DENTAL
SERVICES
W
HEN the Study’ was first projected, its content was a major theme of discussion.It is of interest that the Study Committee unanimously gave children’s dental care
a high priority among the items for examination. This decision was significant because
pediatricians and general practitioners as a group are not particularly interested or
well-informed in this area of medicine. It may have been their very lack of dental knowledge
which promoted this part of the Study.
The question might be asked, “Is the over-all health of children correlated in any way
with the condition of their teeth ?“ In one of the state reports, a correlation was made
between the quality of medical services and dental facilities but this does not answer the
question of the true relationship between dental health and over-all health. However, the
Committee felt that dental health is generally accepted as an important item in a health
program for children. Although the exact cause of tooth decay is not yet determined, it is
known that restoration of cavities prolongs the life of the tooth.
AREAS OF NEED
The findings of the Study’ do not tell precisely how much dental care is actually
re-quired by children in various sections and communities in the country. However, even
without exact inform.tion on the amount of dental care needed, it is evident that at
present not even a minimal amount of dental service can be offered to every child in
the United States.
The study of dental facilities for children shows that even states and counties which
have the highest service ratings are unable to provide adequately for their entire child
population. Even in New York and Massachusetts, for example, where facilities are well
above the national average, children do not receive adequate dental care, appraised in
terms of the dental profession’s own criteria. In other words, the findings indicate that a
high incidence of dental caries exists even in areas where dental facilities are most availa-ble, and that in isolated areas, especially in the South, little dental care is given.
Although accurate statistical data on the incidence of dental caries in this country is
lacking, there is sufficient evidence to indicate that it is high. The great variation in
facili-ties as shown by the Studyl cannot in any way be regarded as an index of dental services
needed in various regions. The discrepancies between what should be and what actually is
available are indisputable.
If, in addition to the evident lack of general dental care of children, the fact is
con-sidered that pedodontists, orthodontists, and pedodontically trained general practitioners constitute only about 10 percent of the dental profession, the disproportion must he looked upon as much greater than noted in the Study.
From the findings, and from consultation with dental authorities, it is estimated that
the dental profession in the United States is not equipped to give even minimal service,
equitably distributed, to that 25 percent of the population which presumably needs it
most. Redistribution of the available manpower cannot be expected to solve the problem
DENTAL SERVICES 27
especially in children’s dentistry, as well as more dental auxiliary personnel.
Above all, a more definite scientifically established concept is needed of the efficiency
of present-day methods of symptomatic dental therapy. Granted that the filling and
cx-traction of carious teeth contribute to child health improvement, these measures do not
eradicate the basic etiologic factors responsible for dental disease. It seems questionable, therefore, whether the problem can be solved by expanding dental service along traditional
lines. If dental service is to be considered a true health service, it might be made more
efficient by better integration with other health services.
SUGGESTIONS FOR LOCAL AND STATE PLANNING
Physicians can assume responsibility for making sure that local dentists and dental
so-cieties are represented in all community groups working for child health.
Those associated with medical schools or teaching centers can promote the teaching of
essential facts of stomatology. If dentists, in turn, promote the inclusion of the
funda-mentals of clinical medicine in dental schools, a start can be made toward better
under-standing of the place which dental services should have in child health services.
Physicians can help to integrate dental services with other public health services by
supporting local and state health department efforts in this direction. Some state health
departments, for example, are supplying dental service to isolated rural areas by
employ-ing their own dental personnel, and using mobile trailers and portable operating units.as
Another public health measure which physicians can support is the fluoridation of
municipal water supplies. The Council of Dental Therapeutics of the American Dental
Association is constantly re-examining reports on the safety and efficacy of fluoridation of public water supplies, and examining the claims made by persons who oppose fluoridation.
The Council continues to reaffirm its recommendation of controlled fluoridation as a safe
and effective dental health measure.’9
REFERENCES
1. Child Health Services and Pediatric Education. American Academy of Pediatrics. Commonwealth
Fund, New York, 1949. (The report appears in two volumes: A general summary and
supplement containing methodology and detailed tabulations.)
2. Volume I-Better iMedical Care for Children. (Supplement to the September 1950 issue of
PEDIATRICS, Vol. 6, No. 3, Pt. 2)
3. Hospital Services in the United States. Commonwealth Fund, New York.
4. Children’s Bureau, Federal Security Agency. Standards and Recommendations for Hospital Care of Newborn Infants. Publication No. 311.
5. Manual on the Care of the Newborn and Premature Infant. American Academy of Pediatrics. 6. Minimum Standards for Formula Preparation. American Hospital Association.
7. On Being Human. Ashley Montague, Sherman.
8. ‘Public Health Nursing Program and Functions,” Public Health Nursing, June 1944. 9. Public Health Is Peaple. Ethel S. Ginsburg. Commonwealth Fund, New York. io. Principles of Public Health Administration. John J. Hanlon. Mosby, St. Louis. 11. Community Health Organization. Ira V. Hiscock. Commonwealth Fund, New York. 12. Extension of Rural Medical Service. American Medical Association, Chicago.
19. Public Health Numsing For You; Community. National Organization for Public Health Nursing, New York, 1950.
20. The Community Health Council-Its Organization, its Function, and a Few Suggested Proect.
American Medical Association, Chicago.
21. Stepping Stones to a Health Council. Yolande Lyon. National Health Council, New York. 22. Your Community-li. Provision for Health Education, Safety, lVelfare. Joanna C. Colord.
Russell Sage Foundation, New York.
23. These Things W7e T,ied. Jean and Jesse Ogden. University of Virginia Extension. A five-year experiment in community development initiated and carried out by the Extension Division of
the University of Virginia.
24. Evaluation Schedule. For use in the study of appraisal of a community health program. American Public Health Assoiiation, New York.
25. Health Super: irion o/the W’ell Young Child JY/ith Especial Reference to the Child Health Conference. Amerkan Public Health Association, New York.
26. Proceedings of the Mid-Century ll”hite House Conference on Children and Youth. Health Publications Institute, Raleigh, NC. 1951.
27. Health Observation of School Children. George M. Wheatley, M.D., and Grace T. Flallock.
- McGraw-Hill, New York. 1951.
28. Denial Care For Children. John T. Fulton, D.D.S., American Journal of Public Health. April 1950.
29. Current Status of Denial Uses of Fluorides. The Journal of the American Dental Association. October 1952, Page 468.
30. Local Health Units for the Nat’on. The Commonwealth Fund, New York. 1945.
31. Proceedings of 1932 Annual Meeting. National Advisory Committee on Local Health Units.
