3S,s«t?'|soFFsrrE jSTANDARD * _Dentalhygiene;pub| RECAP RK2L CoUege of ^ijjjgiciansf anb ^urgeonfi Hifararp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/dentalhygienepubOOmill CALIFORNIA STATE BOARD OF HEALTH -SPECIAL BULLETIN No. 21 DENTAL HYGIENE Public Dental Clinics in California and Their Purpose BT GUY S. MILLBERRY, D. D. S. Dean College of Dentistry University of California ISSUED BY CALIFORNIA STATE BOARD OF HEALTH MARCH 1, 1917 CALIFORNIA STATE PRINTING OFFICE SACRAMENTO 19 17 PUBLIC DENTAL CLINICS IN CALIFORNIA AND THEIR PURPOSE. By Gut S. Millberry, D.D.S., Dean of the College of Dentistry, University of California. This wonderful state with its vast resources, its varied climatic conditions, its opportunity for living out of doors, offers every possible advantage for the maintenance of good health. Good health is essen- tial to the progress of humanity and the achievement of individual success. The foundation of good health is, first, the practice of hygienic methods of living, whether it be while at work, at rest, or during our recreation; and, second, the effective prevention of the spread of disease. The former deals primarily with the individual, the latter largely with the community. Sacramento Public School Dental Clinic. To prevent epidemics which may impair the health of the people of a community, laws are enacted in the form of quarantine regulations, ordinances to prevent the pollution of water and milk supplies, pure food laws, etc. The health of a given locality, however, is in reality the sum total of the health of the individuals in that locality. The care of the mouth and teeth plays a very important part in this phase of public health, and it is because of this that public dental clinics have' been established in many cities throughout the world. Nearly all of the diseases which flesh is heir to are either infectious diseases, that is they occur as a result of bacterial invasion, or they are the aftermath of some previous infection. The majority of them find their way into the body through the mouth or nose, either with the air we breathe, the food we eat, the liquids we drink, from cooking utensils, our hands, clothing, etc. Some diseases such as measles, chickenpox, scarlet fever, smallpox, and other skin diseases, if acquired during the period when the teeth are forming, may have a very bad effect upon such teeth, producing serious defects which later in life may impair the general health of the individual or mar his or her appearance. - 3 The conditions under which disease germs thrive most favorably are darkness, moisture, suitable temperature, and food. All of these con- ditions are to be found in the mouth. The conditions which are unfavor- able to the growth of these germs and the diseases they cause are clean- liness, and normal bodily or biologic resistance, the latter depending upon the state of health. Cleanliness, as one of the most potent factors in maintaining normal health and mouth hygiene as practiced by the individual, is no exception to the rule. Importance of Mouth Hygiene. Sound teeth enable one to properly masticate the food which provides the body with nourishment to build bodily resistance. The daily cleansing of the mouth and teeth removes large numbers of disease producing germs which might otherwise find their way into the body and cause disease, either in a brief time or perhaps aft^r a long time, for some of the diseased conditions in remote parts of the body, having their origin in the mouth, may have had their begin- ning twenty-five years before the symptoms become alarm- ing, so insidious are these causes. The tendency in the estab- lishment of dental clinics has been to educate both by precept and practice in order to overcome the in- herent fear which all people have for dental operations. News notices, lectures and, books arouse interest, but they are not as effective as a method which will carry the teachings into the school and the home. There is a natural abhorrence on the part of many people to read or discuss matters pertaining to health and hygiene, but happily we are awakening to a realization- that knowl- edge and not ignorance of disease is the best safeguard against it. Lectures do not have the same effect as personal contact with the individual, for the individual is directly concerned with his own health,. and the lesson can be much more forcibly impressed without encounter- ing as much skepticism or antagonism. The most important thing for us to remember is that practically all dental disorders are preventable. This applies as well to disease in other parts of the body as may have originated from a focus of infection in the mouth, such as an alveolar abscess, a pyorrhoeal pocket, or from San Francisco Public School Clinic, in oral hygiene. Instruction — 4 — an insufficient number of sound masticating teeth, resulting in digestive disorders. The prevention of dental disorders, and their sequelae, may be divided into two orders of procedure. First and most important is the practice of mouth hygiene by the patient. This consists of brushing the teeth- carefully at least twice a day from the gums toward the biting surfaces with a rotary motion to remove all the food debris and mucous deposits. Main operating room in San Quentin State Prison Dental Clinic. and the additional u>se of a mouth syringe or floss silk for cleansing the surfaces the brush does not reach. The second procedure includes such prophylactic treatment as may be given by the dentist in removing the hard calcareous deposits and stains, and restoring to normal such teeth as may require operative work. Value of Public Dental Clinic. If the daily practice of mouth hygiene is begun early in childhood and done thoroughly, and frequent regular visits are made to the dentist for prophylactic treatment if necessary, there is very little danger of decay or inflammatory disturbances occurring. There is enough evi- dence to substantiate this statement, even though 90 per cent of the people are afflicted, because they are either uninformed as to the importance of the care and conservation of the teeth, or they are unable to afford dental service. The public dental clinic will supply both the information, and for the children at present, dental service. School dental clinics originated in Europe. From the "viewpoint of municipal interest and support they have developed rapidlj- in Germany and England. They were instituted shortly after the Boer war, when it was learned that not only a large number of regular soldiers were incapacitated because of dental disorders but that most of the recruits were rejected for the same reason. The public schools being the prin- cipal assembling places for the classes of people from which the recruits were drawn it was decided to institute preventive measures therein, in order that the health of the common people might be conserved as a bulwark to the nation, both in war and industry. In America, while there are many more cities in which dental clinics have been established than in Europe, the majority of them are privately maintained by parent-teachers organizations or dental associations, or they are endowed. Their permanence and usefulness depend entirely upon municipal support. Every large city and every county maintains its hospital for the care of the indigent sick, but very few maintain a dental clinic or employ the services of a dentist in connection therewith. The care of every other human ailment is provided for except the care of the mouth and teeth, though occasionally a tooth may be extracted by a surgeon or steward. Yet many of the diseases which are responsible for the patients residence in such institutions, at the expense of the city or county, are due to diseased conditions of the mouth, and are not eradicated until the mouth is put in order. Is it not better to provide good dental service for those who are suffering from these conditions? Physical Development Necessary. These are some of the reasons why those most conversant with the problem are desirous of having the physical development of the child in the school receive as much consideration as his mental development. There is no desire to interfere with the rights of parents or the influences of the home, but in so many instances it has been found that the parents were ignorant of conditions, so that it was advisable to recommend or undertake dental treatment in justice to the child. The terms "medical" or "dental inspection" should not be used in connection with such health and hygiene propaganda, for inspection implies an interference with one 's personal rights or liberties and though usually just, is seldom graciously accepted. I believe the greatest antagonism to these move- ments has been aroused by the use of the word inspection. In California, the movement began in 1910 in San Francisco and Los Angeles, the initiative being taken by the dental societies in both cities as well as in Sacramento, Oakland, Berkeley, San Jose, Pasadena, San Diego and other cities shortly afterward. Depending on voluntary serv- ice, cheerfully given at first but later becoming less dependable, they were continued with variable degrees of efficiency or were discontinued altogether. Renewed agitation and the pressing need of dental serv- ice for certain groups of children aroused further interest which was extended to other social organizations and municipal boards with the result that a fairly constant or improved and increasing service is being rendered to those most in need and unable to pay. Work of Dispensaries. The social and civic bodies, such as parent-teachers clubs, have been largely instrumental in securing funds and equipment as well as creat- ing municipal interest in this work. They were wholly instrumental in — 6 — securing a fund of $45,000.00 for the erection of a public school dis- pensar}' in Los Angeles, Mr. 0. T. Johnson being the donor. This new dispensary, opened October 1, 1916, is given over to the care of those children who may need dental, eye, ear, nose or throat treatment. From those who can afford to pay a small fee is collected, the other sources of revenue for general maintenance being from entertainments and from parent-teachers circles. The salaries of three dentists and the two assistants are paid by the Board of Education, while the physi- cians give their services without compensation. In 1915-16, 1,345 chil- dren were cared for, involving 7,482 operations. Twelve thousand cases Dental Clinic in a Department Store, San Francisco. have been handled in the past five years. Along with this work, sys- temic instruction in mouth hygiene in the schools is being inaugurated. In San Francisco the results until the last half year have been less satisfactory. Undertaken by the San Francisco District Dental Society with the aid of the Associated Charities it was carried on for two years, then continued by the Associated Charities for over a year and finally discontinued. The Congress of Mothers revivified the interest early in 1916 and were able to secure an appropriation of $3,000 from the board of supervisors for the fiscal year 1916-17. Two dentists and two assist- ants were appointed and have been carrying on the work in eleven different schools. During three and a half months, ending Decem- ber 15, 1916, 1,255 operations were performed on 368 pupils. The work has been carried on in districts where the need was greatest, and a liberal allowance of time has been spent in giving instruction to the classes in mouth hygiene. Sacramento has carried on a most effective work. Instituted in 1911 by the Board of Education, a well-equipped and liberally maintained clinic has been rendering good service ever since. In 1916, 813 new- patients were registered with a total of 3,608 operations to_ the credit of the dentist and his nurse. An average of seven appointments a day, with all necessary work except gold work being done, is the general — 7 — report. San Diego, Pasadena, Merced and Berkeley have regular clinics, and Stockton, having received municipal support, is just establishing one. Emergency and Permanent Service. While this character of public dental service is preventive, in that it offers instruction in mouth hygiene, as well as providing dental service, there are a number of public dental clinics which aim to provide emer- gency and permanent service for the relief of suffering, in institutions where large groups of people are housed either permanently or tempo- rarily. Without such service, these people, at times, have been obliged to suffer excruciating pain from dental disorders. The penal institutions at San Quentin and Folsom now provide dental service. It was instituted in 1913. To quote Warden Johnston in a paper recently presented before the San Francisco District Dental Society, speaking of the health of the inmates, "while physical better- ment may not be the most important, it is the most necessary in that it is a prerequisite to mental and moral progress" and "how they ever managed to get along in years past without a dentist is beyond under- standing. " Every person is examined at the time of entrance and the condition of the teeth and oral cavity noted. The records show that ■91 per cent require dental attention. A complete equipment, modern in every detail, affording every possible facility for rapid and efficient service and for the relief of pain is provided. In the Juvenile Detention Home in San Francisco Mr. J. C. Astredo has installed a complete dental equipment. At present the appropria- tion permits of only two half -day's service a week, which is wholly inadequate. Only emergency service can be rendered except in a few instances and since the period of residence is generally transient the teaching of mouth hygiene is not as effective as it should be. However, the health department as at present organized, will be able to improve these conditions in time. Dental Equipment in Hospitals. In no place is the need for dental equipment and service greater than in the large hospitals. Los Angeles recognized this several years ago and has had a dentist on the permanent staff giving full time service. During the fiscal year ending July 1, 1916, 2,091 operations were per- formed. Included in this were 14 fracture cases. Probably no feature of this service is more important than the eradication of septic foci, by removing diseased teeth and roots and giving prophylactic treatment prior to surgical operations upon the nose, throat, or gastro-intestinal tract. At Lane Hospital, Stanford University Medical School, a dentist gives half time service. All cases in the orthopedic clinic, where diseased teeth are suspected as being a primal cause, are first referred to the dental clinic for radiographs, and such prophylactic or surgical treatment as may be necessary in handling the case. The dental clinic also cooperates with the nose and throat clinic in handling cases. At the San Francisco Hospital a resident dentist is now employed, giving half time to the hospital service where during the past four months 505 operations have been performed for 182 patients and half 8 — time to the care of the foster mother children, whose welfare is in the hands of the Associated Charities. Five hundred and nine operations have been performed for 109 of these children, about one-fifth of the number who require service. The commercial interests of the state, realizing that the conservation of the health of their employees is good business policy, have in some instances made careful pro- vision for their physical betterment. A department store in San Francisco, in conjunction with its hos]")ital service which is under the supervision of the Welfare Department, has rendered dental service gratuitously to its 1,500 employees for the past three years. An average of 135 operations per month are rendered by the dentist, with an assist- ant giving half time service, and these include jjerma- nent service of a minor char- acter, emergency and prophylactic service. The employees are instructed collectively by illustrated lectures as well as individu- ally on the care of the teeth by the dentist. A follow up system determines whether the individual patients conform to t,he instruction given. Each new employee in undergoing the required physical examination is referred to the dentist as well. The University of California has installed at the Infirmary on the campus at Berkeley two dental equipments with two dentists and one nurse in full time service. Physical examination includes the oral cavity and instruction is given to all freshman students under the Department of Hygiene. Berkeley Public School Dental Clinic. Public Dental Clinics a Necessity. Public dental clinics are just as necessary for the physical welfare of humanity as are hospitals. The conditions which necessitate their establishment are more prevalent than any other form of human ailment and though usually less acute, are generally more insidious than all others. It is the generally accepted belief that all dental disorders and their sequelae are preventable, so that from an economic viewpoint the establishment of school and other public dental clinics is worth careful consideration as a profitable investment in any community. COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special arrange- ment with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE C28(i14i)m100 T)en^a AQA-iii A /1i R i ^.^^.Ajl^^-l.