From 90 to 98 percent of all children in the average American community suffer from tooth decay.

Decay may start as early as 2 years of age. In a study made in a New York City clinic, nearly half the 2-year-olds have some decayed teeth.

By the time a child reaches school age, his chances of complete freedom from dental decay are only one or two in a hundred.

The child starting to school, if he has had no previous dental attention, averages 6 or 7 cavities in his teeth. During his school years, he develops, on an average, about 12 additional cavities.

By the time he finishes high school, the typical American youth who has had no reparative dental care exhibits a mouth in which not even twelve of the normal quota of 32 teeth are present in properly functioning position. At the age of 18 or thereabouts, he is a dental cripple. This fact has been definitely established by recent Army dental examinations.

One's first reaction to these appalling statements is to ask, "Could not this situation have been prevented?" Almost all the cases of dental crippling in young inductees could have been prevented by timely dental care. A dentist is naturally somewhat diffident in placing so much emphasis on the need for the services of his own profession, but the fact is inescapable. Unfortunately, we do not yet possess any dependable preventive of dental decay, the great destroyer of children's teeth. If we could rear children like little Eskimos, in an isolated community where they would never come in contact with the highcarbohydrate diets of civilized mankind, we might be able to prevent a great deal of dental decay. Or if we could arrange that all children should ingest an optimum amount of fluorine during the formative period of their teeth, it is likely that we could reduce the present amount of decay by 50 to 65 percent.' Such preventive measures, however, are quite impractical on a large scale. What, then, can be done?

Although we cannot prevent decay, we can prevent the harmful results of decay-the loss or hopeless damaging of teeth, the infection that is a common sequel of advanced decay, the toothaches, the unsightly irregularities that are often caused by loss of the child's permanent teeth or too-early loss of his baby teeth, the tendency to pyorrhea in later life that is induced by neglect of dentalhealth measures in childhood, the emotional maladjustment, disappointment, and frustration that the young person with bad teeth almost invariably suffers in his social and business relationships.

NEED FOR PARENTAL EDUCATION

Parents cannot be expected to know these facts unless they are taught, and taught in such a way that they can grasp the situation clearly and thoroughly. A widely experienced health educator tells us that we generally overestimate people's knowledge and underestimate their intelligence. Parents, even those with little educational background, are eager for all reliable information concerning the welfare of their children. Their interest in child health does not have to be built up. It is already established. An important task of all agencies devoted to child health and welfare is to give parents information that they can readily understand and put into immediate practice.

The quantity of dental health educational literature available to parents has hitherto been greatly in excess of its quality. Parents have been told too much about too many irrelevant things, while the essential facts have been overlooked. Often, too, the information given them has been erroneous or misleading.

All the facts that parents need to know about children's dental health are stated plainly and briefly in the attractive little leaflet, How to Save Teeth-and Money,' which any moderately literate parent can read in 10 minutes. I should like to see it translated in Czech and Chinese, Spanish and Swedish, and all the other languages understood by our foreign-born citizens. I should like to see the leaflets displayed in every dental office with an invitation to parents to help themselves to a copy.

There is no need for me to repeat or paraphrase the information set down in How to Save Teeth-and Money. Several points, however, may well be given special emphasis. Among the questions asked and answered in the leaflet are these: Why should a child go to the dentist? Why should decayed teeth be filled? At what age should dental care begin? What can be done about children's fear of the dentist? How much does dental care cost?

1 National Dental Hygiene Association, Washington 5, D. C.

Parents repeatedly ask these questions because their experience arouses the questions in their minds. And they are certainly entitled to true and helpful answers. But others beside parents need to be told the facts about children's dental health needs. The need for preparental education is becoming more and more apparent. Wartime is an era of early marriage and early child bearing. A high-school girl graduating this year may be a mother a few years hence. Highschool students, with the possible exception of outstanding athletes, have the reputation of being very heedless about their health and generally bored with health education. This situation may be the fault of the kind of health education that has been provided for them and the uninspired manner in which it has been presented. Given health information that is scientific, interesting, and, above all, practical, the high-school student is likely to remember it and act upon it.

EDUCATION OF OTHER GROUPS

Another group that needs to become thoroughly acquainted with children's dental needs is that composed of educators-mainly school teachers and superintendents. Let us not overlook the superintendents. A teacher trying to run a program of dental health under an unsympathetic or antagonistic superintendent is not likely to get very far with it. On the other hand, it has been repeatedly shown that a superintendent who is "sold" on the benefits of dental health for children is one of the most valuable allies such a teacher can have. Perhaps most important of all is the job of convincing the dental profession of the need for children's dentistry. Far too often the dentist in general practice has a definite aversion to handling child patients, chiefly because he is untrained in both the techniques and the psychology of such work. There are few more deplorable situations in the dental field today than the one exemplified by communities in which teachers persuade children to seek dental care, parents cooperate by taking the children to the dentist, and then-the dentist either refuses to take the child as a patient or handles him so unskillfully that the child is prejudiced against dentists forever after.

In this connection, a word on the selection of dentists for children may not be out of order. Parents should be advised, if they have any choice, to pick a dentist for their children whom they know to be interested in children, or at least tolerant of them. If they have no choice, as may be the case in a very small community, they should talk with the dentist before taking a child to him for the first time. It is vitally important that the first dental visit should leave a not unpleasant impression in the child's mind. Cooperation of parents and dentists in this matter is a fundamental requirement.

The barrier between the child and the dentist is a two-sided one in many instances the dentist's fear of the child on one side and the child's fear of the dentist on the other. Both fears are unreasonable and groundless, and both can be overcome by increased knowledge and experience. Much of the dentist's fear of child patients is traceable to a feeling of inadequacy or incompetence, which further training will eradicate. It is to be hoped that all postwar plans for dental education will provide for thorough and practical courses in children's dentistry in the curricula of dental schools, and that postgraduate courses in the same subject will be provided for practicing dentists in all sections of the country. All such courses should include not only the latest approved techniques but also the psychological aspects of dealing with child dental patients.

THE CHILD IN THE DENTAL OFFICE

Looking at the problem from the dentist's point of view, it seems to me that he has a right to expect cooperation from parents in preparing children's minds for dental visits. As Dr. George E. Morgan pointed out a few years ago, until our knowledge regarding prevention of dental disease is greatly augmented, dental corrective work "should be looked upon as a common experience and not the traditionally branded ordeal which mankind must fear and avoid." Confidence concerning dental treatments cannot be established in a frightened child by telling him that "It won't hurt" or "You must be brave." It probably will hurt, and the young child cannot understand why he should be brave in the face of pain and discomfort from which, so far as he can see, he has nothing to gain.

In a situation like this, example weighs a great deal more than precept. Let the child watch his mother or a dependable older child in the dental chair. His fears will in most cases be eliminated if he gets the idea that this business of

having a tooth filled is a normal and commonplace experience and if he sees people whom he knows accepting it matter-of-factly.

As Dr. Morgan further points out, children's fears of dentistry are not natural, but acquired. Building up confidence may not be so easy as generating fear, but it can be done. A thing that appears terrifying at first can become acceptable through familiarity. Acquaintance with the nature and function of dental instruments will quiet many a child's fears. Every sensible person is wary of things he does not understand and of people who, according to his standards, behave queerly. A visit to the dental office is potentially alarming for a child, but it may be transformed into an intensely interesting experience if the dentist will take a little time to let the youngster explore his house of wonders and to explain the how and the why of common dental paraphernalia.

Most important in establishing a good relationship between child and dentist is the factor of timely dental care. A child whose teeth have been neglected until he is 8 or 10 years old may have a bad time in the dental chair. The average youngster aged 2 or 3, if he is a tactfully introduced to dental examination and treatment, will need only a minimum of corrective care and he need experience very little if any unpleasantness during his first dental visit. Physically, mentally, and emotionally, the child benefits by early dental care, repeated at frequent intervals.

COST OF DENTAL CARE

In the dental health education of parents, the point should also be stressed that the cost of timely dental care is very much less than the expense necessitated by dental neglect. Simple fillings, which constitute all the dental treatments required by the great majority of children, need constitute only a small item in the average family's annual budget. Repair of the ravages caused by a long period of neglect are the chief factors behind large dental bills. The cost of frequent and regular care practically never adds up to anything like the expense occasioned by neglect.

Nothing has been said thus far about educating parents regarding diet and tooth brushing. Today's parents can scarcely escape picking up the fundamental principles of good nutrition, if they own a radio or read any magazines or newspapers. The usefulness of these principles is by no means limited to dental health. The rules of good nutrition should be known and practiced by everyone. Nutrition appears to be important for dental health during the formative period of the teeth, but its value as a caries-preventive has been greatly overrated in the past, and too many parents have depended upon it, to the exclusion of more important things.

As stated earlier, a considerable increase in dental decay could probably be effected if parents and children alike could be persuaded to cut down on their consumption of sweet and starchy foods; but such a suggestion is so utopian that it will probably remain in the category of things "devoutly to be wished," rather than in that of things possible of fulfillment. And, as to oral cleanliness, children who are not taught to brush their teeth are today a comparative rarity, except in the lowest socioeconomic groups. Tooth brushing is a necessary daily chore, like washing the hands and combing the hair, and most children regard it as such. Probably most parents regard it the same way.

Our main point of attack in setting up educational programs designed for the betterment of children's dental health is and must probably continue to be the desirability and need of timely dental care. It is the only measure we can depend upon. until the findings of dental research provide us with reliable and practical methods of caries prevention.

Parents are concerned not only about their children's health but also about their appearance. Every parent wants his child to make a favorable impression, and no one can do this, either as a child or as an adult, if his personal appearance is marred by gross irregularities of the teeth or malformations of the face and jaws. Many such handicaps can be avoided by proper dental care. Parents should be taught that the preservation of the first permanent molars by fillings may prevent many causes of malocclusion and consequent disfigurement.

The large problem of providing dental care for those millions of children whose parents are either totally indigent or who must at least be classed as "dentally indigent" is beyond the scope of the present discussion. So far as education is concerned, however, we must consider them. Families who are destitute or existing on a mere subsistence level cannot logically be left out of dental health education programs. But when the need for dental care is urged upon such families, the means for obtaining such care should be readily available and the

responsible persons in the family should be told the proper procedures for obtaining it. Otherwise "education" becomes both pointless and heartless—a manmade mirage in an economic desert.

PRESENT AND FUTURE NEEDS

It is unlikely that any one agency can draft and provide for setting up a complete program for public and professional education regarding children's dental needs. Contributions to such a program must necessarily come from many sources, and their integration will require time and effort. Some of the essential contributions that should be provided in any postwar program to meet children's dental needs are these:

1. Factual, practical, and universal dental health education for parents and teachers.

2. Preparental education of high-school students.

3. More and better courses in children's dentistry for dental students and practicing dentists.

4. Dental-health education and training of all children-of preschool children in the home and the dental office, of older children in the school as well. 5. Adequate provision of care for dentally indigent children and of information for their parents on the procedure necessary to obtain such care.

6. General recognition of the fact that dental decay is a universal malady and that the only effective defensive weapon we possess at present is timely dental

care.

EXHIBIT 84

How OUR TAX POLICY AFFECTS THE LOW INCOME GROUPS

(Speech of Hon. Albert J. Engel, of Michigan, in the House of Representatives, March 19, 1946)

Mr. ENGEL of Michigan. I want to speak today in behalf of the millions of people in low-income groups who find themselves with prewar or nearly prewar incomes, with wartime deductions and increased costs of living, and who find it difficult under present conditions to keep body and soul together and to live decently. This is true despite the fact that we are living in the era of the greatest prosperity in the history of the world.

Instead of following a tax policy based upon the ability of the taxpayer to pay, we have followed a policy of increasing the tax rate, decreasing the individual and family tax exemption of the low-income group as living costs went up and then freezing their incomes at a level so low as to bring actual suffering to that group and their families. Lowering of individual and family tax exemption, increasing the tax rate, increased living costs, and the freezing of the wages of the lower-income group have lowered living standards of that group far below 1939 standards. This despite the fact that we are today enjoying the largest income payments and the greatest prosperity that any nation has enjoyed in the history of the world. Unless these people are given some relief, they will turn to socialism, communism, or some other "ism." This is going to be the real problem during the coming postwar years.

Before I proceed, I desire to lay down what I consider four fundamental principles:

First. Every man, woman, and child in America is entitled to a decent living. Many are not getting it.

Second. Paying an individual or the head of a family enough money whether in wages or other income to support himself or herself and family in common decency, is not and can never be inflationary. Money spent for the necessities of life to keep body and soul together will never bring about inflation. The anti-inflation policy of the Government has been to keep all wage increases to 15 percent under the Little Steel formula, regardless as to whether that wage brought a decent living or not. That policy is wrong.

Third. Taking money we call taxes from the low-income groups, which should be spent for bread, butter, milk, and food to fill the stomachs of hungry children will not avert inflation. Such a policy can only bring about suffering, crime, immorality, and poor citizenship. No policy of making everyone pay a tax to make people tax conscious can be justified when the tax dollar collected forces the living standards of the taxpayer below a decent level.

Fourth. Real, sound peacetime prosperity must be based upon increased purchasing power for this low-income group. Peacetime prosperity cannot be based upon starvation wages or income, either before or after taxation. Automobiles, radios, decent housing or living will not be bought with family incomes of $1,000 or even $2,000.

EVERY AMERICAN MAN, WOMAN, AND CHILD IS ENTITLED TO A DECENT LIVING

In 1933 when Mr. Roosevelt first took office he stated, and properly so, that one-third of the people in America were ill-fed, ill-clothed, and ill-housed. At that time the total income payments of the Nation reached a low point of $46,000,000,000 a year. By income payments I mean the total income of the Nation including wages and, salaries, farm income, rents, dividends, and so forth. It is this income against which taxes are levied. Only recently Mr. Roosevelt in a message to Congress set forth what he called a second Bill of Rights in which he stated that every family had:

First. The right to earn enough to provide adequate food, clothing, and recreation.

Second. The right of every farmer to raise and sell his products at a rate which would give him and his family a decent living.

Third. The right of every family to a decent home.

Fourth. The right of a good education.

Fifth. The right to adequate protection through old-age security, accident and unemployment insurance, and so forth.

He made the statement, "Necessitous men are not freemen."

Again, "People who are hungry and out of a job are the stuff out of which dictators are made."

To all this I readily agree. Hungry men and women brought about the French Revolution.

However, Mr. Roosevelt's definition as to who is entitled to a decent living is too narrow. He continues to talk about men and women without a job. He speaks of the farmers not having a decent income, to all of which we agree. He seems to have forgotten the millions of small investors who have invested their savings in stocks, bonds, mortgages, insurance policies, or who are receiving retirement pay and who are depending on that type of income for a decent living. The widow who has invested her life savings or perhaps the insurance of her husband in some business, stocks, bonds, or mortgages and is receiving a reduced income on those savings can be just as hungry if that investment is not producing enough to give her a decent living as if she were out of a job.

A railroad worker, postal, or other civil-service worker, or a worker who has retired from private industry, who depends upon his retirement pay, can be just as hungy if his dollar is not purchasing enough to give him that decent living as if he were in the relief line. People on old-age assistance and socialsecurity benefits are in the same class. Many of these people are being paid retirement or insurance annuities in a dollar that today purchases as little as 50 percent in living costs compared to what the dollar purchased which they paid into the fund years ago. Many of these people find themselves in a position where their purchasing power has been reduced to a point where their income no longer pays for the necessities of life, not to speak of a decent standard of living. Interest rates on bonds they have purchased or the investment made by them either directly or through insurance companies have been drastically reduced. Dividends on the small amount of stock they may have purchased have been and are being eaten up by taxes until there is little, if anything, left. It is for this reason that I am speaking of low-income groups which include low wage and low farm income groups rather than low wage or low farm income groups only.

I shall confine my remarks to the discussion of the present cost of living, present incomes, including wages and the difficulties of the low-income group to live decently now. I shall not attempt to discuss the question of why we are where we are in this field. The important thing now is to try to bring relief to this low income group.

II. WHAT CONSTITUTES A DECENT LIVING?

The question as to what constitutes a decent living for an individual or a family group depends upon the city or locality in which they reside. To compare the cost of living in different cities, a standard budget was established by the Works Progress Administration. The family budget was first devised by the