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Preparing the oral health workforce to effectively address public health challenges.

In the decades prior to the recognition of Dental Public Health (DPH) as a specialty of dentistry by the American Dental Association (ADA), the US population faced significant oral health challenges. The ADA actively debated the role of the dental profession in improving the health of the public. Dental schools were responding to the William J. Gies’s report (1) to define dentistry as an essential component of higher education in the health professions. Dental professionals were beginning to establish a presence in the federal services and agencies, hospitals, and other institutional settings. The pressure to extend medical and dental care to a broader segment of the US population continued to increase. Public health was a relatively new venture for dental professionals in the 1940s and 1950s, and public health efforts were more likely to focus on ensuring access to clean water supplies and controlling devastating communicable diseases. That is not to say that oral health challenges did not exist. Extensive dental caries was common in the United States and most developed countries (2). Many children and adults were not able to afford dental care during the economic depression of the 1930s and dental needs reflected the accumulation of disease and the inability of patients to access needed services. One of the better known outcomes of these circumstances was the unexpected finding that about 8.8 percent of Army inductees were disqualified for service for dental reasons based on oral examinations conducted in 1940-41 (3). While access to care improved during the postdepression recovery, a Gallup poll conducted in 1950 indicated that 47 percent of the US adult population had had not seen a dentist for 2 years or more (4). Also, the discussions about the adequacy of the size and preparation of the dental workforce were actively debated, much as they are today. Also during the early 20th century, the role of the dental hygienist as a dental team member was becoming defined. Dr. Alfred Civilion Fones is credited with coining the term dental hygienist in 1913, although dental hygiene education and practice as well as the activities of dental nurses, for example, predate the use of this term and the acknowledgment of dental hygiene as a true college discipline (5). Fones also helped define the dental hygienist’s role in dental public health by developing curricula for hygienists working within the public school system of Bridgeport, Connecticut. While the role of the dental hygienist was being actively debated by national and state dental associations, population-leveland individual-focused preventive strategies were recognized as critical to improving oral health. By 1951, hygienists were licensed to practice in all states, the District of Columbia, Alaska, and Hawaii, but only four percent of dentists employed hygienists (6). The role of public health dentists and the core competencies of DPH practice were also being defined during this time. Dr. Easlick set about defining the field of DPH through a series of landmark workshops in Ann Arbor, Michigan, through the 1940s and 1950s. The results defined the scope of DPH practice and the necessary competencies for public health dentists. This work was seminal in many ways, and it led to the ADA’s recognition of DPH as a board-certified specialty of dentistry in 1950 (7). This began the critical recognition of DPH as a unique dental specialty, and the only specialty in the dental profession that focuses on dental and oral health issues in communities and populations rather than individuals. DPH units were established in virtually every state health department, and the Oral Health Unit in the World Health Organization was established in 1953. Pioneer public health dentists and oral epidemiologists developed the first index to measure the prevalence of caries and to begin the process to systematically study preventive and other strategies to reduce dental disease rates, among many other contributions to the improvement of oral health in the US and globally. It was not until the beginning of the 21st century that the first ever Oral Health in America: A Report of the Surgeon General (8) was published followed by the National Call to Action to Promote Oral Health (9). These publications alerted Americans to the importance of oral health in their daily lives and brought important attention to barriers that continue to hinder the ability of some Americans from attaining optimal oral health. One of four action items focused on the dental workforce and the need to enhance diversity, capacity, and flexibility. Around the same time, the Institute of Medicine’s report on The Future of the Public’s Health in the 21 Century (10) embraced the vision originally articulated by Healthy People 2000 (11) recognizing the importance of not only a governmental public health infrastructure as the backbone of the public health system, but also critical partners including academic institutions who train the health-care workers for the future. While the nation’s public health infrastructure and experts are critical elements in our national public health strategy, the health care delivery systems and the private practice commuJournal of Public Health Dentistry 75 (2015) S1–S3