Also, some of the research has dealt with high-speed equipment. We think that is extremely important because it will enable a single dentist with his auxiliary personnel, to render a greater service to more people.

Along that same line, you might be interested to know that parallel to our whole program of desiring to train more auxiliary personnel, we are now including in our requirement for accreditation that every dental school train every dentist before he graduates on how to use the auxiliary personnel more efficiently and more effectively, which again we hope will cut down on needs which we cannot meet at the present time.

We have the philosophy that when a student enters a dental school, he is not registering merely for a period of 4 years, but that he is registering for life. We think that a dental school has a real responsibility to every dental graduate that it puts out. We think that, in turn, every dental graduate, when he becomes an alumni member, ought to look to that school and get from that school continued education to let him keep up with the standards of dentistry and dental practice and also help him to acquire those techniques and that knowledge so that he can work efficiently and effectively in his dental office.

One last point that I would like to make in view of our whole study of this entire problem is that we are just now entering upon a 2-year survey of dentistry, which is supported partially from the funds of the American Dental Association and 1 or 2 foundations.

This, again, is designed not just to study dental education, but to study also the practice of dentistry, because we want to be able to serve a greater number of the population with the personnel that we can foresee in the future that can come out of dental schools, dental hygiene schools, and other educational institutions.

Gentlemen, I thank you for the time that you have given me.

Mr. NEAL. Doctor, may I ask you: Do the alumni of your dental schools make any great amount of contribution to the mother institutions toward the upkeep of the operation? Do you get any support from your alumni?

Dr. PETERSON. There are about three schools, Doctor, that do have rather significant support. One is Dr. Herz' school, P. N. & S. in San Francisco.

We have just completed the survey. I am sorry that the data was not tabulated fast enough so that I could bring it to you.

I would say that, in general, the alumni support is rather poor, nationwide, to the dental schools.

Mr. NEAL. Purely voluntary?

Dr. PETERSON. Purely voluntary, yes. In 2 or 3 schools like Kansas City and P. N. and S. the alumni program is fairly strong. Our program is that of encouraging continuing education so our alumni groups will make demands upon their schools, and they in turn will pay the school for some support for those additional teachers that are required, which, in turn, will raise the standards of the entire education institution."

Does that answer your question?

Mr. NEAL. Yes.

Mr. DINGELL. May I be recognized?

Mr. WILLIAMS. Yes.

Mr. DINGELL. Doctor, if you get every cent that is in these several bills before us, if you get the money that you were telling us you hope to have available over the next few years, would you still be able to meet the projected needs of the people of this country for doctors of dentistry?

Dr. PETERSON. Even with these additional funds and the 10 schools that we predict will be created in this length of time and with the expansion which this money would provide, we will not be able to maintain the ratio of 1 to 1886 by 1975. We would have had to have 3 years ago, for a period of 20 years, an additional 800 students graduate before this entire 20-year period.

We are falling backwards so rapidly. That is why we have to look to these auxiliary aids to help us out of our pinch. We must do something, and that is why we are not only looking for funds, we are looking for other methods by which this improvement can be made.

Mr. Chairman, I forgot to mention earlier that I would also ask if we could present some of this data in a report which could be submitted at a later time.

Mr. WILLIAMS. The committee will be glad to receive that. (The information referred to follows:)

STATEMENT OF THE AMERICAN DENTAL ASSOCIATION ON H. R. 6874 AND 6875, H. R. 7481 AND H. R. 11913, LEGISLATION AUTHORIZING CONSTRUCTION GRANTS FOR HEALTH, SCIENCE TEACHING AND RESEARCH FACILITIES

PART I

Mr. Chairman and members of the committee, I am Dr. Francis Herz of San Francisco, Calif., where I am engaged in the general practice of dentistry. I am a member of the council on legislation of the American Dental Association. With me is Dr. Shailer Peterson of Chicago, Ill., who is secretary of the association's council on dental education. We are here today to present the association's position on the three proposals before this committee to provide grants-in-aid to dental schools and related institutions for constructing teaching and research facilities. The American Dental Association has a membership of 90,000 and represents more than 80 percent of the Nation's dentists.

Policy of American Dental Association.-Representatives of the American Dental Association have testified before Congress in support of Federal grantin-aid legislation for assisting the dental schools four times since 1949. In that year the association's house of delegates adopted the following resolution at its annual meeting:

"Resolved, That the American Dental Association approve the policy that Federal funds, with justification, might be appropriated in support of dental education programs, provided that such funds when appropriated should be accepted with the understanding that the Government shall not exercise any control over, or prescribe any requirements with respect to, the curriculum, teaching personnel, or administration of any school or the admission of applicants thereto."

Each of the bills which are the subject of these hearings is in keeping with the policy of the American Dental Association.

Recommendation.-The American Dental Association urges Congress to enact legislation which will provide Federal grant-in-aid funds to assist in the construction, expansion, remodeling and equipping of vitally needed teaching and research facilities for the Nation's dental schools. Specifically, the association recommends that the grants authorized be adequate to assist the existing 47 dental schools to fulfill their essential needs over the next 5 years. The total cost of this 5-year program would be $95 million or thereabouts.

The association also recommends that provision be made for the construction of at least 8 new dental schools during the next 5 to 10 years. The association estimates that the total cost of this construction would be $30 million. Dr. Peterson will amplify these recommendations in his statement.

The detailed information on the specific financial needs of the dental schools, which Dr. Peterson will present, will illustrate that Representative Roberts' bill, H. R. 11913, is best adapted to meeting the essential requirements for expanding dental teaching and research facilities.

At this time, I should like to call upon Dr. Shailer Peterson, secretary of the council on dental education. Dr. Peterson is a specialist in the field of education, having obtained his doctorate in that field.

PART II

I am Dr. Shailer Peterson, of Chicago, Ill. I am secretary of the council on dental education of the American Dental Association and am here to present the association's position on the legislation that has been proposed to stimulate the construction of critically needed educational and research facilities in dentistry.

This committee has available to it the very excellent staff report assembled in 1957 by the professional staff of the committee on the basis of data submitted by the American Dental Association and other agencies concerned with the educational and research needs of the dental institutions in this country. It is not my intention to review the information which has been provided in the report prepared by your staff other than to submit more current information where available and to supplement some of the data which were not available in complete form at the time the staff report was prepared.

Present capacity of the dental schools.-There are now 47 dental schools in operation with an enrollment of 15,645 students. Of this total 1,052 students are enrolled in graduate, postgraduate, and special courses and 1,314 are enrolled in dental hygiene courses. (An additional 842 dental hygiene students are being trained in 10 schools which are not affiliated with dental schools, but which offer programs that have been approved by the American Dental Association.) Four new dental scools have been opened since October 1956 and have increased undergraduate dental student enrollment by 126.

From October 1955 to October 1957 undergraduate dental school enrollment has increased from 12,730 to 13,279; the number of students engaged in special studies or seeking an advanced degree has increased from 539 to 597; the number of dental hygiene undergraduates has increased from 1,160 to 1,340; the number of continuing or refresher students has increased from 4,673 to 5,017. The continuing expansion of training programs offered by the schools in these years reflects the constant effort of the schools to meet the growing demand for dentists and dental auxiliaries made necessary by the prevailing population growth and the replacement of dentists and auxiliaries lost through death and retirement from active practice.

With the single exception of last year, the number of dental graduates has increased each year for the past decade and can be expected to continue this increase for the next several years. It is estimated that nearly 3,100 dentists will be graduated in June 1958, and that by 1961, when all of the existing schools will be graduating students, the number of graduates will reach about 3,400. However, when the death and retirement rates for dentists are taken into consideration, and in view of the rapidly increasing population growth in this country, the efforts that have been made by the dental profession and dental educators are not adequate to maintain the proportion between dentists and population as it exists today. Data supporting this statement and observations on other factors which substantiate the clear need for an expanded program for producing dental manpower are available in many of the publications of the American Dental Association and will be submitted for the records of this committee.

Research activities conducted in the dental schools.-As is true in all scientific and professional fields, the educational institutions are responsible for the conduct of a large part of the research in the field. In dentistry, it is estimated that more than 80 percent of the research is conducted in dental schools and closely related academic facilities. Among the many reasons for this condition is the very essential relationship which exists between higher education discipline and research in that field. One of the important criteria used by the council on dental education in its evaluation of dental education programs is the existence of an active program of research, as indicated by the following statement from the Requirements for the Approval of a Dental School: "The mere prosecution of routine class and laboratory assignments is purposeless without genuine

scientific approach; no dental school fulfills its mission unless the spirit of research permeates the activities of both teachers and students. ***"

Although the dental schools have been cognizant of this important responsibility for a number of years, they have been handicapped in developing a truly effective program by the lack of adequate financial support. As recently as 10 years ago Federal support of dental research was practically nonexistent. Up to that time, despite the fact that dental disease is the Nation's most prevalent disease-afflicting 95 percent of the population-there was no coordinated plan under which personnel and facilities could be marshaled for an investigation into the causes of dental disease. Through the support given to the activities of the National Institute of Dental Research by Congress, a significant program of dental research is now a reality and investigators from all parts of this country are now making an intensive search into the nature of oral diseases and their relation to the general health of our people. This expansion occurred chiefly as a result of the appropriations provided by the Congress in 1956 and 1957 for grants to the dental schools and other dental research centers.

It must be recognized, however, that this program is yet in the beginning stages. In terms of the research capacity of this Nation, the potential in the area of oral disease investigation has only been touched. Much more needs to be done; for example, with available personnel and facilities, the dental schools are in a position to carry on at least a hundred projects in addition to those being conducted and those to be activated this year. The growth of research in the dental schools, moreover, is essential to a continuing improvement in the standards of dental education.

As will be pointed out in later sections of this report, the dental schools have been able to expand considerably their facilities for educating dental students during the past several years and presently have plans to expand still further in the future. The need for increasing the space for training additional dental and dental hygiene students has been so great, however, that the schools have not been able to participate as many would have liked in the Health Research Facilities Act. The council reported to this committee in June 1955 the amount of construction funds that might be utilized by the dental schools for the construction of research facilities and was concerned when the participation of the dental schools in this program did not approach the extent that had been indicated. However, further investigation into this matter confirmed the fact that the dental schools were confronted with the very difficult decision of how the funds which they had available for matching construction grants might best be used. Even though many of the schools need expanded research facilities desperately, and even though most of the schools could have qualified for grants under the terms of the Health Research Facilities Act, they felt constrained to withhold applications for the purely research construction grants in anticipation of a Federal matching grant program which would be usable for the construction of both teaching and research facilities.

I am confident that the dental schools will participate to a substantial extent in the matching grant program for the construction of research facilities if legislation is approved which would make possible the construction of both teaching and research quarters. The bill introduced by Representative Roberts, H. R. 11913, particularly is a realistic approach to a solution of the problem which has confronted those institutions that feel an obligation to expand both teaching and research facilities and which do not have the funds to engage in purely research construction at the possible expense of the essential construction of more educational facilities.

Alternatives confronting the schools in providing dental care for the future.— It appears now that the population projection of 2281⁄2 million by 1975 is realistic. American Dental Association statistics show that in 1955 there were 87,599 dentists in active practice for a population of 162,248,000. This would indicate a dentist-population ratio of 1 to 1,886. On the basis of the present number of dental-school graduates, it can be estimated that by 1975 there will be about 104,461 dentists in active practice. This is an adjusted figure which allows for a normal rate of death and retirement of dentists now in practice. In this projection there would be a dentist-population ratio of 1 to 2,187 by 1975. To maintain the 1955 ratio of 1 to 1,886, the schools would have to graduate 16,669 more dentists than their present capacity will permit, or about 833 more students per year, over the 20-year period.

Many leaders in the profession and many dental educators view these statistics with real concern. To provide sufficient manpower in the future to maintain

1955 levels of dental care, which is a conservative basis for there is every reason to believe that the percent of the population seeking dental care will continue to increase, there would appear to be four alternate methods that should be given serious consideration:

1. Expand existing facilities through remodeling and additions to present school plants.

2. Construct additional new facilities.

3. Increase the use of dental auxiliary personnel.

4. Expand the dental research program.

The schools will work toward a solution of the problem by using 1 or more of these 4 approaches, each doing so within the limits of its financial ability to expand and its present need for additional space and new equipment.

Expansion of facilities for teaching and research through remodeling.-The council on dental education recently conducted a survey of the dental schools to determine the extent to which their enrollments could be increased if Federal matching funds were available. A summary of the data from this survey is presented in exhibit A to this report. According to the information submitted by the schools, if matching funds were made available, the existing schools would be in a position to expand their undergraduate enrollments by 636 dental students a year within the next 5 years. An additional 594 dental hygiene students could be accepted into these expanded facilities, according to the survey results. Twenty-five schools (53 percent) would start new programs to train auxiliary personnel; 10 schools (22 percent) would start new programs to train an additional 225 dental hygiene students per year; 17 schools (36 percent) would plan to have training programs for dental assistants; 7 schools (15 percent) would expect to introduce new programs for the dental laboratory technician. Thitry-four schools (72 percent) intend to enlarge their facilities for conducting research; 35 schools (74 percent) would remodel or build new facilities to increase the number of graduate degree programs; and 34 schools (72 percent) would provide additional study programs for the postgraduate student. It is obvious from these figures that even without the addition of new schools to the present 47 now in operation, enrollment capacity for undergraduate, graduate, and auxiliary personnel would be increased in impressive numbers. In this 5-year period, coincidentally, with the increase in the size of its physical plant, the quality and scope of dental education would also be improved. By additions to the physical plant, the purchase of new equipment for science laboratories and clinics, the teaching and research programs at many schools would gain in both effectiveness and efficiency.

In addition to this expansion of existing facilities, there are definite plans to establish 2 new dental schools within the next 2 years and reasonable assurance that an additional 7 or 8 schools will be put into operation within the next 10 years. The two schools for which nearly definite provisions have been made are in Kentucky and Florida. There has been serious discussion of the possibility of establishing dental schools in the following States: South Carolina, Oklahoma, New York, Connecticut, California, Colorado, and possibly in Utah. There is no doubt that the existence of a Federal matching grant program for construction of teaching facilities would hasten the establishment of these schools and, in at least some of the cases, it is unlikely that the schools could be established without a Federal matching grant program. On the basis of a two-thirds matching grant for new construction, it is estimated that the two States which have definite plans at the present time would request grants of about $5 million. If the 10-year provision for new construction were to be approved on a two-thirds-one-third basis, the 7 or 8 schools which now appear to be in the stage of serious study and planning would be in need of $25 million to $30 million depending upon the size of the institution planned and other factors. This would mean then that new dental-school construction which can be anticipated within the next 10 years could be aided materially, and in some cases assured, by the provision of $30 million to $35 million within the 10-year periods proposed in H. R. 11913.

Increase the use of dental auxiliary personnel-The dental profession, like other health professions, is aided materially by the services of auxiliary personnel who are trained to perform certain functions which do not require the direct participation of the dentist. During the past few years there has been increasing recognition of the extent to which the effective utilization of these auxiliary personnel makes it possible for the dentist to devote his time to those procedures for which only he is qualified. For example, current studies show that a dentist can increase his weekly patient load by 36.8 percent by employing