October 19, 1971
Page 36666
THE CHILDREN'S DENTAL HEALTH ACT OF 1971
Mr. MUSKIE. Mr. President, I am pleased to join with 37 of my fellow Senators in cosponsoring the Children's Dental Health Act of 1971, which was introduced on May 14, 1971, by the distinguished senior Senator from Washington (Mr. MAGNUSON).
The primary goals of the bill (S: 1874) are:
First, to inaugurate a series of pilot oral health care programs for needy children – programs with an emphasis on prevention;
Second, to provide one-time matching grants to communities and school districts wishing to fluoridate their water supplies;
Third, to increase Federal assistance in the training of greater numbers of dental auxiliaries; and,
Fourth, to provide Federal support for demonstration projects helping dental students and dentists learn how best to work with new types of dental auxiliaries.
There are several reasons why I feel this legislation should be enacted this year.
First, oral diseases – and most specifically dental decay and periodontal disease – are the most common diseases in America. The epidemic proportion of these diseases in the United States is overwhelming. Recall these disturbing facts from Senator MAGNUSON'S speech introducing this bill.
By age 2, half of America's children have decayed teeth. By the time he enters school, the average child has three decayed teeth and by his fifteenth year, he has eleven decayed, missing, or filled teeth ... For every 100 Selective Service recruits the Armed Forces supply or perform 500 fillings, 80 extractions, 25 bridges, and 20 dentures.
Other sources tell us that industry annually loses more than 100 million man-hours of production time because of dental illness. Over half the adult population by middle age has chronic destructive periodontal disease – "pyorrhea" – leading to loss of teeth. And nearly 25 million Americans – and three out of 10 people over the age of 35 – have lost all their natural teeth.
Second, the costs of oral disease are as significant as they are real. Recent figures released by the Social Security Administration have revealed that in 1970 nearly $1.1 billion – $1,061,000,000 – was spent for the dental care of the 50 percent of those under 19 in this country who were able to see a dentist in 1970. In addition, a large proportion of the costs reported for individuals age 19-64 – nearly $3 billion – $2,714,000,000 – were incurred because of neglected dental needs in youth. In addition to the burdensome cost, the physical pain, psychosocial distress and physiological compromise of such vital functions as speech, taste and eating that are present in so many Americans as sequellae of oral disease are immeasurable.
Third, S. 1874 promotes application of one of the safest, most efficacious preventive health measures known to man – fluoridation – in order to significantly diminish the ravages and costs of dental decay. Only about 43 percent of the Nation's population presently enjoys the benefits of fluoridation. As indicated in Senator MAGNUSON's speech, fluoridation of community or school water supplies can result in decay reductions approximating 60 percent in most children. Dollar for dollar, one of the best health investments this country could make would be to support fluoridation. I quote from a recent brochure from the Division of Dental Health of the U.S. Public Health Service to indicate how fluoridation can result in enormous potential savings in American tax dollars–
In the California communities of San Francisco and Vallejo – both fluoridated – dental costs of Head Start children were 2/3 lower than costs for the same basic care in the nonfluoridated cities of Berkeley and San Joaquin. Similar reduced costs have been found in Head Start Programs in fluoridated communities in other communities across the nation.
In Philadelphia, fluoridated since 1955, it is estimated that fluoridation represents a potential financial saving in dental care of $2 million annually.
In Toledo, Ohio, savings of at least $29 per child per year in the second and third grades have been attributed to fluoridation. Fluoridation costs only pennies per person per year. If every community fluoridates its water supply, the annual saving in unneeded dental treatments would be about $700 million – a return of approximately $50 for every dollar invested in fluoridation.
We should keep these facts in mind as we consider various plans for National Health Insurance, many of which may include coverage of dental care and will therefore sharply escalate future demands for care and governmental costs.
S. 1874 authorizes that $15 million be spent over a 5-year period to provide one-time matching grants to States, communities, or school systems wishing to fluoridate their water supplies. If we spend an average of $3 million annually on fluoridation for the next 5 years, we could potentially save approximately $500 million annually in the dental bills of youths 19 and under. Physically and fiscally, everyone – the individual, the family, and the country – will benefit from an investment in fluoridation.
Finally, S. 1874 proposes to increase Federal funds for the training of greater numbers of dental auxiliary personnel and for demonstration projects helping dental students and dentists learn how best to work with such auxiliaries.
It has long been evident that the Nation's health manpower resources are inadequate to meet the demand for care. This is especially so in dentistry where the demand for oral health care has been growing precipitously, not only because of such factors as population growth and rising consumer incomes, but also because of increased public recognition of the importance of oral health and the newly increased accessibility to dental care through its inclusion in private insurance coverage and in several recently negotiated labor-management contacts.
Despite efforts of the Federal Government to give financial support to the opening of new schools of dentistry, and the expansion of pre-existing schools, the ratio of active dentists to population is today no better – indeed, it is slightly worse – than in 1950. While it is commendable to increase the numbers of dentists, this effort must be accompanied by an intensive effort to increase their productivity. Several studies at the Division of Dental Health's Louisville, Ky., research center have shown that this can be accomplished most effectively through the efficient employment of dental allied health workers – dental hygienists, chairside assistants, and laboratory technicians – and the improvement of the utilization of the skills of these individuals. A strong effort is now being made to expand the training of both dentists and dental auxiliaries so that additional functions can be delegated to auxiliary members of the dental team. By changing the pattern of dental practice to encompass the use of these expanded function auxiliaries, still further increases in productivity can be possible.
S. 1874 authorizes grants to educational institutions to assist them in establishing and carrying out programs to educate and train persons for careers as auxiliary dental personnel. I believe it is especially noteworthy that special emphasis will be given to the continued education and training of veterans of the Armed Forces who have previously received experience and training in dental auxiliary functions. It is also of significance that S. 1874 contains provisions for grants and contracts to institutions to establish programs to teach dental students the efficient and effective utilization and management of dental auxiliaries not only for the type procedures that the auxiliaries presently perform, but also for additional functions which do not require the skill and knowledge of the dentist.
Finally, I feel it is most important that S. 1874 relates manpower training and grants to the needs of improved oral health care in urban and rural areas characterized by low family incomes or shortage of dental manpower and services.
In summary, then, Mr. President, I strongly support passage of the Children's Dental Health Act of 1971. This act promotes the application of an efficient, effective, low-cost, proven, and safe measure – fluoridation – for the prevention of the Nation's most prevalent diseases – dental decay. It provides for the alleviation of dental manpower problems through the training of increased numbers of conventional and expanded-duty dental auxiliaries.
This act also establishes pilot programs for the provision of direct dental care to the youth of our country, special emphasis on providing care in low-income and manpower shortage areas.
The provisions of the Children's Dental Health Act of 1971 thus will make significant inroads in reducing the incidence of dental disease in this country and improving the dental profession's ability to deliver care to those with preexisting disease. The comparatively modest expenditure called for by this act will promote significant financial savings and prevent unnecessary suffering and discomfort for a large proportion of the Nation's population.