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In This Issue: Pages Preventive Dentistry .................................................. 1 State-of-the-Art Report on AMHT ............................ 3 Health Education for U.S: Schools .......................... 7 I Vol.2/No. 4• Published for the Advancement of Preventive Medicine • September/1970 Preventive Dentistry ... A Look At Its Future by Paul Hughling Scott, D.M.D. The results of the 1969 national survey of dental services rendered to individual patients, which was conducted by the Bureau of Economic Research and Statistics of the American Dental Association, show a marked improvement in oral health in comparison with the 1950 and 1959 surveys. In particular, the 1969 survey found that the em- phasis in dentistry had shifted from reparative care to preventive care. More patients received preven- tive care, such as x-rays, prophylaxis and fluoride treatments, and orthodontia, while fewer patients received fillings, extractions, and partial or full dentures. The 1969 sur- vey also revealed that there were more youngsters treated, indicating that the dental pro- fession, as well as the public, recognized the importance of early preventive dental care. Even with these improvements, however, today there are still approximately 800- million unfilled cavities in the U.S. and 20-million toothless Americans. Unique Air Force Study: There are four fundamentals of prevention in dentistry involving oral and total body health: diet control, proper oral hygiene, utiliza- tion of fluorides topically and systematically, and regularly scheduled check-ups to detect any changes from normal in the mouth structure. In March, 1965, the U.S. Air Force School of Aerospace Medicine at Brooks Air Force Base, Texas, in cooperation with the Air Force Academy in Colorado Springs, Colo., started a unique long-term study, headed by General . Lee Lightner. It was the first scientific attempt to determine the effectiveness of the different preven- tive measures on a major public health program- periodontal disease (gingivitis and periodontitis). The study was scientifically unique, arousing wide- spread interest among government agencies and the health profession, for the cadets were from 50 states and territories, and all 4,000 cadets ate their meals at one sitting and had the same environmental con- ditions. The dentists and their assistants used set procedures for the examinations, cleanings, gum treatments, education aids, and home care tech- niques. The home care involved teaching the proper use of the toothbrush, dental floss, irrigation, and now the use of the water pik. Reviewing the Results: In August, 1970, at the invita- tion of Colonel Philip Manners, Command Dental Officer, I visited, the Air Force Academy in Colorado Springs and reviewed the results of the first five years of the periodontal study. The study shows the prevalence and severity of gum disease in a highly select group of young males. Gingival inflammation is a regular occurrence from childhood through adult life. As the cadets became older, new cavity forma- tion decreased, but during the aging period the incidence and severity of gum trouble increased rapidly. Gum recession was seen commonly i:n ex- tremely clean mouths, and seemed to be associated with incorrect or too vigorous tooth brushing. Other significant findings of the studies were: a Preventive programs must be channeled toward prevention of periodontal disease, as well as the prevention of cavities. • The relationship between local irritants (plaque and tartar) and the development of gingivitis and periodontitis was shown, confirming a number of common clinical findings. e The largest plaque (a microbial mat of bacteria, food, debris, and other materials) accumulation occurs on the outside'surfaces of the upper molars, the inner surfaces of the lower molars, and the lower front teeth. ® The upper front teeth showed the least gingival disease, but nevertheless 66% of the cadets showed some gingival inflammation in this area. 9 Bacterial plaque at or below the gingival line pro- duces toxins which destroy the attachments between the gum and the teeth. If the excess food is not removed after eating, the bacterial population in- . creases three times in six hours and can aggravate periodontal problems. The largest hard deposit for- mation (calculus) appears on the lower front teeth. Preventive Procedures: The importance of instruction in home care is well documented in the Air Force continued P.2

r The American I-iealth Foundation Newsletter The ',nt~ric~n t; a;in FoWtd-;t:cn. I;tc. t'L',0 't:iSt E nf.i -..,:.. iJuYo: k. N.Y. (2_ 12) 623-G30J 2. _ C? .. ' C, i'. .` . .. .^..'..?~f~ Jf.. .. L'. ~.• OFFICERS AND BOARD OF TRU3TEE3: , President Emest L, r'.ynder, M.D. iec'e!ilty . Thom.?s J. Ross. Jr. Vice Prc:ident Aa:ericen A,r!u,es, It!c- Executive Vice Pres:dent David L. Da'nes T lU.185! re f Vvirner G- Cosgrove, Jr. Managing P2,tnnr ShwlCs & Company Horo;ary P.ciicr•aI Pretod::nl' Patrick J. Doyle, t+.D.. ?" ° H. Chairmen, Dept. ot Con,munity'sedicrne, Gcorqeto+m Uniaersity TRUSTL'ES: Ch ,lrm. n D.',+.y!r! J. 6`ifhoney Prc,9o.1^mt i<o.ton Simon, Inc. Lc-~rs• V. Aronson, !t Pr,~sdcnt Roason Corhor:!;,on F: rs. Charle. A. Oan4 [:r9'. .~ ie• :C'iKCf ~ , Pre:ident Decke' Con n'tut:7rtd n^,S, fnc. alh•r =. H,:,ro:; ~2:1vCf i ~rlnPr Yr=tt. f/tr7rl.IcK. (". Co. Gr orrJ^ Jt3c:es, M D., td.P.Hr D="•.3n Mount Sinai School ot fv!eC:cme avi1!iam J. Levitt Chairman, Doard of Duectors Leti:•t & snns„tnc. G. Moore rreSr~E,rt Inc. Jo: t .,':rrt a s dont a ri~ .n S htur,n::. inc. Robert R. i'au•ay ",. R+Abb Patlner ,`".,;,or,':k +?; J:roo:.k u Lav;tn t3DARJ OF .",CiE.:"JTir1C CONSULTANTS: Ct2s'C,an G: Jamu~• :l.P . !.°.I4. . 'it :ica Cd!i~r 3 Conyu:; ~nt ;rr.3.fnG. P•I„n aI • t; D, hta i C~-..a' a^d A: i1C D;seases At D.. `1 P H. :1 P~. ~0 :i9'~!.h P!e UC9 co!urr!l,a Un,ersityc T.,~t=r,i F+.+•rz'rnrt !•t J. G :R .>C'.r:,.•~{J~:c.1n1 t T S ' ...'EI jvr;.!ces t' o tfca! C(n'c'r Nh.~ ~, Y' , .:n~,nsk~iv °h.D Jc^,n C.',=.se1. t' D,?t P.i-1. Je :~r.'e Co":- d. ti- _ . L`.:... .,. . • D. F:,itt4r ^ :;n ot \ . . r:.en°:a> o, ---------__-._~ - i study. The toothbrush, dental floss, and irrigation reduced the formation of plaque and hard deposits, producing a continuous improvement in periodontal health. Another preventive periodontal procedure, the study shows, is the three-month prophylaxis, which reduces the irritation deposits on the teeth and results in healthier gingiva. Preventive periodontal (gum) treatments repeated at short intervals were shown to improve gingival health, due to a decrease in local irritants. The rate of decrease in plaque and tartar was greatest during the first year of the study. With the treat- ment regimes used, there is a leveling off during the following years, and even the mouths of the best patients showed some areas of plaque and calculus accumulation. The study also conclusively demon- strates that effective preventive dental measures and well-trained, motivated patients are essential to the prevention of moderate to advanced periodontal dis- ease, which is the main cause of tooth loss after the age of 35. New Mouthguard for Bruxism: Another study at the Air Force Academy involves the use of preventive dentistry in the daily contact sports of 4,000 cadets. The prevention of damaged or lost teeth, fractured jaws, and temporomandibular joint problems is achieved by the use of mouthguards. Colonel Philip Manners and his associates have de- signed and are now using a new, more durable, custom-built, comfortably-fitting mouthguard-one with a built-in shock absorber and a lock-in device for the lower jaw to prevent the occurrence of trau- matic injuries during contact sports. The new mouth- guard, because of its strength, comfort, design, and shock-absorption qualities, can replace the more cum- bersome appliances used today for bruxism. Bruxism is the clenching and grinding of the teeth which may lead to wear or breakage of the teeth, gingivitis, peri- odontitis, muscle spasms, facial pain, chronic head- aches, and temporomandibular joint problems. By wearing" this new mouthguard, patients can prevent the destructive effects of bruxism. Early Detection Needed: The dentist today, as a result of following a regular three-month recall system, is able. to render still another preventive service by recognizing and controlling many dental and sys- temic diseases. In this procedure, the study of changes in the mouth tissues is important, because the oral cavity may be the site of the first appear- ance of systemic diseases. The early recognition of such diseases is vital to their cure. Many cancers, for example, begin on tissue surfaces, such as the skin, stomach, intestine, and mouth• The early detection of cancer, before the malignancy can spread, is the key to life itself. Some 30,000 new cases of mouth cancer are detected each year. If de- tected early, the patient has a 30 % chance of sur- viving and prolonging his life. continued P. 8

Mu.ltiphasie Screening: Time for A Turnaround? . Unless you are completely fascinated by the subject, few literary exercises are more difficult-and less re- warding-than that of reading what educators and researchers have always referred to as a State-of-the- Art Paper. While such studies are the stuff that scientific progress often begins with, and eventually is made of, they are also a kind of king-size catalog of footnotes, unfamiliar nomenclature, overwhelming statistics, repititious quotations, appendices, tables, and "additional references" to sources not always available in the country of your choice. In short, a State-of-the-Art Paper is not really for the layman; it'is of consuming interest to only a limited number of professionals; and it is avoided with trepidation by newsletter editors whose facility with short, timely, provocative news items can be mangled beyond re- pair by long, erudite, circumlocutory analysis. For Whom It Tolls: Having placed our caveats on the table, however, let it also be noted here that a well- done State-of-the-Art Paper may contain information you can't get anywhere else. It may-by linking all known factors together-become a landmark in the evolution of a process or system or technique to ad- vance universal medical practices. It may-even with- out your reading it-help to save your life one day. Abstracts from AHP' Papers: On these next few pages, consequently, we are abstracting certain comments and findings from two papers completed by The American Health Foundation this past year. One is aptly titled, "Multiphasic Health Testing/Screening Systems-State of the Art." It was sponsored by the U.S. Public Health Service, Department of Health, Education, and Welfare, and AHF was the contrac- tor. The other is titled, "Automated Multiphasic Health Testing," and it represents a preliminary iin- vestigation for the Health Surveillance Center which AHF plans to open in New York City as a prototype for other communities. Anna C. Gelman, assistant professor of epidemiology at Columbia University, served as the AHF project director responsible for preparing both papers. A Group Concept: For those who by now are fairly certain that they don't know what multiphasic screen- ing is all about-automated or not-the stylized flow- chart above will help to visualize its operations. Generally speaking, multiphasic screening is distin- guished from the comprehensive annual health check- ups many people now undergo, for the latter cus- tomarily include diagnostic procedures. Screening per se is defined as "the presumptive identification of unrecognized disease or defect" by a series of tests, examinations, or other procedures. Multiphasic screening, on the other hand, is the application of two or more tests in combination to large groups of people. It is a means of rapidly identifying the ap- 3

parently well persons who probably have a disease and those who probably do not. State-of-the-Art Today: Desirable as its objectives might seem, the proclaimed merits of AMHT (auto- mated multiphasic health testing)-and whether di- agnostic or follow-up treatment should be included- have provoked considerable debate within medical circles. Those who champion AMHT say it is eco- nomical, time-saving, reliable, and with more studies and experience will become even better. Those op- posed question how it can be integrated into our present health-care system. They also charge it dumps large numbers of disease suspects upon pri- vate practitioners-while failing to provide financing or facilities for diagnosis and treatment. Variations on these themes have reverberated through medical conferences for well over half a century. But today, with medical costs skyrocketing and new alternatives needed, there is increasing agreement among physi- cians that "multiphasic screening is here, and we had better learn how to adjust to it." The Case for Periodic Preventive Examinations In the first AHF paper on AMHT's status, readers are reminded, "The belief that it is good practice. to visit one's physician periodically for a preventive examination is not new." Lecturing in London in 1861, the paper notes, Horace Dobell recommended that such an examination for all members of the family-to include family history, personal and medi- cal histories, advice and follow-up-would confer "immense benefit upon the public." Since that time-and before, in fact-there have been many other advocates of a periodic preventive ex- amination. Indeed, such examinations are being conducted today by many physicians and medical groups. One survey, conducted in 1957-59, found that there had been approximately 74 million visits to doctors annually for a general checkup-about 8% of all physician visits. Acceptance of the concept has been increasing. The Ideal Way: No one can deny that in an ideal situation every person would consult his or her per- sanal physician-who is ready and waiting, with a modern, fully-equipped office and qualified technical staff for a thorough physical examination, as well as facilities for follow-up treatment. However, there are just not enough general practitioners, internists, and pediatricians available for such annual face-to-face services. At best, if all 260,000 licensed physicians in the U.S.-regardless of specialty-were to assume responsibility for an annual physical examination, it wouldn't work very well. For based on the estimated figure of 60-65 "family service" physicians per 100,600 population, each doctor would have to per- form roughly seven physical examinations a day-if all 200,000,000 of us were examined annually. Who, then, would have time to treat the sick? Seen under these conditions, the "ideal" way becomes more visionary than viable, and AMHT seems more in- evitable. 4 Here's how U.S. spent $63-billion f or medical care in 1969. Annual cost is expected to reach $200-billion by the early 1980's. Advantages of Automation: Since there is a shortage of doctors, and since medical schools can't graduate them fast enough, the medical profession is virtually being compelled to take greater advantage of tech- nological alternatives. Automatic recording devices, biochemical and hematological autoanalyzers, sensi- marked questionnaires, and data processing systems are mushrooming everywhere. It has been estimated, moreover, that "a 3% increase in the productivity of the physician would be equivalent in service to all members of graduating classes in all medical schools in a given year." Can we afford, then, not to have a wide network of AMHT centers, public and private, within the framework of the existing organization of medical care in this country? If definitive answers are lacking-and they are-there is no lack of opin- ions or interest or planning. Where Industry Stands: Investment capital believes that the answer to AMHT is affirmative, and is rapidly movirig to "get in on the ground floor." The entrepreneur is concerned with whether or not this new system can be marketed. Among the many in- dustries involved already are the data processing companies, and their satellites, all looking for fresh outlets for their services. Instrument manufacturers, too, see in AMHT the competition for more ac- ceptable instrumentation. Systems designers and architectural firms anticipate. a growth market for stationary health care centers and mobile units alike. Pharmaceutical companies, always interested in ex- panding their biochemical and other testing services, are also waiting in the wings. And not to be over- looked, of course, is the insurance industry. With few exceptions, insurance policies do not currently provide for preventive examinations, but future.

31 AMHT centers may very well affect disability and hospital claims as well as longevity. of this century, if science and automation are man's to control, then surely the future of AMHT is secure. A Concert of Constraints: It would not be quite cricket to say that either a loyal or a disloyal opposition to the go and no-go aspects of AMHT has developed. What has happened to mitigate its momentum is that, from many responsible sources, special interest problems are being evaluated and the end results of change are still in need of a consensus. Govern- mental agencies are concerned with both the validity and legality of various AMHT components in order to protect the individual consumer at whom all of this automation is directed. Consumers themselves, as represented by unions and other consumer groups, are asking for evidence that AMHT is something desirable which will be of benefit to them. Employers, in turn, are more interested in knowing whether the use of such a system will lessen - absenteeism and increase production. Even among scientists- particularly epidemiologists, geneticists, biostatisti- cians, social scientists, sociologists, health planners- the ability of AMHT to provide valid and significant numbers relating to the variables of health and dis- ease is a matter of great concern. Challenging the Status Quo: Perhaps the most search- ing and sensitive questions have been raised by the professional groups. Educators, psychologists, hos- pital administrators, and biochemists, among others, have laid it on the line. Does AMHT create new op- portunities, they are asking, or does it threaten the status quo-which is the product of many centuries? Organized medicine, as represented by the A.M.A., is currently of the opinion that "automated multi- phasic screening at this point in time is a promising technique which requires further experimentation and controlled evaluation to fully identify its benefits, limitations, and ultimate potential." The fact that AMHT must be supported by follow-up treatment for the identified "high risk" patient, seemingly does not influence A.M.A.'s position. A not dissimilar stand was taken by The American Public Health Association in the 1968 policy state- ment of its Governing Council: "Comprehensive multiphasic screening programs of the type recom- mended require careful detailed planning and coordi- nation. Time and effort must be spent to survey exist- ing programs, past histories of different programs, existing community needs, services and resources, the cost, value and feasibility of various tests, and to sample the attitudes and desires of the target popula- tions and the medical community concerning a screening program. Only after this basic work has been completed can an effective program be tailored to the specific community concerned." Slowly but Surely: Unlike the Gordian Knot-which had to be severed by sword-the conflicting convic- tions of private enterprise on the one hand and those of medical and public health professionals on the other are apt to come unraveled one at a time, though not overnight. If the periodic health examination has been an acceptable procedure since the early part Variables in Cost of AMIIT vs. Cost of Illness High among the obstacles to overcome before any new program such as AMHT can be integrated into the overall medical care system are predictable ques- tions about its cost and its benefits. "Will it be worth the expenditure?" That's the inevitable query from government, industry, medicine, and insur- ance. Undeniably, automated multiphasic health testing installations do require vast expenditures of time, effort, personnel, and money, even before a center can open for service. In addition, the cost of conducting such a center requires a steady stream of examinees to keep it solvent. Since AMHT has only been in operation for a rela- tively short time, data on cost, cost benefit, and cost effectiveness are sorely lacking. Much time is being spent, however, on the development of appropriate cost formulas. These will eventually be of value in detecting unnecessary examinations, the need for new or less expensive instrumentation, relating cost of test to frequency of the abnormality detected in the population group under study, and many other variable factors. Meanwhile, it must be recognized that the cost of tests in one program may differ widely from another because of the volume of tests performed. Also, if an AMHT center is associated with a hospital which already has much of the es- sential equipment, facilities, and professional staff, its cost per examination may be less than one which stands alone. In other situations, the geographic loca- tion of the facility-in terms of heating needs, rental costs, labor, and various overhead charges-will in- fluence the cost. Basis for Comparisons: One of the largest and best known of AMHT programs is that conducted by the Permanente Medical Group in Oakland, California. According to a cost analysis study reported (5/8/69) in the New England Journal of Medicine, the cost to Permanente per multiphasic screening was $21.32. This figure included data processing, direct and in- direct charges, and related to a patient load of 2,000 per month. If only 1,000 patients were screened, the cost was estimated at $40-50 per examination. If the patient load could be raised to 3,000 per month, it was estimated the cost would drop to $15-17. This same article pointed out: "On the basis of two multiphasic laboratories, each operating for 40 hours weekly and each examining about 500 patients a week, the cost per screening was $21.32, including central staff and data pro- cessing and all direct and indirect charges. This figure includes physician interpretations of electro- cardiograms, x-ray films and retinal photographs, but excludes physicians' physical and supplemental follow-up examinations. Personnel salaries at $8.60 per patient examination comprised the largest cost category. Clinical laboratory and mammography were the most expensive phases." 5

~ I Claims and Counter-Claims: While the Permanente cost study is indicative and revealing, it is not con- clusive. For most of the other currently operating AMHT centers have not been in operation long enough to evaluate the impact of their efforts. They are not yet in a position to evaluate.their procedures in terms of yield, effectiveness, interpretation, ac- ceptance by both patient and physician, cost and cost benefits, etc. And there are no available regula- tory guidelines for the conduct of non-governmental sponsored centers, for quality control and repro- ducibility of results, for interpretation of findings and long-term effect upon medical demands, hos- pital bed utilization, and patient benefits. Some supporters of AMHT do claim to have suf- ficient evidence to justify their programs. But their opponents offer a variety of criticisms directed against the preventive examination concept in gen- eral, the danger of overwhelming busy physicians with trivial abnormalities, the imperfections of auto- mated procedures, etc. It is to be hoped, nonetheless, that the availability of automated data processing and automated instrumentation will make it possible to rapidly analyze the data derived from AMHT centers, so that the questions posed by A.M.A., A.P.H.A., and other groups can be answered with authority. The Ultimate Decisions: If the AHF papers seem to dwell heavily on the restraints invoked by AMHT- and they do-they also make a very compelling case for the future of this complex preventive concept. They do not put a price tag on building an AMHT center for the reasons already cited. But they do point to multiphasic screening programs which have tso ~ HosDital daily cn,,,es All medf ~ue so anyslc h /~ E I I I ' I ost of l ~ In f{ationary prices are the biggest single contributor to medical costs in the U.S. today. 6 cal ns ivinq brought the cost of comprehensive physical examina- tions to a point that most people can comfortably afford. They do not advocate the replacement of traditional medical practices and doctrines. But they do conclude that what we have is not enough, and that something more is needed to strengthen our current health care system. Seen within these parameters, it may well be that the ultimate decisions concerning AMHT will be made for us-not by medical authorities, but by the imperatives of our national needs and resources. Look at the soaring 1970 census figures, and one can only conclude that a population of 205-million -with its medical services already over-burdened- must take full advantage of preventive medicine tech- niques and automated facilities. Look at the $63- billion spent (see chart on P. 4) for U.S. medical care in 1969, or compare the rising costs (see chart on P.6) of medical care with the cost of living, and again one concludes that medicine today needs all the help it can get. Used in Many Ways: Apart from their contribution to periodic preventive examinations, AMHT centers can and should be used for physical fitness ap- praisals: by athletes in competitive sports; by chil- dren entering school, summer camp, or college; by the armed services for pre-induction physicals; by many employers for hazardous occupations; and by inmates of public institutions. There are, in fact, a vast number of other special uses for AMHT, including pre-trial assessment of health status after an accident, periodic nutrition surveys to detect abnormalities before and after therapy, and determining the medical needs of persons obtaining government assistance. Physicians would supervise all such programs, and perform those examinations which only a physician is qualified to do. Many of the tests and the data processing, however, could be performed by para- medical personnel and technicians-so that physi- cians can concentrate on diagnostic problems and patient care. Some Wait, Some Won't: Clearly, then, AMHT is a system with the potential for widespread applica- tion. The cost problems can be solved-with tech- nology, with good management. The primary con- sideration should be whether AMHT is an effective method of administering that part of the "physical check-up" which it encompasses, and whether it conserves medical manpower without lowering ex- amination standards. Today, laboratory examina- tions, EKG's, x-rays, and many other testing devices are an accepted part of the requirements for sound medical practice. They are also a part of the pa- tient's expectation. Thus, in its present state-of-the- art, AMHT appears to be the next logical extension of what has now been accepted by many physicians and much of the general public. While some wait for its promise to be proven and perfected, others see AMHT as a portal to chronic disease control through early detection and follow-up treatment.

0 r LJ.S. School Systcui-The Countdown Ilas Bcbun For New I'ro grauis in Ilealth and Family Living by Virginia Schroeder Burnham* Scientific progress has brought many chronic dis- eases within our powers of correction or control. There still exists, however, a deplorable lag between what the scientist knows and what the public does. In particular, there is an acknowledged lack of infor- mation concerning good health habits and preventive medical techniques which are essential to the main- tenance of optimum health. It also is generally con- ceded that an accelerating social disintegration is taking place today. Ours is not a Great Society, it is being said, ours is a Sick Society. The evidence of our failures in health education and family life takes many forms. Life expectancy has not been extended in the over 40 age group. It is a national disgrace that our country stands 15th in Mrs. Burnham survival of infants during their first year. Venereal disease in- fects more than 250,000 young persons annually. In one re- cent year, abortions performed on high school age girls exceeded 180,000. Every year we author- ize and spend billions of dollars to solve the problems of alcohol- ism, delinquency, mental illness, retardation, suicide, narcotic ad- diction and other manifestations of inadequate human development. All of this is not news, nor has it hap- pened overnight. But if we are to reverse these down- hill trends-and reach the levels of environmental health and family living to which we aspire-a con- certed national effort must be undertaken. Restructure the Schools: What better medium have we for changing habits and attitudes and establishing an understanding than the learning process to which young people are exposed throughout their long 13 years of schooling? My proposal, therefore, is to in- troduce a program of health maintenance and prep- aration for family life into the schools of our nation. Starting at kindergarten and continuing through the 12 grades, the curriculum would be planned to pro- vide (1) adequate instruction in good health habits for prevention, early detection, and control of dis- ease, and (2) reinforcement of the home as the basic unit of society through preparation for marriage, parenthood, and family life. Support from Many Sources: The momentum to sustain this proposal is anticipated from many responsible sources. It is significant, for example, that Congress has already seen fit to amend the Higher Education Act of 1965 to include the training and retraining of teachers in these subject areas-and has made federal funds available for this purpose. Moreover, the National Commission on Community Health Services has stated: "Health education must become a fundamental part of the basic balanced curriculum [in schoolsj. It can be effectively taught in school, f and no other public agency today offers health in- struction to children of school age." Health Education Today: According to one recent sur- vey of U.S. schools, health instruction is not only inadequate, it is virtually nonexistent. In recent years, however, some schools in Cleveland, Los Angeles, Roanoke, Washington, D.C., and several other cities have introduced a comprehensive health-and-family-life curriculum for all grade levels. Others can be expected to follow their example in time. Although parental and community resistance to classroom discussions of sex is a continuing prob- lem, the National Congress of Parents and Teachers has fully endorsed a sex education program for all schools. Family Living Today: It is within the family that most social learning takes place-a good deal of it through example set by the parents. It is through the family that we learn how to live with others, that we learn honesty, decency, cleanliness, fairness, obedience, discipline, and most important-love. Basically, the family does two things: it insures physical survival and builds the essential humanness of the individual. Thus the family is the basic unit of society. Yet, to a large segment of our population, the family and the home are no longer considered of much signifi- cance. We live in an era of crime and delinquency at , all social levels-and the symptoms are too familiar to recite here again. It is my conviction, therefore, that preventive measures are needed. It is my contention they should take the form of educational preparation for family life and parenthood. In a few short years, our young people of today will marry and produce a new generation. Will this be done in a healthy home atmosphere-or will the sorry record we have made be repeated? Preparing for Prevention: In this brief space, it has been possible to present only the highlights of a multi-disciplinary concept. National interest and acceptance must be sought and initiated, even while state and local boards of education are being offered a choice of curricula to suit their needs and require- ments. It is also a regrettable fact that most physi- cians-as well as teachers-need further training in sex education and preventive medicine. Each premature death from disease is a personal tragedy, but each preventable death is a national reproach. Since more and more parents are abdicating their responsibilities, education in the schools is the best way to revitalize the family and its role in our society. Most efforts to date, however, have focused on finding cures, rather than correcting the causes. The time is already upon us to recognize that pre- vention, not cure, is our only hope for the future- and it must begin with the children. *htrs. Burnhana is president of Connecticut Manufactur- ing Co., Inc. •(metal fabricators) and has served as a director or member of numerous government, comrnu- nity, and non-profit agencies concerned with public health and medical research. Recently she was appointed the chairman of a volunteer committee to organize a Con- necticut division of The American Health Foundation. 7

i ment was made by David J. Mahoney, AHF board chair- man and president of Norton Simon, Inc., who noted that the Foundation was established originally in the conviction- since confirmed-that an organi- zation of both laymen and medi- M~ t cal professionals was needed to Mr.ll7itchell New Member Elected to AIiF's Board of Trustees John H. Mitchell, president of the Screen Gems Division of Columbia Pictures Industries, Inc., has been elected a member of the board of trustees for The American Health Foundation. The announce- create a national commitment to the concepts of preventive medicine. Mr. Mitchell joined Screen Gems in 1952 as a vice president and, under his aegis, Screen Gems has grown into one of the largest producers and dis- tributors of television programming. Preuentiue Dentistry (cont.) There are other serious diseases which may also first appear in the mouth: dermatological conditions, such as leukoplahia and herpes; tumors and cysts; blood diseases, such as leukemia and anemia; avitaminosis (scurvy and pellagra); chemical and drug poison- ing; and specific infections, such as syphilis and tuberculosis. Many of these diseases can be con- trolled or treated more effectively if detected early by the dentist. New Breakthroughs Ahead: Scientific research in pre- ventive dentistry has been increasing at a rapid pace. New materials and techniques are being studied to control and prevent dental problems of many kinds. One major breakthrough in cavity prevention is a new I plastic sealant, which is bonded directly onto the chewing surface of the tooth and is effective on the biting surface, where fluorides are not as effective. This sealant may be available to dentists by the end of this year for use in the dental office. The results of research by Dr. Michael Buonocore of the Eastman Dental Center, Rochester, N.Y., on this plastic sealant - after it was applied to the vulnerable biting surfaces - showed 100% cavity protection after one year. To date, the two-year study shows 99% effectiveness in cavity prevention in per- manent teeth and 87% protection in baby teeth. -There also is continuous research involving the fluor- ides and phosphates to prevent cavities. Studies are being made, too, of enzymes and anti-microbial agents which will destroy cavity-producing bacteria. Other work is being done on new procedures in food processing, and on the incorporation of food additives to prevent dental decay. Also, the use of laser beams to strengthen the teeth against decay is under re- search. The Public Health Service and the U.S. Navy are even studying an oral vaccine with the hope that it may eliminate cavities within the next decade. Towards the True Goal: The ideal of greater preven- tion in dentistry can be achieved only through education and research on a national scale. Such education, treatment, and home care should origi- nate with the expectant mother and continue through- out the life of the child. For these measures will help to eliminate early dental crippling, with the ensuing need for reparative treatments in later life. As for the immediate future, the 1970's will con- tinue to show a transition from repair and treatment to prevention and control, opening a new era in dentistry. More and more patients in the new age of preventive dentistry will need less and less re- parative care, bringing us closer to the true goal of dentistry-effective prevention of dental disease. i r >ric•an , ., . . . . . ~ •~~... ..~. ~ „ .-,. U.