PUBLIG HEALTH LIBRARY selected LOCAL DENTAL HEALTH PROGRAMS Hartford, Connectioul YO elas COED Alabama lamba CAT. FOR PUBLIC HEALTH Se b AN] MENT) ; eS, { i | : it \ j L | ! iS ul A U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE — Public Health Service PHS pu t 1402 2, 19S oe ~~. '' DISCRIMINATION PROHIBITED—Title VI of the Civil Rights Act of 1964 states: ‘“‘No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program or activity receiving Federal financial assistance." There- fore, the dental programs discussed in this publication, like every program or activity receiving financial assistance from the Depart- ment of Health, Education, and Welfare, must be operated in compliance with this law. ''SELECTED LOCAL DENTAL HEALTH PROGRAMS Contra Costa County, California Hartford, Connecticut Jefferson County, Alabama By George E. Mitchell, D.M.D., M.P.H. Selvin Sonken, D.D.S., M.P.H. and Kathryn J. Connor U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service—Division of Dental Health Washington, D.C. 20201 ''— PUBLIC HEA Acknowledgments The authors wish to express their sincere gratitude to Dr. Polly Ayers (Director, Bureau of Dental Health, Jefferson County Department of Health, Alabama), Dr. Zachary M. Stadt (Public Health Dental Officer, Contra Costa County, California), and to Dr. Leonard F. Menczer (Director of the Bureau of Dental Health, Hartford Health Department, Connecticut) for their coop- eration and assistance in preparing this report. Public Health Service Publication No. 1402 1965 U.S. GOVERNMENT PRINTING OFFICE WASHINGTON, D.C. 20401 ''Contents Introduction__._.___.--.--_________-_-_-_______ 1 The Dental Program of the Contra Costa County Health Department I. Program Background________._._------- =e 3 II. The Dental Program_________---- ees 4 III. Program Activities___.-_. ee 5 The Dental Program of the Hartford Health Department I. Program Background__________________- ee 11 II. The Dental Program__________________ =e 12 III. Program Activities______....-..---- eee 12 The Dental Program of the Jefferson County Department of Health I. Program Background____________________--_---2-- eee 19 II. The Dental Program________________________-__ Le 21 III. Program Activities__________________2 eee 21 '' ''What is the best way to attack the Nation’s serious dental health problem? This is a ques- tion that has long troubled dental public health officials. Although techniques and methods for combating the dental health problem have long been known, organizations, both public and pri- vate, to conduct the attack have too often been lacking. Whose responsibility is this problem? Ac- cording to a statement of policy of the American Dental Association, “Dental health is the re- sponsibility of the individual, the family, and the community in that order.” This policy creates the major objective of a health depart- ment dental program—to provide consultative and educational services for motivating people _to utilize preventive and control techniques against disease. The widespread lack of correct information concerning dental health, along with the far- from-ideal degree to which the public takes ap- propriate action, presents a massive educational challenge to dental public health professionals. The major effort of the community must be to motivate the individual to accept the responsi- bility for his own dental health. However, such motivation will not be possible unless there are strong public health activities at the local or community level. Community dental health programs are particularly effective because they Introduction can be planned specifically to meet the needs of the community involved. A local dental health program should be centered around prevention, health education, and the provision of dental care, but the relative priority for the three types of services will be determined by community needs. If local dental programs already include treatment, or the community leaders and advisory groups de- cide that they should include treatment, then the major share of the budget available will be spent for the dental treatment in the program. When agencies include treatment in their pro- grams, however, budgets are usually consider- ably larger than those which do not include treatment. A clinical program should be a part of but not the only activity of a program of dental public health. Other areas require attention because a dental program supported by taxes should be directed toward the improvement of the oral health of all living within the region that it serves. What is the status of present programs? The information available reveals that dental pro- grams for communities are few in number, ex- tremely limited in stafling, and narrow in scope. With some outstanding exceptions, local health department dental programs have been char- acterized as widely scattered, thinly spread, in- ''adequately staffed with poorly paid personnel, and primarily clinical in nature. Although competent in clinical dentistry, they frequently lack effectiveness in conducting health educa- tion programs or promoting preventive pro- cedures. The situation appears to demand attention. It seems imperative that local programs be es- tablished at a faster pace and that the dental effectiveness of existing programs be increased. In speeding up the establishment of such pro- grams, one very important step has recently been taken. Money has been made available through Federal formula grants which have been specifically appropriated by Congress to support State and local dental health programs. The existing local dental health programs in the United States are of many types. They are operated or sponsored by State and community health departments, welfare agencies, school systems, and various other institutions. The information available concerning these pro- grams is, in general, severely limited. It is known, however, that many suffer from a lack of sound administrative policies and proper coordination. Program managers often lack the ability to select and organize activities so that the best results can be obtained from the resources at hand. For these and other reasons, studies of the best operating programs are badly needed. The American Dental Association and the Commission on the Survey of Dentistry have recognized the need for comprehensive studies of organized dental health programs and have recommended that they be undertaken. The Division of Dental Health of the Public Health Service has begun a series of investiga- tions of organized State, local, and institutional dental health programs working with the advice and cooperation of the appropriate dental health authorities. A detailed study is planned of a number of programs representative of the better local dental programs in this coun- try. The study report—describing program organization, administration, and content— will serve as basic source material and as a guide to local dental program administrators in other areas. This information will also be part of the basic data to be used in developing dental program standards. The three programs covered in this report were selected both for their uniqueness and the variety of their programs. Not only are there differences among the three programs, but there are also important differences among the popu- lation groups living in the areas studied. Demographic characteristics of these groups vary widely. All three localities are primarily urban, but one has a large nonwhite group. Widely separated, one each is situated in the eastern, southern, and western regions of the country. Differences between programs and _ people served should allow for a number of interesting comparisons or observations. Each of these local programs is strong in some areas but weak in others. For example, both the Contra Costa County and the Jefferson County dental health programs place great emphasis on dental health education. Yet the Hartford program has been more successful in promoting fluoridation. Such paradoxes result, no doubt, because dental public health programs must deal with human beings. Operating in dynamic settings, pro- grams constantly require adjustments to poli- tics, public opinion, social situations, and technology. The successful operation of these programs has heartened dental public health officials struggling with the persistent problem of poor dental health among the Nation’s citizens. Widely based and with significant experience, these programs deserve careful consideration by all dental public health officials. Such pro- grams, although all too few in number, have pioneered in the effort to establish meaningful dental health activities at the local level. A1- though community dental health programs have been inadequate in number and scope, ample activity has taken place to demonstrate their worth. If dental health is to be improved, many such local programs must be established or enlarged. ''The Dental Program of the Contra Costa County Health Department I. Program Background A. The County Contra Costa County is a 734-square-mile area across the bay from San Francisco, adja- cent to Berkeley and Oakland in Alameda County. With an estimated 1964 population of 486,000, the county now has about 662 persons per square mile. Rapidly growing, it is ex- pected to have twice as many residents in another 20 years. Centrally located and with a long waterfront, the county has attracted many varied industries whose work force includes a high percentage of trained or skilled employees. Asa result, wages and salaries are above average. For example, in 1963 the effective buying income for households in Contra Costa County was estimated at $8,479 as compared to the national average of $7,130. In 1960, 81 percent of the county’s total popu- lation was classified as urban, with 10 cities ranging from about 10,000 to more than 100,000. Of the total population, 7.4 percent was nonwhite. Compared to the national average, the county has a relatively young population; more than 40 percent of the residents are under 18 years of age. There are an estimated 50,000 preschool children and 142,000 of school age in the county. Of these, about 6,000 attend parochial schools. In addition, more than 6,500 students are en- rolled at two campuses of the Junior College District. (Public schools are operated by au- tonomous, elected school boards, many of which are now being consolidated.) There are 234 dentists in this county, 225 of whom are members of the local dental society. The population-dentist ratio is 1: 2077. B. The Health Department Contra Costa County is governed by an elected board of supervisors under which the health department and other government agencies operate independently. In 1950, the board appointed the present health officer, who serves indirectly under the county administra- tor. Three years later the current dental officer was employed, one of six assistant health officers responsible to the health officer. The depart- ment was reorganized in June 1965, when two semiautonomous districts were established. The health department’s budget for fiscal year 1964 is a little more than $2 million. The dental division has 4 of the total health depart- ment staff of 178 employees and, based on pre- vious expenditures, is currently spending only about 8 percent of the department’s total funds 3 ''C. History Before 1950, the county health department operated a very limited public health program, consisting of sanitation and nursing services and some dental health care. The county’s dental program began around 1921 when a dental hy- gienist was hired by the county superintendent of schools. She used portable equipment to perform routine prophylaxis of children’s teeth. In 1930, a dental hygienist was em- ployed by the health department to work in the rural schools. An annual report the follow- ing year showed that she worked 7 months, in- specting and cleaning teeth and teaching oral hygiene. During the same period, a part-time dentist was employed for 2 days a week to perform extractions and basic dentistry. His services were available only to those unable to pay, whereas the dental hygienist served all school children. By 1935, a second part-time dental hygienist was added to the staff and the two hygienists continued to refer children needing care to the part-time clinicians. Transportation was pro- vided for school children in isolated areas. Dental treatment was discontinued in 1942 be- cause many dentists were entering military service, thus limiting the number available for local dental practice. From that time until 1950, when the present health officer was ap- pointed, there was practically no organized dental health program. In 1950, a new dental program was started with the outfitting of a mobile dental trailer manned by a retired Navy dentist. He was em- ployed to provide limited clinical care such as extractions and fillings. A hygienist employed to work with this mobile clinic inspected chil- dren in the kindergarten and first grade and referred those selected for care to the dentist. One-third of the children in kindergarten and first grade had radiographs taken that were diagnosed by the dentist. The radiographs were sent home to the parent to take to his dentist or, if eligible, the parent could request that treatment be provided. This limited den- tal care program was terminated in 1952. With the employment of the present dental director in 1952, a different approach was 4 adopted to meet the problems of public health. From that time, emphasis was placed on the prevention of dental diseases rather than the treatment of specific dental conditions. Grad- ually, as experienced was gained, the current program took shape. ll. The Dental Program A. Objectives The objectives of the present program are to determine the extent of the dental health needs in Contra Costa County and to support a con- tinuing preventive program through health education activities, public observations, and re- ferrals. Since effective dental health education is a fundamental goal of the program, all proj- ects are planned to stimulate the participation of various groups in the community. The efforts of the health department are reinforced by involving elements of the lay public as well as representatives of the professions in promot- ing good dental health and services for all. B. Personnel To carry out this program, the dental divi- sion employes a full-time public health dentist, two dental hygienists, and a clerk. Two of the Contra Costa County school districts, Pitts- burgh and Richmond, each employ a dental hygienist. The two hygienists serve 95,000 school children, or a dental hygienist popula- tion ratio of 1:47,500. The dental director has requested that another hygienist be hired, which would reduce the ratio to 1: 31,700. C. Salaries The 1964-65 minimum and maximum monthly salary ranges for the four employees of the dental division are: Minimum Mavimum Public health dentist-___________ $1, 242 $1, 511 (2) Dental hygienists (each) ____ 543 660 Clerical worker_________________ 436 530 ''In addition to this regular staff, the health edu- cators and public health nurses promote interest in dental health. Under the districting plan, the chief health educator works with central staff in developing new ideas and evaluation. Each of the two districts has its own health educator and staff of public health nurses. Each health educator is responsible for health education activities in half of the county. Priorities are established in consultation with the district health officer. The health educator working with the dental division orders audio- visual aids, pamphlets, reprints, and other in- formational material at the request of the dental officer. He also prepares special posters and may develop his own material for the dental division. D. Budget More than half a million dollars of tax revenue ($544,900) was spent for dental health activities by all the county’s official agencies in fiscal year 1962. Less than 10 percent of this amount ($46,000) was spent directly by the dental division. Local funds made up $42,300 of the division’s expense, $3,040 came from Fed- eral funds, and $660 from State funds. The average per capita expenditure of the dental program amounted to 11 cents. The funds for this program, except those for personnel, are directly controlled by the health officer. In addition to the money spent directly by the dental division, the health department spent $39,000 for orthodontic services through the crippled children’s program. Dental treatment for indigents in Contra Costa County is provided through the services of the county hospital outpatient department, and the referral system of the social service de- partment. In fiscal year 1962, these agencies spent amounts estimated at $115,000 and $277,- 500, respectively. Other funds spent for dental health activities during this period include $45,000 by the Contra Costa Junior College District to train dental auxiliary personnel on its two campuses. The probation department spent $4,500 for dental services provided to wards of the court. 793—215—66——2 Ill. Program Activities The three basic activities of the Contra Costa County dental program are dental health edu- cation, inspection and referral, and the pro- motion of dental care and services. ae : ny, ae I 7 i es eam! yey - a ec i aad eal ''a ay iL As f ge gl Fl Ly oT = a : '''' U.C. BERKELEY LIBRARI wenn cOe9etb??? ''