special dental benefit shall include at least (1) examination (including X-ray survey) and disagnosis; (2) prophylaxis; (3) extraction of teeth which are considered by the dentist and an attending physician to be or likely to be injurious to the general health of the individual: and (4) treatment of acute diseases of the teeth, their support.g structures, and adjacent parts, including factures of the teeth or jaws.' Contrast this limited, emergency type of program in S. 1606 with that proposed by the Council on Dental Health; for the 12-18 year age group. 1. Examination using posterior bitewing radiograms at least once a year and other radiograms as may be needed. 2. Prophylaxis at intervals depending on patient need and susceptibility. 3. Restoration of carious teeth with silver amalgam, silicate cement and gold. 4. Pulp treatments including pulp capping, pulpectomy of vital exposed pulps and treatment of putrescent teeth in young patients.. 5. Restoration and appliances including prosthetic restorations to replace missing teeth and appliances to maintain space so as to prevent malocclusion. 6. Treatment of mouth infection. 7. Extraction of infected teeth, supernumerary teeth, impacted teeth using local or general anesthesia. 8. Surgery as may be necessary to maintain health including, if necessary, root resection of infected permanent teeth. 9. Health education of the patient. Authorities in the field of dentistry have agreed after a careful study that the services listed above would be considered minin.um services for the protection and maintenance of dental health. Any amount less than that would be inconsistent with modern denta. practice. The vast difference in dental benefits of the two proposals emphasize again the need for technical advice in planning health legislation Such advice obviously was not sought or taken into account in drafting the dental provisions of S. 1606. There are other valid reasons for seriously questioning the deni benefits in the proposed legislation. S. 1606 provides, for exampæ. that every insured person will be entitled to receive "treatment of acute diseases of the teeth * **" A careful reading of the bill does not disclose what is meant by the term "acute diseases of the teeth.” If dental decay is an "acute disease" of the teeth, and many authorties believe that it should be so classified, then the bill promises that all types of dental procedures for treating diseased teeth would be included in the plan, and only prosthetic dentistry would be excluda Under this provision, the American people would not know the amou of dental-health service to which they would be entitled. Such vague and indefinite wordings constitute a basic objection to the proposal. The American Dental Association also wishes to raise another ob jection to the dental provisions of S. 1606. Experience in foreign countries reveals that effective dental-health programs have not been developed under the compulsory-health-insurance system. The following short quotations are taken from the report of an fficial committee of Parliament appointed to study the British dental rogram: Roughly two-thirds of the insured population; that is, between 13 and 14 million eople are entitled to dental benefit, but only 800,000 (less than 7 percent) of ese claim it on an average each year. It is the contention of the American Dental Association that there something intrinsically wrong with a program which compels 13 r 14 million people to contribute for a service which only 800,000 eceive. Another quotation from the committee's report: The state of the dental health of our population is bad and its effect on their eneral health is bad. The American Dental Association does not believe that any program hich must make such an admission after several decades of existence ives any indication that it will aid in rearing a generation of adults ess afflicted with dental disease. Perhaps it might be impressive to add the general opinion expressed y our veterans of the Dental Corps stationed in England during the Far. Their opinion is, "The dental health of the people of England s very poor and so is their dentistry." PROPOSED DENTAL HEALTH PROGRAM The American Dental Association would be reluctant to end its estimony with mere opposition to the proposal that is now before this ommittee. So intense have been the interest and activity of the American Dental Association in this great problem of better dental ealth for our people that it has sponsored two measures which are lso pending before this committee: S. 190 and S. 1099. These bills rovide, as has been stated, Federal grants-in-aid for intensified denal research and experimental programs in all phases of dental-health lucation and care. The advantages of this legislation over that roposed by S. 1606 are summarized in these conclusions: 1. Unlike S. 1606, the two bills make use of a well-tried and successul method of providing Federal aid to the States, a method that has roven to be the successful basis of the Social Security Act-grants-aid. 2. Unlike S. 1606, the two bills give the States and communities the ght, within broad limits, to determine their needs and programs for emselves. This right is traditional in this country. Since the needs iffer in various States, so will the programs differ in various States. 3. Unlike S. 1606, the two bills propose an experimental approach o this great problem on which much evidence is still lacking. This xperimental approach can be as broad and as extensive as existing ersonnel and funds permit. 4. Unlike S. 1606, the two bills will place major emphasis upon revention and control of dental disease, rather than on treatment. The two bills are designed to prevent disease rather than to repair its vages. 5. Unlike S. 1606, the two bills do not promise something which innot be delivered. 6. The two bills will encourage the development of new dental r sources to meet the problem instead of restricting those already existence by a monotonous program of primitive dentistry that .. little beginning and no ending. This series could be continued at great length, but I believe the por has been made; the American Dental Association is opposed to th enactment of S. 1606 because it is not good legislation for improv. dental health. In its proposal, American dentistry has offered a carefully planned solution which will make lasting contributions to der.. health in this country. The American Dental Association recommends that S. 1606 sho not be enacted. The American Dental Association recommends the immediate sage of S. 190 and S. 1099. The American Dental Association again wishes to express its a preciation for the privilege of appearing before this committee.. especially do we wish to thank Senator Murray for his many k nesses to dentistry in the American Dental Association. He been extremely kind in assisting the dental profession in its devel ment. We shall be pleased to answer any question or supply fur information at this time. Thank you. The CHAIRMAN. Thank you, Doctor, for you able statement. W will probably wish to ask a few questions. The American Dental Association has issued a statement of p ciples of the house of delegates of the American Dental Associatio I ask you if what I read here are not the principles of the asso tion: One. Research: Adequate provisions should be made for research which = lead to the prevention or control of dental disease. That is one of the main principles of your association? Dr. FLAGSTAD. Yes. The CHAIRMAN. You have been kind enough to invite me on n.. occasions to sit with the representatives of your association wit. view of preparing legislation to carry out that idea. Dr. FLAGSTAD. That is right, Senator. The CHAIRMAN. And at your suggestion and the suggest your organization, I have filed, some years back, a bill to provide research in the study of dental diseases. Dr. FLAGSTAD. That is right, Senator. The CHAIRMAN. And subsequently other bills which have bee tioned here today, have been filed and and are now pending. I believe, is one of them, and S. 1099 is another. Dr. FLAGSTAD. That is right. The CHAIRMAN. Now, the other principles that I have refer to here are as follows: Dental Health Education: Dental health education should be included : basic educational and treatment programs for children and adults. That is another essential principle of your organization? Dr. FLAGSTAD. That is right. The CHAIRMAN. Which I believe we all recognize. Dental care should be made available to all regardless of income or geographic ocation. Programs developed for dental care should be based on the prevention nd control of dental diseases. All available resources should first be used to rovide adequate dental treatment for children and to eliminate pain and inection for adults. Dental health is the responsibility of the individual, the amily, and the community, in that order. When this responsibility, however, s not assumed by the community, it should be assumed by the State and then y the Federal Government. The community in all cases shall determine the methods for providing service in its area. Those are the principles of your organization, Doctor? Dr. FLAGSTAD. That is right, Senator. The CHAIRMAN. Now, you recognize that there is a grave shortage of practicing dentists in this country and that with the present force of dental practitioners, it would be impossible to give the American >eople full and complete dental care? Dr. FLAGSTAD. Right, sir. The CHAIRMAN. Of course, the fact is that the dental practitioners ave been kept busy with people who are able to pay adequately for he treatment they receive, but if dental care was opened freely to he American people, of course, there would not be sufficient dentists o take care of them at all. Dr. FLAGSTAD. That is right. The CHAIRMAN. Most people neglect their teeth and as the result permit the diseases to advance in them to such a degree that finally t becomes an expensive matter to treat them, and that is the situaion with the great majority of the American people in this country oday, is it not? Dr. FLAGSTAD. To a certain extent, Senator, what you say is true. People neglect the care of their teeth for a number of reasons. One of them may be financial. It may be that they are not motivated. Ve hope to have a dental education program that will motivate them o the care, and we hope to begin with the children and have an adeuate program, and through education they will take care of their eeth, and so we will prevent some of these ravages that occur in ater life. The CHAIRMAN. I agree with you fully, and that is the reason why I was induced to file the legislation which your association roposed. Dr. FLAGSTAD. We are very grateful to you, Senator. The CHAIRMAN. It is very obvious that if we could take care of he children of the country and educate them in the early years with ference to the need for dental care, we would put them in a position here, if they continued that care through their lives, they would e less likely to be required to go into any extensive dental treatment later years. Of course, I suppose under our modern system of living it is imossible in this country without continual dental investigation and eatment? Dr. FLAGSTAD. That is the hope of dental research, Senator. That why we are intensifying research. The CHAIRMAN. You think dental research would reveal certain methods and practices that could be followed in this country which would give the American people better teeth? Dr. FLAGSTAD. I believe there is some hope. Changing the habits f people is difficult, as you know. 85907-46-pt. 2-31 The CHAIRMAN. I remember when I filed that legislation, I receive letters from all over the country, not from dentists or physicians, įfrom individuals. Among others I got a letter from a man who was a noted explor and he told me that a large cause or an important cause of dent decay in people of this country was the fact that their diet was r proper, and he told me he was in Iceland where they had ma. investigations and by digging up the graves of people that had buried for several hundred years, they found that there were peo; • there apaprently 100 years old who still had their teeth becane tr lived on a meat diet, and that he thought that the good teeth of the people was largely due to the fact that they did not eat the kind food we eat in this country. So as the result of that investigation, you think it might be revede that some of our trouble is due to a defective diet? Dr. FLAGSTAD. I believe that diet is quite a factor. There are ma other factors, however. The CHAIRMAN. In addition to that, cleanliness of the teeth, ca ful treatment of the teeth in the early periods of life would effective in preserving good teeth. Dr. FLAGSTAD. That is right, Senator. The CHAIRMAN. Now, you do not think that any effort shonid made to bring dental care into this national health program th envisaged by this bill, this S. 1606? Dr. FLAGSTAD. Unless it could be brought in as we are provide g in S. 190 and S. 1099. The CHAIRMAN. Well, yes. I approve of that legislation, of coarand hope that it will be enacted. I do not think anyone could oppe that legislation if they understood it. Dr. FLAGSTAD. The hearing was very favorable, Senator, as you w recall. The CHAIRMAN. Yes. The National Health Service is, of course favor of it, and are already carrying on a certain amount of der a studies but not sufficient to comply with what you think shots, done in that direction. So that that legislation. I agree with y should be made a part of the national legislation as a means of pr viding better dental health for the American people. But in addition to that, do you not think that something shou' i 'e done to provide for the dental care for the people when they gr older and when the dental diseases do become apparent, and t need care? GRANTS IN AID PREFERABLE TO COMPULSORY INSURANCE Dr. FLAGSTAD. There are many programs to take care of the ad... We have many programs now. They should be entended, howet, But they could also be taken care of under the grants-in-aid syste The CHAIRMAN. Under a grants-in-aid system. Dr. FLAGSTAD. Yes. ste The CHAIRMAN. Of course, it is very difficult to provide a of care for teeth under a health insurance program. That is to s it is not so susceptible to that method of protection as other disease Dr. FLAGSTAD. That is what we have been trying to point out in " statement, Senator. We pointed that out in the statement. |