ciation. I have been engaged in private dental practice for 35 years and am a professor and chairman of the Division of Prosthetic Denistry at the University of Minnesota.

The CHAIRMAN. You may proceed with your statement, Doctor. Dr. FLAGSTAD. I desire to present a statement on behalf of the members of the American Dental Association in reference to S. 1606. I also wish to express the appreciation of our association for this opportunity to present its views in the interests of improving dental health in this Nation.

In order to conserve time, the viewpoint of the American Dental Association has been summarized into a single statement. We request the privilege of inserting supportive technical data into the records so that the additional information may be available to members of this committee and to other members of the Senate. The American Dencal Association has in attendance at this hearing various officers, comnittee members, and technical consultants, all of whom will be pleased to provide further information, if it is desired, at the finish of this presentation. These men have long studied various plans for improvng the dental health of our people and, therefore, are qualified o speak with authority.

The American Dental Association presents its statement under the Following headings:

First: The American Dental Association and its objectives.

Second: The American Dental Association's attitude towards health security as shown by its past record.

Third: The American Dental Association's concept of the basis for a dental health program.

Fourth: The American Dental Association's attitude towards S. 606, especially the dental sections.

Fifth: The American Dental Association's proposed dental health program and the dental provisions of S. 1606.

Sixth: The American Dental Association's recommendations.

THE AMERICAN DENTAL ASSOCIATION AND ITS OBJECTIVES

The American Dental Association, whose headquarters are in Chicago, has a membership of 56,000 dentists. This represents more than wo-thirds of the 75,000 dentists registered in the United States. The association has 58 constituent societies comprising all of the 48 States, each territory and possession, the Army, the Navy, the United States Public Health Service, and the Veterans' Administration. Within the constituent societies there are 440 organized district dental societies located in all parts of our country, and each of these constituent societies annually selects delegates to send as voting members to sessions of the house of delegates, the policy-making body of the American Dental Association.

The committee on legislation, of which I am chairman, has its mempers elected by the house of delegates and we serve without personal remuneration.

This democratic pattern of organization with extensive membership n every State of the Union, unquestionably gives the American Dental Association the right to voice the opinion of the great majority of the dentists in the United States. The objectives of the association are in the interest of the public welfare.

THE AMERICAN DENTAL ASSOCIATION'S ATTITUDE TOWARD HEALTH SEATRIT

LEGISLATION

The American Dental Association has always been willing to operate in every worthy effort leading to the development of sour legislation for the improvement of the general and dental health of our people. The objectives of our association and its 50 years of actual achievement attest the fact that we have continually endeavor: to promote dental health programs. Through the efforts of our 3ciation and its constituent societies, dental divisions have been est lished in 44 out of the 48 State health departments; dental heal programs, particularly for children, have been established in hundre of cities and counties and dental health education and dental resea have been extensively stimulated and fostered.

In 1939 when legislation similar to S. 1606 (the first Wagner He bill, S. 1620) was pending before this committee, the association pressed itself as being in accord with the general objectives of s legislation. The association, at the request of the Senate commit prepared at that time a series of amendments incorporating its s gestions for the development of a national program for dental heal In the intervening 7 years the American Dental Association has e sistently pressed for Federal legislation which would translate program into reality.

On two occasions prior to 1945, in cooperation with the kind b of the chairman of this very committee, Senator Murray, the An ican Dental Association sponsored the introduction of bills into C gress to initiate its program on a national scale by intensifying der. research. These bills were reported favorably by the committee, did not proceed to full legislative enactment.

In 1944 the association again called attention to the need for leg lation at the national level, and adopted four principles outling a practical basis for such a program. The four principles are .. follows:

1. Research.-Adequate provisions should be made for resea” which may lead to the prevention or control of dental disease.

2. Dental health education.-Dental health education should b cluded in all basic educational and treatment programs for chil and adults.

3. Dental care.-Dental care should be made available to all, regar. less of income or geographic location. Programs developed for de care should be based on the prevention and control of dental dies~All available resources should first be used to provide adequate dtreatment for children and to eliminate pain and infection for a Dental health is the responsibility of the individual, the family, a the community, in that order. When this responsibility, howe is not assumed by the community, it should be assumed by the S. and then by the Federal Government. The community in all ca-shall determine the methods for providing service in its area.

4. In all conferences that may lead to the formation of a plan dental research, dental health education and dental care, there sh be participation by authorized representatives of the American Der Association.

The American Dental Association again in 1945 in keeping its record of seeking sound legislation for a national dental hea

program, sought the introduction of bills to translate this program into reality. Through the cooperation of Senator Murray, Senator Pepper, and Senator Aiken, all members of this committee, two bills were introduced into the Senate. S. 190 proposes a Federal appropriation for the erection of a National Institute for Dental Research as a part of the National Institute of Health at Bethesda, Md., and for providing grants-in-aid to public and private agencies for the intensification of dental research. S. 1099 proposes a Federal system of grants-in-aid to the States for the development of experimental programs in all phases of dental health education, dental treatment, and dental administration. Both bills provide that administration at the Federal level would be in the hands of the United States Public Health Service, Federal Security Agency. A subcommittee of your group, under the chairmanship of Senator Pepper, held a most favorable hearing on these bills in June 1945.

THE AMERICAN DENTAL ASSOCIATION'S CONCEPT OF THE BASIS FOR A

DENTAL HEALTH PROGRAM

In legislation of the type of S. 1606, there has been a tendency to include dental practice and treatment under the categorical head of "medical service." It is true that close cooperation between dental and medical practitioners exists in routine and special practice, but it does not follow that the needs and program of both professions are identical. There are some specific facts about dental disease and dental practice which must be taken into consideration before an intelligent and long-range program can be planned. It is impossible to present these facts in detail in our allotted time so that I have taken the liberty of presenting a summary of them. Additional evidence will be placed in the record to support the various contentions.

1. Dentistry must include in its program provisions for treating a disease that is almost universal. It is almost axiomatic that 95 percent of our population suffer from dental diseases at some point or other in life and that an extremely high percentage need annual dental

care.

2. Because of the extremely high prevalence of untreated dental defects, it is impossible to apply the insurance principle.

3. The real causes of the chief dental diseases, dental caries and periodontocclasia, are not entirely known, so it is impossible to prevent them in the true sense of the word by attacking the cause. The best methods of control that are known to date are early and regular dental treatment.

4. If such early dental treatment is not sought, the ensuing dental neglect becomes much more costly than timely dental treatment.

5. If early and regular dental treatment can be given to children, it will assure a definite lowering of serious dental defects later in life and the production of a generation of adults comparatively free from the accumulated defects caused by early neglect.

6. The cost of providing such essential dental service for children is, according to present estimates, less than one-half the cost of providing essential dental service for adults.

7. Since many people do not seek dental care until great damage has occurred, it is absolutely essential to maintain a continuing program of dental health education to inform all of the importance of dental health and to motivate them to secure dental care.

8. Because of the limited number of dentists, it is impossible to carry out any program that promises complete dental care to both children and adults.

9. In the face of this dental personnel problem, it is obvious that the most efficient use should be made of the present number of dentists. It is the opinion of competent dental authorities that in public dental health programs the most efficient use of available dental services is to devote all needed attention to dental disease in children and provide additionally as much service as possible for adults.

10. One of the reasons for dental neglect besides those already mentioned is that the prevention and control of dental diseases have never been given continuing financial suport by either public or private agencies.

All of these factors are brought to your attention to demonstrate that legislation even if it may be well designed to meet medical prob lems and conditions is not necessarily as well adapted to meet dental problems which are quite different in nature. The attitude of the American Dental Association toward the current bill, S. 1606, is based largely on the fact that it does not take into sufficient account the unique complex problem of providing adequate dental care.

THE AMERICAN DENTAL ASSOCIATION'S ATTITUDE TOWARD 8. 1606

The American Dental Association is opposed to the enactment of S. 1606 because:

1. The American Dental Association believes that compulsory health insurance for a majority of the population should not be established in this country without preliminary scientific experimentation involving less extensive groups of the population.

2. The American Dental Association believes that it is unsound administration to disperse responsibility for health among the three agencies mentioned by the bill; the United States Public Health Service, the Children's Bureau of the Department of Labor, and the Social Security Board.

3. The American Dental Association believes that a compulsory health insurance system, basically similar to those in effect in foreign countries, should not be established on a national basis until there is incontrovertible evidence that the American pattern is an improve ment and that the errors of the foreign systems will not be perpetuated in the American program.

4. The American Dental Association believes that a program the size of the one proposed should not be established without directly facing the problem of expense. This expense should be clearly enunciated in terms of both cost to the individual and cost to the Nation

5. The American Dental Association believes that the grants-in-aid system has been effective in meeting certain health needs under the Social Security Act. The American Dental Association believes that this system should be enlarged to meet all health needs and that there is no necessity for enacting a national compulsory prepayment plan. 6. The American Dental Association believes that the right of a State to determine the methods of meeting its health needs should not be taken away.

7. The American Dental Association believes that a program as comprehensive as the one proposed should not be designed without seeking the official cooperation of all agencies and professions involved. These are general statements, but time does not permit the documentation of each one.

The dental provisions of S. 1606 have been examined more minutely and the reaction of the profession is recorded in greater detail because of the American Dental Association's particular interest in the dental problem.

The primary objective of the dental profession is to prevent and control dental diseases through the application of sound dental and public health practices. S. 1606 is in direct conflict with this objective.

In

In the early development of dentistry patients received little more than emergency types of dental service consisting largely of relief of pain, extraction of teeth, and treatment of acute infection. the light of modern dental practice these dental services constitute only a small part of the routine dental treatment necessary for the protection of dental health. By no stretch of the imagination can such limited services form the basis for a national dental health gram, yet only these primitive services are promised to the American. people by S. 1606.

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Some may be inclined to argue that in years to come the present restricted content of dental benefits proposed by the bill would be enlarged to include more than examination, diagnosis, prophylaxis, extractions, and special treatments. Even if such a possibility exists, which may be doubted in the face of experiences abroad, there is still the undeniable fact that a large segment of the American people will be compelled to pay a tax for dental services which they cannot receive under a national insurance plan because of the limitations on dental personnel.

S. 1606 proposes to make emergency dental care available to larger groups of the population. This proposal involves a false concept in public dental health practice because if only emergency dental treatment is given the problem of dental disease will be as great 10 or 50 years from now as it is today. In contrast to this uneconomic and unscientific approach, the dental profession of this country supports the view that the problem can be solved through a coordinated program of disease prevention and dental care for children. If we cannot prevent the occurrence of dental disease we must concentrate our efforts on dental research. If we cannot provide services to all persons (which is obviously the case) the benefits of the plan must be limited to the age groups in which dental disease begins.

The American Dental Association and the dental profession at large are of the opinion that no dental-care program can be successful if its content is severely restricted in terms of dental service. To illustrate this point a comparison should be made between S. 1606 and the dental-care plan for low-income groups proposed by the Council on Dental Health of the American Dental Association.

S. 1606 provides that dental benefits shall have such restricted content as the Surgeon General may determine: "Provided, that on and after July 1, 1947, the restricted content of general dental or