will emerge as quite an asset is the dental health aide who would work especially, but not exclusively,
in the disadvantaged communities. These aides, as I saw them in Watts, were indigenous to the community and acted as intermediaries between the community and the health center. They can help bridge the communications gap and explain to community residents the why, what, how, when, and where of oral health procedures, not to men tion the relationship of oral health to general health.
P o litic a l p o w e r
By the year 2000, there is a great likelihood that even more power will be vested in the federal gov ernment. It has been confidently predicted that the nation’s economy will be directed by the trade unions, management, and the government, with the government assuming the most powerful role. This means that we must understand existing and future government relations. It should be observed that the philosophies of community dentistry have been responsible to a great extent for publicizing and stimulating an appreciation of these relations. During the next 30 years there will be complete acceptance o f the fact that these subject matter areas are all-important facets of the dental curric ulum: social welfare, political science, American culture, economics, human values and motivation, personality development, government organiza tion, health legislation, methods of financing den tal care, systems for the delivery of health care, bio metrics, and epidemiology. This will mean a com
plete repudiation of dentistry’s formerly self-imposed insularity. As an important part of dental educational curriculums, community dentistry will have been given the opportunity to help immea surably in the preparation of dental leaders intent on solving many of the problems that confront the health professions. One of the difficulties will be getting the peo ple to recognize those dental enigmas that are amenable to their political actions after they have become informed about the scientific facts. A num ber o f failures in getting community water supplies fluoridated have been due to dentists’ lack of po litical astuteness. The recognition of political re lationships will serve as the prelude to an in creased utilization of the experts in psychology and government organization to promote forms of po litical action to bring about desired goals.
P o v e rty
In the year 2000, the chances are that poverty and its accompaniments will still be here. It is hoped, however, that there will be a substantial change in the attitudes of health personnel toward prevent ing sickness among the population in general and the poor in particular. Preventing illness will be fi nancially rewarding to private practitioners as it is not now under either private or federal health plans. There have been discussions concerning federal aid for physical examinations of which oral examinations are an integral part. In actuality this is a first step in preventive and community health.
Dummett: COMMUNITY DENTISTRY ■ 283
As an integer in the provision of health, dentists will have to become competent in providing com prehensive, high quality, preventive and curative health treatment on the basis of need. This means care for special groups in clinics, hospitals, and neighborhood health centers. It means group and specialty practices. Realistic assessments indicate that the next 30 years will probably bring stricter government rules and regulations designed to proctor more adequately the quality of health ser vices. Increased federal input in medical care will dictate an even higher degree of federal interven tion. In 1969 the nation’s health bill of 60 billion dollars (6.7 % of the gross national product) was ex ceeded only by the 81 billion dollars spent for military purposes. In 1950, the figure was 12.1 billion or 4.2% of the gross national product. Health costs for the average American went from $128 a year in 1960 to $328 in 1969, representing an increase of more than 80% during a period when the consumer price index rose less than 25% . It is probable that there will be a commensurate rise in the next 30 years. Both disadvantaged and advantaged are unconvinced that they are getting corresponding amounts of good health care. The rise in dentists’ and physicians’ fees, and the in finitely greater increase in hospital costs are con ditions with which the public has been unsympa thetic. Attention has been called to the fact that many more Americans are demanding dental care today than in 1940. The current figure of 40% who seek 284 ■ JADA, Vol. 82, February 1971
dental care is larger than that of 20 or 30 years ago, but undoubtedly much smaller than that of 30 years hence. Even though the various types of oral health services now being rendered are like ly to change somewhat in the future, the new de mands for mainstream dentistry will have added significantly to costs that have already been esca lating. Compelled to increase their patient loads, dentists, like other health personnel, have in creased the costs of care. There will be a prodigious growth in the num ber of plans and programs designed to help peo ple withstand the costs of health care. Prepaid den tal programs are most popular at present, and are all designed to assist families in carrying the eco nomic burden of their dental care more easily. N a tional health insurance programs have been pro moted. Future programs will probably cover all citizens, without individual limit, for the entire range of health services, including dental services, nursing home care, psychiatric treatment, and pharmaceuticals. The fault with many existing pro grams and legislative provisions is that dentistry has been excluded. The Committee of 100 for N a tional Health Insurance recently proposed a new health plan to cover all Americans and this plan did include dental care for children up to age 15 at the start of the plan, with an increasing eligibil ity age each year until all age groups are included. A further prediction is that if a national health insurance program is activated, then health care will become the nation’s largest industry. It is to be hoped that the professions will be stimulated to prepare for such an eventuality.
P o llu tio n
People are becoming more and more aware that clean air, water, land, and general environment are the sine qua non of urban existence. Because interest and knowledge are on the increase, it is predictable that the next 30 years will bring about significant solutions to some pollution problems. For instance, there is a good chance that electric automobiles and the artificial conversion of ali phatic compounds to aromatic hydrocarbons will eliminate gasoline exhaust. Moreover, it is essen tial to point out that even though pollution prob lems may be mainly urban in nature, there is a significant number of rural problems that need just as precise attention. Much publicity has been given to the use of pesticides and their effects on the soil, the plants, the streams; the polluting ef
fects of tractors and other farm equipm ent; and the inadequate disposal o f anim al debris. With the interest and real determ ination to do som ething about them , m any o f the problem s as sociated with waste disposal, je t aircraft emissions, dental office contam inants, sanitation, defoliation, and beautification will probably have been solved in the next 30 years. A nd com m unity dentistry will have m ade its contribution to the problem -solving process because it was busy in 1970 educating den tists to cope with the problem s of practice in the tw enty-first century. D entists will be less sensitive about t'ee-for-service and free choice of dentist, and m ore concerned with their responsibilities as citizens o f com m unities in which they practice, and with w hat they do as com m unity m em bers to iden tify and am eliorate pollution problem s. These lat ter contributions will be ju st as im portant as their professional services and their support o f research on specific ecologic problem s associated with den tal offices and clinics. If com m unity dentistry can add to the dental cu r riculum that substance which will kindle in the
dentist an acute awareness of him self as a vital, dy nam ic participant in the com m unity at large, sub je ct to its pressures, influenced by its needs, and eager to becom e involved in its concerns— then indeed dentistry will be able to m ake the kinds of creative, im aginative, and innovative changes that are necessary to fulfill its com m itm ent o f providing first rate dental care to all people.
Presented at the Indiana University Sesquicentennial cele bration, Indianapolis, Oct 14, 1970. Doctor Dummett is associate dean for extramural affairs and chairman, departm ent of community dentistry, Univer sity of Southern California, 925 W 34th St, Los Angeles, 90007. 1. Questionnaire prepared by author and mailed to 37 US dental schools, September 1947. 2. Dummett, C.O. Mental health principles in dental edu cation. Bull Ala DentAssn 34:15 Oct 1950. 3. Veterans Administration. Dentists sponsor Rural Health Institute. Public Health Rep 69 (no. 2): 151 Feb 1954. 4. Dummett, C.O. Dentistry contributes to public health by sponsoring its first public health institute in the South. J N at Med Assn 46:168 May 1954. 5. Blackerby, P.E. Why not a Departm ent of Social Den tistry? J Dent Educ 24:197 Sept 1960.
Dummett: C O M M U N ITY DENTISTRY ■ 285