In 1931 a dental health education and stimulation program was begun in the Waynesboro, Pa., schools. The percentage of children receiving dental care rose from 24.2 percent in 1931-32, the school year, to 87.8 percent in 1938-39, as a result of this stimulation and educational program. The parents and teachers were motivated to care for the children's dental needs, and the dentists were stimulated to allocate a larger proportion of their time to child patients. TRAINING OF DENTAL PERSONNEL I should like to say a few words now about the need for training of dental personnel. An increase in the quantity and an improvement in the quality of dentistry for children undoubtedly will result if this bill is enacted into law. Realizing that operative care has to start as early after cavities begin as is practical (and 50 percent of the group 2 to 3 years of age already may have cavities 23), and realizing that special techniques are required for the care of the first teeth and the young permanent teeth in growing jaws in order to prevent serious dental disease, the Council of Dental Education of the American Dental Association, in 1941, added the course Dentistry for Children to the required courses in the undergraduate dental curriculum. Obviously, many postgraduate courses must be provided to give adequate training in dentistry for children to the older dentists now in practice. A survey of the need for dental care in the city of Detroit in 1935-36, showed that but 7.1 percent of the younger age group of white children, the 3- to 5-year-old group, had been to a dentist during the year, as compared to 31.5 percent of the 15- to 19-year-olds. To add to an appreciation of the problem of dental care for children, a survey last year of the attitudes of dentists in two sections of Minnesota revealed that not much more than 30 percent of the dentists felt qualified or willing to accept small children as patients. 5 If the definition of actual dental health needs in Michigan and the estimate of the average dentist's time required to provide necessary care are correct, then Michigan would need a 60-percent increase in available dentists to start an immediate program that would provide such care for the children for 3 years of age through high school. If a program, on the other hand, to provide complete dental health services for the 3-year-olds in Michigan were begun this year and continued for a 15-year period by the yearly addition of a new 3-yearold group each year, at the end of the 15-year period, instead of needing a 60-percent increase in dentists, eight of the present available dentists will be left to provide care for adults. DATA NEEDED FOR PLANNING To test the validity of these conclusions in Michigan, dentistry urgently needs the provision for administrative research the bill S. 1099 affords. Those who plan dental programs scientifically for the 2 Morris, E. W. The Utilization of Community Resources In a Health Program. American Dental Association Journal, 26: 493-505, March 1939. 3 The Murray and Leonie Guggenheim Dental Clinic. Annual report, 1940. New York, The Clinic, 1940, 54 p. 4 Britten, R. H. A Study of Dental Care in Detroit, Mich., American Dental Association Journal and Dental Cosmos, 25: 281-6, May 1938. 5 Jordan, W. A. Dental Manpower of Minnesota in the Postwar Period. Unpublished thesis, June 1945. 51 p. future, programs which assure that public funds are spent economically for the maximum in health benefit, should have information in 12 areas of basic data, and I should like to state them: 1. Population facts that deal with the concentration of people by geographical location, race, income, family, age, and trade areas. 2. The effect of family income on dental needs and ability to provide for them. 3. The most scientific evaluation possible of the measures available for the reduction and treatment of dental needs. 4. A most careful and scientific definition of the dental services essential to maintain the total health of the recipient. 5. An accurate report, in terms of the defined health services of the average dental needs of a large population. 6. The average operating time in hours to provide these services. 7. An accurate census of dentists and their technical auxiliaries by age, distribution, and specialization. 8. An estimate of the best methods to increase the productivity of dentists. 9. Factual information about the psychologic blocks to dental care. 10. A summary of the accumulated experience in conducting dental programs. 11. Some experience with the financing of dental programs. 12. Techniques for the evaluation of the results achieved by dental programs. 6 Dentists who secure and analyze such data and organize programs require specialized graduate training, training which is not provided in the undegraduate teaching of dentistry. As the recent report of the committee on professional education of the American Public Health Association points out, the Public Health dentist should have the following qualifications: Graduation from an accredited dental school; sufficient training in Public Health methods to fit himself into a health department and to administer a bureau; specialized training in the techniques of Public Health dentistry; and training in or information about dentistry for children, current dental research, laboratory diagnosis, and health education techniques. I should like to close my formal statement with this observation: I have received requests during the last 2 months to supply five State dental directors who have this type of training. None is available. The CHAIRMAN. Any questions, Senators? DETERRENTS TO DENTAL CAREERS Senator AIKEN. I think, Mr. Chairman, Dr. Mead told us yesterday Dr. Easlick would tell us why more men and women do not undertake to acquire dental training. Perhaps he did so before I came in. Dr. EASLICK. Senator, I don't have a very objective answer, as you probably would suspect. We do have a survey that has just been made of the dental-school population at the University of Michigan. From that we may draw some objective answers. Proposed report on the educational qualifications of Public Health dentists. American Journal, Public Health, 35: 48-48, January 1945. I think, in the first place, you must remember, as has been pointed out this morning-before you came, perhaps that dentistry is a new profession as a scientific health profession. People generally do not realize how scientific it is. They have notions only from earlier times about what constitutes modern dentistry. According to this survey, many of the students came from homes of modest family incomes, and they came from the smaller communities. The cost of the dental course is quite an item for students, particularly students who come from homes which have modest family incomes. That perhaps is one deterrent from admissions into schools. The tuition per semester for schools may range from $100 to $200 or better. Instruments and supplies required during the course may amount to from eight hundred to a thousand dollars. Added to that, of course, is maintenance for one's self while in school. According to this survey, too, many of our dental students have previously applied to a school of medicine for admittance. Medicine for most students, I think, is more glamorous. Certainly, medicine draws students from higher income levels than does dentistry. In talking with young people about the possibility of the practice of dentistry as a career, I have often had expressed to me an abhorrence of this notion of working in a person's mouth. Of course, that is something for education to correct. At any rate, I think that highschool students apparently have not learned, through the people who are doing guidance work, how desirable dentistry is, how attractive it could be as a profession. Probably that is about all I can say in answer to your question. Senator AIKEN. No. The CHAIRMAN. Thank you very much, Dr. Easlick. Dr. MEAD. I should like next to introduce Dr. Fred Conrad, from Tallahassee, Fla., who is president of the Florida State Dental Association and who will talk to you from the viewpoint of the State organizations in regard to this problem of dental care. Dr. Conrad. TESTIMONY BY DR. FRED O. CONRAD, PRESIDENT OF THE FLORIDA STATE DENTAL ASSOCIATION Dr. CONRAD. I am Dr. Fred O. Conrad, president of the Florida State Dental Association. Much of the discussion on Senate bill 190 and Senate bill 1099 has centered around the national aspects of dental research, dental health, education, and dental care. I should like briefly to discuss some of the phases of this legislation which are of deep concern to all citizens at the level of the State and community. As president of a State dental society which has given consideration for many years to State and community dental health programs, I should like to urge the committee's support for the passage of these two bills. Senate bill 1099 will permit the official health agencies of State and community to receive Federal aid. This is invaluable in providing assurance that the particular needs of the State and community will be given consideration. In our State health department, for example, we have a children's program whose effectiveness is greatly hampered by a lack of facili ties. In addition, there is a great necessity of knowing more about the techniques of providing dental care more effectively and more extensively for the younger age groups, where prevention and control would be most productive. Senate bill 1099 makes such aid possible and, as previous witnesses have indicated, there is a desperate need for such help in every State of the country. These bills have had the best thought of leaders in the dental profession, men whose training, skill, and experience would be expected to provide a scientific solution for this great problem. These bills have the active support of the American Dental Association and, as president of one of its constituent societies, I can assure you that these bills will have support in the States and communities as well. The dental profession of the State of Florida welcomes the opportunity to make its views known and also welcomes the opportunity to take part in such a far-reaching program for the improvement of the national health. The dentists of Florida are glad to express their solidarity with the American Dental Association and to urge this committee to make a favorable report on these bills. The CHAIRMAN. I should like either Dr. Conrad or Dr. Mead to be sure that some other witness will tell us, in as much detail as you can, how this program contemplated under S. 1099 would work out in practice. Doctor, have you somebody for that? Dr. MEAD. I think we have. Thank you very much, Doctor. Dr. MEAD. I should like next to call upon Dr. Allen O. Gruebbel, who is secretary of the council on education of the American Dental Association, who will talk upon problems in public-health dentistry associated with this bill, and I think that he can very nicely answer many of the questions that you have brought up. TESTIMONY BY DR. ALLEN O. GRUEBBEL, EXECUTIVE SECRETARY OF THE COUNCIL ON DENTAL HEALTH, AMERICAN DENTAL ASSOCIATION Dr. GRUEBBEL. Mr. Chairman and members of the committee, I should like, first of all, to correct a slight error that Dr. Mead made. I am the executive secretary of the council on dental health, instead of the secretary of the council on education, of the American Dental Association. Many surveys and investigations in recent years have revealed the tremendous prevalence of dental diseases among the public. It is an obvious fact that a health problem of this magnitude is of serious concern to all who are responsible for the health and well-being of our citizens. NATION-WIDE PROGRAM NEEDED The Congress of the United States, in recognizing the need for a concentrated effort to solve specific health problems, has very wisely enacted laws to carry out a Nation-wide program of venereal-disease control and tuberculosis control. An attack on the dental-disease problem should be made in the same way. Earmarked funds should be made available for the development of effective dental-diseasecontrol projects. The dental-disease problem can never be solved completely by attempting to repair or replace diseased or lost dental tissue, no matter how much money is available for treatment services. The approach must be made through the application of preventive measures to reduce the incidence of dental diseases, through the wider use of public-health methods, through a carefully planned and efficiently conducted program of dental care for children, and through Nation-wide health education. In view of the fact that almost all people are in need of dental services to some extent, it is impossible to develop a Nation-wide program in which all people are included in a dental-treatment plan. For this reason first effort must be limited to children. In the words of Surgeon General Parran, of the United States Public Health Service (and I am quoting): The problem of dental caries grows like a snowball, like compound interest. And up to now we have measured-not only the annual attack rate of dental caries but we have measured all the past years of accumulated neglect. It would seem to be sensible, assuming that we cannot multiply by several times the number of dentists overnight, nor can we secure overnight tremendous increased expenditures on the part of the general public for dental care that we can do the best job, under present knowledge of preventive dentistry, by taking care of the annual crop of new dental defects which appear in grade-school children. Every community should support a comprehensive dental-health program. It is the responsibility of every community to finance projects of this nature without outside assistance. If, however, a community is unable to do so, it has the right to seek aid from the State or Federal Government. This principle has been widely accepted in the grants-in-aid system. The same principle should be applied to an expanded public dental-health program. FUNDS LACKING FOR ADEQUATE PROGRAM While it is true that almost all State health agencies carry out some type of dental-health program, it is also true that such programs have never received a fair proportion of public funds allotted for health services. The amount of money budgeted for dental health plans at the State level in the United States for the fiscal year 1941 was only six-tenths of 1 percent of the $109,000,000 budgeted from all sources for cooperative health work. The extent of the dental-disease problem is far out of proportion to the small percentage now allocated for dental purposes. Dentists and dental-health officers who have worked in the public-health field for many years are unanimous in their opinion that this problem will never be solved until funds are specifically allotted for dental-health programs. It would seem logical that the sensible approach to this problem would be to use and strengthen the official health agencies by making funds available to them for the purpose of applying public-health principles and practices to a dental-health problem. Such principles and practices include a careful study and analysis of the dental health problem in all of the areas of the country as well as a determination of the resources for meeting those problems in each community, establish |