IMPORTANCE OF PUBLIC HEALTH DENTISTRY By BRUCE D. FORSYTH, D.D.S. Assistant Xurgeon General, U. X. Public Realth Xervice

Transcription

1 IMPORTANCE OF PUBLIC HEALTH DENTISTRY By BRUCE D. FORSYTH, D.D.S. Assistant Xurgeon General, U. X. Publi Realth Xervie Prior to a disussion of problems relating to health and health servies, it is fitting and proper that some definition of terms be stated. By the term publi health is meant the phgsial and mental well-being of the total population of any given area. When so used, this term enompasses a problem of tremendous signifiane and one whih is vital to the very existene of mankind. The partiular phase of this total problem, whih 1 should like to disuss briefly, deals with diseases and onditions of the oral tissues. Dental diseases today are probably the most ommon human ailment. Entire populations are afflited with them, and they frequently indue a train of related maladies. Dental diseases are not peuliar to any one group of people whether defined by age, rae, sex, geographi loation, eonomi status, or eduational levels. In the younger age groups, but by no means onfined to youth, dental aries is the great offender. Every survey made in the past 14 years has shown that from 75 to 98 per ent of shool hildren examined have dental aries. On the average aries attaks one additional tooth every 16 months in hildren 6 to 14 years of age. The most reent surveys onduted in ertain ities in the United States showed that, on the average, dental aries has attaked from 5 to 10 permanent teeth in eah 13 year old Child. In the middle age group, pyorrhea and its attendant ills begin to take a heavy toll of the remaining teeth. Oral aner, neoplasms, and many diseases of oupational origin are more frequently enountered. Negleted, untreated, diseased teeth and gingivae may be the diret or indiret ause of many systemi disorders, suh as arthritis, neuritis, neuralgia, valvular heart disease, diseases of the kidneys and gastrointestinal trat, and even psyhosomati disturbanes. From a onsideration of the very real threats to health whih may arise as a result of oral disorders, it beomes apparent that dentistry oupies an important plae in publi health servies. The publi health attak upon dental diseases is direted upon three main fronts; i.e., dental researh, linial are, and preventive programs. Progress in the solution of anypubli health problem depends upon an ever-expanding bodyof sientifi knowledge. In thefield of oral disease, there has been a pauity of researh into the underlying and ontributory auses. The determination of preventive tehniques and, indeed, of more effetive therapy for these afflitions has been retarded by the lak of basi dental researh. 56

2 [January 1949 ] DENTISTRY 57., The major emphasis in dental researh in the United States has been upon dental aries. Investigations have shown a orrelation between the inidene of dental deay and the presente or absene of fluorine in the publi water supply of a ommunity. Although the ause of dental aries remains unknown, linial evidente is available whih indiates a redution of aries in those areas where the potable water supply ontains from one to two parts per million of fluorine. It is also reognised that an exess of fluorine ingested by hildren mil1 result in dental fluorosis, a mottling or disoloration of the enamel struture of the teeth. Studies of long-term duration are now underway to verify these findings, to determine the total systemi effets of ingested fluorides, and to establish the effiay of artifiial versus natural fluorination of water supplies. In the United States, the addition of fluorine to publi water supplies would reah approximately 70 perent of the population. The remaining 30 perent derive their drinking water from Wells, springs, et., whih are not readily fluorinated. Realizing this disrepany, investigators onduted a series of linial demonstrations from whih has been derived a method for the topial appliation of sodium fluoride to the teeth of hildren. This tehnique is reported as being effetive in reduing the inidene of dental aries by at least 40 perent. The proedure onsists of four topial appliations of a 2 perent aqueous solution of sodium fluoride to the hild s teeth. The teeth are leansed before the first appliation; and three sueeding appliations are made at about weekly intervals. It is reommended that a series of suh appliations be made at the ages of 3, 7, 10, and 13 years-with a view to preventing aries in both deiduous and permanent teeth. Beause fluorine is readily available, beause its ost is Iow, and the methods of appliation-topially or in publi water supplies-are relatively simple, this substane is an admirable agent for the prevention of earies. To date no undesirable sequelae have been observed. Our enthusiasm for the use of fluorine to redue dental aries does not prelude reognition of the equahy important parts played by diet, nutritional status, endorine, and metaboli fators. It is realized, however, that fluorine is not the perfet agent, for it does not ompletely prevent dental aries in hildren. Neither have we been able to demonstrate signifiant results from its appliation to the teeth of adults. Nevertheless, the use of fluorine is one of the important results of basi and applied researh. We annot over-emphasize the fat that adequately finaned and supported researh an point the way to suppression or arrest of oral diseases. Investigations into the fundamental problems, with parallel study of the linial phases and an ultimate dissemination of proved knowledge to the publi, will insure future suess in the prevention of dental disorders.

3 58 PAN AMERICAN SANITARY BUREAU [January The problem of providing linial are to meet the needs of the total population, is of astronomial proportions. It has been estimated that. in the United States alone 400,000 dentists, working diligently for a period of one year, would be required to restore the present defetive oral mehanisms of the whole population. With our present supply of dental personnel this would be a never-ending job. The enormity of suh a task makes it obvious that linial are, at present, an only meet emergeny needs. Perhaps the points at whih linial treatment an make its greatest ontribution is in the extension of dental are programs to vulnerable population groups. For example, hildren of pre-shool and shool age, pregnant women, and nursing mothers. The adolesent Child is partiularly suseptible to development of dental disease beause of the metaboli hanges whih are going on in the body. The same is true of the pregnant woman and the nursing mother. Por these vulnerable groups, adequate linial are should be provided through suh organizations as loal health departments and the shool systems. Another large population group with high prevalene of oral disease an be reahed easily; namely, the industrial workers. In the United States, the majority of large industries have well-organized industrial hygiene servies, inluding thorough preplaement and follow-up medial examination of employees. A few of these ompanies have made omprehensive dental examinations an important part of their industrial hygiene programs, referring patients to private pratitioners for treatment. A seond step whih may be taken is the use of well-trained auxiliary personnel, under the supervision of a dentist, to perform the simpler, routine tasks and thereby spread the servies of a skilled dentist more widely. Another approah to the problem, obviously, is to train more dentists and thus inrease the total supply of dental manpower. Clinial are and researh are only two of the supporting ohmms in the effetive attak upon dental disease. In addition, there must be a wide-sale program of dental health eduation to motivate people to utilize the most effetive methods of prevention and ontrol. Dental health is a responsibility of the individual, the family, and the ommunity. The problem of eduating the average man or woman to take advantage of aeptable preventive and ontrol methods poses a diffiult and long-term task. For example, it has been shown that elimination of ertain refined arbohydrates from the diet will derease the inidene and lessen the severity of attaks of dental aries. Yet however worthy this objetive may be it beomes insignifiant when ompared to the fondness of hildren for sweets. The programs for the purpose of publi eduation on oral health have in the past been too narrow in sope and have failed to present the knowl-

4 19491 DENTISTRY 59 edge in a realisti manner, adjusted to the ulture and ustoms of the people. Let us now onsider the plae of dentistry in a program of publi health. Sir William Osler, the father of modern mediine, years ago reognized the signifiane of healthy oral strutures when he said, There is not one thing in preventive mediine that equals in importane mouth hygiene and the preservation of the teeth. Dental are should be onsidered as muh more than a osmeti luxury. People need to learn that diseases affeting the oral tissues annot be eradiated by removing the offending teeth. Teeth annot be negleted or disarded without serious onsequenes to the whole bodily mehanism. Biologists have amply demonstrated that robust adulthood and old age are dependent on the small and almost inlinitestimal fators of our life proesses. Many ases of general debility and ill health our among people who lak the hewing funtion. Restoration and maintenane of this funtion are indispensable in any plan for the total medial and dental are of suh patients. Therefore, every fator ontributing to the development and natural maintenane of oral strutures, and the normal funtioning of the mouth, should be promoted to the fullest extent. However important any suh health promoting measures may be, the fat remains that the real problem, duty, and purpose of the physiian and dentist are the early reognition and suessful intereption of disease. Only by suh alertness an the natural ravages and dire onsequenes of untreated disease be prevented. Many, if not all, of the systemi ills attributed to the mouth ould be suessfully interepted by the proper and timely appliation of suitable remedies. Therefore, good treatment and sound preventive proedures stand today as the most prominent and promising health measure of the healing arts. The individual dentist of today an no longer restrit his work to a small dental operating room, with the narrow perspetive of its onfines. He is a part of the great pattern of publi health servies. He must remember that the oral tissues at as mirrors to reflet signals whih indiate systemi imbalanes and upsets. He should reognize bis responsibility in the diagnosis of Iesions suh as those of syphilis, tuberulosis, and the blood dysrasias. He should aept his obligation to refer patients to speialists for further are. It is the duty of the medial and dental professions to investigate and develop new methods of prevention and treatment. When proved to the point of aeptability, this knowledge should be disseminated by the professions to the publi. The dentist, as a professional man, must onstantly stimulate the inauguration and maintenane of ommunity failities wherein the genera1 publi an reeive both preventive and restorative treatment.

5 60 OFICINA SANITARIA PANAMERICANA [Enero Notwithstanding the dieiulties inherent in the ontrol of oral diseases, the potentialities of improving the publi health by well-planned, preventive dental servies are so great that no publi health offiial or private pratitioner an ignore the hallenge. The expansion of dental researh, linial are, and publi eduation programs is essential to progress in the prevention of oral disease and its attendant ill health. Only by these methods an the leve1 of oral health be raised in the total population. IMPORTANCIA DE LA ODONTOLOGfA EN EL CAMPO DE LA SALUBRIDAD PUBLICA (Sumario) Todas las exploraiones sanitarias hehas en los filtimos 14 años, han demostrado que de 75 a 98yo de los esolares examinados,padeian de aries dental. En el promedio de los asos la aries ataa un diente más, ada 16 meses en niños de seis a 14 años de edad, demostrando las exploraiones más reientes realizadas en algunas iudades de Estados Unidos que por regla general la aries dental ataa de 5 a 10 dientes permanentes a todos los niños de tree años de edad. Se ha omprobado estreha relaión entre la aries dental y la existenia o falta de flríor en la dotaión públia de agua potable de la oletividad. Aunque la ausa de la aries dental permanee desonoida, hay pruebas línias valiosas de que disminuye en las zonas en que la dotaión de agua potable ontiene de 1 a 2 partes por millón de Mor. El iudado línio y la investigaión representan ~610 dos de las olumnas en que desansa el esfuerzo efetivo ontra las enfermedades dentales. El problema de proporionar atenión línia para remediar las neesidades de toda poblaión, es de proporiones astronómias. S610 en Estados Unidos se requerirían 400,000 dentistas que trabajaran efiazmente durante un año para restableer el estado normal de la boa en toda la poblaión. Es un deber de la profesión média y dental desarrollar nuevos métodos de preveni6n y de tratamiento. A pesar de las difiultades inherentes al ontrol de las enfermedades buales, son tan grandes las posibilidades de mejorar la salud públia por medio de serviios dentales preventivos bien planeados, que ningbn empleado de salubridad o profesional partiular puede ignorarlas o despreiarlas.