ASGIS, ALFRED J.: College of Dentistry, New York University, New York City (Oct. 15, 1938).

The biologic approach (system—nutrition, diet, general health, etc.) to the problem of preventing caries, and associated oral diseases, holds out the greatest promise in terms of lasting benefits. The limitations of this system are mainly sociological ; it requires modification of national dietary habits, adjustments of hygienic environment in an industrial society, coordination with psychological factors, adaptation of individuals to changing modes of living, etc. These are temporary obstacles—not fundamental—to the biologic solution. Limitations of individual and collective methods, within the biologic system, are self-evident ; its effectiveness depends upon application of pro­cedures of a collective or group character. Success depends also, in part, upon appreciation by society of the ultimate community-benefits to be derived from control of dental and oral diseases.

Opposed to the biologic solution is the social approach—dental prophylaxis, tooth-brushing, operative care, etc. This system offers immediate advantages over the biologic, insofar as effects on group end-results can be measured quantitatively. The social system, therefore, has some merits of expediency. Because there are no immediate needs for group modification of community habits that impose group changes upon the individual, it has greater immediate advantages. It does not require special effort by the individual members of society. It implies essentially individual methods, even though it is accomplished through group effort. The collective outcomes and practices are cumulative, not integrative or synthetic. Society may here be considered as consisting of lazy individuals, hence its greater popular influence. Herein lie the advantages of the social approach with the individual method. Since effectiveness in control of dental and oral diseases, by the individual method, depends upon direct community support, which is economic (public-school clinics, public-health dentistry, etc.), the limitations are often very great and sometimes insurmountable. Since social sanction is essential for eco­nomic support for both systems in the control of dental disease, the biologic system offers greater and more lasting benefits to the community and to the individual. All three dental-health programs—preventive, prophylactic and curative—should be so organized that their foundations would rest primarily upon the biologic system. On this basis, dental plans would embody features of the social system and, where- ever expedient, also synchronize the individual and collective methods.

Existing social methods call for modification of dental education and dental practice along biomedical lines, with professional and social objectives stressed in their preventive aims. In developing dental-health programs, this order of prefer­ence should be followed : (a) Preventive over prophylactic and curative programs. (b) The biologic system over the social system. (c) The collective method over the individual method. (d) Combination of systems and methods in above order. The bristle-hair tooth-brush and its sterilization, and dentifrices—as methods and aids in control of caries and oral lesions, or in establishment of mouth health—are of questionable value. These are vital problems for dental research in the social system. Superiority of the biologic system over the social leads to the conclusion that greater attention should henceforth be directed toward dental research; the activities should aim at development of scientific and public-health means for furtherance of the biologic system; and efforts should be concentrated on develop­ment of more positive procedures for eradication of dental disease. (Dental-health education is implied as an essential public-health technique in all these considera­tions.)

References: School and Society, 1923 ; Den. 11,Iag., 1925 ; Int. J. Med. Surg., 1925; Review Clin. Stour., 1925 ; Oral Topics, 1926; Clin. Med. Surg., 1928; Am. Den. Surg., 1929; Den. Digest, 1929; Northw. J. Den., 1929; Hungarian Den. J., 1931; Proc. IInd Int. Stone. Cong., 1935.

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