Introduction to Dental Public Health

MODULE © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT INTRODUCTIONFOR SALE OR DISTRIBUTION TO DENTAL NOT FOR SALE OR DISTRIBUTION PUBLIC HEALTH

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC HistoryNOT and FOR Principles SALE OR DISTRIBUTION of Dental NOT FOR SALE OR DISTRIBUTION Public Health 1 © JonesObjectives & Bartlett Learning, LLC © JonesASSESSMENT & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTDocumentation FOR SALEDiagnosis OR DISTRIBUTION After studying this chapter and completing the study questions and activities, the learner will be able to: • Define dental public health. • Define common public health terms. © Jones & Bartlett• Describe Learning, three core LLC functions of public health. © Jones & Bartlett Learning, LLC NOT FOR SALE• ORDescribe DISTRIBUTION what constitutes a public health problem. NOT FOR SALE OR DISTRIBUTION • Describe the four phases in the history of public health. Evaluation PLANNING • Identify key organizations and events that have shaped dental public Implementation health. • Identify federal agencies involved in public health activities.

KEY TERMS© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION American Association of Public Canadian Association of Public National Center for Health Statistics Health Dentistry Health Dentistry National Institute of Dental and American Board of Dental Public Community Craniofacial Research Health Core public health functions Pan American Health Organization © JonesAmerican & Dental Bartlett Hygienists’ Learning, LLCDental public health © JonesPublic health & Bartlett Learning, LLC Association Health Social Security Act NOTAmerican FOR Public SALE Health OR Association DISTRIBUTIONHealthy People NOTSurgeon FOR General’s SALE Report OR on DISTRIBUTION Oral Association of State and Territorial Institute of Medicine Health Dental Directors Maternal and Child Health World Health Organization

See Appendix 3 for the ADEA competencies addressed in this chapter.1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION provide you with the skills and knowledge neces- Introduction sary to be a valuable contributor in the commu- As you begin to explore the public health aspects nity in which you practice. of the oral health profession, you will find both It is essential all oral care providers, regardless differences and© similarities Jones & to Bartlett your clinical Learning, expe- of LLC practice location and mode,© are Jones aware of& theBartlett Learning, LLC riences. This chapter highlights the history and unique problems in ensuring oral health for all philosophy of NOTdental FORpublic SALEhealth, the OR structure DISTRIBUTION members of society and participateNOT inFOR the soluSALE- OR DISTRIBUTION of the profession, and the goals of public health. tions. This text is developed around the philosophy You may find many of your clinical skills in treat- that all members of the oral health professions, ment planning, problem solving, and critical and our allies from outside the profession, are all thinking are valuable in identifying and solving pieces of a puzzle that, when complete, would © Jonespublic health & Bartlett issues in Learning,the communities LLC in which assure oral health© Jones for all members& Bartlett of society. Learning, You LLC NOTyou FOR choose SALE to practice. OR ItDISTRIBUTION is the aim of this text to will also discoverNOT that FOR the puzzleSALE is ORnot completeDISTRIBUTION

CHAPTER 1 / HISTORY AND PRINCIPLES OF DENTAL PUBLIC HEALTH 3

and there is much opportunity for providers of definition does not define what constitutes a all types to© help Jones shape &and Bartlett complete Learning,the puzzle. LLChealthy public so much as it© provides Jones a & descrip Bartlett- Learning, LLC It may seemNOT that FOR in comparing SALE OR public DISTRIBUTION health tion of the professional NOTdiscipline FOR of SALEpublic OR DISTRIBUTION with private practice, they are separate from one health and the method used by that profession another. In fact, they are all pieces of the same to attain or maintain public health. In 1955, J.W. puzzle. Although private practice settings treat a Knutson5 also defined the discipline, reflect- significant portion of the population, public health ing the community nature of public health as, © Jonesreaches & outBartlett to many Learning, who may not LLC have access to “Public health© Jones is people’s & Bartlett health. It isLearning, concerned LLC NOT thatFOR mode SALE of care. OR It DISTRIBUTIONrequires everyone’s unique with the aggregateNOT FOR health SALE of a group, OR DISTRIBUTIONa commu- abilities working together to complete the puzzle. nity, a state, or a nation.” In 1988, the Institute As you learn about public health, consider how of Medicine (IOM)6 defined the mission of you, in the type of practice you eventually choose, public health as “… fulfilling society’s inter- can help complete the puzzle. est in assuring conditions in which people can © Jones & Bartlett Learning, LLC © Jonesbe healthy.” & Bartlett Interestingly, Learning, this LLC last definition NOT FOR SALE ORWHAT DISTRIBUTION IS DENTAL PUBLIC HEALTH? NOT FORincludes SALE “society’s OR DISTRIBUTIONinterest” as a component in the attainment of the public’s health. As you will encounter throughout this text, the interest, health If someone were to ask you about your , acceptance, and input from recipients of public how would you respond? Great? Good? Poor? health interventions are important elements of Lousy? Do you think only of your physical status © Jones & Bartlett Learning, LLCpublic health practice. © Jones & Bartlett Learning, LLC and not your mental mindset? Over time, many If we add oral health to our exploration of the people haveNOT attempted FOR to SALE define health.OR DISTRIBUTION Webster definition of health, we nextNOT attempt FOR to SALEdefine OR DISTRIBUTION defines health as “physical and mental well-being; dental public health. Dental public health freedom from disease.”2 This is an abbreviated is one of nine specialties of dentistry recog- version of the often-used definition established nized by the American Dental Association. The in 1948 by the World Health Organization 3 definition of dental public health adopted by the © Jones(WHO) & :Bartlett “health is Learning,a state of complete LLC physical, American© Board Jones of & Dental Bartlett Public Learning, Health LLC NOT mental,FOR SALE and social OR well-being DISTRIBUTION and is not merely (ABDPH),NOT the governing FOR SALE body forOR the DISTRIBUTION specialty, the absence of disease or infirmity.” How does defines dental public health as: one know when they have complete physical, mental, and social well-being? What about the “The science and art of preventing and control- multitude of people who live with chronic dis- ling dental diseases and promoting dental health © Jones & Bartletteases, Learning, such as LLCdiabetes or hypertension, and© Jonesthrough & Bartlett organized Learning,community efforts. LLC It is that consider themselves healthy? Even given the form of dental practice that serves the commu- NOT FOR SALE ORavailability DISTRIBUTION of a definition by a preeminent healthNOT FORnity as SALE a patient OR rather DISTRIBUTION than the individual. It organization like WHO, can one definition suf- is concerned with dental health education of the fice for all of the nuances and individual percep- public, with applied dental research, and with tions that surround health? Attempting to define the administration of group dental care pro- health as a dichotomy when it is, in reality, a grams, as well as the prevention and control of continuum ©continues Jones to & present Bartlett difficulties. Learning, LLCdental diseases on a community© Jones basis.”7 & Bartlett Learning, LLC A similarNOT difficulty FOR is SALEpresent ORwhen DISTRIBUTION defining NOT FOR SALE OR DISTRIBUTION The Canadian Association of Public public health. If health is difficult to define, Health Dentistry similarly defines public how does one define public health? A defini- health dentistry: tion presented by Winslow4 in 1920 is still used today. He defined public health as “the science “Dental public health is concerned with the diagno- © Jonesand art& Bartlettof preventing Learning, disease, prolongingLLC life, sis, prevention,© Jones and control & Bartlett of dental Learning, diseases and LLC NOT andFOR promoting SALE ORphysical DISTRIBUTION health and efficiency the promotionNOT of FOR oral healthSALE through OR DISTRIBUTION organized through organized community efforts.” The community efforts. Dental public health serves

4 MODULE 1 / INTRODUCTION TO DENTAL PUBLIC HEALTH

the community as the patient rather than the sions for the person in your chair are impacted individual, through© Jones research, & Bartlett health promotion, Learning, byLLC the larger community and© Jonesthe setting & Bartlettin Learning, LLC education, andNOT group FOR dental SALEcare programs.” OR DISTRIBUTION8 which the person is treated, alongNOT with FOR financ SALE- OR DISTRIBUTION ing mechanisms. Dental public health positions These definitions incorporate the concept of require skills in assessing and diagnosing com- the community as the patient, rather than the munity oral health needs; planning, implement- individual, a key concept of public health that ing, and evaluating community-based oral health you will encounter throughout this text. The defi- © Jones & Bartlett Learning, LLC programs; providing© Jones educational & Bartlett services; Learning, apply- LLC nitions also articulate the importance of public ing research; using epidemiology; formulating NOTeducation, FOR SALE research, OR and DISTRIBUTION program administration NOT FOR SALE OR DISTRIBUTION policy; advocating; and understanding the orga- to control disease on a community level; how- nization of health care. The specific competen- ever, they may fall short in addressing the impact cies for community involvement stated in the of societal changes and the role played by various Competencies for Entry into the Profession of models of health care. In addition, the ABDPH Dental Hygiene (American Dental Education © Jones & Bartlettdefinition Learning, was adopted LLC prior to the increased© Jones & Bartlett Learning, LLC Association [ADEA])1 and the competencies for NOT FOR SALEacceptance OR DISTRIBUTION of the term oral health rather thanNOT FOR SALE OR DISTRIBUTION dental public health practitioners7–9 express the dental health, whereas the Canadian version specific skills needed for practice or employment uses the term oral health. This terminology has in dental public health. These will be explored in changed, replacing the term dental health with more detail in Chapter 4. In addition, all of the oral health to emphasize more than just teeth dental hygienist roles described by the American in the oral cavity.© Jones Professionals & Bartlett recognize Learning, that LLC © Jones & Bartlett Learning, LLC Dental Hygienists’ Association (ADHA)10 oral cavity health extends beyond dental care of NOT FOR SALE OR DISTRIBUTION(advocate, educator, clinician,NOT researcher, FOR SALEand OR DISTRIBUTION the teeth and supporting structures. Lately, the administrator/manager) illustrate the close align- general public has begun also to make the con- ment between dental hygiene and public health nection beyond teeth and gums. With oral health practice. It should not be overlooked that all now known to be so influential in the general dental professionals can and should become health of the body and vice versa, it is time to © Jones & Bartlett Learning, LLC involved in community© Jones public& Bartlett health Learning,efforts. A LLC incorporate a broader scope for ensuring the NOT FOR SALE OR DISTRIBUTION clear understandingNOT FOR of public SALE health OR principles DISTRIBUTION public’s oral health. The term oral health also is necessary for all oral health practitioners to encourages other groups to readily join the effort meet this challenge. It is the ethical responsibil- in improving the public’s oral health when the ity of all health care practitioners to work toward effort is not so closely aligned with the term den- improvement of the health of the community, tistry. Unfortunately, dentistry is too often seen especially for those who have limited access to © Jones & Bartlettas an Learning, exclusive profession, LLC keeping a distance© Jones & Bartlett Learning, LLC care or cannot advocate for themselves. NOT FOR SALEfrom OR theDISTRIBUTION rest of the health care system. ThisNOT FOR SALE OR DISTRIBUTION may be perceived as a barrier for other partners outside the oral health professions who may join in our efforts. Other groups interested in oral CORE PUBLIC HEALTH PRINCIPLES health may include other health care provider groups, citizen© coalitions, Jones philanthropic& Bartlett organizaLearning,- Public LLC health is often an invisible© Jones infrastructure & Bartlett Learning, LLC tions, third-partyNOT payers, FOR schools, SALE faith OR organiza DISTRIBUTION- until crisis occurs. The publicNOT health FOR infra SALE- OR DISTRIBUTION tions, and businesses. structure includes all governmental and non- The most distinctive difference between pub- governmental entities that provide any public lic health practice and private practice is the health services.11 From how many public health concept of the community as the patient. In pri- measures have you personally benefited? Have © Jonesvate practice, & Bartlett the patient Learning, is the person LLC currently you been immunized?© Jones Do & youBartlett drink fluoridated Learning, LLC NOTin theFOR dental SALE chair OR and DISTRIBUTION care is provided based water? WhatNOT other measuresFOR SALE can you OR think DISTRIBUTION of? on the individual’s needs and desires. In public A recent trend in business and government is health, even in a clinical setting, the care deci- increased accountability. For example, schools

CHAPTER 1 / HISTORY AND PRINCIPLES OF DENTAL PUBLIC HEALTH 5

are expected to be accountable to the public A S © Jones & Bartlett Learning, LLC © JonesSE & Bartlett Learning, LLC SS for the educational achievement of their stu- M E dents, businessesNOT FOR must SALEbe more OR accountable DISTRIBUTION NOT FOR NSALE OR DISTRIBUTION Evaluate Monitor T to clients and investors, and government enti- Health ties must be more accountable to the taxpayers Assure who fund their programs. In this era of demand Diagnose & Competent an M ag for greater accountability, it is incumbent on m e Investigate E Workforce e m t e C s © Jonesschools, & businesses,Bartlett Learning, and governments LLC to develop © Jones & Bartlett Learning, LLC y n N t S

methods to evaluate and ensure quality in their A Research NOT FOR SALE OR DISTRIBUTION R LinkNOT to/ FOR SALE ORInform, DISTRIBUTION respective endeavors. Dental public health prac- U

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tice is not without guidelines, competencies, A Care Empower P

goals, and expectations at all levels of prac-

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Association of State and Territorial Dental Develop L

NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONO P

Directors (ASTDD), have developed frame- Policies M E

T works to assess progress, quality, and success in public health.6,12,13 These frameworks work well to elucidate the nature of public health practice. FIGURE 1-1 The government’s role in public health.12 In 1988,© the Jones IOM6 delineated& Bartlett the Learning, core func- LLC © Jones & Bartlett Learning, LLC tions of public health agencies as assessment, All of these important public health func- policy development,NOT FOR and SALE assurance OR (BoxDISTRIBUTION 1-1). tions are interrelated and continuousNOT FOR and SALE based OR DISTRIBUTION This landmark report prompted the public on evidence provided by research to form a health community to look closely at services pro- strong foundation for public health practice. vided and develop a statement of core public This interrelationship is illustrated in Figure 1-1 health functions that are considered essential by the diagram developed by the Public Health © Jonespublic & health Bartlett services Learning, (Box 1-2). 12LLC Functions© Steering Jones Committee. & Bartlett12 Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

BOX 1-1 The Role of the Government in Public Health—Core Functions of Public Health Agencies © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORAssessment: DISTRIBUTION Each public health agency regularlyNOT andFOR systematically SALE OR collects, DISTRIBUTION assembles, analyzes, and makes available information on the health of the community, including statistics on health status, community health needs, and epidemiologic and other studies of health problems. Policy Development: Each public health agency exercises its responsibility to serve the public interest in the development of comprehensive pubic health policies by promoting use of the scientific© Jones knowledge & Bartlett base inLearning, decision making LLC and leading in the development© Jones of public& Bartlett Learning, LLC health policy.NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Assurance: Public health agencies assure their constituents that services necessary to achieve agreed upon goals are provided by encouraging actions by other entities, requiring such action through regulation or providing services directly. Each public health agency involves key policy makers and the general public in determining high-priority personal and community-wide health © Jonesservices, & Bartlett which theLearning, government LLC guarantees to every member© of Jones the community. & Bartlett Learning, LLC NOT FORFrom SALE The Future OR of PublicDISTRIBUTION Health. Institute of Medicine. National AcademyNOT of Sciences, FOR 1988.SALE6 OR DISTRIBUTION

6 MODULE 1 / INTRODUCTION TO DENTAL PUBLIC HEALTH

© Jones & BartlettBOX 1-2 Learning, Essential LLC Public Health Services © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION What Public Health Does (The Purpose of Public Health): • Prevents epidemics and the spread of disease • Protects against environmental hazards • Prevents injuries © Jones• Promotes & Bartlett and encourages Learning, healthy LLC behaviors and mental health© Jones & Bartlett Learning, LLC NOT •FOR Responds SALE to disastersOR DISTRIBUTION and assists communities in recovery NOT FOR SALE OR DISTRIBUTION • Assures the quality and accessibility of health services. How Public Health Serves (The Practice of Public Health) (Essential Services): • Monitors health status to identify and solve community health problems • Diagnoses and investigates health problems and hazards in the community © Jones & Bartlett• Learning,Informs, educates, LLC and empowers people about© Jones health issues& Bartlett Learning, LLC NOT FOR SALE OR• Mobilizes DISTRIBUTION community partnerships and actionsNOT to FORidentify SALE and solve OR health DISTRIBUTION problems • Develops policies and plans that support individual and community health efforts • Enforces laws and regulations that protect health and ensure safety • Links people to needed personal health services and assures the provision of health care when otherwise unavailable • Assures a© competent Jones & public Bartlett and personal Learning, health LLCcare workforce © Jones & Bartlett Learning, LLC • EvaluatesNOT effectiveness, FOR SALE accessibility, OR DISTRIBUTION and quality of personal and population-basedNOT FOR health SALE OR DISTRIBUTION services • Researches for new insights and innovative solutions to health problems.

From Public Health in America, Fall 1994. Public Health Functions Steering Committee.12 Available at: www.health.gov/ © Jonesphfunctions/public.htm. & Bartlett AccessedLearning, August 2008.LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Following this report of essential public health public health workforce responded to all public functions, the ASTDD further developed the list concerns regarding health, it would result in a © Jones & Bartlettof services Learning, as it relates LLC directly to dental public© Jonesreactive, & knee-jerk, Bartlett inefficient,Learning, and LLC ineffective NOT FOR SALEhealth OR DISTRIBUTIONservices provided at the state level (BoxNOT response FOR SALEto society’s OR health DISTRIBUTION needs. 1-3).13 These guidelines, used at national, state, The current criteria used to define a public and local levels, provide a unified framework for health problem are (i) a condition or situation all public health efforts, allowing all public health that is a widespread actual or potential cause of programs to work toward common goals. The morbidity or mortality, and (ii) a perception on common framework© Jones also &allows Bartlett for better Learning, col- the LLC part of the public, the government,© Jones or public& Bartlett Learning, LLC laboration, sharing of information, and documen- health authorities that the condition is a public tation of successNOT among FOR public SALE health OR partners. DISTRIBUTIONhealth problem.14 This definitionNOT allows FOR a broad SALE OR DISTRIBUTION interpretation of a public health problem in DEFINING A PUBLIC HEALTH PROBLEM that “widespread,” “potential,” and “perception” can all be interpreted differently in different © JonesAfter defining & Bartlett the role Learning, of public health LLC and the situations with© Jonesdifferent & threats Bartlett to the Learning, public. LLC essential services that should be provided, what Bioterrorism, West Nile Virus, Severe Acute NOTconstitutes FOR SALE a public OR health DISTRIBUTION problem that warrants Respiratory SyndromeNOT FOR (SARS), SALE natural OR disasters,DISTRIBUTION resources applied toward its solution? If the automobile safety, water purification, and oral

CHAPTER 1 / HISTORY AND PRINCIPLES OF DENTAL PUBLIC HEALTH 7

© Jones &BOX Bartlett 1-3 Essential Learning, State LLC Dental Public Health Services© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Assessment Assess oral health status and needs Analyze determinants of identified needs Assess fluoridation status of water systems and other sources of fluorides © Jones &Implement Bartlett oral Learning, health surveillance LLC systems © Jones & Bartlett Learning, LLC NOT FORPolicy SALE Development OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Develop plans and policies through a collaborative process Provide leadership to address oral health problems Mobilize community partnerships © Jones & Bartlett Learning,Assurance LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONInform, educate, and empower the publicNOT FOR SALE OR DISTRIBUTION Promote and enforce laws Link people to oral health services; assure availability, access, and acceptability Support primary and secondary prevention programs Assure the capacity and expertise of the public and personal health workforce Evaluate© Jones effectiveness, & Bartlett accessibility, Learning, and quality LLC of oral health services © Jones & Bartlett Learning, LLC Conduct research and support demonstration projects NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION From Guidelines for State and Territorial Oral Health Programs: Essential Public Health Services to Promote Oral Health in the United States (2007 Revision). The Association of State and Territorial Dental Directors. Available at: http://www. astdd.org. Accessed January 2009.13

disease may be seen as more or less a problem In the second phase (1880–1930), population- depending on whom you ask. Later chapters will based prevention strategies were possible with describe methods for identifying public health advances in bacteriology and immunizations, © Jones & Bartlettproblems Learning, and developing LLC solutions. © Jonesreducing & Bartlett the effects Learning, of infectious LLC diseases. NOT FOR SALE OR DISTRIBUTION NOT FORImmunization SALE ORprograms DISTRIBUTION were an outgrowth of HISTORY OF PUBLIC HEALTH this phase. Continued advancements in technology in a Public health has traversed through three phases third phase (1930–1975) allowed a further shift into a current, fourth phase that is centered on to the treatment of disease through increasingly the current© societal Jones needs & Bartlett of the times Learning, and the LLCcomplex medical treatments.© JonesInterventions & Bartlett in Learning, LLC progression of industrialization and technology this phase occurred increasingly in hospitals in the world.NOT During FOR the firstSALE phase OR (1849–1900), DISTRIBUTION rather than with community-basedNOT FOR public SALE health OR DISTRIBUTION public health activities were related to the elimi- measures. During this phase, many major infec- nation and control of diseases that grew out of tious diseases, such as smallpox, were eradicated rapid industrialization and crowded and poor and cures for many acute health problems were living conditions. Many activities were aimed at developed. © Jonesreducing & Bartlett the morbidity Learning, and mortality LLC of such dis- The current,© Jones or fourth, & Bartlett phase arises Learning, from the LLC NOT easesFOR as SALE cholera, OR polio, DISTRIBUTION and plague. Efforts, there- realizationNOT that FORtechnology SALE may OR be DISTRIBUTION strikingly fore, were directed at basic sanitation methods. effective in the treatment or cure of acute health

8 MODULE 1 / INTRODUCTION TO DENTAL PUBLIC HEALTH

problems but ineffective in managing chronic and where we are going. Several key events have lifestyle diseases© Jones and controlling & Bartlett the Learning,spiraling shapedLLC the profession of dental© publicJones health & Bartlett to Learning, LLC cost of high technologyNOT FOR health SALE care. OR The DISTRIBUTION value make it what it is today. NOT FOR SALE OR DISTRIBUTION of technology is limited because of the lack of The dental hygiene profession originated in availability to all members of the public and the 1906 as Dr. Alfred C. Fones began a course of inability to correct the most prevalent diseases we study for his assistant, Irene Newman.15 This now face, those that occur as a result of longer life early profession was centered in public health © Jonesexpectancy & Bartlettgained from Learning, earlier phases LLC of public practice. The© dental Jones hygienist & Bartlett was prepared Learning, to LLC NOThealth FOR and SALE lifestyle OR choices. DISTRIBUTION This current phase provide educationNOT and FOR treatment SALE in OR the commuDISTRIBUTION- now emphasizes a broader approach to health. nity setting and to work as an advocate for dental It goes beyond prevention of specific diseases care. The preventive nature of the dental hygiene to encompass the concept of overall wellness. profession is still a perfect fit in the public health Health promotion strategies are used to encour- arena as envisioned by Alfred Fones. Even today, © Jones & Bartlettage healthy Learning, lifestyles, LLC resulting in a reduced risk© Jonesthe mission & Bartlett of the ADHA Learning, is “to improve LLC the pub- 16 NOT FOR SALEof OR multiple DISTRIBUTION problems. For example, choosing notNOT lic’s FOR total SALEhealth.” OR DISTRIBUTION to smoke or choosing to stop smoking can reduce Public health continues to be an arena in the risk for lung cancer, hypertension, periodon- which oral health professionals work together tal disease, heart disease, or emphysema. and with other groups to improve the oral health Will terrorist actions, such as the events of of the communities in which they work and live. September 11,© 2001, Jones and & natural Bartlett disasters, Learning, like ItLLC is sad to think that the original© Jonespurpose &of theBartlett Learning, LLC Hurricane Katrina and others, cause us to look dental hygiene profession has blurred because of again at our publicNOT health FOR infrastructure SALE OR andDISTRIBUTION our the fear that dental hygienists mayNOT be FOR a threat SALE to OR DISTRIBUTION ability to respond to new public health threats, dental practices and the public. This perception such as bioterrorism? Will we enter a new phase has resulted in limitations put on dental hygiene of public health? Will we strengthen the protec- licensure and practice through restrictive dental tion from and rapid response to unknown or practice acts, which are only now starting to © Jonesundefined & threatsBartlett to health? Learning, The quick LLC responses reverse, with ©more Jones states &allowing Bartlett dental Learning, hygien- LLC NOTand FOR measures SALE taken OR to DISTRIBUTIONstop the spread of the ists to practiceNOT in other FOR than SALE private OR settings DISTRIBUTION and SARS epidemic indicate how rapid information under less restrictive supervision requirements. transfer and global cooperation can protect the State dental practice acts are also evolving to public’s health and highlight how important allow dental hygienists to perform services not cooperation and information sharing can be in permitted in the past. However, it will be some © Jones & Bartlettpreventing Learning, a world LLC disaster. The effectiveness© Jonestime before & Bartlett Fones’ vision Learning, is truly fulfilled. LLC NOT FOR SALEof OR our DISTRIBUTIONresponse to major disasters teaches usNOT FORA key publicSALE health OR eventDISTRIBUTION occurred in August what pieces of the puzzle are missing and what 1935. The Social Security Act,17 passed by improvements can be made. Congress, established unemployment compen- sation and benefits for the elderly. In addi- HISTORIC HIGHLIGHTS IN DENTAL tion, it provided aid to the individual states for PUBLIC HEALTH© Jones & Bartlett Learning,health LLC and welfare activities, including© Jones grants & Bartlettfor Learning, LLC Maternal and Child Health (MCH). Because NOT FOR SALE OR DISTRIBUTIONoral health services were includedNOT inFOR maternal SALE OR DISTRIBUTION “Trying to plan for the future without a sense of and child health block grants, many states estab- the past is like trying to plant cut flowers”— lished dental public health units within their Daniel Boorstin health department structure. The number of © JonesNo text & Bartlettwould be Learning,complete without LLC setting dental public© health Jones units & grewBartlett so rapidly Learning, that, LLC the stage for what is to come by exploring the in 1937, a group of state dental administrators NOTpath FOR by which SALE we haveOR traveled.DISTRIBUTION Knowing where founded theNOT American FOR AssociationSALE OR of DISTRIBUTION Public we have been helps us understand where we are Health Dentists (AAPHD), which was changed

CHAPTER 1 / HISTORY AND PRINCIPLES OF DENTAL PUBLIC HEALTH 9

in 1983 to the American Association of Public BOX 1-4 Ten Great Public Health Dentistry© Jones, reflecting& Bartlett the Learning, expanded LLC © Jones & Bartlett Learning, LLC membershipNOT that FOR included SALE dental OR hygienists,DISTRIBUTION Health AchievementsNOT FOR of SALE the OR DISTRIBUTION health educators, and others. In 1977, the 20th Century AAPHD voted to allow dental hygienists to be voting members of the organization, becoming Vaccination the first and only sponsoring organization of Motor vehicle safety © Jonesa dental & Bartlettspecialty toLearning, allow full membershipLLC to Workplace© Jones safety & Bartlett Learning, LLC NOT dentalFOR hygienists.SALE OR18 DISTRIBUTION InfectiousNOT disease FOR control SALE OR DISTRIBUTION The 1940s saw many dental public health Reduction in death from coronary heart developments. During World War II (WWII), disease and stroke the dental services of the armed forces expanded Safer and healthier food considerably. This was a direct result of the poor Healthier mothers and babies © Jones & Bartlettoral Learning, health status LLC of the young recruits being© JonesFamily & Bartlett planning Learning, LLC NOT FOR SALE ORinducted, DISTRIBUTION which shed light on the extensiveNOT FORFluoridated SALE ORdrinking DISTRIBUTION water dental needs of the United States population.19 Recognition of tobacco use as a health Dental services for the armed forces increased hazard during WWII because of selective service rejections, resulting from about 10% of potential From Ten Great Public Health Achievements—United recruits failing the military physical examination. States, 1900–1999. Centers for Disease Control and © Jones & Bartlett Learning, LLCPrevention. MMWR 1999;48(12):241–243.© Jones20 & Bartlett Learning, LLC The recruits lacked the necessary six opposing teeth in eachNOT arch FORto meet SALE the military OR standard.DISTRIBUTION19 NOT FOR SALE OR DISTRIBUTION To accommodate the manpower needs for the war, selective service requirements were again lowered twice before the end of the war. The In 1951, public health dentistry was rec- growth in armed forces dental services and the ognized as the seventh of what are currently © Jonesneed &to Bartletttreat large Learning,groups of people LLC efficiently nine specialties© Jones in dentistry. & Bartlett The ADHA Learning, also is LLC NOT andFOR effectively SALE becameOR DISTRIBUTION the seed for the concept developingNOT special FOR emphases SALE in OR dental DISTRIBUTION hygiene of the community as the patient, which has practice, one of which would be public health. remained a core concept for dental public health This is evidenced by the ADHA 2008 adoption practice. The armed forces experience led to the of the Competencies for the Advanced Dental development in 1948 of the National Institute of Hygiene Practitioner.21 This new practitioner is © Jones & BartlettDental Learning, Research LLC (NIDR) to address the national© Jones expected & Bartlett to provide Learning, a wide range LLC of services in NOT FOR SALE ORdental DISTRIBUTION problem.19 The NIDR was eventuallyNOT FORpublic SALEhealth, ORbecoming DISTRIBUTION another piece of the changed to the National Institute of Dental public health framework. and Craniofacial Research (NIDCR), reflect- In January 2000, the Department of Health ing a broader perspective about oral growth and and Human Services launched Healthy People development. 2010, a comprehensive, nationwide health pro- In 1945,© controlledJones & clinical Bartlett trials Learning, of water LLCmotion and disease prevention© Jones plan.22 &It buildsBartlett Learning, LLC fluoridationNOT began FOR in Grand SALE Rapids, OR Michigan,DISTRIBUTION on similar documents of 1990NOT and 2000FOR and SALE con- OR DISTRIBUTION and Newburgh, New York. These trials forever tains 467 objectives designed to be a framework changed the smiles of America and led to the for improving the health of the nation during establishment of water fluoridation as a safe, the first decade of the 21st century. There are effective means of preventing dental caries. 28 focus areas, each representing a public health © JonesIndeed, & Bartlettwater fluoridation, Learning, considered LLC one of area, including© Jones oral health. & Bartlett The objectives Learning, serve LLC ten great public health achievements of the 20th as targets for the health of the nation for the NOT century,FOR SALE20 is supported OR DISTRIBUTION by all major health profes- year 2010NOT and provideFOR SALE a basis ORfor comparisonDISTRIBUTION sional organizations (Box 1-4). and a focus for health agencies at all levels to

10 MODULE 1 / INTRODUCTION TO DENTAL PUBLIC HEALTH

participate in the goals of the nation. Tracking The dental public health network also appears of progress is ©the Jones responsibility & Bartlett of the NationalLearning, atLLC all levels of society. Many local,© Jones national, & andBartlett Learning, LLC Center for HealthNOT FOR Statistics SALE, which OR provides DISTRIBUTION international governmental agenciesNOT FOR include SALE a OR DISTRIBUTION a centralized location for information and data dental public health component and opportuni- related to the objectives. Healthy People 2020 ties for dental public health careers. Chapter 4 is the next step in the process and is planned for highlights many of these career opportunities in release in 2010. greater detail. © JonesThe Surgeon& Bartlett General’s Learning, Report LLC on Oral The United© StatesJones Government & Bartlett will Learning, be used LLC NOTHealth FOR was SALE released OR in MayDISTRIBUTION 2000.23 This was the here to illustrateNOT a public FOR health SALE and OR dental DISTRIBUTION pub- first Surgeon General’s Report on Oral Health lic health infrastructure. In the United States, in the more than 50-year history of Surgeon the President’s Cabinet includes leading officials General Reports. The report highlights the fact of the fifteen executive departments of the gov- that oral health is better now than ever before ernment. Within these departments are many © Jones & Bartlettin history. Learning, The report’s LLC primary message is that© Jonesagencies & responsibleBartlett Learning,for essential LLC services in NOT FOR SALEoral OR health DISTRIBUTION is essential to the general health andNOT public FOR health. SALE Figure OR 1-2DISTRIBUTION highlights the depart- well-being of all Americans and that it can be ments and agencies with significant dental public achieved by all Americans. However, the report health functions. Many of these agencies work also illustrates the profound disparities that exist together and in tandem with schools, community in oral health in America—children, the elderly, organizations, philanthropic organizations, and members of racial© Jones and ethnic & Bartlett groups, and Learning, those othersLLC to accomplish their goals.© Jones Similar &infra Bartlett- Learning, LLC with disabilities and complex health conditions structures also occur at local, state, provincial, are at greaterNOT risk for FOR oral SALEdisease. OR The DISTRIBUTIONreport and international levels. NOT FOR SALE OR DISTRIBUTION calls for a national partnership to provide oppor- Global health also affects the health of the tunities for individuals, communities, and the local population. With the increased ability to health professionals to work together to main- travel throughout the world, health concerns tain and improve the nation’s oral health. It is can quickly transfer from one country or area of © Jonestoo early & to Bartlett know the Learning,full impact of LLC this report the world to another© Jones and &become Bartlett a global Learning, public LLC NOTon FORoral healthSALE in OR America; DISTRIBUTION however, public health problem.NOT Infectious FOR SALE and life-threatening OR DISTRIBUTION health dentistry professionals are taking the diseases, such as SARS and HIV/AIDS, are a charge seriously. leading concern. The effect of global move- ment of people from one country to another also affects the need for a strong oral health © Jones & BartlettPUBLIC Learning, HEALTH INFRASTRUCTURELLC © Jonesinfrastructure. & Bartlett Therefore, Learning, it behooves LLC public NOT FOR SALE OR DISTRIBUTION NOThealth FOR professionals SALE OR and DISTRIBUTION agencies from various The fabric of the public health infrastructure countries to work together to solve problems, in the United States is an example of a broad, eradicate disease, and protect people from newly sweeping network of many entities, working at developing threats. Certain, more notable, glob- all levels of government and society to protect al entities involved in public health endeavors the health of ©Americans. Jones &A Bartlettconstant challenge Learning, are LLC the WHO and the Pan American© Jones Health & Bartlett Learning, LLC in public health is that efforts are occurring on Organization (PAHO). so many frontsNOT that coordinationFOR SALE and OR collabora DISTRIBUTION- The WHO headquarters is locatedNOT FORin Geneva, SALE OR DISTRIBUTION tion are often difficult. However, the Internet Switzerland. Their objective is attainment of the and common goals and frameworks allow for highest possible level of health by all peoples.24 better communication and easier access to infor- WHO acts as the directing and coordinating © Jonesmation. &This Bartlett network Learning, is often invisible LLC to the authority on ©international Jones & healthBartlett work Learning, and pro- LLC beneficiaries of the efforts; however, all of these poses regulations and makes recommendations NOTprotections FOR SALE and core OR functions DISTRIBUTION of a public health about global NOTpublic FORhealth SALEpractices. OR The DISTRIBUTION World infrastructure are part of our everyday lives. Oral Health Report 2003 states that oral diseases

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Author ISBN # Author's review Mason 978-1-58255-841-7 (if needed) Fig. # Document name OK Correx F01-02 58417_F01.02.eps Initials Date Artist Date 05/05/2009 Accurate Art, Inc. Check if revision CE's review B x W 2/C 4/C PMS 266 OK Correx © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Final Size (Width x Depth in Picas) NOT FOR SALE OR DISTRIBUTION NOT FOR40w xSALE 42d OR DISTRIBUTION Initials Date

CHAPTER 1 / HISTORY AND PRINCIPLES OF DENTAL PUBLIC HEALTH 11

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC YF F OHS OFA OPA OPRE OCSE ORR OCS OLAB ORO ADD ANA AC NOT FOR SALE OR DISTRIBUTIONAC NOT FOR SALE OR DISTRIBUTION Offices CDHPC CMM CMSO CMS

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NOT FOR SALE OR DISTRIBUTION rp NOT FOR SALE OR DISTRIBUTION SDR NCEH EEHS EHHE DLS AT DH AC DHS DTEM DRO Divisions NCEH/ATSDR blic Health Offices blic blic Health Serviceblic * Pu A © Jones & Bartlett Learning, LLC © Pu Jones & Bartlett Learning, LLC re AT S. Co NOT FOR SALE OR DISTRIBUTIONCS CSAP CMHS NOT FOR SALE OR DISTRIBUTION Centers 12 OSG Co USPHS Commissioned SAMHS ty ansportation easury T * Tr Tr AC * CDOM CF COE CP3 CQuIPS gy AHRQ s components of the U. © Jones & Bartlett Learning, LLC Centers © Jones & Bartlett Learning, LLC ta te Homeland Secu ri NOT FOR SALE OR DISTRIBUTIONOPHS NOT FOR SALE OR DISTRIBUTION Deno te * N * FDA CBER CDRH CDER CF SA CVM NCTR Centers lopment Ener ns Departments) ve ra ve te Affairs Ve Education © Jones & Bartlett Learning, LLC © * Jones & Bartlett Learning, LLC aus NOT FOR SALE ORPr esident DISTRIBUTION NOT FOR SALE OR DISTRIBUTION HRSA Bu re BPHC BH Pr MCHB HAB BCRS HSB eS SDR * Human Housing and Urban De Cabinet (Executi Health & Services Defens CDC Centers

e © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONCOGH COTPER CCEHIP NCEH/ AT NCIPC CCHIS NCHM NCHS NCPHI CCHP NCBDDD NCCDPHP CCID NCIRD NOT NCZVED NCHHSTP NCPDCID NIOSH FOR SALE OR DISTRIBUTION s te * Comme rc stice nters NIH Interior Ju Insti tu NCI NEI NHLBI NHGRI NIA NIAAA NIAID NIAMS NIBIB NICHD NIDCD NIDCR NIDDK NI DA NIEHS NIGMS NIMH NINDS NINR NLM 7 Ce bor culture ri La © Jones & Bartlett Learning, LLC © Jonesia & Bartlett Learning, LLC * rn jo Ag land va li fo IHS NOT FOR SALE OR DISTRIBUTION NOT FORrt SALE OR DISTRIBUTION cson Areas Aberdeen Alas ka Albuquerque Bemidji Billings Ca Nashville Na Oklahoma Phoenix Po Tu FIGURE 1-2 United States—Federal Infrastructure of Health Services. (See Appendix 2 for a listing the acronyms and their meanings).

12 MODULE 1 / INTRODUCTION TO DENTAL PUBLIC HEALTH

are a major public health problem and that of its mission, activities, budget, and role in increased emphasis© Jones should & Bartlettbe on developing Learning, LLCthe dental public health infrastructure.© Jones & Bartlett Learning, LLC global policiesNOT in oral FOR health SALE promotion OR and DISTRIBUTION oral 4. Write a reflection paper discussingNOT FOR what SALEcon- OR DISTRIBUTION disease prevention.25 One priority is more effec- stitutes good oral health. tive coordination with other WHO programs and 5. Choose a particular oral health problem in external partners. your community and create a list of organiza- The PAHO headquarters is located in tions or community groups in your community © JonesWashington, & Bartlett DC. It isLearning, an international LLC public that would© be Jones important & Bartlett partners inLearning, an oral LLC NOThealth FOR agency, SALE founded OR DISTRIBUTION in 1902, that includes health coalitionNOT formedFOR SALEto address OR the DISTRIBUTION prob- all 35 countries in the Americas.26 Its mission is lem (e.g., early childhood caries, fluoridation to strengthen national and local health systems of the community’s water supply, school fluo- and to improve the health of the peoples of the ride rinse program). Americas. PAHO collaborates with such entities 6. Write a reflection paper on the pros and © Jones & Bartlettas Ministries Learning, of Health, LLC governmental agencies,© Jonescons &of Bartlettthe public Learning,health infrastructure LLC being NOT FOR SALEnongovernmental OR DISTRIBUTION organizations (NGOs), univer-NOT FOR“invisible.” SALE OR DISTRIBUTION sities, social security agencies, and community 7. Identify a public health problem and describe groups. why it constitutes a public health problem. 8. Choose a state, province, or a country other than the United States and investigate the Summary© Jones & Bartlett Learning, LLCdental public health infrastructure© Jones of the & cho Bartlett- Learning, LLC sen area. Much of publicNOT health, FOR which SALE has evolvedOR DISTRIBUTION with 9. Create a classroom game basedNOT onFOR the abilSALE- OR DISTRIBUTION time, is an invisible infrastructure that has been ity to link an acronym with a public agency developed to protect the health of the public. and the role it has in public health. Include Public health activities occur at all levels of the agency’s mission and location and other government and society and include efforts to details. © Jonesimprove &the Bartlett public’s oral Learning, health. Core LLC functions © Jones & Bartlett Learning, LLC NOTof publicFOR SALEhealth entities OR DISTRIBUTION and competencies for NOT FOR SALE OR DISTRIBUTION public health professionals guide public health practice. The dental public health profession Resources has a rich history of working to improve the oral American Association of Public Health Dentistry health of the public. In addition, the mission of (AAPHD) (listserve): http://www.aaphd.org © Jones & Bartlettthe dentalLearning, hygiene LLC profession and the profes-© JonesAmerican & PublicBartlett Health Learning, Association LLC Oral Health sional roles of dental hygienists are a reflection NOT FOR SALE OR DISTRIBUTION NOT FORSection: SALE http://www.apha-oh.org OR DISTRIBUTION of the natural fit between dental hygiene and Association of State and Territorial Dental public health, which was envisioned by Dr. Directors.: http://www.astdd.org Alfred Fones as he prepared the first dental World Health Organization: http://www.who. hygienist. int/en/ © Jones & Bartlett Learning,Pan LLC American Health Organization.:© Jones http://& Bartlett Learning, LLC new.paho.org/hq/index/php?lang=en Learning NOTActivities FOR SALE OR DISTRIBUTIONU.S. Government official WebNOT portal: FOR http:// SALE OR DISTRIBUTION www.usa.gov 1. List public health services from which you Healthy People 2020: http://www.healthypeople. have personally benefited. gov/HP2020 2. Develop your own definition of dental public American Dental Hygienists’ Association: http:// © Joneshealth. & Bartlett Learning, LLC adha.org © Jones & Bartlett Learning, LLC NOT3. ChooseFOR SALE a governmental OR DISTRIBUTION agency with oral Canadian AssociationNOT FOR of Public SALE Health OR Dentistry: DISTRIBUTION health responsibilities and write a description http://www.caphd-acsdp.org

CHAPTER 1 / HISTORY AND PRINCIPLES OF DENTAL PUBLIC HEALTH 13

REFERENCES © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Review Questions 1. American Dental Education Association. Competencies NOT FOR SALE OR DISTRIBUTIONfor entry into the profession ofNOT dental hygiene.FOR ExhibitSALE 7. OR DISTRIBUTION 1. The third phase of public health included all J Dent Educ 2004;68(7):745–749. of the following EXCEPT the: 2. Webster’s New World Dictionary. Simon and Schuster, a. treatment of disease with complex medical 1995. treatment. 3. World Health Organization. Preamble to the Constitution © Jonesb. &eradication Bartlett of Learning,smallpox. LLC Adopted© by Jones the International & Bartlett Health Conference, Learning, New LLC York, June 19–22, 1946. NOT FORc. intervention SALE OR through DISTRIBUTION hospitalization rather NOT FOR SALE OR DISTRIBUTION than the community. 4. Winslow CEA. The untilled fields of public health. Modern Med 1920;2:183–191. d. cure for acute health problems. 5 Knutson JW. What is public health? In: Pelton WJ, e. effective management of chronic, lifestyle- Wisan JM, eds. Dentistry in Public Health, 2nd ed. related diseases. Philadelphia, PA: W.B. Saunders, 1955. © Jones & Bartlett Learning, LLC © Jones 6. The & BartlettFuture of Public Learning, Health. Institute LLC of Medicine, 2. State dental public health units originally Committee for the Study of the Future of Public Health. NOT FOR SALE ORdeveloped DISTRIBUTION as a result of the: NOT FORWashington, SALE DC: OR National DISTRIBUTION Academy Press, October 1988. a. establishment of the American Association 7. American Association of Public Health Dentistry/ of Public Health Dentistry. American Board of Dental Public Health. Competency b. need for recruits during WWII. statements for dental public health. J Public Health c. Surgeon General’s Report. Dent 1998;58(Suppl. 1):119–122. d. Maternal and Child Health grants to states. 8. Canadian Association of Public Health Dentistry. Available © Jones & Bartlett Learning, LLC at: http://www.caphd-acsdp.org.© Accessed Jones January & Bartlett 2009. Learning, LLC e. creationNOT of theFOR NIDR. SALE OR DISTRIBUTION 9. Core competencies for public healthNOT professionals. FOR SALE Council OR DISTRIBUTION 3. The controlled clinical trials of water fluorida- on Linkages Between Academia and Public Health tion began in: Practice. Washington, DC: Public Health Foundation. Available at: http://phf.org. Accessed August 2009. a. 1937. 10. Types of dental hygiene careers. American Dental b. 1942. Hygienists’ Association Online. Available at: http:// © Jonesc. &1945. Bartlett Learning, LLC www.adha.org/careerinfo/dhcareers.htm.© Jones & Bartlett Learning, Accessed LLC NOT FORd. 1948. SALE OR DISTRIBUTION JanuaryNOT 2009. FOR SALE OR DISTRIBUTION e. 1953. 11. Chapter 23: Public Health Infrastructure. In: Healthy People 2010 (Conference Edition; two volumes). 4. The primary reason for developing the NIDR Washington, DC: Department of Health and Human was to: Services, January 2000. a. provide a central agency to monitor state 12. Public Health in America. Fall 1994. Public Health © Jones & Bartlett Learning,fluoridation LLC efforts. © JonesFunctions & Bartlett Steering Learning, Committee. AvailableLLC at: http:// b. address the national dental problems discov- www.health.gov/phfunctions/public.htm. Accessed NOT FOR SALE OR DISTRIBUTION NOT FORJanuary SALE 2009. OR DISTRIBUTION ered through selective service rejections. 13. Guidelines for state and territorial oral health programs: c. create educational opportunities for dental Essential public health services to promote oral health public health professionals. in the United States (2007 Revision). The Association d. make dentistry more visible at the National of State and Territorial Dental Directors. Available Institutes© Jones of Health. & Bartlett Learning, LLCat: http://www.astdd.org/docs/ASTDDGuidelines.pdf.© Jones & Bartlett Learning, LLC e. study the cost-effectiveness of community Accessed January 2009. NOT FOR SALE OR DISTRIBUTION 14. The practice of dental public health.NOT In: FOR Burt BA, SALE Eklund OR DISTRIBUTION water fluoridation. SA, eds. Dentistry, Dental Practice, and the Community. 5. Core functions of public health include: 6th ed. Philadelphia, PA: W.B. Saunders, 2005, p. 39. a. assessment. 15. Motley WE. History of the American Dental Hygienists’ Association, 1923–1982. Chicago, IL: American Dental b. policy development. © Jones & Bartlett Learning, LLC Hygienists’© JonesAssociation, & 1983, Bartlett p. 21. Learning, LLC c. assurance. 16. Profile of ADHA—Mission Statement. Available at: NOT FORd. funding SALE of OR oral DISTRIBUTIONhealth programs. http://www.adha.org/aboutadha/profile.htm.NOT FOR SALE OR DISTRIBUTION Accessed e. a, b, and c. January 2009.

14 MODULE 1 / INTRODUCTION TO DENTAL PUBLIC HEALTH

17. Social Security Act of 1935. Available at: http://www. 22. Healthy People 2010 (Conference Edition; two vol- usconstitution.com/socialsecurityactof1935.htm.© Jones & Bartlett Learning, LLCumes). Washington, DC: Department© Jones of Health & Bartlettand Learning, LLC Accessed JanuaryNOT 2009. FOR SALE OR DISTRIBUTIONHuman Services, January 2000. NOT FOR SALE OR DISTRIBUTION 18. Application for Continued Recognition of the Specialty 23. Oral Health in America: A Report of the Surgeon of Dental Public Health. Submitted by the American General—Executive Summary. Rockville, MD: DHHS, Association of Public Health Dentistry to the American National Institute of Dental and Craniofacial Research, Dental Association, 1986. Available at: http://www. National Institutes of Health, 2000. aaphd.org/default.asp?page=history.htm. Accessed 24. World Health Organization (WHO). About WHO. © JonesJanuary & 2009. Bartlett Learning, LLC Available at:© http://www.who.int/about/en/.Jones & Bartlett Learning, Accessed LLC 19. Harris RR. Dental Science in a New Age: A History of January 2009. NOT FORthe National SALE Institute OR of DISTRIBUTION Dental Research. Rockville, 25. WHO OralNOT Health FORReport SALEfor 2003. ORCommun DISTRIBUTION Dent MD: Montrose Press, 1989, pp. 78–91. Oral Epidemiol 2003;31(Suppl. 1):3–23. Available at: 20. Ten Greatest Public Health Achievements—United http://www.who.int/oral_health/publications/report03/ States, 1900–1999. Centers for Disease Control and en/. Accessed January 2009. Prevention. MMWR 1999;48(12):241–243. 26. Pan American Health Organization (PAHO). About © Jones & Bartlett 21. American Learning, Dental Hygienists’ LLC Association. Competencies© JonesPAHO. & AvailableBartlett at: http://www.paho.org/english/paho/Learning, LLC for the Advanced Dental Hygiene Practitioner. Adopted What-PAHO.htm. Accessed January 2009. NOT FOR SALE ORMa rchDISTRIBUTION 2008. Available at: http://www.adha.org/NOT FOR SALE OR DISTRIBUTION downloads/competencies.pdf.