1942: Dentistry

War Dentistry.

Rejection of draftees for dental defects averaged 20.9 per cent, and in some localities reached 50 per cent. Accordingly the Army undertook to rehabilitate the dentally deficient after induction. Rejection for dental defects is now allowed only for gross dental infection, the correction of which would entail a long period of treatment and the provision of special diets for recruits.

Although there are 14,000 men under 37 years of age now in dental practice, it was found necessary to induct men up to 44 years, because of the number rejected for physical defects and on other grounds. However, with the assistance of the national Procurement and Assignment Service, and because of voluntary enlistments, in addition to Selective Service inductions, the need for dentists by the armed forces was met and commissions for dentists were discontinued for a number of months. Dental Commissions are now again available for men under 37 years of age.

Approximately 21 per cent of dental laboratory technicians have gone into the armed forces, while laboratory requirements of dentists have increased. It is estimated that the army will absorb less than 18 per cent of the dentists as against over 38 per cent of dental laboratory technicians, increasing the ratio to sixty-three dentists to each technician, against a pre-war ratio of seven dentists to each technician.

Prompt dental treatment and early evacuation of combat casualties have been found most essential. Methods of combatting shock, the use of sulfonamide compounds to eliminate infection, first aid and emergency treatment, the care of gas casualties, hemorrhage, and many other duties form an important part in the training of dental officers.

Treatment of wounds about the jaws, especially those involving bone fractures is now done almost altogether by dental surgeons who receive intensive training at leading dental schools.

Industrial and Civilian Dental Needs.

Dental health in industry came in for its share of attention along with the general effort for bettering health conditions among workers. The sudden shift of civilian population necessitated by the developments of war industries in formerly sparsely settled communities, plus the induction of dentists into the armed forces, resulted in a shortage of dentists in some localities.

Plans for meeting dental needs in these communities are being made now by the U. S. Public Health Service and the Procurement and Assignment Service of the War Powers Commission. This effort has received the cooperation of the War Service Committee of the American Dental Association, which is aiding the work through similar committees appointed by state and local dental societies. The attempt is being made also to prevent, treat and eliminate dental and oral diseases of occupational origin. An example of occupational effects on the teeth and mouth is found in a report of the U. S. Public Health Service which showed two-thirds of Utah metal mine, coal mine and smelter workers, from age 35 to 64 years, to show evidence of pyorrhea.

Dental Progress.

Reports of the leading endowed dental clinics show that so-called 'prevention' is in effect merely the early treatment of dental decay. True prevention was found to require consideration of the sequence and velocity of tooth eruption, the physiologic time for shedding the deciduous (baby) teeth and the restoration of the anatomic form of decayed teeth.

Silver nitrate, long employed by dentists as a means for arresting dental decay in the teeth of children, was shown by dental investigators of the U. S. Public Health Service in a controlled study to have no such effect. Teeth treated by silver nitrate decayed just as often as those not so treated. In another study it was shown that dental caries was more prevalent in communities whose water supply was free of fluorine than in other communities whose drinking water showed a fluorine content of 0.5 parts per million.

Vitamins and calcium were found to play an important role in dental development. Lesions of the lips, gums, tongue and buccal mucous membranes, characteristic of deficiency of vitamin C and of several members of the vitamin B complex, responded to specific therapy.

In the growing child vitamin D and calcium compounds were shown to be important in calcification of growing bones and teeth. Those obtained from foods rather than through medications seem to be better assimilated and retained. The physical character of food and the carbohydrate content of the diet play an important part in the production of caries — as does the lack of cleanliness, quality and quantity of saliva, bacteria, etc. Special vitamin or calcium compound therapy is not indicated in the prevention of caries.

'Speedup' in Dental Education.

Accelerated programs have been adopted by dental colleges for the period of the war. The term hours of instruction devoted to the dental course remain, as heretofore, within a range of 3,800 to 4,400 hours, with proper distribution over a three-year period. The number of students in the thirty-nine dental colleges was 8,355. This is an increase of 635 students over the previous year and is the largest number enrolled in any one year in the last fifteen years. Of the 732 hospitals approved by the American Medical Association for intern and residency training 152 employ dental interns.

Dental Materials and Priorities.

Dental materials have been made available as far as possible for dentists in civilian practice. The National Bureau of Standards, U. S. Department of Commerce, has published the results of 23 years of research on dental materials. This is destined to prove of immeasurable value to the practicing dentist. Among the materials discussed are dental alloys, including amalgam, mercury, gold and base metals, ceramics and cements. Included are also instructions on purchasing and testing materials and the standard Federal and American Dental Association specifications.

Dental plastics, notably acrylic resins, are more widely used than heretofore for filling teeth, in dental bridgework and in dentures, especially in view of the shortage of rubber for making vulcanite dentures. A Bill to make it unlawful to sell 'mail order dentures' has been passed by the House and is now before the Senate of the United States.

1941: Dentistry

Dental Defects in Draftees.

Dental defects lead all causes for physical rejection of registrants under the Selective Service Act with 20.9 per cent, or over 200,000, of the 1,000,000 men rejected. This was sufficient to impress government defense and public health agencies with the fact, long known to dentists, that the teeth of the nation are badly neglected, although America is conceded everywhere to lead the world in dental education and technical advancement.

An investigation by the United States Public Health Service of dental conditions according to Selective Service standards, of about 1,400 rejectees in West Virginia and Maryland revealed 2.4 teeth per man to require extraction; 7.6 tooth surfaces needed to be filled; and, because on the average, 13 teeth have been extracted, 9 out of every 10 need full or partial artificial dentures. Perennial dental servicing, beginning with childhood is advocated by the United States Public Health Service. Prompt placement of fillings is urged during school attendance, at a rate equal to the incidence with which dental lesions arise.

A program for rehabilitation of dental rejectees was approved by the Board of Trustees of the American Dental Association. This called for dentally deficient registrants to be either inducted into the service and then to have their needs cared for by the respective dental divisions of the armed forces of the Nation, or to be treated privately before induction, partly through the voluntary service of dentists and partly through public funds.

Shortage of Dentists.

The national defense program as now outlined requires 5,220 dentists for the Army and 100 additional dentists each year for the Navy. These requirements, plus other increased demands, represent a reduction of at least five per cent in the number of dentists available for service in civilian life. Over the past few years there has been an actual decrease in the number of dentists practicing in this country, in spite of a growing population.

It has been estimated that the United States requires an additional 2,250 dentists annually in order to maintain the present number of approximately 70,000 practicing dentists. This figure has fallen short by approximately 700 dentists annually.

Dental Education.

A great change in dental education has been initiated at Harvard University. The new program provides for medical and dental students to be taught together in the same classes and in the curriculum of a newly created School of Dental Medicine within the School of Medicine. The combined undergraduate curricula will extend through five academic years, three and one-half in classes with medical students; one and one-half in separate classes in dental subjects. Two degrees — M. D. and D. M. D. — will be awarded on graduation at the end of the fifth year. The number of students to be admitted will be limited annually for the present to fifteen students. It is proposed to discontinue the Harvard Dental School in 1944, after the graduation of the present sophomore, junior and senior classes.

Sulfonamides in Dentistry.

The action of sulfanilamide depends on a minimum concentration of the free drug in the blood, of about 8 mg. per 100 cc. Topical application of the sulfonamides was shown to moderate postoperative discomfort in dental operations, irrespective of the degree of injury involved. Thus infection, rather than tissue damage, will have to be considered the essential factor in producing inflammatory reactions following extraction. Trauma is secondary, although its avoidance is still imperative because the more extensive tissue damage becomes, the wider are the avenues opened for the invasion of contaminated material.

Acrylic Resins for Filling Teeth.

Acrylic teeth for dentures, bridge pontics, acrylic-faced gold inlays, jacket crowns, etc., have been undergoing experimental observation with encouraging reports. The hue effects and graduations of hues of teeth possible with acrylics rivals and may exceed anything achieved in porcelain. Jacket crowns which will withstand stress that would fracture porcelain seems to be a possibility at present. Acrylic teeth, being non-abrasive, will not wear down gold restorations in the opposing teeth.

Priority of Dental Materials.

The Office of Production Management, the War Department, and the Deputy Director of Selective Service have issued a ruling on the priority use of dental materials. It was stated that the dental profession constitutes an activity essential to national health and that a serious interruption may adversely affect the health of the nation. A Pan American Day, the first observance of its kind by the American Dental Association, was held at the Annual Meeting of the American Dental Association at Houston, Texas, Oct. 27-31, 1941. Dental organizations of 18 republics of the Western Hemisphere participated. See also MEDICAL JURISPRUDENCE.

1940: Dentistry

Dental Centenary.

The year 1940 marked the centenary of American dentistry as an organized profession. It was in the winter of 1839-40 that the first dental college in America, the Baltimore College of Dental Surgery, was established, the American Society of Dental Surgeons, the first dental society in America, was organized and The American Journal of Dental Science, the first dental periodical in America, was founded. A formal celebration of the aforementioned events was held at Baltimore in March 1940. Dentists from all over the United States, Canada, South and Central America and from other foreign countries attended. In addition to the scientific program of the Centenary meeting, there was an historical exhibit and a theatrical pageant depicting the evolution of American dentistry from earliest times to the present.

Progress of Dentistry.

A topical review of the discoveries and developments in dentistry and their relation to human welfare during the past hundred years indicates that the profession evolved from a purely mechanical calling to an established branch of scientific health service. Medico-dental relationship has become an accepted fact during this period and diseases of the teeth have become recognized as possible focal areas for the spread of infection to other parts of the body. The treatment of affections of the gums, usually referred to under the collective term 'pyorrhea' has become more effective. The practice of orthodontics (straightening of the teeth) has been extended and improved so that it is no longer a question of mechanical pushing of the teeth, but has now become a process of stimulating growth of the jaws in keeping with biologic principles. Prevention of malocclusion (crooked teeth) and early treatment of dentofacial abnormalities is steadily gaining adherents and promises to become a major phase of dental practice. The role of nutrition and the vitamins in the development of sound teeth in children has become well established, with the importance of prenatal and early infancy nutritional care receiving general support. Oral hygiene, especially as it relates to children has assumed such importance that a new, auxiliary profession, that of dental hygienist, has been established, whose chief duties are to teach mouth hygiene and practice oral prophylaxis.

Instruments and tools used in dentistry have undergone tremendous change and on a par with the highest type of precision instruments, far surpassing those of similar use developed in other countries. The use of the X-ray has become routine in the practice of dentistry and the taking and interpretation of X-ray films has become generally standardized. Asepsis in dental operations is taken as a matter of course.

Role in Anesthesia.

Perhaps the greatest advancement of which dentistry may justifiably feel proud lies in the field of anesthesia. The importance of the adaptation of general and local anesthesia for operations of the jaws and teeth is overshadowed only by its acceptance in general surgical procedure. H. G. Wells of Hartford, a dentist, was the first to employ nitrous-oxide as an anesthetic in 1844 when he had one of his own teeth extracted while under the influence of this gas, known as 'laughing gas' at that time. Well's contribution has since been eclipsed by the claims of W. G. T. Morton, also a dentist, and Crawford Long, a physician, in recently published popular books. However, the role of dentistry in the introduction and development of anesthesia is well-established and universally recognized.

Public Health and Education.

As further evidence of the significance of dentistry in the public health field, it can be pointed out that more than three-quarters of the states now employ dentists in the capacity of public health officers. Dental organizations, in cooperation with the foregoing are conducting refresher courses in the practice of dentistry for children, for those who desire to perfect themselves in this work. A number of universities are now conducting courses in dental public health. The number of hospitals with dental services has been steadily increasing. Many boards of health and of education employ dental hygienists and teachers of dental hygiene in public schools and in health education departments.

It may be indicative of the trend of dental education that Harvard University has seen fit to rename its dental school 'Harvard School of Dental Medicine.' Students are to attend lectures in this school and at the Harvard Medical School, taking three and a half years of the same medical courses as regular medical students, and in addition, one and a half years of specific dental training. Whether this foretells the absorption of dental education by the medical schools remains to be seen.

Endowment and Research.

Endowment for dental purposes, while still grossly deficient at present, has grown apace during the past century. Although significant research in dentistry was being carried on as early as the 1880's, endowment for this purpose dates back not more than the past twenty-five years. Many foundations and philanthropists, notably Eastman, the Guggenheims, Zoller and Samuels, have established dental clinics or donated funds for providing dental care for underprivileged children. Grants in support of dental research are steadily increasing. The Rockefeller Foundation, the Commonwealth Fund and the Carnegie Corporation have materially aided by establishing graduate fellowships and teaching positions. Recently a bill introduced by Senator James E. Murray of Montana, for appropriation of funds by the Federal Government for dental research by the United States Public Health Service, was passed by the Senate. This Bill will make available over $600,000 for research in dentistry.

National Defense.

Although dental requirements of applicants for enlistment into the armed forces are extremely low, a recent survey of rejections of voluntary applicants for enlistment in the Second Corps area, including Greater New York, showed rejections of 23 per cent because of failure to meet dental standards. The foregoing findings are without doubt indicative of the poor dental condition of men throughout the country who come within the compulsory military age limits.

At its Annual Meeting held at Cleveland, the American Dental Association officially offered its full cooperation to the Federal Government in the program of National Defense. The following activities have since been undertaken at the suggestion of Major General James C. McGee, Surgeon General, United States Army: (1) a survey of available dental personnel for military and civilian service: (2) dental service programs which would be conducive to reducing the number of rejections due to dental defects and (3) a program of postgraduate courses for dentists which would familiarize them with the requirements of military dental surgery. According to Brig. Gen. Leigh C. Fairbank, ranking dental officer of the United States Army, the number of military dentists will be increased to 3,000 in order to meet the needs of the enlarged Army following the induction of men under the Compulsory Service Act.

A community plan for dental care, in relation to a national health project, has been published, comprising a report by the Committee on community dental service of the New York Tuberculosis and Health Association, and contains proposals as to organization, salaries and types of service to be rendered, and the method of selection of those to be served in the attempt to raise dental health standards of children and those within the compulsory military age range, as well as the population in general.

1939: Dentistry

During the past year, dentistry celebrated the centennial of the discovery of vulcanized rubber by Charles Goodyear in 1839. In the course of the century, since 'vulcanite' (hard rubber) was adapted for use in making dentures or 'plates,' many attempts have been made to introduce new low cost denture materials such as celluloid, aluminum, gum-resins and others. Outside of gold and stainless steel or the comparatively newer chrome alloys, all denture materials have thus far failed to displace vulcanite in popularity. At present dentures of acryloid resins bid fair to displace vulcanite from its time honored position in denture prosthesis.

Acrylic acid, the parent substance of the acryloid resins, was itself discovered almost a century ago in 1843, but was practically forgotten until 1931 when it was reintroduced in the intermediate layer in safety glass. Tests made at Northwestern University Dental School indicate that the methyl-methacrylate resins of the acryloid group are the most adaptable for denture work. The Research Commission of the American Dental Association, in collaboration with the United States Bureau of Standards, is conducting further tests on denture base materials as well as on other dental materials.

It should not be deduced from the foregoing that dentistry is interested mainly in the perfection of the mechanics as they apply to dental practice. During the year 1939, the Research Commission of the American Dental Association published a volume on Dental Caries (tooth decay) which may establish the long sought for cause of dental decay.

Dental Caries.

Dental Caries is the most prevalent of all diseases. At three years of age, 84 per cent of children examined showed the presence of decayed teeth while at five years of age the percentage jumped to 96. It has been estimated that 98 per cent of the children of the nation suffer from tooth decay which interferes with their general physical development and school progress to varying degrees. The publication of the American Dental Association presents the findings of 195 research workers in 27 different countries throughout the world. While no attempt was made in the above publication to evaluate the findings and the conclusions presented, the work does afford an opportunity for interested workers to learn the essence of the researches in the various fields that they may coordinate their own work. (See also BIOLOGIAL CHEMISTRY.)

Orthodontics.

In order to bring the benefits of orthodontics (popularly known as 'tooth straightening') to a greater number of the children of the nation, the American Association of Orthodontists has established a Bureau of Public Relations. The work of this Bureau is conducted mainly through public health workers, health educators and the medical profession, who are supplied with reliable information relative to the possible prevention of deformities of the face, jaws and teeth. Orthodontic specialists are keenly aware of the great number of children who are being denied the benefits of competent care because of the general lack of information.

World's Fair Exhibit.

Dentistry received due attention at the New York World's Fair. An exhibit for the public was erected in the Medicine and Public Health Building by the Dental Society of the State of New York. This exhibit which occupied over 700 square feet of space portrayed the results of dental neglect, and the benefits of regular dental care and attention. The relationship of the teeth to the body as a whole were shown by means of large automatic models. One of the outstanding exhibits dealt with the relation of dentistry to general public health, from infancy to old age.

Dental Survey.

'Who goes to the dentist?' was answered at least in part in a survey published by the United States Public Health Service. This survey was made to determine the amount and kind of dental care received by a representative sample of the population. Over 70,000 persons, 3 years of age or over were surveyed. According to this survey, one out of every three members of the entire population of the country actually visited the dentist in any one year. However, these visits included free clinic service as well as private dental care. The percentage of persons reported as having visited a dentist in the year before the canvass was made varied greatly with the economic condition of the family. Fully 42 per cent of those who visited a dentist belonged to professional families while only 16 per cent were members of unskilled workers' families. Approximately 15 teeth were filled for each one hundred persons in the low income group while one hundred teeth per one hundred persons were filled in the higher income families.

In the meantime, a publication of the United States Department of Commerce points out that the incomes of dentists are comparatively low when measured in terms of incomes in other professional fields.

Suggested Dental Service Improvement.

Among the methods proposed for making dental care more available was one dealing with lowering of the educational requirements of dentists. 'American dentistry' now regarded as the most outstanding in the world was thought by some as 'too expensive' for the average American citizen. However, when the comparatively low income of dentists is considered, it can readily be seen that lowering the quality of American dentistry is certainly not among the solutions for obtaining more widespread dental care.

As a result of the conditions described in the foregoing and because of the general trend towards the provision of health care either on a government subsidized or insurance basis, the American Dental Association has appointed a National Health Program Committee to represent the Association in helping to frame legislation which would include dental care in a national health program. At a hearing held before the United States Senate Sub-Committee on Education and Labor, which is now considering a health bill, the American Dental Association's Committee made the following proposal among others: That a program of preventive dentistry for children be inaugurated, together with increased efforts in dental health education and in research on the causation of dental disease.

1938: Dentistry

The dental profession continues to show advancement in two distinct directions: (1), preventive dental care and (2), reparative dental service. With the United States Public Health Service leading the way, decay of the teeth, the most prevalent defect found in American school children (over 98 per cent), is being attacked on all fronts. Although the cause of dental caries (decay) has as yet not been definitely established, developments in this field of research indicate that diet, including drinking water, are perhaps main factors. More attention is therefore being given to the dental factor in the feeding of infants before the teeth erupt and even earlier, to the diet of the expectant mother.

Preventive Dental Care.

From a practical standpoint, dentists are urging dental care for preschool children. The care of the baby teeth is of value not only because of their function in chewing but also because affections in the first set of teeth can be transmitted to the second or permanent teeth. It has, moreover, been found that retention of the baby teeth for their full natural period is necessary to the growth and development of the jaws and face as well as for the proper alignment of the permanent teeth as they erupt. At the same time, early extraction of permanent teeth without artificial replacement, especially common in children, initiates drifting of all of the teeth, changes in their relationship which show themselves in the imbalance of the face and, what is of even greater importance, an increase in the number of teeth affected by decay.

Additional evidence of the progress made in the prevention of dental disease is the growth of preventive orthodontic measures intended to forestall gross mal-relationship of the jaws and teeth commonly referred to as 'crooked teeth.' Progress in the methods of treatment of the latter condition continues apace with the recognition of the fact that 'crooked teeth' are really crooked jaws and that changes in the shape of the jaws have to be effected before the teeth can be aligned in a normal position. Muscular exercises for the correction of certain mal-relationships are coming into use as an adjunct to the metallic appliances or 'braces.' In addition to other benefits, parents can now give their children the advantage of a pleasing facial appearance.

In what was known as Youth Lane at the dental convention at St. Louis in October, 1938, hundreds of local prize-winning posters made by school children and gathered from all parts of the country were exhibited. This was the result of the campaign on Dental Health for American Youth initiated by the president of the American Dental Association. The poster campaign has proven of inestimable educational value by emphasizing dental-health care among school children as well as their parents. During the same meeting resolutions were passed calling for the inclusion of measures for the study, reduction and prevention of dental decay among school children of the nation to be included in Federal and state health plans. With the rise in public health activity by Federal, state and local authorities, dentistry which has been pleading its cause in that field for some time has begun to receive increased attention with the result that many states are now including dental health education as well as service among their activities. Many articles and a book dealing with public health dentistry in all its phases have made their appearance. It is now generally recognized among health workers and physicians that dental care is an important phase of general public health endeavor. At the health conference held in Washington, D. C., during July, the American Dental Association went on record as supporting a national program of prevention as well as of universal dental care for school children. Since the prevalence of dental caries is so great, dentists feel that the most logical way to increase dental health standards would be to begin with a program of dental health education directed to the child.

Reparative Service.

On the other hand, dentistry has shown active progress in the development of new techniques and materials for the improvement of artificial appliances used to replace lost teeth. Of importance to those whose business and social duties do not allow them to retire into seclusion during the period when teeth are lost and before artificial replacement can be made is the new method developed by dentists which makes it possible to construct artificial dentures to replace extracted teeth, even before the natural teeth are removed from the mouth. Thus, as soon as the diseased teeth are extracted the artificial denture is inserted into the mouth without interrupting the routine of the patient.

Conservative estimates show that only 20 per cent of the people avail themselves of the services of dentists. Of the many reasons for this low percentage, perhaps the leading one is that people are still afraid of the dentist. This is, however, no longer a valid reason for neglecting one's teeth, and though the use of so-called 'pain-killers' to eliminate dread of the dentist have not proven 100 per cent efficient, newer developments have actually made it possible to perform almost all dental operations with a complete absence of pain. These methods do not necessarily involve the use of general anesthetics such as nitrous oxide, but may be accomplished by the local application of drugs which reduce sensitivity of the teeth themselves.