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Dentistry

Dentistry


Dentistry began to emerge as a recognized specialty within medical surgery in seventeenth-century Europe, although scattered examples of basic dental practice (especially extractions) and attention to oral hygiene can be traced to earlier centuries. The French surgeon Pierre Fauchard, author of Le Chirurgien Dentiste (1728), is generally recognized as the "father" of modern dentistry. Among his select clientele was an occasional child, usually a daughter of one of his (mainly female) patients, who would present with a badly carious, visible tooth that she was reluctant to extract because an empty space or replacement tooth might threaten her physical appearance and social position. Fauchard's creative solution, which apparently met with some success, was to withdraw the diseased tooth and then replace it immediately in its socket. Beyond providing pain relief, Fauchard and his contemporaries also experimented with new procedures to straighten misaligned teeth; children ages twelve to fourteen were the principal clientele.

These early examples notwithstanding, it was rare for a child of any social class to visit a dentist in the eighteenth and nineteenth centuries. Even among leading professional spokesmen, the traditional view still held that children's primary (deciduous) teeth were expendable, unworthy of financial investment, and unrelated to future oral health. The reparative treatment of carious teeth improved in quality and gained in popularity during the late nineteenth century, but its primary reliance on expensive gold fillings militated against its general extension to children. Extraction remained the primary response to children's dental diseases. Trained dentistsfew in number, located mainly in cities, and expensivewere largely peripheral to the extraction trade, which was dominated by barbers, nostrum salesmen, and itinerant "tooth-pullers" who promised instant, pain-free relief. Not surprisingly, business boomed for replacement teeth and prosthetic devices in the nineteenth century, not just for the elderly but also for young adults who emerged from childhood with few usable teeth and constant mouth pain. Dentists and craftsmen worked singly and collaboratively to meet public demand and to improve the quality and fit of prosthetic devices (famous portraits of George Washington's clenched mouth exemplified why technical improvements were considered necessary). Dentists in the United States established clear superiority in "mechanical dentistry" and in the production, quality, variety, and economy of prosthetic devices.

Education, Child Welfare, and the Rise of Children's Dentistry

Children's dentistry emerged as a distinct subspecialty in Canada, Great Britain, and the United States in the first half of the twentieth century. Oddly, the field took shape mainly outside rather than inside dentists' offices, and under public rather than private sponsorship. Most dentists remained ambivalent, if not hostile, to integrating children into their private practices. The challenges and rewards of technically sophisticated, adult-oriented mechanical dentistry, not child-oriented, poorly compensated, preventive dentistry, drove the bulk of the profession. Nonetheless, a major shift in scientific direction, professional orientation, and public discourse about dental disease was evident by the early 1900s. For the first time, dentists seriously questioned the panacea of extraction and the presumed inevitability of toothlessness. A new gospel of "prevention" became a clarion call for dentistry to transform its customary assumptions about children's dental needs, and to make "mouth hygiene" a vital concern in medicine, public health, and education.

Several scientific advances in the 1880s and 1890s underlay the new viewpoint. Most important were Dr. William Miller's "chemico-parasitic" theory, which described the bacteriological process by which caries emerged under gelatinous plaques, and his "focal infection" theory, in which an unclean oral cavity was seen as the prime avenue of penetration for infectious disease in children. Also important in building professional confidence were Dr. Edward Angle's creative inventions for straightening teeth, which raised hopes for addressing the entire range of difficult problems surrounding malocclusion. New techniques and equipment for saving carious teeth with better, longer lasting, and cheaper filling materials also promised a bright future for reparative dentistry.

Children's dentistry was integral to the Progressive Era's (18901920) wide-ranging child welfare and Americanization campaigns, and, in particular, to the school health movement. Educational programs made prevention the central theme of children's dentistry. While educators emphasized the importance of nutrition and regular prophylaxis, they urged above all that children maintain lengthy, stringent, technically perfect standards of brushing their teeth: three, four, and ideally five times per day. Mothers as much as children were the audience for the new conventional wisdom. As with other elements of the Progressive child welfare agenda, mothers were assigned major responsibility for sparing their children needless pain and suffering, and thereby ensuring their success in school and assimilation into American life.

The provision of operative treatment via schools and clinics was the boldest innovation of early-twentieth-century children's dentistry. In the 1910s, several dozen dental clinics were established exclusively or primarily to serve children in public schools and in local health departments; a few clinics with private support, most notably in Boston and Rochester, were also founded. These clinics brought prevention-and-treatment oriented dentistry to the masses for the first time. In many clinics, dentists not only inspected children's teeth but also performed reparative treatments and extractions. Equally innovative was the introduction of regular prophylaxis, usually performed by members of the new, entirely female, school-centered specialty of dental hygienists. Despite its acknowledged importance in caries prevention, prophylaxis was time-consuming, laborious, and generated low fees. Dentists rarely performed prophylaxes in their private offices until hygienists or comparably trained assistants became more widely available. Although male dentists provided most school- and clinic-based operative service, it was lower-level women professionalsteachers, nurses, and hygienistswho mainly carried the banner of children's dentistry, much as in other areas of Progressive child-welfare reform.

A small corps of women dentists also emerged in the early twentieth century that began to focus primarily on children. M. Evangeline Jordon was arguably the first specialist in children's dentistry, beginning in 1909. Jordon authored the field's first expert textbook, Operative Dentistry for Children, in 1925. In his preface to Jordon's text, the prominent dental scholar Rodrigues Ottolengui observed that prior to 1915 he "had never heard of a dentist specializing exclusively in dentistry for children," and that "Dr. Jordon, so far as we have been able to learn, was the first dentist to practice exclusively for children, and thus she is the pioneer pedodontist of the United States, and perhaps of the world" (p. vii). In 1927, around the time of her retirement as a practitioner, a small group of dentists formed the American Society for the Promotion of Dentistry for Children, based on a common understanding that "if children are to be served, general dentists would have to provide most of the treatment." In 1933, the Journal of Dentistry for Children was founded.

General dentists did begin to serve children in larger numbers during the Great Depression, but mainly as paid employees in schools and clinics that expanded under government auspices. The Depression brought considerable hardship for dentists, and publicly funded programs in school and clinic settings were essential for their professional survival. Now numbering in the hundreds, these clinics provided around half of the total amount of dental treatment that children received from any source during the 1930s. (As the draft examinations in World War II would reveal, however, the oral health of American children and youth was still abominable, especially in rural communities and in the South, where publicly financed school and dental clinics never took hold.) Thus, out of necessity more than design or desire, children and dentists were no longer strangers to one another. A base of professional experience and client expectation for integrating children into general dentistry had been laid. Signifying the subspecialty's gradual arrival at professional legitimacy, the American Society for the Promotion of Dentistry for Children was renamed the American Society of Dentistry for Children in 1940.

Toward the Cavity Free Child: New Advances and New Horizons in Children's Dentistry

The provision of free reparative and restorative dentistry to several million servicemen during World War II also did much to create a new consumer base for children's dentistry in the postwar era. With the return of prosperity, this potential was soon realizedbut now in the private rather than in the public sector. In the decade following the war, the private practice of American dentistry boomed as never before, and the share of children receiving private dental care expanded dramatically. By the late 1950s, nearly half of the school-age population was visiting a dentist about once per year. Organized dentistrywhich, unlike organized medicine, had largely supported free school and clinic dental programs for children during the previous half-centuryadopted a condescending stance toward such programs in the 1950s, claiming that they provided inferior treatment, used outdated equipment, misled parents about their children's true dental needs, and were no longer necessary. School clinics and other public agencies that had grown accustomed to calling upon unemployed or underemployed dentists on an hourly per capita or fee basis to treat children now found that dentists no longer had the time or financial inclination to participate in such arrangements. The long-sought ideal of the "family dentist" was finally becoming a reality.

An equally major change emerged in the postwar years that would profoundly transform children's oral health by the 1980s. This was the discovery of the preventive possibilities of fluorides for dental caries. Schools returned briefly in the 1970s to a central role in children's dentistry as the National Institute of Dental Research launched a major publicity campaign to convince educators and dentists alike that school-based fluoride rinse programs represented the most cost-effective, school-based means available to prevent tooth decay. By 1980, nearly one-quarter of the nation's school districts were participating in fluoride rinse programs, which may have reached as many as 8 million children. Although bitter fights over water fluoridation occurred in numerous communities, with some opponents casting fluoridation as a Communist plot, the fluoridation of water supplies grew rapidly in the postwar era. By the end of the 1950s, nearly two thousand communities serving over 33 million people had fluoridated their water supplies. By 1980, over eight thousand communities and more than half of the U.S. population was drinking from artificially or naturally fluoridated water supplies.

In addition, the advent of fluoride-based toothpastes beginning in the 1960s and the growing availability of fluoride mouth rinses in the 1970s further increased the likelihood that children, whether their community had fluoridated its water supply or not, had ready access to fluorides' preventive possibilities. The impact of pervasive exposure to fluorides on children's dental health was spectacular. By the late 1970s, a precipitous nationwide decline in the incidence of dental caries was evident, in non-fluoridated as well as in fluoridated communities. Dentists began to report substantial growth in the numbers of cavity free children, who were virtually unknown just two decades earlier. While the precise causes were uncertain, the omnipresence of fluorides in the food chain, as well as their widespread ingestion via community water supplies, tablets, mouth rinses, and toothpastes, contributed substantially to the decline.

By the beginning of the twenty-first century, the perceived crisis in "mouth hygiene" that had given rise to the specialty of children's dentistry was clearly over. To be sure, dental caries still compromise children's health, and some subgroups of children, particularly among the disadvantaged, continue to suffer disproportionately from caries. But leaders in the field have understandably turned their attention to a variety of new issues and unmet needs. These include paying more attention to periodontal diseases in children; intervening earlier to treat malocclusions; grounding dentistchild relations more consistently on scientific principles of child development; extending dental care to disabled children; expanding the dentist's responsibility in recognizing child abuse and neglect; managing medically compromised patients, such as those with AIDS; and inventing a caries vaccine. Concerns about aesthetic issues as well as health issues led to growing rates of treatment with braces and other straightening devices from the mid-twentieth century onward.

Perhaps bolder still, some leaders in "preschool dentistry" insist that the relatively recently established ideal age for children to see a dentist for the first timeage threeis in fact far too late to preserve optimal dental health. Instead, they recommend that parents schedule their child's first dental appointment between six months and one year of age. The entire field of preschool dentistry was inconceivable a century ago. But its basic premise remains consistent with that of Jordon and other pioneers in early-twentieth-century children's dentistry: "The prevention of disease can never be started too early" (Pinkham, p. 4).

See also: Hygiene; Pediatrics.

bibliography

Adams, Tracey I. 2000. A Dentist and a Gentleman: Gender and the Rise of Dentistry in Ontario. Toronto: University of Toronto Press.

Campbell, J. M. 1963. Dentistry, Then and Now. Glasgow, UK: Pickering and Inglis.

Dunning, James Morse. 1970. Principles of Public Health, 3rd ed. Cambridge, MA: Harvard University Press.

Gies, William J. 1926. Dental Education in the United States and Canada. New York: The Carnegie Foundation for the Advancement of Teaching.

Jordon, M. Evangeline. 1925. Operative Dentistry for Children. Brooklyn, NY: Dental Items of Interest Publishing.

King, Roger. 1998. The Making of the Dentiste, c. 16501760. Brookfield, VT: Ashgate.

Lambert, Camille, Jr., and Howard E. Freeman. 1967. The Clinic Habit. New Haven, CT: College and University Press.

Loevy, Hannelore T. 1984. "M. Evangeline Jordon, Pioneer in Pedodontics." Bulletin of the History of Dentistry 32, no. 1 (April).

McBride, Walter C. 1945. Juvenile Dentistry. Philadelphia: Lea and Febiger.

McCluggage, Robert W. 1959. A History of the American Dental Association: A Century of Health Service. Chicago: American Dental Association.

McDonald, Ralph E. 1963. Dentistry for the Child and Adolescent. Saint Louis, MO: C. V. Mosby.

Nettleton, Sarah. 1992. Power, Pain, and Dentistry. Buckingham, UK: Open University Press.

Pelton, Walter J., and Jacob M. Wisan. 1955. Dentistry in Public Health. Philadelphia: W. B. Saunders.

Pinkham, J. R. 1988. Pediatric Dentistry: Infancy through Adolescence. Philadelphia: W. B. Saunder.

Schlossman, Steven L., Joanne Brown, and Michael Sedlak. 1986. The Public School in American Dentistry.

Santa Monica, CA: Rand.

Welbury, Richard R. 2001. Paediatric Dentistry. Oxford, UK: Oxford University Press.

Steven Schlossman

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Dentistry

DENTISTRY

DENTISTRY. In the eighteenth century, the practice of dentistry was primarily concerned with extracting diseased teeth, not protecting healthy ones. When George Washington was inaugurated in 1789 at the age of 57, he had only one natural tooth left. State-of-the-art dental care in his day consisted of yanking out rotten teeth without benefit of painkillers and crafting awkward dentures from elk and cow teeth, and from the ivory tusks of elephants, hippopotami, and walruses. (Washington owned several pairs of such dentures, though none made of wood, despite the myth.) Dr. A. A. Plantou, a Frenchman who had emigrated to Philadelphia, introduced porcelain teeth to the United States in 1817. (France was the center of dentistry in the eighteenth century; American dominance in the field began in the nineteenth century.) In the 1850s, Nelson Goodyear's invention of Vulcanite—an inexpensive hard rubber that could be molded to the shape of the jaw and fitted with porcelain teeth—finally made false teeth affordable for the average person.

The introduction of nitrous oxide ("laughing gas") in the early 1830s made extraction less painful, but correct dosages were hard to determine. Ether was first used in surgery in 1842 by Dr. Crawford W. Long (though the patent went to Drs. William Thomas Green Morton and Charles Thomas Jackson in 1846). Chloroform, discovered in the early 1830s by doctors in several countries, also began to be used as an anesthetic in dentistry. In 1884, Dr. William Stuart Halsted reported that morphine injected into the lower jaw resulted in complete numbness in six minutes. However, the drug was addictive and could cause localized tissue death (necrosis). It wasn't until 1905 and the invention of the first non-addictive anesthetic, novocaine ("new cocaine"), that dental work could be both safe and painless.

In 1855, Dr. Robert Arthur introduced a cohesive gold foil filling for teeth, produced by heating and cooling the metal to make it stronger. The first crowns were developed in 1880 by Dr. Cassius M. Richmond, who patented a porcelain tooth soldered to a gold body. The invention of the electric furnace (in 1894) and low-fusing porcelain (in 1898) made possible the first strong porcelain "jacket" crown, introduced in 1903.

The first dental school, the Baltimore College of Dental Surgery, was founded in 1840 in Maryland. For decades, however, dentists were not required to pass a test or obtain a license in order to practice. It took nearly one hundred years for dental education to develop its present form: three or four years of undergraduate study and four years of dental school, with a curriculum including medical science, technical training, and clinical practice.

The Mercury Controversy

Mercury compounds introduced to the United States in 1832 as a filling for the cavities left after dental caries are removed provoked a controversy that continues to the present day. Because the injurious effects of mercury poisoning—ranging from muscle tremors to hallucinations— were well known in the nineteenth century, many were fearful of the new treatment. Mercury still accounts for 50 percent of modern silver amalgam fillings, developed in 1895 by Dr. G. V. Black (known as "the father of scientific dentistry"). The other components are: 35 percent silver, about 15 percent tin (or tin and copper, for added strength), and a trace of zinc. In the late 1980s it was discovered that minute amounts of mercury vapor are released in chewing. A few years later researchers demonstrated the ill effects of silver amalgam in sheep (the mercury caused kidney malfunction) and human fetuses (mercury from mothers with silver fillings was found in the brain tissue of stillborn babies). Some worried patients have had all their amalgam fillings removed and replaced with porcelain inlays (developed in the late 1890s) or composite resin fillings (invented in the late 1930s). On the other hand, considering the long and widespread use of amalgam fillings—contained in the teeth of more than 100 million living Americans, and handled constantly by dentists—many experts believe such findings to be inconclusive. The American Dental Association (ADA) not only affirms the safety of dental amalgam but also claims that it is unethical for dentists to recommend removal of amalgam fillings from a patient's teeth "for the alleged purpose of removing toxic substances from the body." The ADA cites other studies, of dentists as well as patients, that show no correlation between amalgam fillings and kidney disease or nervous disorders.

Treating Tooth Decay

In the early nineteenth century, it was believed that decay (dental caries) originated on the surface of the tooth. In 1890, American dentist Willoughby D. Miller's ground-breaking work, The Micro-organisms of the Human Mouth, revealed that acids from dissolved sugars in foods decalcify tooth enamel, followed by bacterial action that destroys the bone-like dentin underneath that surrounds living tissue. This discovery led dentists to place more emphasis on oral prophylaxis—disease-preventive measures—as well as on proper sterilization of dental tools. Yet dental health nationwide remained less than optimum. During World War II, the Selective Service initially required each new armed forces recruit to have at least twelve teeth, three pairs of matching front teeth (incisors) and three pairs of chewing teeth (molars). When it turned out that one in five of the first two million men didn't qualify, all dental standards were dropped.

The addition of fluoride to city water systems, beginning in 1945 in Michigan and Illinois, sparked a major controversy. In 1942, a U.S. Public Health Service dentist, Dr. H. Trendley Dean, had determined that adding one part fluoride per million of drinking water reduced dental caries. By 1950, more than 50 cities had fluoridated their water supply. Then came the protests, most famously those of the John Birch Society, which believed the program to be a Communist plot to poison Americans. Others, including health food advocates, were concerned about potential poisons. Yet by the 1960s fluoride was in nearly 3,000 water systems serving 83 million people. By the end of the twentieth century, some 155 million Americans—62 percent of the population—had fluoridated water. Fluoride also has been added to many toothpaste and mouthwash brands.

In 1954 a team of scientists at the University of Notre Dame, led by Frank J. Orland, identified Streptococcus mutans as the bacteria that produces the acid that dissolves tooth enamel and dentin. The origin of gum (periodontal) disease was unknown until the mid-1960s, when bacterial plaque was found to be the culprit. Since the 1970s, biotechnology has helped the dental researchers known as oral ecologists to begin to identify some of the more than 400 species of microorganisms (mostly bacteria) that live in the mouth.

Dental Tools

Invented in 1895 in Germany, x-rays were demonstrated for dental use the following year in the United States by Dr. Charles Edmund Kells Jr., who also invented the automatic electric suction pump to drain saliva. (The first tool for saliva control was the rubber dental dam, invented in 1864 by Dr. Sanford C. Barnum.) Commercial x-ray equipment made for dentistry was first used in the United States in 1913. Other features of modern dental offices took many decades to achieve their present form. In 1832 James Snell developed the first dental chair, which included a spirit lamp and mirror to illuminate the patient's mouth. A major breakthrough in chair design occurred in 1954, with Dr. Sanford S. Golden's reclining model. John Naughton's Den-Tal-Ez chair, powered by hydraulic cylinders, was introduced in the 1960s. The first self-cleaning device to receive patients' spit was the Whitcomb Fountain Spittoon, marketed in 1867.

The electric-powered drill was invented in 1868 by George F. Green, a mechanic employed by the S. S. White Company. Inspired by the workings of the Singer sewing machine mass-produced a decade earlier, James Beall Morrison added a foot treadle and pulley system in 1871. But the drill was still very heavy, and dentists' offices were not wired for electricity until the late 1880s, when Dr. Kells first adopted the new technology. In 1953 a team at the National Bureau of Standards, led by Dr. Robert J. Nelson, finally developed a hydraulic-powered turbine drill that could achieve speeds of 61,000 revolutions per minute. (Today, electrically powered drill speeds of 400,000 revolutions per minute or more are common.) Speed is significant because it reduces not only the time it takes to remove caries but also the amount of pressure on the tooth.

Recent Developments

Since the mid-1980s composite resin fillings have grown increasingly popular in the United States as an alternative to amalgam. The first composite filling was developed in 1955 by Michael Buonocore and others, but the acrylic proved too soft for the stress caused by chewing. The addition of microscopic particles of glass or quartz to the plastic resin base in 1967 solved this problem. While composite resin is white—and therefore relatively invisible—it is not as long-lasting as silver amalgam, can be more costly for the patient, and requires greater skill on the dentist's part because it is applied in separate layers that must harden under a strong light.

Numerous advances in dental treatment in the late twentieth century have radically altered the field. Digital imagery of the teeth, transmitted through fiber optics from an x-ray sensor to a computer screen, offers a faster, safer, and more easily readable alternative to x-ray film. This process emits 90 to 95 percent less radiation than ordinary x-rays, and allows the image to be magnified and more easily stored, reproduced, and shared with other doctors. The first laser "drill" was approved by the FDA in 1997. Lasers burn through decay without vibration or pressure on the tooth. Other advances include "invisible" braces that attach to the insides of teeth, dental implants that anchor to the jaw to permanently replace missing teeth, and computer-generated tooth restorations. Cosmetic dentistry, including bonding (using composite resin to improve tooth shape and whiteness) and bleaching, has spawned business franchises devoted exclusively to these services.

BIBLIOGRAPHY

Hoffmann-Axthelm, Walter, trans. H. M. Koehler. History of Dentistry. Chicago: Quintessence, 1981.

Jedynakiewicz, Nicolas M. A Practical Guide to Technology in Dentistry. London: Wolfe, 1992.

Jong, Anthony W., ed. Community Dental Health. St. Louis, Mo.: Mosby, 1988.

Prinz, Hermann. Dental Chronology: A Record of the More Important Historic Events in the Evolution of Dentistry. Philadelphia: Lea & Febiger, 1945.

Ring, Malvin E. Dentistry: An Illustrated History. New York: Abrams, 1985.

Weinberger, Bernhard W. An Introduction to the History of Dentistry. St. Louis, Mo.: Mosby, 1948.

Wynbrandt, James. The Excruciating History of Dentistry. New York: St. Martin's Press, 1998.

CathyCurtis

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dentistry

dentistry is the art or science of treating diseases of the teeth and of the gums around them. As with medicine, dentistry is subdivided into a number of specialities. Oral surgery includes tooth extractions and operations on the jaw bones and the soft tissues of the mouth. Oral medicine deals with the treatment of local or systemic diseases affecting the mouth. Restorative dentistry involves replacement of parts of teeth or missing teeth. Fillings may be made from ‘plastic’ materials, such as amalgams or tooth-coloured composite resins, or pre-cast inlays; larger restorations may require metal or ceramic crowns. Restorative dentistry also includes endodontics (treating the pulps or root canals of teeth) and prosthodontics. In prosthodontics, missing teeth are replaced either with fixed bridges (using crowns placed on healthy teeth to support the ‘pontic’ that replaces the missing tooth or teeth) or removable dentures (false teeth) that may be partial or complete, depending on whether some or all of the natural teeth have been lost. Periodontics covers treatment of diseases of the gums (gingivitis) and other tissues around the teeth (periodontitis). Orthodontics is the correction of misalignment of teeth using appliances (‘braces’), which may be held by brackets glued to the teeth (fixed appliances) or retained with wire clasps (removable appliances). Paedodontics covers all aspects of dentistry in children.

The earliest references to teeth and dental diseases are inscriptions written on clay tablets around 5000 years ago in Mesopotamia. The first known dentist was Hesi-Re. He lived in Egypt around 3000 years ago, and was described as ‘the greatest of the physicians who treat teeth’. In ancient times, dental ‘treatment’ consisted mainly of tooth cleaning and perhaps some tooth extractions. Dentures (false teeth) first appeared in Sidon (Lebanon) and Tuscany around 630 bce. Here, gold bands and wires were used to attach false teeth (usually carved from ivory) to adjacent healthy teeth. The Romans were very oral hygiene-conscious. They washed their teeth and cleaned them with tooth powders (dentifrices). In ancient Greece and Rome, as in Egypt, dentistry was performed by general physicians. Practitioners were skilled in restoring carious teeth with gold and replacing missing teeth with false ones. These false teeth were ridiculed by the poet Martial, who wrote in the first century ad:
Lucania has white teeth; Thaïs brown. How comes it? One has false teeth, one her own.During the Dark and Middle Ages in Europe (approximately from 500–1500 ad), progress in medicine halted and there were no real advances for nearly 1000 years. However, during this period knowledge was sustained by Islamic scholars such as Albucasis, who wrote extensively on teeth and tooth cleaning. The importance of oral hygiene was widely recognized in the Orient. During this period Hindus and the Chinese developed various dental treatments and complex surgical procedures. In Europe, by the fifteenth century ‘dentistry’ was undertaken by barber–surgeons, physicians or apothecaries, blacksmiths, and other ‘tooth-drawers’. Herbal concoctions were the main ‘remedies’ for toothache and ‘treatment’ was confined mainly to extractions. The upper classes cleaned their teeth with cloth or sponges, and some even had gold or silver toothpicks. These were often hung round the owner's neck as an item of jewellery.

Knowledge blossomed in the Renaissance. Many of the new anatomical texts, such as Andreas Vesalius' great work De humani corporis fabrica, contained sections on teeth. Some purely dental texts were published in the sixteenth and seventeenth centuries, but the foundations of modern dental practice were laid in Pierre Fauchard's Le Chirurgien Dentiste (1728). Fauchard's book was a comprehensive discourse on a wide range of treatments. He described techniques for scraping out caries and filling the cavities with soft metals such as tin, lead, or gold. His book also gave rise to the modern term ‘dentist’ or ‘dental surgeon’.

Prior to 1844, there were no anaesthetics to abolish the pain of surgery. However, opium and laudanum (tincture of opium) were freely available ‘over the counter’. Dorothy Wordsworth (sister of the poet William) wrote: ‘I had toothache in the night. Took laudanum.’ In 1844, an American dentist, Horace Wells, was the first person to experience tooth extraction under nitrous oxide analgesia. Two years later, William Morton extracted a tooth under ether anaesthesia. In 1884, a Dr Nash was the first person to fill a tooth using cocaine injected as a local anaesthetic. In 1905, cocaine was replaced by the synthetic drug novocaine (procaine). This in turn was replaced by lignocaine (lidocaine), which is in use today.

In the eighteenth century, dentures were hand-carved from materials such as ivory, and so did not fit well. Springs were sometimes used to help improve the stability of these loose dentures. However, dentures did not improve until the invention (by Nelson Goodyear) of a hardened rubber (‘Vulcanite’) which allowed closely-fitting denture bases to be constructed on casts made from impressions of the patient's mouth. As well as fitting better, vulcanite dentures were cheaper to make.

Other developments in the nineteenth century included the reclining dental chair, amalgam fillings (which were controversial even in the 1850s), and the treadle engine for driving the dental drill. The first electric-powered dental drill was invented in 1868. Many of the technical aspects and skills of dentistry were established by the end of the nineteenth century and some have remained more or less unaltered to the present day. The principles of cavity cutting, formulated by G. V. Black in the 1880s, have been supplanted only recently with the advent of adhesive filling materials. Developments in the twentieth century included improvements in dental materials, the introduction of the ‘high-speed’ drills (powered by compressed air), and greater emphasis on instrument sterility and cross infection control.

The modern dentist is part of a team, which includes a dental nurse (dental assistant), a technician, and ancillary operators such as dental hygienists, dental therapists, and dental radiographers. Dentistry is changing from being a pain-relief and patch-up service to a profession which places emphasis on prevention of tooth decay (dental caries) and gum disease (gingivitis and periodontitis). These diseases are largely preventable with good diet and effective oral hygiene. Their effects can be minimized by early diagnosis and treatment. Fluoride can help prevent caries, by making the enamel more resistant to attack by plaque acids, but it can also cause staining or mottling of the teeth (fluorosis). Artificial fluoridation of water supplies would reduce the incidence of caries, especially amongst people with poor standards of oral hygiene. However, fluoridation of public water supplies is a controversial political issue. The recent improvements in dental health can be illustrated by data from Great Britain. In 1968, 37% of adults in England and Wales had no natural teeth. In Scotland in 1972, 44% of adults had lost all their teeth. By 1988, these figures had fallen to 20% in England and Wales and 26% in Scotland. These improvements were due mainly to the better dental health in people under 35 years of age.

In spite of these improvements in dental health, teeth are still extracted because of decay. General anaesthesia (GA) was widely used for tooth extraction in young children and in some adults with a fear of injections. In the UK, the use of GA for dental procedures has been restricted. This is intended to eliminate the small numbers of deaths each year associated with dental GA. Since 1998, GA can be administered only by suitably qualified anaesthetists in clinics where proper emergency facilities and staff are available. One alternative to GA is conscious sedation. Here, the patient is awake and can respond to verbal commands, but is ‘relaxed’. Sedation is produced using drugs such as a nitrous oxide– oxygen mixture, or tranquillizers such as diazepam (Valium), and is normally used along with appropriate local anaesthesia.

What of the future? The improvements in dental health must be sustained. A major priority is to find effective alternatives for injected local anaesthetics and replacements for the dental drill. One interesting area of development is the use of chemicals to remove caries without the need for drilling. The decay is dissolved by acids and the softened debris is scooped out. Laser technology, too, is developing and in time may replace the drill in restorative dentistry. The advent of adhesive, tooth-coloured fillings has revolutionized restorative dentistry. It is no longer necessary to cut large cavities for amalgam fillings. Instead, fillings can be placed with the minimum loss of healthy tooth substance. In prosthodontics, metal posts implanted in the jaw bones can be used to improve the support and efficiency of dentures. Nowadays, people live longer and can expect to have their natural teeth when they die. The science of dental gerontology has emerged to meet the dental needs of elderly people. Cosmetic dentistry, too, is a growth industry. Thin veneers can be used to correct defects on the outer surfaces of anterior teeth. The current trend of body adornment has extended to teeth, and small gems or gold shapes (‘Twinkles’) can be glued to the tooth surface. But cosmetic dentistry is not new. Many societies in Africa and America file the teeth for decorative and ceremonial purposes. In the ninth century the Mayans placed decorative inlays in anterior teeth. These inlays of semi-precious stones were fixed into cavities cut with a simple bow drill. Such skills were not introduced to Europe until many centuries later.

Robin Orchardson

Bibliography

Hillam, C. (1990). The roots of dentistry. British Dental Association, London.
Ring, M. E. (1993). Dentistry: an illustrated history. H. N. Abrams Inc., New York.


See also teeth.

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Dentistry

Dentistry

Dentistry is the medical field concerned with the treatment and care of the teeth, the gums, and the oral cavity. This includes treating teeth damaged by tooth decay, accidents, or disease. Dentistry is considered an independent medical art, with its own licensing procedure. Orthodontics is the branch of dentistry concerned with tooth problems such as gaps between the teeth, crowded teeth, and irregular bite. Periodontics, another branch, focuses on gum problems.

Historical dental practices

Dental disease has been one of the most common ailments known to humankind. Ancient men and women worked hard to alleviate dental pain. As early as 1550 b.c., Egyptians used various remedies for toothache, which included such familiar ingredients as dough, honey, onions, incense, and fennel seeds.

The Egyptians also turned to superstition for help in preventing tooth pain. The mouse, which was considered to be protected by the Sun and capable of fending off death, was often used by individuals with a toothache. A common remedy involved applying half of the body of a dead mouse to the aching tooth while the body was still warm.

The Greek physician Hippocrates (c. 460c. 377 b.c.), considered the father of medicine, believed that food lodged between teeth was responsible for tooth decay. He suggested pulling teeth that were loose and decayed. Hippocrates also offered advice for bad breath. He suggested a mouth wash containing oil of anise seed, myrrh, and white wine.

Clean teeth were valued by the ancient Romans. Rich families had slaves clean their mouths using small sticks of wood and tooth powder. Such powders could include burned eggshell, bay leaves, and myrrh. These powders could also include more unusual ingredients, such as burned heads of mice and lizard livers. Earthworms marinated in vinegar were used for a mouth wash, and urine was thought of as a gum strengthener.

The Chinese were the first to develop an amalgam (mixture of metals) filling, which was mentioned in medical texts as early as 659. The Chinese also developed full dentures by the twelfth century and invented the toothbrush model for our contemporary toothbrushes in the fifteenth century.

The writings of Abu al-Qasim (9361013), a Spanish Arab surgeon, influenced Islamic and European medical practitioners. He described surgery for dental irregularities, the use of gold wire to make teeth more stable, and the use of artificial teeth made of ox-bone. Abu al-Qasim (also known as Abulcasis) was one of the first to document the size and shape of dental tools, including drawings of dental saws, files, and extraction forceps.

Words to Know

Amalgam: Mixture of mercury and other metal elements used in making tooth cements.

Bridge: Partial denture anchored to adjacent teeth.

Denture: Set of false teeth.

Gingivitis: Gum inflammation.

Orthodontics: Branch of dentistry concerned with tooth problems such as gaps between the teeth, crowded teeth, and irregular bite.

Periodontics: Branch of dentistry focusing on gum problems.

Periodontitis: Gum disease involving damage to the periodontal ligament, which connects each tooth to the bone.

Plaque: Deposit of bacteria and their products on the surface of teeth.

The father of modern dentistry is considered to be French dentist Pierre Fauchard (16781761). Fauchard's work included filling teeth with lead or gold leaf tin foil. He also made various types of dentures and crowns from ivory or human teeth. In his influential writings, Fauchard explained how to straighten teeth and how to protect teeth against periodontal damage. Fauchard also took aim at some of the dental superstitions of the day, which included the mistaken belief that worms in the mouth played a role in tooth decay.

The development of many dental tools and practices in the nineteenth century laid the groundwork for present-day dentistry. Many of the great advances were made by Americans. The world's first dental school, the Baltimore College of Dentistry, opened in 1847. Around this time, anesthesia such as ether and nitrous oxide (laughing gas) was first used by dentists on patients having their teeth pulled. The practice of dentistry was further changed by the development of a drill powered by a foot pedal in 1871 and powered by electricity in 1872.

Another major discovery of the era was the X ray by German physicist Wilhelm Conrad Röntgen (18451923) in 1895. The first X ray of the teeth was made in 1896. Contemporary dentists continue to use X rays extensively to determine the condition of the teeth and the roots.

Cavities and fillings

Dental cavities, or caries, are perhaps the most common type of present-day oral disease. Cavities occur when bacteria forms a dental plaque on the surface of the tooth. Plaque, which is sticky and colorless, is a deposit of bacteria and their products. After the plaque is formed, food and the bacteria combine to create acids that slowly dissolve the substance of the tooth. The result is a hole in the tooth that must be filled or greater damage may occur, including eventual loss of the tooth.

The process of fixing dental cavities can be a short procedure depending on the size of the cavity. Small cavities may require no anesthesia and minimal drilling. Extensive dental cavities may require extensive drilling and novocaine or nitrous oxide to dull the pain. The process of

filling a cavity typically begins with the dentist using a drill or a hand tool to grind down the part of the tooth surrounding the cavity. The dentist then shapes the cavity, removes debris from the cavity, and dries it off. A cement lining is then added to insulate the inside of the tooth. The cavity is filled by inserting an amalgam or some other substance in small increments, compressing the material soundly.

Teeth are usually filled with an amalgam including silver, copper, tin, mercury, indium, and palladium. Other materials may be used for front teeth where metallic fillings would stand out. These include plastic composite material, which can be made to match tooth color.

Tooth replacement

Teeth that have large cavities, are badly discolored, or badly broken are often capped with a crown, which covers all or part of the damaged tooth. A crown can be made of gold or dental porcelain. Dental cement is used to keep the crown in place.

Bridges are devices that clasp new teeth in place, keep decayed teeth strong, and support the teeth in a proper arrangement. Some are removable by the dentist, and may be attached to the mouth by screws or soft cement. Others, called fixed bridges, are intended to be permanent.

Dentures, a set of replacement teeth, are used when all or a large part of the teeth must be replaced. New teeth can be made of acrylic resin or porcelain. A base in which to set the teeth must be designed to fit the mouth exactly. An impression of the existing teeth and jaws is taken to form this base. Modern dentists generally use acrylic plastics as the base for dentures. Acrylic plastic is mixed as a dough, heated, molded, and set in shape.

Gum disease

Gum disease is an immense problem among adults. Common gum diseases include gingivitis and periodontitis. Gingivitis is the inflammation of gum tissue, and is marked by bleeding, swollen gums. Periodontitis involves damage to the periodontal ligament, which connects each tooth to the bone. It also involves damage to the alveolar bone to which teeth are attached.

Periodontitis and gingivitis are caused primarily by bacterial dental plaque. This plaque includes bacteria that produces destructive enzymes in the mouth. These enzymes can damage cells and connective tissue. Untreated periodontal disease results in exposure of tooth root surfaces and pockets between the teeth and supporting tissue. This leaves teeth and roots open to decay, ending in tooth loss. When damage from the disease is too great, periodontal surgery is performed to clean out and regenerate the damaged area.

The art of moving teeth

The position of teeth in the mouth can be shaped and changed gradually using pressure. To straighten teeth, dentists usually apply braces. Braces are made up of a network of wires and bands of stainless steel or clear plastic. The bands are often anchored on the molars at the back of the mouth and the wires are adjusted to provide steady pressure on the surface of the teeth. This pressure slowly moves the teeth to a more desirable location in the mouth and enables new bone to build up where it is needed. Braces are usually applied to patients in their early teens and are worn for a specific period of time.

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Dentistry

DENTISTRY

DENTISTRY. Food and dental health interact, with each having effects on the other. Patterns of eating affect the health of the teeth and other tissues in the mouth, while the ability to chew a variety of foods without discomfort influences a person's nutritional state as well his or her enjoyment of eating.

Sugar and Dental Caries

The clearest link between food and dental health is between sugar consumption and caries (cavities). A study in the 1940s compared the dental health of children in an area of northern India, where food was scarce and malnutrition common, to that of better-nourished children in Lahore and in Rochester, New York. The poorly nourished children had the fewest cavities. Subsequent research confirmed that populations who enjoyed a good nutritional status had more caries than less well-nourished populations.

Researchers then looked at the mechanism of caries development to discern the role of diet. Cavities are the end result of a process that involves bacteria and sugars in the mouth over time. Streptococcus mutans, bacteria that are normally present in plaque, a very fine film which covers the surfaces of the teeth, metabolize sugar and form acid. When a person consumes sugar in foods or beverages, acid is formed that can dissolve minute amounts of minerals from the enamel surface of the tooth. When this happens repeatedly over time, enough minerals are lost for a cavity to form.

This relationship between sugar consumption and caries was tested in a classic study conducted at Vipeholm, a mental institution in Sweden, and reported in 1954. Although modern ethical standards would preclude a study in which subjects were unable to give informed consent, it remains a landmark piece of research. Residents were assigned to several groups. All ate the standard diet of the institution, but some were given additional sweets in varying quantities and frequency, up to twenty-four sticky toffee candies per day. After five years of observation, the researchers concluded that the stickiness of the sweets and the frequency with which they were consumed, both increasing the amount of time that the bacteria in plaque could produce acid, were more important than the total amount of sugar.

Streptococcus mutans can feed on any carbohydrate, not just sugars. The bacteria make no distinction between "natural" carbohydrates, such as the sugars in fruit, and refined sugars; they make acid from any of them.

Oral bacteria also make acid from sugar in liquids. This can lead to a particular pattern of caries called "baby-bottle caries," which develops when a baby is put to bed with a bottle filled with sugar-containing liquid, including milk. When the baby falls asleep, the liquid pools in the mouth, leading to decay, most often of the front upper teeth.

Since sugar has been shown to play such a significant role in the development of tooth decay, a basic preventive measure is to limit the frequency of sugar consumption. Because it is the action of bacteria on the sugar that is of concern, minimizing the bacteria by careful attention to oral hygiene is equally important. Fluoride, a mineral that is naturally present in water in some areas, has a strong protective effect as well. It binds to the other minerals to become part of the enamel, making the enamel harder and more resistant to decay. It also slows acid formation and promotes repair of places on the teeth where acid has dissolved some of the minerals.

In areas where the naturally occurring level of fluoride in water is low, it is often added during water treatment. Although there have been controversies about water fluoridation, public health authorities, including the American Dental Association, the United States Public Health Service, and the World Health Organization, all support it as a safe and effective preventive measure. One can see its effectiveness in the fact that, although sugar consumption in the United States has been increasing, children have fewer cavities than they had in the years before fluoridation became widespread.

Sugar substitutes are used to produce candies, chewing gum, and beverages that taste sweet without harming the teeth. Chewing gum containing xylitol, one of these alternative sweeteners, has been shown to be protective.

Diet and Periodontal Disease

Gingivitis, or periodontal disease, is the other common dental disorder. The bacteria in dental plaque cause an infection of the gums and structures that hold the teeth in place. The gums become red, swollen, and tender. Food does not play an important role in the development of gum disease, as it does in the formation of caries. Good oral hygiene is the most important preventive measure. A nutritious diet, which supplies generous amounts of vitamins and minerals, can offer some benefit by helping to maintain the immune system's ability to fight the infection.

Dental Status and Eating

The other side of the food and dental health interaction is the importance of healthy dentition in enabling people to eat and enjoy a wide variety of foods. The absence of a significant number of teeth or a condition such as periodontal disease or poorly fitting dentures, which makes chewing uncomfortable, may limit a person's food choices and compromise his or her nutritional status. This problem occurs most frequently in elderly and low-income populations, who are more likely to be at risk for nutritional problems.

Some researchers do not find this effect, possibly because the subjects with poor dentition have chosen nutritious foods that are easy to chew, or because the comparison population ate no better in spite of good dental status. In general, however, poor dental health increases the risk of poor nutritional health. Good dental care can correct most of these problems and enable individuals to enjoy eating a nutritious diet.

See also Digestion ; Fluoride .

BIBLIOGRAPHY

American Dental Association web site. Available at www.ada.org.

Burt, B. A., and S. Pai. "Sugar Consumption and Caries Risk: A Systematic Review." Paper presented at the Consensus Development Conference on Diagnosis and Management of Dental Caries throughout Life, Bethesda, Md., March 2001.

FDI Working Group. "Nutrition, Diet, and Oral Health: Report of and FDI Working Group." International Dental Journal 44 (1994): 599612.

Gustaffson, B. E., C. E. Quensel, L. S. Lanke, et al. "The Vipeholm Dental Caries Study: The Effect of Different Levels of Carbohydrate Intake on Caries Activity in 436 Individuals Observed for Five Years." Acta Odontologica Scandinavica 11 (1954): 232364.

Mona R. Sutnick

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dentistry

dentistry, treatment and care of the teeth and associated oral structures. Dentistry is mainly concerned with tooth decay, disease of the supporting structures, such as the gums, and faulty positioning of the teeth. Like medicine and surgery, it is practiced in specialized fields: oral surgery, orthodontics (corrective dentistry), periodontics (diseases of the gums), prosthodontics (partial or total tooth replacement), endodontics (treatment of dental pulp chamber and canals), and pedodontics (dental problems of children).

Some researchers believe that there is clear evidence of dental drilling in human teeth found in Pakistan that date to 7000 BC, but unquestioned evidence of dentistry is found only from subsequent millenia. Excellent crowns and bridges were made by the Etruscans in the 7th cent. BC At about that time, teeth were being extracted in Asia Minor as a cure for bodily ills and diseases. Skills achieved by the Etruscans, Phoenicians, Egyptians, Greeks, and Romans were largely lost during the Middle Ages, when barbers and roving bands of charlatans practiced unskilled dentistry at marketplaces and fairs. Abulcasis, a Spanish Moor, was one of the few in his time who studied dental surgery, leaving behind instruments and theories quite advanced for the 10th cent. AD

French scientist Pierre Fauchard is considered the founder of modern dentistry; by the end of the 17th cent., he was making fillings of lead, tin, and gold and devising artificial dentures. In the 18th cent., German scientist Philip Pfaff was making dentures of plaster of Paris, and shortly thereafter the French discovered how to mold porcelain into dentures. The first American to make use of this process was Charles Willson Peale; he who made the now-famous set of false teeth for George Washington.

As dentistry progressed, the center of accomplishment shifted from Europe to the United States. The first dental school in the world was established in Baltimore in 1840. The development of local and general anesthesia, the invention of the drilling machine, discovery of better substances for filling teeth (amalgam and gold), and, most importantly, the ability to devise replacements closely approximating natural teeth in function and appearance contributed much to the rapid growth of dentistry as a science and an art. Adding fluoride to the local water supply (fluoridation) has made teeth more resistant to cavities; annual applications of fluoride and clear liquid plastic to children's teeth also make them more decay resistant.

New developments include the implantation of artificial teeth or binding posts into the gums or jawbone; antibiotic fiber for periodontal disease; root canal surgery, a procedure that ameliorates pain while permitting teeth to remain in place; and nearly painless lasers to repair dental cavities, usually making local anesthesia unnecessary. In the early 1990s, it was reported that five patients of a Florida dentist with AIDS became infected with HIV; as a result, the Occupational Safety and Health Administration (OSHA) ruled that full protective garb (gloves, mask, glasses or goggles, coat) be worn by dental personnel to protect patients and themselves.

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dentistry

dentistry Profession concerned with the care and treatment of the mouth, particularly the teeth and their supporting tissues, the gums and oral bones. As well as general practice, dentistry includes specialities such as oral surgery, periodontics (structures around the teeth) and orthodontics (irregular teeth and jaws).

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dentistry

dentistry (den-tist-ri) n. the profession concerned with care and treatment of diseases of the teeth, gums, and jaws.

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dentistry

dentistry •hara-kiri • ribaldry • chivalry • Tishri •figtree • wintry • poetry • casuistry •Babbittry • banditry • pedigree •punditry • verdigris • sophistry •porphyry • gadgetry • registry •Valkyrie •marquetry, parquetry •basketry • trinketry • daiquiri •coquetry, rocketry •circuitry • varletry • filigree •palmistry •biochemistry, chemistry, photochemistry •gimmickry, mimicry •asymmetry, symmetry •craniometry, geometry, micrometry, optometry, psychometry, pyrometry, sociometry, trigonometry •tenebrae • ministry • cabinetry •tapestry • carpentry • papistry •piripiri • puppetry •agroforestry, floristry, forestry •ancestry • corsetry • artistry •dentistry • Nyree • rivalry • pinetree

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Dentistry

Dentistry

2764 ■ ALASKA COMMISSION ON POSTSECONDARY EDUCATION

Attn: AlaskAdvantage Programs
3030 Vintage Boulevard
Juneau, AK 99801-7109
Tel: (907)465-6779; (866)427-5683
Fax: (907)465-5316
E-mail: [email protected]
Web Site: http://alaskaadvantage.state.ak.us/page/256
To provide educational loans to Alaska residents who attend out-of-state professional schools in specified fields through the Professional Student Exchange Program (PSEP) of the Western Interstate Commission for Higher Education (WICHE).
Title of Award: Alaska Professional Student Exchange Loan Program Area, Field, or Subject: Dentistry; Medical assisting; Occupational therapy; Optometry; Pharmaceutical sciences; Physical therapy; Podiatry Level of Education for which Award is Granted: Undergraduate Number Awarded: Varies each year. Funds Available: Loans up to the annual support fee are available, to a maximum of $17,200. No origination fee is charged. The interest rate is 6%. Duration: 1 year; may be renewed.
Eligibility Requirements: This program is open to residents of Alaska who are attending a professional school in another state as part of the PSEP of WICHE. The fields of study currently available are dentistry, occupational therapy, optometry, physician assistant, podiatry, pharmacy, and physical therapy. In most cases, PSEP students pay resident tuition (or reduced tuition at private institutions) and their home state pays an additional support fee to the institution. Alaska requires PSEP students to pay the tuition and support fee, and provides these loans to enable them to do so.

2765 ■ AMERICAN ASSOCIATION OF WOMEN DENTISTS

330 South Wells Street, Suite 1100
Chicago, IL 60606
Tel: (312)913-9327
Free: 800-920-AAWD
Fax: (312)461-0238
E-mail: [email protected]
Web Site: http://www.aawd.org
To provide low-interest loans to promising women dental students.
Title of Award: Gillette Hayden Memorial Foundation Loan Program Area, Field, or Subject: Dentistry Level of Education for which Award is Granted: Four Year College, Graduate Number Awarded: Varies, depending upon available funds; generally ranges from 2 to 6 each year. Funds Available: Loans are made up to $2,000. Interest at 5% begins 1 month after graduation. The note is due and payable 13 months after graduation.
Eligibility Requirements: Eligible to apply are women dental students exhibiting financial need who are juniors, seniors, or graduate students. Selection is based on scholarship, need for assistance, and reasons for and amount of indebtedness already accumulated. Deadline for Receipt: July of each year.

2766 ■ AMERICAN DENTAL ASSOCIATION

Attn: ADA Foundation
211 East Chicago Avenue
Chicago, IL 60611
Tel: (312)440-2547
Fax: (312)440-3526
E-mail: [email protected]
Web Site: http://www.ada.org/ada/prod/adaf/prog_scholarship_prog.asp
To provide financial assistance to dental assisting students.
Title of Award: ADA Dental Assisting Scholarships Area, Field, or Subject: Dental laboratory technology Level of Education for which Award is Granted: Undergraduate Number Awarded: 10 each year. Funds Available: Stipends range up to $1,000 per year. Funds are to be used to cover school expenses (tuition, fees, books, supplies, living expenses) and are paid in 2 equal installments to the recipient's school. Duration: 1 year.
Eligibility Requirements: Applicants must be U.S. citizens and entering students accepted by a dental assisting program accredited by the Commission on Dental Accreditation. They must have a GPA of 3.0 or higher and be able to demonstrate financial need of at least $1,000. Selection is based on academic achievement, a written summary of personal and professional goals, letters of reference, and financial need. Deadline for Receipt: September of each year. Additional Information: This program was established in 1991.

2767 ■ AMERICAN DENTAL ASSOCIATION

Attn: ADA Foundation
211 East Chicago Avenue
Chicago, IL 60611
Tel: (312)440-2547
Fax: (312)440-3526
E-mail: [email protected]
Web Site: http://www.ada.org/ada/prod/adaf/prog_scholarship_prog.asp
To provide financial assistance to dental hygiene students.
Title of Award: ADA Dental Hygiene Scholarships Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 15 each year. Funds Available: Stipends range up to $1,000 per year. Funds are to be used to cover school expenses (tuition, fees, books, supplies, living expenses) and are paid in 2 equal installments to the recipient's school. Duration: 1 year.
Eligibility Requirements: Applicants must be U.S. citizens and entering their final year of study at a dental hygiene program accredited by the Commission on Dental Accreditation. They must have a GPA of 3.0 or higher and be able to demonstrate financial need of at least $1,000. Selection is based on academic achievement, a written summary of personal and professional goals, letters of reference, and financial need. Deadline for Receipt: August of each year. Additional Information: This program was established in 1991.

2768 ■ AMERICAN DENTAL ASSOCIATION

Attn: ADA Foundation
211 East Chicago Avenue
Chicago, IL 60611
Tel: (312)440-2547
Fax: (312)440-3526
E-mail: [email protected]
Web Site: http://www.ada.org/ada/prod/adaf/prog_scholarship_prog.asp
To provide financial assistance to dental laboratory technology students.
Title of Award: ADA Dental Laboratory Technology Scholarships Area, Field, or Subject: Dental laboratory technology Level of Education for which Award is Granted: Undergraduate Number Awarded: 5 each year. Funds Available: Stipends range up to $1,000 per year. Funds are to be used to cover school expenses (tuition, fees, books, supplies, living expenses) and are paid in 2 equal installments to the recipient's school. Duration: 1 year.
Eligibility Requirements: Applicants must be U.S. citizens and entering their final year of study at a dental laboratory technology program accredited by the Commission on Dental Accreditation. They must have a GPA of 3.0 or higher and be able to demonstrate financial need of at least $1,000. Selection is based on academic achievement, a written summary of personal and professional goals, letters of reference, and financial need. Deadline for Receipt: August of each year. Additional Information: This program, established in 1991, is sponsored by Handler Manufacturing, Inc.

2769 ■ AMERICAN DENTAL EDUCATION ASSOCIATION

Attn: Awards Selection Committee
1400 K Street, N.W., Suite 1100
Washington, DC 20005
Tel: (202)289-7201
Fax: (202)289-7204
E-mail: [email protected]
Web Site: http://www.adea.org
To provide financial assistance to dental hygiene students who are interested in an academic career.
Title of Award: Oral-B Scholarships for Dental Hygiene Students Pursuing Academic Careers Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Four Year College, Graduate Number Awarded: 2 each year. Funds Available: The stipend is $2,500. Funds are applied to tuition and fees. Duration: 1 year; nonrenewable.
Eligibility Requirements: This program is open to students who have graduated from an accredited dental hygiene program with an associate degree or certificate to practice dental hygiene and are currently enrolled in a degree completion program for a bachelor's or graduate degree at an institution that is a member of the American Dental Education Association (ADEA). Applicants must show a commitment to pursuing an academic degree in dental hygiene and be individual ADEA members. Along with their application, they must submit a personal statement that details their experiences, influences, and decision-making that demonstrate a firm commitment to become an allied dental faculty member. Priority is given to qualified candidates enrolled in bachelor's degree completion programs. Deadline for Receipt: December of each year. Additional Information: Funding for this program is provided by Oral-B Laboratories.

2770 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to undergraduate students who are preparing for careers in dental hygiene and have been active in community service activities.
Title of Award: Cadbury Adams Community Outreach Scholarships Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 10 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.0 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit 2 essays: 1) a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity; and 2) an essay on their commitment to improving oral health through community service and specific examples of community service projects in which they have participated. Deadline for Receipt: April of each year. Additional Information: This program, established in 2004, is sponsored by Cadbury Adams, maker of Trident Sugarfree Chewing Gum.

2771 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to needy undergraduate students preparing for careers in dental hygiene.
Title of Award: ADHA Institute General Scholarships Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: Varies each year; recently, 20 of these scholarships were awarded. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.0 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year.

2772 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to exceptional undergraduate students preparing for careers in dental hygiene.
Title of Award: ADHA Institute Merit Scholarships Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: Varies each year; the ADHA awards 10% of all general scholarship funds on the basis of academic merit. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.0 or higher, be able to demonstrate exceptional academic merit, and have completed at least 1 year in an accredited dental hygiene program in the United States. Financial need is not considered in the selection process. Deadline for Receipt: April of each year.

2773 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to students enrolled part time in doctoral, master's, baccalaureate, or certificate/associate programs in dental hygiene.
Title of Award: ADHA Institute Part-Time Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to part-time undergraduate and graduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.0 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year.

2774 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-243-2342
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Grants/Research/rgdescription.htm
To provide funding to dental hygienists and dental hygiene students who are interested in conducting research.
Title of Award: ADHA Institute Research Grant Competition Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Graduate, Professional, Undergraduate Number Awarded: 1or more each year. Funds Available: Grants range from $1,000 to $10,000 for licensed hygienists or from $1,000 to $5,000 for dental hygiene students. Duration: 1 year.
Eligibility Requirements: This program is open to licensed dental hygienists and to dental hygiene students, undergraduate or graduate, full-time or part-time. Applicants must be proposing to conduct research related to dental hygiene. They must be active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Priority is given to proposals addressing these topics: access to care/underserved populations, health promotion and disease prevention, alternative practice settings, and oral health public policy. Deadline for Receipt: January of each year.

2775 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to minority students and males of any race enrolled in undergraduate programs in dental hygiene.
Title of Award: American Dental Hygienists' Association Institute Minority Scholarships Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 2 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year; nonrenewable.
Eligibility Requirements: This program is open to members of groups currently underrepresented in the dental hygiene profession (Native Americans, African Americans, Hispanics, Asians, and males) who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.0 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year of full-time enrollment in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year.

2776 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to undergraduate students in selected states who are preparing for careers in dental hygiene.
Title of Award: Carol Bauhs Benson Memorial Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Four Year College Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.0 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in Minnesota, North Dakota, South Dakota, or Wisconsin. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year.

2777 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health 444
North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to minority students and males of any race enrolled in undergraduate programs in dental hygiene.
Title of Award: Colgate "Bright Smiles, Bright Futures" Minority Scholarships Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 2 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year; nonrenewable.
Eligibility Requirements: This program is open to members of groups currently underrepresented in the dental hygiene profession (Native Americans, African Americans, Hispanics, Asians, and males) who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.0 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year of full-time enrollment in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year. Additional Information: These scholarships are sponsored by the Colgate-Palmolive Company.

2778 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to undergraduate students preparing for careers in dental hygiene.
Title of Award: Rebecca Fisk Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.0 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year.

2779 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to dental hygiene students who are in a bachelor's or graduate degree program and intend to become teachers or educators.
Title of Award: Dr. Alfred C. Fones Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Graduate, Four Year College Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to dental hygiene students at the baccalaureate, master's, and doctoral level who have completed at least 1 year of study with a GPA of at least 3.0. Applicants must intend to prepare for a career as a dental hygiene teacher or educator. They must be active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA) and be able to document financial need of at least $1,500. Along year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Graduate applicants must also include a description of the research in which they are involved or would like to become involved and a list of past and/or present involvement in professional and/or community activities. Deadline for Receipt: April of each year.

2780 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to students enrolled in a baccalaureate dental hygiene program who can demonstrate exceptional academic and clinical performance.
Title of Award: Dr. Harold Hillenbrand Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Four Year College Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.5 or higher, be able to document financial need of at least $1,500, be able to demonstrate academic excellence and outstanding clinical performance, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year.

2781 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to undergraduate students preparing for careers in dental hygiene.
Title of Award: Marsh Affinity Group Services Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA between 3.0 and 3.5, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year. Additional Information: This program is sponsored by Marsh Affinity Group Services, a service of Seabury and Smith, Inc.

2782 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to undergraduate students in California preparing for careers in dental hygiene.
Title of Award: Wilma Motley California Merit Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.5 or higher, be able to demonstrate exceptional academic merit, and have completed at least 1 year in an accredited dental hygiene program in California. Financial need is not considered in the selection process. Deadline for Receipt: April of each year.

2783 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to undergraduate students who are preparing for careers in dental hygiene and have a 4.0 GPA.
Title of Award: Wilma E. Motley Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 4.0, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year.

2784 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to students in a baccalaureate or graduate degree program in dental hygiene who demonstrate strong potential in public health or community dental health.
Title of Award: Irene E. Newman Scholarship Area, Field, or Subject: Dental hygiene; Public health Level of Education for which Award is Granted: Graduate, Four Year College Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to students who have completed at least 1 year in a dental hygiene program at the baccalaureate, master's, or doctoral level with a GPA of at least 3.0. Applicants must demonstrate strong potential in public health or community dental health. They must be active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA) and be able to document financial need of at least $1,500. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Graduate applicants must also include a description of the research in which they are involved or would like to become involved and a list of past and/or present involvement in professional and/or community activities. and full-time enrollment. Selection is based on their potential in public health or community dental health. Deadline for Receipt: April of each year.

2785 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to baccalaureate students in dental hygiene.
Title of Award: Oral-B Laboratories Dental Hygiene Scholarships Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Four Year College Number Awarded: 2 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.5 or higher, be able to document financial need of at least $1,500, be able to demonstrate academic excellence and outstanding clinical performance, and have completed at least 1 year in an accredited dental hygiene program in the United States. They must be able to demonstrate an intent to encourage professional excellence and scholarship, quality research, and dental hygiene through public and private education. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year. Additional Information: Funds for these scholarships are provided by Oral-B Laboratories.

2786 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to undergraduate students preparing for careers in dental hygiene.
Title of Award: Pfizer Inc. Scholarships Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 5 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.5 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year. Additional Information: This program is sponsored by Pfizer Inc.

2787 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to full-time students enrolled in undergraduate programs in dental hygiene who are members of Sigma Phi Alpha.
Title of Award: Sigma Phi Alpha Undergraduate Scholarship Program Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of Sigma Phi Alpha. Applicants must have a GPA of 3.5 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year.

2788 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to students enrolled in a dental hygiene program who demonstrate exceptional organizational leadership potential.
Title of Award: Margaret E. Swanson Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to students who have completed at least 1 year in a certificate/associate, baccalaureate, master's, or doctoral program in dental hygiene with at least a 3.0 GPA. Applicants must be able to demonstrate exceptional organizational leadership potential. They must be active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA) and be able to document financial need of at least $1,500. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Graduate applicants must also include a description of the research in which they are involved or would like to become involved and a list of past and/or present involvement in professional and/or community activities. and full-time enrollment. Selection is based on their potential in public health or community dental health. Deadline for Receipt: April of each year.

2789 ■ AMERICAN DENTAL HYGIENISTS' ASSOCIATION

Attn: Institute for Oral Health
444 North Michigan Avenue, Suite 3400
Chicago, IL 60611
Tel: (312)440-8918
Free: 800-735-4916
Fax: (312)440-8929
E-mail: [email protected]
Web Site: http://www.adha.org/institute/Scholarship/index.htm
To provide financial assistance to undergraduate students preparing for careers in dental hygiene.
Title of Award: Esther Wilkins/Lippincott Williams & Wilkins Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 1 each year. Funds Available: Stipends range from $1,000 to $2,000. Duration: 1 year.
Eligibility Requirements: This program is open to full-time undergraduate students who are active members of the Student American Dental Hygienists' Association (SADHA) or the American Dental Hygienists' Association (ADHA). Applicants must have a GPA of 3.5 or higher, be able to document financial need of at least $1,500, and have completed at least 1 year in an accredited dental hygiene program in the United States. Along with their application, they must submit a statement that covers their long-term career goals, their intended contribution to the dental hygiene profession, their professional interests, and the manner in which their degree will enhance their professional capacity. Deadline for Receipt: April of each year. Additional Information: This program is sponsored by Lippincott Williams & Wilkins.

2790 ■ H. FLETCHER BROWN TRUST

PNC Bank Delaware
Attn: Donald W. Davis
222 Delaware Avenue, 16th Floor
Wilmington, DE 19899
Tel: (302)429-2827
Fax: (302)429-5658
E-mail: [email protected]
To provide financial assistance to residents of Delaware who are interested in studying engineering, chemistry, medicine, dentistry, or law.
Title of Award: H. Fletcher Brown Scholarship Area, Field, or Subject: Chemistry; Dentistry; Engineering; Law; Medicine; Medicine, Osteopathic Level of Education for which Award is Granted: Graduate, Professional, Undergraduate Funds Available: The amount of the scholarship is determined by the scholarship committee and is awarded in installments over the length of study. Duration: 1 year; may be renewed if the recipient maintains a GPA of 2.5 or higher and continues to be worthy of and eligible for the award.
Eligibility Requirements: This program is open to Delaware residents who were born in Delaware, are either high school seniors entering the first year of college or college seniors entering the first year of graduate school, are of good moral character, and need financial assistance from sources outside their family. Applicants must have combined mathematics and verbal SAT scores of 1000 or higher, rank in the upper 20% of their class, and come from a family whose income is less than $75,000. Their proposed fields of study must be engineering, chemistry, medicine (for an M.D. or D.O. degree only), dentistry, or law. Finalists are interviewed. Deadline for Receipt: March of each year.

2791 ■ BUSINESS AND PROFESSIONAL WOMEN OF VIRGINIA

Attn: Virginia BPW Foundation
P.O. Box 4842
McLean, VA 22103-4842
Web Site: http://www.bpwva.org/Foundation.shtml
To provide financial assistance to women in Virginia who are interested in working on a bachelor's or advanced degree in science or technology.
Title of Award: Women in Science and Technology Scholarship Area, Field, or Subject: Actuarial science; Biological and clinical sciences; Chemistry; Computer and information sciences; Dentistry; Engineering; Engineering, Biomedical; Insurance and insurance-related fields; Mathematics and mathematical sciences; Medicine; Physics; Science; Technology Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: At least 1 each year. Funds Available: Stipends range from $500 to $1,000 per year, depending on the need of the recipient; funds may be used for tuition, fees, books, transportation, living expenses, and dependent care. Duration: 1 year; recipients may reapply (but prior recipients are not given priority).
Eligibility Requirements: This program is open to women who are at least 18 years of age, U.S. citizens, Virginia residents, accepted at or currently studying at a Virginia college or university, and working on a bachelor's, master's, or doctoral degree in 1 of the following fields: actuarial science, biology, bioengineering, chemistry, computer science, dentistry, engineering, mathematics, medicine, physics, or a similar scientific or technical field. Applicants must have a definite plan to use their education in a scientific or technical profession. They must be able to demonstrate financial need. Deadline for Receipt: March of each year. Additional Information: Recipients must complete their studies within 2 years.

2792 ■ CANADIAN INSTITUTES OF HEALTH RESEARCH

Attn: Grants and Awards
160 Elgin Street, Ninth Floor
Address Locator 4809A
Ottawa, ON, Canada K1A 0W9
Tel: (613)954-1968; 888-603-4178
Fax: (613)954-1800
E-mail: [email protected]
Web Site: http://www.cihr-irsc.gc.ca
To provide research funding to undergraduate and graduate students interested in preparing for a career in health-related fields in Canada.
Title of Award: Health Professional Students Research Awards of the Canadian Institutes of Health Research Area, Field, or Subject: Dentistry; Medicine; Nursing; Optometry; Pharmaceutical sciences Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year. Funds Available: The stipend for students registered in a health professional school is $C1,417 per month. The stipend for students enrolled in a combined degree program is $C1,987 per month. Duration: Up to 3 months.
Eligibility Requirements: This program is open to 1) undergraduate and graduate students enrolled at Canadian schools offered programs leading to licensure in medicine, dentistry, nursing, physiotherapy, or related fields; and 2) medical students working on a combined degree (e.g., M.D./M.Sc., M.D./Ph.D.). Applicants must have completed their first year of study and be interested in participating in a health research project. They must be citizens or permanent residents of Canada. Deadline for Receipt: February Additional Information: The Canadian Institutes of Health Research (CIHR) was formerly the Medical Research Council (MRC) of Canada. This program was formerly designated the Burroughs Wellcome Fund Student Research Awards.

2793 ■ HAWAI'I COMMUNITY FOUNDATION

Attn: Scholarship Department
1164 Bishop Street, Suite 800
Honolulu, HI 96813
Tel: (808)566-5570; 888-731-3863
Fax: (808)521-6286
E-mail: [email protected]
Web Site: http://www.hawaiicommunityfoundation.org/scholar/scholar.php
To provide financial assistance to Hawaii residents who are interested in preparing for a career in the dental field.
Title of Award: John Dawe Dental Education Scholarship Area, Field, or Subject: Dental hygiene; Dentistry Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year; recently, 8 of these scholarships were awarded. Funds Available: The amounts of the awards depend on the availability of funds and the need of the recipient; recently, stipends averaged $1,000. Duration: 1 year.
Eligibility Requirements: This program is open to Hawaii residents who are interested in full-time study in dentistry, dental hygiene, or dental assisting. They must be able to demonstrate academic achievement (GPA of 2.7 or higher), good moral character, and financial need. In addition to filling out the standard application form, applicants must write a short statement indicating their reasons for attending college, their planned course of study, and their career goals. Deadline for Receipt: February of each year. Additional Information: Recipients may attend college in Hawaii or on the mainland.

2794 ■ INDIAN HEALTH SERVICE

Attn: Scholarship Program
801 Thompson Avenue, Suite 120
Rockville, MD 20852
Tel: (301)443-6197
Fax: (301)443-6048
E-mail: [email protected]
Web Site: http://www.ihs.gov
To provide financial support to American Indian students interested in majoring in pre-medicine or pre-dentistry in college.
Title of Award: Health Professions Pregraduate Scholarship Program Area, Field, or Subject: Dentistry; Medicine; Medicine, Osteopathic Level of Education for which Award is Granted: Undergraduate Number Awarded: Varies each year. Funds Available: Awards provide a payment directly to the school for tuition and required fees; a stipend for living expenses of approximately $1,160 per month for 10 months; a lump sum to cover the costs of books, travel, and other necessary educational expenses; and up to $400 for approved tutorial costs. Duration: Up to 4 years of full-time study or up to 8 years of part-time study.
Eligibility Requirements: Applicants must be American Indians or Alaska Natives; be high school graduates or the equivalent; have the capacity to complete a health professions course of study; and be enrolled or accepted for enrollment in a baccalaureate degree program to prepare for entry into a school of medicine, osteopathy, or dentistry. Priority is given to students entering their junior or senior year; support is provided to freshmen and sophomores only if remaining funds are available. Selection is based on academic performance, work experience and community background, faculty/employer recommendations, and applicant's reasons for seeking the scholarship. Recipients must intend to serve Indian people upon completion of their professional health care education. Deadline for Receipt: February of each year.

2795 ■ INDIAN HEALTH SERVICE

Attn: Scholarship Program
801 Thompson Avenue, Suite 120
Rockville, MD 20852
Tel: (301)443-6197
Fax: (301)443-6048
E-mail: [email protected]
Web Site: http://www.ihs.gov
To provide loans-for-service to American Indian and Alaska Native students enrolled in health professions and allied health professions programs.
Title of Award: Health Professions Scholarship Program Area, Field, or Subject: Counseling/Guidance; Dental hygiene; Dentistry; Health care services; Medical assisting; Medical technology; Medicine; Medicine, Osteopathic; Nursing; Nutrition; Optometry; Pharmaceutical sciences; Physical therapy; Podiatry; Psychology; Public health; Radiology; Respiratory therapy; Social work; Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year. Funds Available: Awards provide a payment directly to the school for tuition and required fees; a stipend for living expenses of approximately $1,160 per month for 12 months; a lump sum to cover the costs of books, travel, and other necessary educational expenses; and up to $400 for approved tutorial costs. Upon completion of their program of study, recipients are required to provide payback service of 1 year for each year of scholarship support at the Indian Health Service, a tribal health programs, an urban Indian health program, or in private practice in a designated health professional shortage area serving a substantial number of Indians. Recipients who fail to complete their service obligation must repay all funds received (although no interest is charged). Duration: 1 year; may be renewed for up to 3 additional years.
Eligibility Requirements: This program is open to American Indians and Alaska Natives who are at least high school graduates and enrolled in a full-time study program leading to a degree in a health-related professions school within the United States. Priority is given to upper-division and graduate students. Qualifying fields of study include chemical dependency counseling (bachelor's or master's degree), clinical psychology (Ph.D. only), coding specialist (certificate), counseling psychology (Ph.D. only), dental hygiene (B.S.), dentistry (D.D.S.), diagnostic radiology technology (certificate, associate, or B.S.), dietitian (B.S.), civil or environmental engineering (B.S.), environmental health (B.S.), health care administration (B.S. or M.S.), health education (B.S. or M.S.), health records (R.H.I.T. or R.H.I.A.), injury prevention specialist (certificate), medical technology (B.S.), allopathic and osteopathic medicine, nursing (A.D.N., B.S.N., or C.R. N.A), optometry, pharmacy (B.S. or Pharm.D.), physician assistant (B.S.), physical therapy (M.S. or D.P.T.), podiatry (D.P.M.), public health (M.P.H. only), public health nutrition (master's only), social work (master's only), respiratory therapy (associate), and ultrasonography. Deadline for Receipt: February of each year.

2796 ■ KOSTER INSURANCE AGENCY

Attn: Scholarship
500 Victory Road
Quincy, MA 02171
Tel: (617)770-9889
Free: 800-457-5599
Fax: (617)479-0860
E-mail: [email protected]
Web Site: http://www.kosterweb.com/about/scholarship_main.php
To provide financial assistance to undergraduate students working on a degree in a health-related field.
Title of Award: Koster Insurance Health Careers Scholarship Program Area, Field, or Subject: Biological and clinical sciences; Chemistry; Dentistry; Health care services; Nursing; Occupational therapy; Optometry; Pharmaceutical sciences; Physical therapy; Physiology; Public health; Social work Level of Education for which Award is Granted: Undergraduate Number Awarded: 5 each year. Funds Available: The stipend is $3,000 per year. Duration: 1 year; may be renewed 1 additional year.
Eligibility Requirements: This program is open to full-time undergraduates entering their second-to-last or final year of study in a health-related field, including (but not limited to) pre-medicine, nursing, public and community health, physical therapy, occupational therapy, pharmacy, biology, chemistry, physiology, social work, dentistry, and optometry. Applicants must have a GPA of 3.0 or higher and be able to demonstrate financial need. Along with their application, they must submit a 1-page essay describing their personal goals, including their reasons for preparing for a career in health care. Selection is based on motivation to pursue a career in health care, academic excellence, dedication to community service, and financial need. Deadline for Receipt: April of each year. Additional Information: This program began in 2001.

2797 ■ PAPA OLA LOKAHI, INC.

Attn: Native Hawaiian Health Scholarship Program
345 Queen Street, Suite 706
Honolulu, HI 96813
Tel: (808)585-8944
Fax: (808)585-8081
-mail: [email protected]
Web Site: http://www.nhhsp.org
To provide scholarship/loans to Native Hawaiians for training in the health professions in exchange for service in a federally-designated health professional shortage area (HPSA) or other facility for Native Hawaiians.
Title of Award: Native Hawaiian Health Scholarship Program Area, Field, or Subject: Dental hygiene; Dentistry; Family/Marital therapy; Health care services; Medical assisting; Medicine; Medicine, Osteopathic; Midwifery; Nursing; Nursing, Psychiatric; Psychiatry; Psychology; Public health Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year, depending upon the funding available. Since the program began, 151 scholars have received support. Funds Available: Full coverage of tuition and fees is paid directly to the health professional school. A stipend, current set at $1,157 per month, is paid directly to the scholar. This is a scholarship/loan program. Participants are obligated To provide full-time clinical primary health care services to populations in 1) a Native Hawaiian Health Care System, or 2) an HPSA in Hawaii, medically underserved area (MUA), or another area or facility in Hawaii designated by the U.S. Department of Health and Human Services. Participants owe 1 year of service in the National Health Service Corps for each full or partial year of support received under this program. The minimum service obligation is 2 years. Duration: 1 year; may be renewed for up to 3 additional years.
Eligibility Requirements: Applicants must be Native Hawaiians training in allopathic or osteopathic medicine, dentistry, clinical psychology, registered nursing, nurse midwifery, psychiatric nursing, public health/community nursing, social work, dental hygiene, physician assistant, public health, marriage and family therapy, or primary care nurse practitioner. They may be studying in any state. Recipients must agree to serve in a designated health-care facility in Hawaii upon completion of training. First priority is given to former scholars who have completed their previous service obligation and are seeking another year of support. Second priority is given to applicants who appear to have characteristics that increase the probability they will continue to serve underserved Native Hawaiians after the completion of their service obligations. Deadline for Receipt: March of each year. Additional Information: This program, which began in 1991, is administered by the U.S. Health Resources and Services Administration, Bureau of Health Professions, through a contract with Papa Ola Lokahi, Inc.

2798 ■ MAINE DENTAL ASSOCIATION

Attn: Executive Director 28 Association Drive
P.O. Box 215
Manchester, ME 04351-0215
Tel: (207)622-7900
Free: 800-369-8217
Fax: (207)622-6210
E-mail: [email protected]
Web Site: http://www.medental.org/resources/student_resources.html
To provide educational loans to dental hygiene students from Maine.
Title of Award: Maine Dental Hygiene Student Loans Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: Varies each year. Funds Available: The maximum loan is $1,000 per academic term (semester, trimester, or 2 quarters). The loan aggregate may not exceed $3,000 during a 2-year program of study leading to a degree in dental hygiene, or $5,000 during a 3-year program of study, or $7,000 during a 4-year program of study. The total loan plus interest shall be due and payable 5 years from date of graduation or completion of postgraduate study. The interest rate is 4% while enrolled in dental hygiene school and during the first 6 months following graduation, 8% during the first full year through the fifth year following graduation or 4% during that period if the recipient secures employment in Maine, and 9% on any balance that remains unpaid at the end of 5 years following graduation. Duration: 1 term; may be renewed.
Eligibility Requirements: Applicants must have been residents of Maine for at least 5 years and have completed at least 1 semester of study in an accredited dental hygiene program. They must submit an up-to-date transcript of academic records and documentation of financial need.

2799 ■ NORTH CAROLINA STATE EDUCATION ASSISTANCE AUTHORITY

Attn: Scholarship and Grant Services
10 T.W. Alexander Drive
P.O. Box 14223
Research Triangle Park, NC 27709-4223
Tel: (919)549-8614
Free: 800-700-1775
Fax: (919)549-8481
E-mail: [email protected]
Web Site: http://www.ncseaa.edu
To provide loans and loans-for-service to North Carolina residents who are interested in preparing for a career in health, science, or mathematics.
Title of Award: North Carolina Student Loan Program for Health, Science, and Mathematics Area, Field, or Subject: Allied health; Dentistry; Medicine; Nursing; Optometry; Public health; Social work Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year; recently, a total of 497 students were receiving $3,238,569 in support through this program. Funds Available: Maximum loans are $3,000 per year for associate degree and certificate programs, $5,000 per year for baccalaureate degree/certificate programs, $6,500 per year for master's degree programs, or $8,500 per year for health/professional doctoral programs. The maximum amount that any student can borrow through this program is $58,000. The interest rate is 4% while the borrowers are attending school and from 10 to 15% after they leave school. Cash repayments must begin 90 days or less after completion of course work and training. Under specified conditions, certain loan recipients in qualifying disciplines may have their loans canceled through service in North Carolina. Duration: 1 year; renewable for 1 additional year for diploma, associate, certificate, and master's degree programs, for 2 additional years for baccalaureate degree programs, or for 3 additional years for doctoral programs.
Eligibility Requirements: North Carolina residents are eligible to apply for this program if they have been accepted as full-time students in an accredited associate, baccalaureate, master's, or doctoral program leading to a degree in 1 of the following areas: allied health (including audiology/communications assistant, cytotechnology, dental hygiene, diagnostic medical sonographer, imaging technologist, medical technology, nuclear medicine technologist, occupational therapy/assistant, physician assistant, physical therapy/assistant, radiation therapist, radiography, respiratory therapy, and speech language pathology); clinical psychology (Ph.D. level only); dentistry; dietetics and nutrition (graduate level only); mathematics education; medicine (including chiropractic medicine, emergency medicine, family medicine, geriatrics, internal medicine, obstetrics and gynecology, osteopathic medicine, pediatrics, podiatry, primary care medicine, and psychiatry); nursing (including anesthetist, family nurse practitioner, nursing administration, general nursing, and midwifery); optometry; pharmacy; public health (graduate level only); science education (including biology, chemistry, communications and technologies, computer and information sciences, engineering, and physical science); social work (graduate level only); and veterinary medicine. U.S. citizenship is required. Selection is based on academic progress, financial ability of sureties to repay all loans and accrued interest in case of applicant's default, applicant's willingness to work in underserved areas of the state or in disciplines for which there is a shortage of professionals, applicant's willingness to comply with all program regulations, and financial need. Deadline for Receipt: May of each year. Additional Information: Recipients may attend a North Carolina postsecondary institution or an eligible out-of-state institution. This program was formerly known as the North Carolina Medical Student Loan Program.

2800 ■ TEXAS HIGHER EDUCATION COORDINATING BOARD

Attn: Hinson-Hazlewood College Student Loan Program
1200 East Anderson Lane
P.O. Box 12788, Capitol Station
Austin, TX 78711-2788
Tel: (512)427-6340
Free: 800-242-3062
Fax: (512)427-6423
E-mail: [email protected]
Web Site: http://www.hhloans.com
To provide educational loans to students in Texas in health-related degree programs.
Title of Award: Hinson-Hazlewood Health Education Loan Program Area, Field, or Subject: Dentistry; Health care services; Medicine; Medicine, Osteopathic; Nursing; Optometry; Pharmaceutical sciences; Podiatry; Public health; Veterinary science and medicine Level of Education for which Award is Granted: Four Year College, Graduate Number Awarded: Varies each year. Funds Available: The maximum annual loan is $12,500 for pharmacy, nursing, allied health, and public health students; or $20,000 for medicine, dentistry, optometry, osteopathy, podiatry, or veterinary medicine students. The origination fee is 3%. After a grace period of 9 months, repayment must be completed within 25 years at a minimum monthly payment of $50. The current interest rate is 5.25% which begins to accrue immediately, even while the student is in school. Duration: 1 year; may be renewed up to 3 additional years. The maximum total loan is $50,000 for pharmacy, nursing, allied health, and public health students or $80,000 for medicine, dentistry, optometry, osteopathy, podiatry, or veterinary medicine students.
Eligibility Requirements: This program is open to students who qualify as Texas residents and meet the academic requirements of a public or private college or university in the state. Applicants must be enrolled at least half time in a course of study leading to 1) a doctoral degree in medicine, dentistry, optometry, osteopathy, podiatry, or veterinary medicine; 2) a bachelor's or master's degree in pharmacy; 3) a graduate or equivalent degree in public health; or 4) an associate, bachelor's, or graduate degree in nursing or allied health fields. They must be able to demonstrate financial need and enroll full time. U.S. citizenship is required. Additional Information: Applications must be submitted through the financial aid office at the college or university attended. This program is part of the Hinton-Hazelwood College Student Loan Program (HHCSLP).

2801 ■ VERMONT STUDENT ASSISTANCE CORPORATION

Champlain Mill
Attn: Scholarship Programs
P.O. Box 2000
Winooski, VT 05404-2601
Tel: (802)654-3798; 888-253-4819
Fax: (802)654-3765
E-mail: [email protected]
Web Site: http://www.vsac.org
To provide financial assistance to Vermont residents who are studying dental hygiene.
Title of Award: Vermont Dental Hygiene Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 1 or more each year. Funds Available: The maximum stipend is $1,000. Duration: 1 year; nonrenewable.
Eligibility Requirements: This scholarship is available to residents of Vermont who are currently enrolled in the second year of a dental hygiene program. Selection is based on academic achievement (GPA of 3.0 or higher), letters of recommendation, required essays, and financial need. Deadline for Receipt: May of each year.

2802 ■ WASHINGTON DENTAL SERVICE FOUNDATION

Attn: Grant Administrator
P.O. Box 75688
Seattle, WA 98125
Tel: (206)528-2337
Free: 800-572-7835
Fax: (206)528-7373
E-mail: [email protected]
Web Site: http://www.DeltaDentalWA.com
To provide financial assistance to members of underrepresented minority groups in Washington who are interested in preparing for a career as a dental hygienist, dental assistant, or laboratory technician.
Title of Award: Washington Dental Service Foundation Scholarships Area, Field, or Subject: Dental hygiene; Dental laboratory technology; Medical technology Level of Education for which Award is Granted: Two Year College, Vocational/Occupational Number Awarded: 1 or more each year. Funds Available: Stipends range from $1,000 to $4,000 per year, depending on the need of the recipient. Duration: 1 year.
Eligibility Requirements: This program is open to residents of Washington who are African or Black Americans, Native Americans, Alaskan Natives, Hispanics/Latinos, or Pacific Islanders. Applicants must be planning to enroll in an eligible program in dental hygiene, dental assisting, or laboratory technology at a community or technical college in the state. They must be able to demonstrate financial need. Along with their application, they must submit essays of 100 to 300 words on 1) why they are interested in becoming a dental professional; 2) their career goals, how they decided upon those goals, and how completion of their proposed program will help them reach those goals; 3) how they have prepared themselves academically for those chosen program of study; 4) a leadership experience they have had in school, work, athletics, family, church, community, or other area of their life; and 5) how they help or serve others in their family and/or community. Deadline for Receipt: September of each year.

2803 ■ WASHINGTON HIGHER EDUCATION COORDINATING BOARD

917 Lakeridge Way
P.O. Box 43430
Olympia, WA 98504-3430
Tel: (360)753-7844
Fax: (360)753-7808
E-mail: [email protected]
Web Site: http://www.hecb.wa.gov/financialaid/other/health.asp
To provide scholarship/loans for primary care health professional education to students who agree to work in designated areas of Washington.
Title of Award: Washington State Health Professional Scholarship Program Area, Field, or Subject: Dental hygiene; Dentistry; Medicine; Medicine, Osteopathic; Midwifery; Nursing; Pharmaceutical sciences Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year. Funds Available: The stipend is intended to cover eligible expenses: tuition, books, equipment, fees, and room and board. This is a scholarship/loan program. Recipients who fail to complete the course of study are required to repay the amount received, plus a penalty and interest. Scholars who fail to serve in health professional shortage areas in Washington are required to repay the scholarship, with penalty plus interest. The interest rate on the repayments is 8% for the first 4 years and 10% for the fifth year. Duration: Up to 5 years.
Eligibility Requirements: Applicants must be enrolled or accepted for enrollment in an accredited program leading to eligibility for licensure in Washington State in a designated health profession. They must agree to practice in Washington for 3 to 5 years following graduation, but they do not need to be Washington residents or to attend an educational institution in the state. Currently, there are no geographic restrictions for registered nurses or practical nurses. For other primary care health professionals (M.D., D.O., N.D., P.A., N.P., C.N.M., L.M.), dental care professionals (D.D.S., R.D.H.), and pharmacists, service must be in designated areas of the state. State correctional facilities, state mental health facilities, community and migrant health centers, and any other facility with more than 40% of its caseload consisting of Medicaid and sliding fee patients also qualify. Deadline for Receipt: April of each year.

2804 ■ WASHINGTON STATE DENTAL HYGIENISTS' ASSOCIATION

Attn: Central Offices
P.O. Box 389
Lynnwood, WA 98046
Tel: (425)771-3201
Fax: (425)776-5289
E-mail: [email protected]
Web Site: http://www.wsdha.com
To provide financial assistance to members of the Washington State Dental Hygienists' Association (WSDHA).
Title of Award: Lona Hulbush Jacobs Memorial Scholarship Area, Field, or Subject: Dental hygiene Level of Education for which Award is Granted: Undergraduate Number Awarded: 1 each year. Funds Available: The stipend is $1,000. Duration: 1 year.
Eligibility Requirements: This program is open to WSDHA members in the first year of a dental hygiene program. Applicants must have a GPA of 3.0 or higher and be able to demonstrate financial need. Along with their application, they must submit a brief essay on why they have pursued dental hygiene as a career. Deadline for Receipt: April of each year. Additional Information: This program was established in 1986.

2805 ■ WESTERN INTERSTATE COMMISSION FOR HIGHER EDUCATION

Attn: Student Exchange Programs
3035 Center Green Drive
P.O. Box 9752
Boulder, CO 80301-9752
Tel: (303)541-0210
Fax: (303)541-0291
E-mail: [email protected]
Web Site: http://www.wiche.edu/sep/psep
To underwrite some of the cost of out-of-state professional schooling for students in selected western states.
Title of Award: Professional Student Exchange Program Area, Field, or Subject: Architecture; Dentistry; Library and archival sciences; Medical assisting; Medicine; Medicine, Osteopathic; Nursing; Occupational therapy; Optometry; Pharmaceutical sciences; Physical therapy; Podiatry; Public health; Veterinary science and medicine Level of Education for which Award is Granted: Graduate, Undergraduate Number Awarded: Varies each year. Funds Available: The assistance consists of reduced levels of tuition, usually resident tuition in public institutions or reduced standard tuition at private schools. The home state pays a support fee to the admitting school to help cover the cost of the recipient's education. Duration: 1 year; may be renewed.
Eligibility Requirements: This program is open to residents of 13 western states who are interested in pursuing professional study at selected out-of-state institutions, usually because those fields of study are not available in their home states. The eligible programs, and the states whose residents are eligible, presently include: 1) architecture (master's degree), for residents of Wyoming, to study at designated institutions in Arizona. California, Colorado, Idaho, Montana, New Mexico, Oregon, Utah, or Washington); 2) dentistry, for residents of Alaska, Arizona, Hawaii, Montana, New Mexico, North Dakota, and Wyoming, to study at designated institutions in Arizona, California, Colorado, Nevada, Oregon, or Washington; 3) library studies (master's degree), for residents of New Mexico and Wyoming, to study at designated institutions in Arizona, California, Hawaii, or Washington; 4) medicine, for residents of Montana and Wyoming, to study at designated institutions in Arizona, California, Colorado, Hawaii, Nevada, New Mexico, North Dakota, Oregon, or Utah; 5) nursing (graduate degree), for residents of Wyoming, to study at designated institutions in California, Hawaii, North Dakota, or Oregon; 6) occupational therapy (bachelors' or master's degree), for residents of Alaska, Arizona, Hawaii, Montana, and Wyoming, to study at designated institutions in Arizona, California, Idaho, New Mexico, North Dakota, Oregon, Utah, or Washington; 7) optometry, for residents of Alaska, Arizona, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, North Dakota, Utah, Washington, and Wyoming, to study at designated institutions in California or Oregon; 8) osteopathic medicine, for residents of Arizona, Montana, New Mexico, Washington, and Wyoming, to study at designated institutions in Arizona or California; 9) pharmacy, for residents of Alaska, Hawaii, and Nevada, to study at designated institutions in Arizona, California, Colorado, Idaho, Montana, New Mexico, North Dakota, Oregon, Utah, Washington, or Wyoming; 10) physical therapy (master's or doctoral degree), for residents of Alaska, Hawaii, and Wyoming, to study at designated institutions in Arizona, California, Colorado, Idaho, Montana, New Mexico, North Dakota, Oregon, Utah, or Washington; 11) physician assistant, for residents of Alaska, Arizona, Nevada, and Wyoming, to study at designated institutions in Arizona, California, Colorado, Idaho, Oregon, Utah, or Washington; 12) podiatry, for residents of Alaska, Montana, New Mexico, Utah, and Wyoming, to study at a designated institution in California; 13) public health, for residents of Montana and New Mexico, to study at designated institutions in California, Colorado, or Washington; and 14) veterinary medicine, for residents of Arizona, Hawaii, Montana, Nevada, New Mexico, North Dakota, Utah, and Wyoming, to study at designated institutions in California, Colorado, Oregon, or Washington. The financial status of the applicants is not considered. Interested students must apply for admission and for PSEP assistance directly from the institution of their choice. They must be certified by their state of residence to become an exchange student and be seeking enrollment at the first professional degree level. Deadline for Receipt: In most states, the deadline for receiving completed applications for certification is in October. After obtaining
certification, students must still apply to the school of their choice, which also sets its own deadline.

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Dentistry

Dentistry

Skill and superstition

Non-western advances

From counting teeth to replacing them

Modern dentistry

A look forward

Resources

Dentistry is the medical activity focused on treating the teeth, the gums and the oral cavity. This includes treating teeth damaged due to accidents or disease, filling teeth damaged due to tooth decay, and replacing damaged or injured teeth with replacement teeth. Major disciplines of dentistry include orthodontics, which focuses on the correction of tooth problems such as gaps between the teeth, crowded teeth and irregular bite; and periodontics, which addresses gum problems. Dentistry is considered an independent medical art, with its own licensing procedure. Medical doctors are not licensed to treat teeth; likewise dentists are not licensed to treat other parts of the body.

Skill and superstition

Ancient, medieval, and early Renaissance dental practice can be seen as a stew of the sensible and the outrageous. In each era, stories of practitioners with wisdom and skill coexist with outrageous tales of superstition and myth connected to teeth. In the ancient and Islamic worlds, doctors often performed dental work. The cleaning and extracting of teeth was often performed by individuals with little or no medical training.

Men and women in ancient times worked hard to alleviate dental pain. As early as 1550 BC, the ancient Egyptians documented their interest in dentistry in the Ebers Papyrus, a document discovered in 1872. The Papyrus listed various remedies for toothache, including such familiar ingredients as dough, honey, onions, incense, and fennel seeds.

The ancient Egyptians also turned to superstition for help preventing tooth pain. The mouse, which was considered to be protected by the sun and capable of fending off death, was often used by individuals with a toothache. A common remedy involved applying half of the body of a dead mouse to the aching tooth while the body was still warm.

The ancient Greeks offered a variety of conventional and unconventional dental therapy. One of the more illustrious dental pioneers was Hippocrates (460375 BC), whose admonition to do no harm continues to be a central goal of medical practice. Hippocrates said that food lodged between teeth was responsible for tooth decay, and suggested pulling teeth that were loose and decayed.

Hippocrates also offered advice for bad breath. He suggested a mouth wash containing oil of anise seed and myrrh and white wine. Other ancient Greeks took a more superstitious approach, with some depending on the mythical power of the mouse to protect their teeth. A recipe for bad breath from the fifth century BC called for a range of ingredients including the bodies of three mice, including one whose intestines had been removed, and the head of a hare. The ingredients were burned and mixed with dust and water before consumption.

The Etruscans, who lived in Tuscany, Italy, between approximately 1000 and 400 BC, also made great advances in dentistry. They are often cited for the sophistication of their gold crowns and bridges. One bridge which has been preserved included three artificial teeth attached to gold bands, which hooked around the natural teeth. The artificial teeth were actually real teeth taken from an immature calf, then divided in two.

The Romans built upon the Etruscan knowledge of dentistry and took seriously the challenge of keeping teeth healthy. Celsus, a Roman writer who lived about 100 BC, wrote about toothache, dental abscesses and other dental ailments. For toothache, which he called among the worst of tortures, he suggested the use of hot poultices, mouthwash, and steam. He also suggested using pain-killers such as opium. The Romans also made bridgework.

Clean teeth were valued by the Romans, and affluent families had slaves clean their mouths using small sticks of wood and tooth powder. Such powders could include burned eggshell, bay-leaves, and myrrh. These powders could also include more unusual ingredients, such as burned heads of mice and lizard livers. Earth worms marinated in vinegar were used for a mouth wash, and urine was thought of as a gum strengthener.

The Romans, like individuals in many other cultures, believed that worms in the teeth caused pain. A vast well of superstition can also be found concerning the premature appearance of teeth. Babies born with one or more teeth were considered dangerous in Africa, Madagascar, and India, and were at one point killed. In contrast, the ancient Romans considered children born with teeth to be special, and children were often given a name, Dentatus, in reference to their early dental development.

Non-western advances

Cultures outside Western civilization also focused on the teeth. The Chinese were the first to develop a silver amalgam filling, which was mentioned in medical texts as early as AD 659. The Chinese also developed full dentures by the twelfth century AD and invented the toothbrush model for contemporary toothbrushes

in the fifteenth century. Dental advances also flourished in the Islamic culture, which emerged around the spiritual and political power of Muhammad (570632) and his followers. Innovators drew from the translated works of Aristotle, Plato, and Hippocrates, whose work was translated by Egyptians with links to Greece.

Mohammeds teaching called explicitly for the maintenance of clean teeth. Clean teeth were seen as a way of praising God, and Mohammed was reported to say a prayer which is preceded by the use of the toothpick is worth 75 ordinary prayers. Dental powders, mouth wash, and polishing sticks were used to keep teeth clean.

Dental surgery advanced greatly with the teaching of Albucasis (9361013), a surgeon whose extensive writing about surgery in the Al-Tasrif influenced Islamic and medieval European medical practitioners. He described surgery for dental irregularities, the use of gold wire to make teeth more stable, and the use of artificial teeth made of ox-bone. Albucasis also was one of the first to document the size and shape of dental tools, including drawings of dental saws, files, and extraction forceps in his book.

As the Islamic world moved ahead in dentistry, European dental practice was overwhelmed by the superstition, ignorance, and religious fervor of the Middle Ages. Scientific research was discouraged during the medieval era, which stretched from the fifth to the fifteenth century. Suffering and illness were widely considered to be punishment from God. Knowledge of dental anatomy and treatment did not advance during the Middle Ages, though the range of superstitious dental treatments flowered.

One fourteenth century therapy called for eating the brains of a hare to make lost teeth grow again. Charms made of stone, wood, or paper devoted to a religious figure were believed to ward off disease. Religious officials suggested prayer as the best protector.

The practice of dentistry during the Middle Ages was generally limited to the pulling of teeth that were decayed or destroyed. This task initially fell to barbers, who also performed minor surgery in England in the fifteenth century and were called barber-surgeons. Transient tooth-pullers, who traveled from place to place, also made money extracting teeth.

From counting teeth to replacing them

By the end of the fifteenth century, the emphasis on obedience to authority was changing, in part under the influence of advances such as the discovery of the printing press in 1436. Dentistry benefited from the new spirit of inquiry. Contemporary thinkers, such as anatomist Andreas Vassalius (15141564) challenged classical ideas about dentistry. One indication of the stagnation of independent thinking was Vassalius successful challenge of Aristotles belief that men had more teeth than women.

Ambrose Pare (15101590), a Frenchman trained as a barber surgeon, gained fame as one of the great medical and dental surgeons of the era. His work resembled the work of a contemporary oral surgeon, focusing on the removal of teeth, the setting of fractured jaws and the draining of dental abscesses. He published extensively, documenting methods for transplanting teeth and for creating devices that held artificial teeth made of bone in place using silver or gold wire.

The eighteenth century saw many significant advances in dentistry, many of them inspired by the work of Pierre Fauchard (16781761). By the year 1700, Parisian dentists such as Fauchard were considered members of a distinct profession, complete with an examining board for new dentists. Fauchards work is best known through his writing about the profession in the 1728, two-volume, Le Chirurgien Dentiste, a 863-page tome. In the book, Fauchard explained how to fill teeth with lead or gold leaf tin foil, and various types of dentures. He also told how to make crowns from ivory or human teeth, how to straighten teeth, and how to protect teeth against periodontal damage.

Fauchard also took aim at some of the dental superstitions of the day, which included the erroneous belief that worms in the mouth played a role in tooth decay. His information was not all accurate, however, and Fauchard did suggest the use of urine as a mouth wash.

Another great eighteenth century finding was the development of porcelain, glazed white clay, as a substance for false teeth. Prior to this time, ivory was commonly used. Carving ivory was time consuming and difficult. The first porcelain teeth were developed by M. DeChateau, a French druggist, and M. Dubois De Chamant, a dentist.

DeChateau was frustrated that his teeth had dis-colored due to the chemicals he tasted while mixing substances for customers. After noticing that the chemicals never discolored his porcelain mortar and pestle, DeChateau decided that porcelain teeth would save him embarrassment and unhappiness. Gaining the help of DeChamant, the two men discovered a way to effectively fit and create a pair of false teeth made of porcelain, gaining a patent on the teeth in 1788.

The nineteenth century saw the development of many dental tools and practices that would be the foundation for modern-day twentieth century and, now, twenty-first century dentistry. Many of the great advances were made by Americans, who emerged as great dental innovators. The worlds first dental school, the Baltimore College of Dentistry (Maryland), opened in 1847, providing an organized curriculum to replace the apprenticeship system.

At the start of the nineteenth century, false teeth were available to only the affluent. They were made of porcelain, which was not expensive. But they needed to be fastened to plates made of gold or silver, which were costly. The successful vulcanization of rubber in 1830 by American Charles Goodyear brought cheap false teeth to the masses. Now false teeth could be attached to vulcanized rubber, and dental laboratories emerged everywhere to keep up with the demand.

The development of anesthesia in the United States was a technological breakthrough which revolutionized surgical and dental practice. Many innovators experimented with the use of gases in the eighteenth and nineteenth centuries. Joseph Priestley, a British cleric, invented nitrous oxide, or laughing gas, in 1772. The substance caused euphoria, then sedation and unconsciousness.

Though researchers explored the application of nitrous oxide and ether in the early nineteenth century, the gases were not used for anesthetic purposes until the 1840s. Physician Crawford Williamson Long, a Georgia physician, first used ether to remove a tumor from a patient in 1842. Dentist Horace Wells used nitrous oxide on patients having their teeth pulled in 1844.

However, dentist William Thomas Green Morton is widely credited with the first public display of anesthesia, in part because of the great success of his public demonstration and in part because of his canny alliance with influential physicians. Morton successfully extracted a tooth from a patient anesthetized with ether in 1846 in Boston, Massachusetts.

Ether, nitrous oxide and chloroform were all used successfully during tooth extraction. But these gases were not effective for many other procedures, particularly those which took a long period of time to complete.

A breakthrough came in the form of the drug cocaine, an addictive drug derived from coca leaves that was highly valued in the nineteenth and early twentieth centuries for its pain-killing power. In 1899, cocaine was first used in New York City as a local anesthetic to prevent pain in the lower jaw. Cocaine was effective but habit-forming and sometimes harmful to patients. The development of procaine, now known as Novocain, in 1905 provided dentists with a safer anesthetic than cocaine. Novocaine could be used for tooth grinding, tooth extraction and many other dental procedures.

Development of a drill powered by a foot pedal in 1871 and the first electric drill in 1872 also changed the practice of dentistry.

Another major discovery of the era was the x ray by William Conrad Roentgen of Germany in 1895. The first x ray of the teeth was made in 1896. At the time, there was some skepticism about x rays. The Pall Mall Gazette of London railed in 1896 about the indecency of viewing another persons bones. William Herbert Rollins of New England reported as early as 1901 that x rays could be dangerous and should be housed properly to prevent excess exposure. Contemporary dentists continue to use x rays extensively to determine the condition of the teeth and the roots.

Modern dentistry

Cavities and fillings

The great nineteenth century advances in dentistry provided dentists with the tools to repair or remove damaged teeth with a minimum of pain. The hallmarks of dentistry in the twentieth century have been in the advances in the preservation of teeth.

The success of these efforts can be seen in the fact that more older Americans retain their teeth. For example, the number of Americans without teeth was 18 million in 1986, according to the Centers for Disease Control and Prevention (CDC). By 1989, the number had dropped to 16.5 million. Children also have fewer dental caries, the technical name for cavities. While nearly three-fourths of all nine-year-olds had cavities in the early 1970s, only one-third of nine-year-olds had cavities in the late 1980s, according to the CDC. As of 2004, the percentage was down to about 12% in the United States. However, as the age of children climbs, so does the percentage of cavities.

But many dental problems and challenges still exist. The two most common types of oral disease are dental caries and periodontal disease, Rowe reports. Dental caries stem from the destruction of the tooth by microbial activity on the surface. Dental caries occur when bacteria forms a dental plaque on the surface of the tooth. Plaque is a deposit of bacteria and their products which is sticky and colorless. After the plaque is formed, food and the bacteria combine to create acids that slowly dissolve the substance of the tooth. The result is a hole in the tooth which must be filled or greater damage may occur, including eventual loss of the tooth.

Many different strategies exist to prevent dental caries. These include the reduction of sugar consumption. While some foods, such as starches, do not digest completely in the mouth, other foods, such as sugars, break down quickly in the mouth and are particularly harmful. Tooth brushing also helps reduce plaque. Other preventive techniques, such as the use of fluoride and sealants, are also helpful.

Fluoride was recognized as early as 1874 as a protector against tooth decay. Great controversy surrounded the addition of fluoride to the public water supply in many communities in the 1950s and 1960s, as concerns were raised about the long-term health affects of fluoride. While controversy on the issue remains in some areas, public health experts suggest that fluoride has greatly improved dental health in young and old people. The number of cavities are reduced, generally, over 50% in areas in which water is fluoridated.

Another advance was the development of sealants for children in the late 1960s. These sealants, made of a clear plastic material, are typically added to an etched tooth surface to protect the tooth from decay. They can protect teeth from cavities for up to 15 years. They are generally used on the chewing surfaces of back teeth, which are most prone to tooth decay. Sealants are currently recommended for all children by the American Dental Association.

Regular dental check-ups are used to monitor teeth and prevent dental caries from growing large. Contemporary dentists typically examine teeth using dental equipment to poke and probe teeth and x rays to see potential dental caries before they can be seen easily without aid. To detect problems, x-ray beams are focused on special photographic film placed in the mouth. The x rays create a record of the tooth, with the film documenting dental cavities or other problems in the tooth.

The process of fixing dental caries can be a short procedure depending on the size of the cavity. Small cavities may require no anesthesia and minimal drilling, while extensive dental caries may require Novocain or nitrous oxide to dull the pain and extensive drilling. Typically the process of filling a cavity begins with the dentist using a drill or a hand tool to grind down the part of the tooth surrounding the dental carry. The dentist then shapes the cavity, removes debris from the cavity, and dries it off. At this point a cement lining is added as to insulate the inside of the tooth. The cavity is filled by inserting an amalgam or some other substance in small increments, compressing the material soundly.

Teeth are usually filled with an amalgam including silver, copper, tin, mercury, indium, and palladium. Other materials may be used for front teeth where metallic fillings would stand out. These include plastic composite material, which can be made to match tooth color.

Controversy about the possible safety hazards of mercury in amalgam fillings led some Americans to have their amalgam fillings removed in the early 1990s. While mercury is a proven toxic chemical, there is no proof that mercury in amalgam fillings causes disease, according to the American Dental Association. Still, some experts suggest that dentists seek alternatives to mercury to combat potential problems and fear linked to mercury exposure.

Tooth replacement

Teeth that have large cavities, are badly discolored, or badly broken often are capped with a crown, which covers all or part of the crown, or visible portion, of the tooth. This can be made of gold or dental porcelain. Dental cement is used to keep the crown in place.

Bridges are created when individuals need some tooth replacement but not enough to warrant dentures, which offer more extensive tooth replacement. These devices clasp new teeth in place, keep decayed teeth strong, and support the teeth in a proper configuration. Missing or damaged teeth may lead to difficulty speaking and eating. Like bridges for rivers or streams, dental bridges can be constructed many different ways, depending on the need and the area that needs bridging. There are cantilever dental bridges and many other types. Some are removable by the dentist, and may be attached to the mouth by screw or soft cement. Others, called fixed bridges, are intended to be permanent.

Dentures, a set of replacement teeth, are used when all or a large part of the teeth must be replaced. New teeth can be made of acrylic resin or porcelain. Creating a base to set the teeth in is an ambitious undertaking, requiring the development of an impression from the existing teeth and jaws and the construction of a base designed to fit the mouth exactly. Contemporary dentists generally use acrylic plastics as the base for dentures. Acrylic plastic is mixed as a dough, heated, molded, and set in shape.

Gum disease and bad breath

Gum disease is an immense problem among adults. The more common gum diseases, gingivitis, can be found in over 40% of all employed Americans 18 to 64 years of age. Periodontitis can be found in at least 14% of this group, though it and gingivitis is far more common among older people. Gingivitis is the inflammation of gum tissue, and is marked by bleeding, swollen gums. Periodontitis involves damage to the periodontal ligament, which connects each tooth to the bone. It also involves damage to the alveolar bone to which teeth are attached.

Untreated periodontal disease results in exposure of tooth root surfaces and pockets between the teeth and supporting tissue. This leaves teeth and roots more susceptible to decay and tooth loss.

Periodontitis and gingivitis are caused primarily by bacterial dental plaque. This plaque includes bacteria that produce destructive enzymes in the mouth. These enzymes can damage cells and connective tissue. To prevent gum disease from forming, experts suggest regular brushing, flossing, and removal of bacterial plaque using various dental tools. Regular mechanical removal of plaque by a dentist or hygienist is also essential.

Periodontal surgery is necessary when damage is too great. During this procedure, gums are moved away from bone and teeth temporarily to allow dentists to clean out and regenerate the damaged area.

Another less serious dental problem is halitosis, or bad breath. Bad breath can be due to normal body processes or to illness. Halitosis early in the morning is normal, due to the added amount of bacteria in the mouth during sleep and the reduced secretion of saliva, which cleanses the mouth. Another normal cause of bad breath is when one is hungry. This occurs because the pancreatic juice enters the intestinal tract when one has not eaten for some time, causing a bad smell. Certain foods also cause bad breath, such as garlic, alcohol, and fatty meat, which causes halitosis because the fatty acids are excreted through the lungs.

Halitosis can also be caused by a wealth of illnesses, ranging from diabetes to kidney failure and chronic lung disease. Dental problems such as plaque and dental caries can also contribute to bad breath. Treatment for the condition typically involves treating the illness, if that is causing the problem, and improving oral hygiene. This means brushing the tongue as well as the teeth.

Orthodontics: the art of moving teeth

The practice of orthodontics depends on the fact that the position of teeth in the mouth can be shaped and changed gradually using pressure. Orthodontia is used to correct problems ranging from a bite that is out of alignment, to a protruding jaw, to crowded teeth. Typically orthodontia begins when individuals are in their early teenage years, and takes about two years. However, with the development of clear plastic braces, adults are increasingly likely to turn to orthodontia to improve their appearance, and make eating and talking more comfortable.

The process may require some teeth to be pulled. The removal of teeth allows for the growth of other teeth to fill the newly-vacant area. Braces are made up of a network of wires and bands made of stainless steel or clear plastic. The tubes are often anchored on the molars and the wires are adjusted to provide steady pressure on the surface of the teeth. This pressure slowly moves the tooth to a more desirable location in the mouth and enables new bone to build up where it is needed. Orthodontia can also be used to help move the jaw by anchoring wires to the opposing jaw.

A look forward

Laser beams are already used in dentistry and in medical practice. However, lasers are currently not used for everyday dentistry, such as the drilling of teeth. In the future, as laser technology becomes more refined, lasers may take the place of many conventional dental tools. Using lasers instead of dental

KEY TERMS

Abscess An enclosed collection of liquefied tissue, known as pus, somewhere in the body.

Bridge Replacement for a missing tooth or teeth which is supported by roots or natural teeth.

Gingivitis Gum inflammation

Vulcanization A process in which sulfur and raw latex are combined at a high temperature to make rubber more durable.

tools would cut down on the opportunity to be exposed to blood-borne illness, and reduce damage to surrounding tissue.

Researchers also are exploring new ways to treat periodontal disease, such as more specific antibacterial therapy and stronger antibacterial agents. Many researchers also see a stronger role for fluoride in the future, in addition to its current presence in many public water supplies. Some dentists advocate the use of fluoride in sealants.

While dentistry has made immense progress since days when a dead mouse was considered high dental technology, there is still progress to be made. Future challenges for the dental profession include continuing to reduce tooth loss and decay due to neglect and the aging process.

Resources

BOOKS

Aschheim, Kenneth W., and Barry G. Dale. Esthetic Dentistry: A Clinical Approach to Techniques and Materials. 2nd ed. St. Louis, MO: Mosby, Inc., 2001.

Fortune, Farida. Human Disease for Dentistry. Oxford, UK, and New York: Oxford University Press, 2006.

Mossey, Peter A., ed. Essential Skills for Dentists. Oxford, UK, and New York: Oxford University Press, 2004.

Peterson, Larry J., ed. Contemporary Oral and Maxillofacial Surgery. 4th ed. St. Louis, MO: Mosby, Inc., 2003.

Roderick, Cawson, and William Binnie, Anderw Barrett, and John Wright. Oral Disease. 3rd ed. St. Louis, MO: Mosby, Inc., 2001.

Patricia Braus

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Dentistry

DENTISTRY

•••

Most dentists in the United States practice as independent entrepreneurs either individually or in small groups. Nevertheless, dental care generally is not viewed as an ordinary commodity in the marketplace. Instead, the vast majority of dentists and most people in the larger community think of dentistry as a profession. That is, they consider dental care to be a component of healthcare and consider dentists to be experts in the relevant knowledge and skills, committed individually and collectively as professionals to giving priority to their patients' well-being as they practice their expertise. Consequently, when a person becomes a dentist, he or she makes a commitment to the larger community and accepts the obligations and ethical standards of the dental profession. Those obligations and standards are the subject matter of the subdiscipline called dental ethics.

Ethical Dilemmas

Because dentists rarely make life-or-death decisions, some people are unaware that the professional obligations of dentists require careful study. Important human values are at stake in dental care: relieving and preventing intense pain as well as less intense pain and discomfort; preserving and restoring patients' oral function, on which both nutrition and speech depend; preserving and restoring patients' physical appearance; and preserving and restoring patients' control over their bodies. These matters are important, and as a result dentists who are committed to responding to them in accordance with ethical standards often face complex questions.

Ethical dilemmas such as the following are faced regularly by almost every dentist:

  1. When examining a new patient, a dentist finds evidence of poor earlier dental work. What should the dentist say to the patient? Should the dentist contact the previous dentist to discuss the matter? Should the dentist contact the local dental society?
  2. May a dentist ethically advertise that his or her practice will produce "happy smiles" as well as quality dental care, or is such advertising false or significantly misleading?
  3. May a dentist tell a patient that the patient's teeth are unattractive with a view to recommending aesthetic treatment when the patient has not asked for an opinion and has indicated no displeasure with his or her appearance?
  4. May a dentist ethically decline to treat a patient with a highly infectious disease? What obligations does the dentist have regarding the information that this patient is a carrier of infection?
  5. How should a dentist deal with an adult patient who cannot participate fully in making decisions about about care? Do treatment considerations depend on the reason for that inability? What should a dentist do when the guardian of a minor or an incompetent adult patient refuses to approve the best kind of therapy?
  6. What may a dentist do to obtain cooperative behavior from a young or developmentally disabled patient who needs dental care but is uncontrollable in the chair?
  7. What obligations does a dentist have and to whom when that dentist learns that another dentist is substance-dependent in a manner that probably affects the care he or she is providing?

Issues and Themes in Dental Ethics

The specific requirements of a dentist's ethical commitments in any aspect of professional practice depend on the specific facts and circumstances of the situation. However, the principal categories of dentists' professional obligations can be surveyed under nine headings:

  1. Who are dentistry's chief clients?
  2. What is the ideal relationship between a dentist and a patient?
  3. What are the central values of dental practice?
  4. What are the norms of competence for dental practice?
  5. What sacrifices is a dentist professionally committed to, and in what respects do obligations to the patient take priority over other morally relevant considerations?
  6. What is the ideal relationship between dentists and coprofessionals?
  7. What is the ideal relationship between dentists, both individually and collectively, and the larger community?
  8. What should members of the dental profession do to make access to the profession's services available to all those who need them?
  9. What are members of the dental profession obligated to do to preserve the integrity of their commitment to its professional values and educate others about them?

THE CHIEF CLIENT. For every profession there is a person or set of persons whose well-being the profession and its members are committed to serving. The patient in the dental chair is the most obvious chief client of a dentist, but dentists also have professional obligations to the patients in the waiting room and all their patients of record, to patients who present with emergency needs, and arguably to the entire larger community, especially in matters of public health. The relative weight of a dentist's obligations to each of these entities when those obligations come into conflict ordinarily is considered to favor the patient in the chair over the others, but comparative judgments of the respective degrees of need also must be made.

THE IDEAL RELATIONSHIP BETWEEN PROFESSIONAL AND PATIENT. What is the proper relationship between the dentist and the patient in the chair as they make judgments and choices about the patient's care? There are a number of different ways of conceiving this ideal relationship when it involves the dentist and a fully competent adult: with the dentist alone making the judgment that determines action, with the judgment resting with the patient alone, and with the judgment shared by both parties.

Since the late 1960s the accepted norm of dental practice in the United States has shifted toward the third type of relationship: shared judgment and shared choice regarding treatment. The legal doctrine of informed consent identifies a minimum standard of shared decision making for dentists and their patients, but it is important to ask whether informed consent fully expresses the ideal relationship between a dentist and a fully capable patient (Segal and Warner; Ozar, 1985; Hirsch and Gert; Ozar and Sokol, 2002).

What is the appropriate relationship between the dentist and a patient who cannot participate fully in treatment decisions? What is the dentist's proper role in this relationship? What is the role of the patient up to the limit of the patient's capacity to participate? What is the proper role of other parties?

In practice most dentists depend on choices made by the parents and guardians of such patients when they are available and when these choices do not involve significant harm to the patients' oral or general health. However, there is no clear consensus about how dentistry should proceed when these conditions are absent. The dental ethics literature has begun a careful discussion of the dentist's relationship with patients of diminished capacity or no capacity for decision making (Bogert and Creedon; Ozar and Sokol, 2002).

A HIERARCHY OF CENTRAL VALUES. Regardless of many professions' rhetoric on the subject, no profession can be expert in fostering the complete well-being of those it serves. There is instead a certain set of values that are the appropriate focus of each profession's particular expertise. These values can be called the central values of that profession. They determine and/or establish parameters for most aspects of a professional's judgments in practice. They are the criteria by which a person is judged to need professional assistance in the first place and by which that need is judged to have been met properly through the professional's intervention.

What, then, are the central values of dental practice, and if there is more than one, how are those central values ranked? One proposal is that the central values of the dental profession are, in the following order:

  1. the patient's life and general health;
  2. the patient's oral health, which is understood as appropriate and pain-free oral functioning;
  3. the patient's autonomy—to the extent that the patient is capable of exercising it—over what happens to his or her body (including the patient's ranking of health, comfort, cost, aesthetic considerations, and other values);
  4. preferred patterns of practice on the part of the dentist (including differing philosophies of dental practice);
  5. aesthetic considerations from the point of view of skilled dental practice and from the point of view of patients' aesthetic values; and
  6. considerations of efficiency, which may include considerations of cost, from the dentist's point of view. (Ozar and Sokol, 2002)

A particular dental intervention may achieve each of these values to a greater or lesser degree, and each value is more or less urgent for a particular patient. The ethical dentist takes the details of each situation into account and attempt to maximize dentistry's central values in accordance with their ranked priority in every encounter with every patient.

COMPETENCE. Every professional is obligated to acquire and maintain the expertise required to undertake his or her professional tasks. Every professional also is obligated to undertake only the tasks that are within his or her competence. Consequently, dentists must be constantly attentive to whether they have sufficient competence to make each specific diagnosis and perform each particular procedure for each patient in light of the clinical circumstances, especially when this involves something nonroutine.

Of necessity the dental community, not the community at large, determines the details of standards of competence because doing this requires dental expertise. However, the larger community is justified in demanding an explanation of the reasoning involved, especially regarding the trade-offs between quality of care and access to care that the setting of such standards inevitably involves.

SACRIFICE AND THE RELATIVE PRIORITY OF THE PATIENT'S WELL-BEING. Most sociologists who study professions and most of the literature of professions speak of "commitment to service" or "commitment to the public" as one of the characteristic features of a profession. Dentistry's self-descriptions are similar in this respect, but these expressions allow many different interpretations with different implications for practice. What sorts of sacrifices, for example, are dentists professionally committed to make for the sake of their patients? What sorts of risks to life and health, financial well-being, and reputation may a dentist be obligated to face?

The related question of the proper relationship between entrepreneurship and commitment to the patient, along with the sacrifice of self-interest this can involve, has been discussed in every age of the dental profession. The consensus is that especially in emergency situations, the patient's oral health and general health require significant sacrifices of personal convenience and financial interest on the part of a dentist. Since the arrival of HIV and AIDS, even more urgent implications of the obligation to give priority to the patient, including accepting an increased risk of infection, also have become part of this discussion.

RELATIONS WITH COPROFESSIONALS. Each profession has norms, usually largely implicit and unstated, concerning the proper relationship between the members of a profession. Should a dentist relate to other dentists as competitors in the marketplace, as cobeneficiaries in the monopoly their exclusive expertise gives them in the marketplace, or in some other way? What is the ideal relationship between dentists, and how is it connected with the fact that they are members of a profession, not only entrepreneurs in the same marketplace?

How should a dentist deal with another dentist's inferior work when its consequences are discovered in the mouth of a new or emergency patient or a patient referred for specialty care? The discovering dentist could inform the patient that bad work has been done or could hide that judgment from the patient. The discovering dentist could contact the dentist whose work had a bad outcome or possibly the local dental society. What is the proper balance between obligations to patients and obligations to one's fellow dentist? As in other professions obligations to the patient ordinarily take priority in dentistry, but this principle does not supply simple or automatic answers to the complexities of such situations.

There are also situations in which members of different professions are caring for the same patients. Many dentists, for example, work very closely with dental hygienists, whose professional skills and central professional values are closely related to but significantly distinct from those of dentists. In the best relationships those differences complement each other to the benefit of the patient, but in other situations the skills of the dental hygienist may be demeaned or the dental hygienist's status as a professional may be challenged. The ethical commitments of these professions imply an obligation to develop a working relationship that is conducive to mutual respect and focused on the well-being of the patient.

RELATIONS BETWEEN DENTISTS AND THE LARGER COMMUNITY. Every profession is involved in numerous relationships with the larger community and with important subgroups in it. Both the dental profession and individual dentists must monitor the quality of dental work and practice and report and address instances of inferior work and unethical practice. They also relate to the community as dental-health educators both through direct educational efforts and by monitoring the dependability and effectiveness of dental-care products offered to the public. Dentistry's relationships with the larger community also include developing proper standards for professional advertising. Dentists play an important role in public-health efforts, preserving public oral health, and addressing serious epidemic diseases such as HIV.

ACCESS TO THE PROFESSION'S SERVICES. Individual dentists and the dental profession as a whole have responsibilities in regard to access to dental care for people with unmet dental needs. Dentists also may be obligated to be educationally and politically active when policies are being made to determine how society will distribute its healthcare resources. Also, organized dentistry has an obligation to monitor access issues and use its resources to promote access for those whose dental needs are not being met.

INTEGRITY AND EDUCATION. A dentist who made no effort to influence patients to incorporate the central values of dental practice into their lives and educate them about how to do that would be falling short as a professional committed to these values. However, dentists influence and educate patients not only through their words and professional interventions at chairside but also by the way they live and act. Thus, there is a ninth category of questions to ask about dentists' professional obligations. What are dentists required to do and what might they be required to avoid to preserve the integrity of the values to which dentistry is committed and to educate others by living in a manner consonant with those values?

Organized Dentistry and Ethics

Ultimately, the content of a profession's obligations is the product of a dialogue between the profession and the larger community that entrusts the profession and its members with a high degree of autonomy in practice, including the power of self-regulation. In the case of dentistry this dialogue is often subtle and informal. Codes of ethics formulated by professional organizations such as the American Dental Association's Principles of Ethics and Code of Professional Conduct (American Dental Association, 2002) play an important role in articulating the most fundamental principles of dentistry's professional ethics within American society. However, such codes, like state dental-practice acts, can never articulate more than a small part of the content of a practicing profession's ethics. It therefore is incumbent on both individual dentists and organized groups of dentists to monitor this ongoing dialogue continuously and offer representative statements of its content as they are needed.

If the larger community had no part in this ongoing dialogue, its trust of the dental profession would make no sense. Nevertheless, the community exercises its role in the dialogue more often through passive tolerance than through active articulation. Therefore, the initiative ordinarily falls first to the members of the profession to articulate in word and action the current understanding of the profession's ethical commitments.

Although the dental profession includes every dentist who practices competently and ethically, those who speak for the profession most articulately and are heard the most widely are dentistry's professional organizations. Therefore, those organizations have a special responsibility to foster reflection on and contribute to discussion of dental ethics (Ozar and Sokol, 2002).

Some dental organizations, such as the American Dental Association (ADA), the American College of Dentists (ACD), and some specialty organizations, have contributed actively to the articulation of dentistry's professional standards. Particular issues have temporarily focused the profession's attention on dentistry's ethical commitments. This occurred when the ADA's Council on Dental Therapeutics first awarded its Seal of Approval to a commercial dentifrice (Dummett and Dummett) and when the ADA first issued a policy statement regarding dentists' obligation to treat HIV-positive patients (American Dental Association, 1991; Ozar, 1993).

Until the late 1970s most dental organizations fulfilled this responsibility chiefly through editorials and other hortatory articles in their journals and sometimes through a published code of conduct. Detailed, carefully reasoned discussions of ethical issues in which assumptions were explicit and alternative points of view were accounted for or that articulated the profession's ethics in more than broad generalities were few and far between. Even the published codes of conduct, significant as they have been as representative articulations of dentistry's professional commitments, have not exhausted the contents of dental ethics, much less effectively addressed new and specific issues as they have arisen.

Since the late 1970s, however, the level of interest in and sophisticated discussion of ethical issues within organized dentistry have increased steadily. Responding to newly significant ethical issues in a rapidly changing social climate, the ADA's Council on Ethics, Bylaws, and Judicial Affairs has regularly prepared, after considerable debate in print and other forums, a number of revisions and amendments of the ADA's Principles of Ethics and Code of Professional Conduct (2002). The ADA and its council also have sponsored national workshops and other educational programs on specific ethical issues facing the dental community.

The ACD sponsored several national workshops and a national grassroots educational program to train dentists in more sophisticated forms of reflection on ethical issues as well as national conferences, Ethics Summits I and II, in which representatives from every part of the oral healthcare community worked to develop common understandings of the ethical issues they face and respectful collaboration in dealing with them (American College of Dentists, 1998,2000). Many other dental organizations have incorporated programs on dental ethics into their meetings and published scholarly and popular articles on those topics in their journals. A number of them also have made major revisions of their codes of ethics.

An organization specifically focused on dental ethics and its teaching, the Professional Ethics in Dentistry Network (PEDNET), was founded in 1982 by a group of dental school faculty members and has grown into a national organization with additional members in full-time practice as well as representatives from organized dentistry, dental hygiene, and the larger healthcare ethics community. The International Dental Ethics and Law Society (IDEALS) was established in 1999 to facilitate dialogue on dental ethics and law around the world.

The literature of dental ethics has grown significantly. In 1988 the Journal of the American Dental Association initiated a regular feature on dental ethics, "Ethics at Chairside," which moved in 1991 to General Dentistry, the journal of the American Academy of General Dentistry, and a similar series of ethics cases and commentary has appeared in the Texas Dental Association Journal. A peer-reviewed series, "Issues in Dental Ethics," supervised by the editorial board of PEDNET began publication in 2000, appearing as a special feature in each quarterly issue of the Journal of the American College of Dentists. Also since 2000, the dental journal Quintessence has published a series on ethical heroes in dentistry.

Dental Education

The changing climate of dental practice from the late 1970s into the 1980s and a heightened awareness of ethical issues throughout the dental profession in that period also brought about changes in dental schools. Until that time few dental schools had formal programs in dental ethics. Inspirational lectures by respected senior faculty members or local or national heroes were the standard fare (Odom). However, with prompting from the American Dental Education Association (ADEA), then called the American Association of Dental Schools, as well as the ACD, and the ADA, many dental schools began offering formal programs in dental ethics. They identified faculty members with an interest in dental ethics who began to develop curricular materials and network with the faculty in other institutions. For example, the University of Minnesota pioneered an innovative four-year curriculum in dental ethics in the early 1980s. With the founding of PEDNET, dental-ethics educators acquired a major resource for their teaching and a locus for scholarly discussions of issues in dental ethics at the national level both at annual meetings and at biennial workshops on teaching dental ethics.

During the 1990s, several new textbooks were published (Rule and Veatch; Weinstein; Ozar and Sokol, 1994,2002) and additional educational programs and materials were developed for use in the classroom, in the clinic, and in continuing education programs. By the beginning of the new millennium, most dental schools had multiyear curricula in dental ethics in place (Zarkowski and Graham) and significant efforts were under way to integrate dental ethics education into the innovative patient-centered and problem-based-learning curricula that are the hallmark of contemporary dental school education.

Dentistry in the Twenty-First Century

As dentistry moves into the twenty-first century the focus on ethics will have to be even greater. Two of dentistry's greatest success stories of the twentieth century will yield two of its most important ethical challenges in the twenty-first.

Dentists deeply committed to preventive healthcare for the whole community lobbied successfully during the twentieth century for the fluoridation of water supplies. As a consequence most twenty-first-century dentists' patients will need much less restorative work to remedy the effects of caries than their predecessors' patients did. In these circumstances how will dentists maintain their practices fiscally and still remain true to their fundamental ethical commitments? For many patients and dentists the answer has been an increasing interest in aesthetic dentistry. However, there is a risk here. Too strong a shift in the focus of dental care in this direction could bring about a significant change in the community's view of dentistry, seeing it much more as a taste-driven commercial enterprise and much less as an expertise-grounded, value-based health profession.

The second success story concerns the tremendous advances made in dental research in recent decades. For example, the ways in which laser technology can be used in dental practice have multiplied at least tenfold since the early 1990s. However, these new technologies frequently require extensive training as well as new forms of theoretical understanding so that dentists can employ them safely and skillfully. Because so many patients are fascinated with new technologies, dentists, often fascinated themselves, feel strong pressure to purchase and employ them. The ethical standard of employing only those therapeutic techniques in which one is expert and that truly produce a marginal benefit for the patient compared with older technologies often is strained in these circumstances, and commercial pressures on dentists, both direct fiscal issues within their practices and the pressure of skillful marketing by manufacturers, enhance the challenge for twenty-first-century dentists to choose new technologies wisely and with their patients' best oral healthcare as the goal.

Further complicating both of these issues is the extent to which managed care has had an increased impact on oral healthcare since the early 1990s. More and more frequently dentists must negotiate with patients about treatments in circumstances in which a patient's insurance will pay only for the cheapest acceptable intervention and in which the patient has been poorly informed. The dentist or dental office staff frequently is the bearer of this bad news. Dealing with such situations in a way that preserves an appropriate dentist-patient relationship is often very challenging (Ozar, 2001).

Dentistry as a profession has always taken its professional ethics seriously. However, as a field of study and as a subdiscipline within the study of moral theory and professional ethics dental ethics is still a young field. Nevertheless, as reflection on ethical issues is taken more seriously and participated in more widely by practicing dentists and dental hygienists, dental school and dental hygiene faculty and students, and the leaders of organized dentistry, the dental profession's ethical standards and their implications for daily practice will be understood more clearly and creative dialogue about the ethical practice of dentistry will be more widespread and sophisticated.

david t. ozar (1995)

revised by author

SEE ALSO: Conflict of Interest; Healthcare Resources; Informed Consent; Profession and Professional Ethics; Professional-Patient Relationship; Public Health; Trust

BIBLIOGRAPHY

American Association of Dental Schools. 1989. "Curriculum Guidelines on Ethics and Professionalism in Dentistry." Journal of Dental Education 53(2):144–148.

American College of Dentists. 1998. "Ethics Summit I." Journal of the American College of Dentists 65(3): 5–26.

American College of Dentists. 2000. "Ethics Summit II." Journal of the American College of Dentists 67(2): 4–22.

American Dental Association. 1991. AIDS Policy Statement. Also incorporated into the ADA Principles of Ethics and Code of Professional Conduct at 4A1.

American Dental Association. 2002. ADA Principles of Ethics and Code of Professional Conduct, with Official Advisory Opinions. Chicago: American Dental Association.

Bebeau, Muriel J. 1991. "Ethics for the Practicing Dentist: Can Ethics Be Taught?" Journal of the American College of Dentists 58(1): 5, 10–15.

Bebeau, Muriel J.; Spidel, Thomas M.; and Yamoor, Catherine M. 1982. A Professional Responsibility Curriculum for Dental Education. Minneapolis: University of Minnesota Press.

Bogert, John, and Creedon, Robert, eds. 1989. Behavior Management for the Pediatric Dental Patient. Chicago: American Academy of Pediatric Dentistry.

Burns, Chester R. 1974. "The Evolution of Professional Ethics in American Dentistry." Bulletin of the History of Dentistry 22(2): 59–70.

Chiodo, Gary T., and Tolle, Susan W. 1992. "Diminished Autonomy: Can a Person with Dementia Consent to Dental Treatment?" General Dentistry 40(5): 372–373.

Dummett, Clifton O., and Dummett, Lois Doyle. 1986. The Hillenbrand Era: Organized Dentistry's "Glanzperiode." Bethesda, MD: American College of Dentists.

Hirsch, Allan C., and Gert, Barnard. 1986. "Ethics in Dental Practice." Journal of the American Dental Association 113(4): 599–603.

Horowitz, Herschell S. 1978. "Overview of Ethical Issues in Clinical Studies." Journal of Public Health Dentistry 38(1): 35–43.

Jong, Anthony, and Heine, Carole Sue. 1982. "The Teaching of Ethics in the Dental Hygiene Curriculum." Journal of Dental Education 46(12): 699–702.

McCullough, Laurence B. 1993. "Ethical Issues in Dentistry." In Clark's Clinical Dentistry, rev. edition, vol. 1, ed. James W. Clark and Jefferson F. Hardin. Philadelphia: Lippincott.

Odom, John G. 1982. "Formal Ethics Instruction in Dental Education." Journal of Dental Education 46(9): 553–557.

Ozar, David T. 1985. "Three Models of Professionalism and Professional Obligation in Dentistry." Journal of the American Dental Association 110(2): 173–177.

Ozar, David T. 1993. "AIDS, Ethics, and Dental Care." In Clark's Clinical Dentistry, rev. edition, vol. 3, ed. James W. Clark and Jefferson Hardin. Philadelphia: Lippincott.

Ozar, David T. 2001. "A Position Paper: Six Lessons about Managed Care in Dentistry." Journal of the American College of Dentists, special section, "Issues in Dental Ethics" 68(1): 33–37.

Ozar, David T., and Sokol, David J. 1994. Dental Ethics at Chairside: Professional Principles and Practical Applications. St. Louis: Mosby-Yearbook.

Ozar, David T., and Sokol, David J. 2002. Dental Ethics at Chairside: Professional Principles and Practical Applications, 2nd edition. Washington, D.C.: Georgetown University Press.

Professional Ethics in Dentistry Network. 1993. The PEDNET Bibliography, 1993. Chicago: Professional Ethics in Dentistry Network.

Rule, James T., and Veatch, Robert M. 1993. Ethical Questions in Dentistry. Chicago: Quintessence.

Segal, Herman, and Warner, Richard. 1979. "Informed Consent in Dentistry." Journal of the American Dental Association 99(6): 957–958.

Weinstein, Bruce D., ed. 1993. Dental Ethics. Philadelphia: Lea & Febiger.

Zarkowski, Pamela, and Graham, Bruce. 2001. "A Four-Year Curriculum in Professional Ethics and Law for Dental Students." Journal of the American College of Dentists, special section, "Issues in Dental Ethics" 68(2): 22–26.

INTERNET RESOURCE

American Dental Association. 2002. ADA Principles of Ethics and Code of Professional Conduct, with Official Advisory Opinions. Available from <www.ada.org/prof/prac/law/code/index.html>.

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Dentistry

Dentistry

Dentistry is the medical activity focused on treating the teeth, the gums and the oral cavity. This includes treating teeth damaged due to accidents or disease , filling teeth damaged due to tooth decay, and replacing damaged or injured teeth with replacement teeth. Major disciplines of dentistry include orthodontics, which focuses on the correction of tooth problems such as gaps between the teeth, crowded teeth and irregular bite; and periodontics, which addresses gum problems. Dentistry is considered an independent medical art, with its own licensing procedure. Medical doctors are not licensed to treat teeth; likewise dentists are not licensed to treat other parts of the body.


Skill and superstition

Ancient, medieval, and early Renaissance dental practice can be seen as a stew of the sensible and the outrageous. In each era, stories of practitioners with wisdom and skill coexist with outrageous tales of superstition and myth connected to teeth. In the ancient and Islamic worlds, doctors often performed dental work. The cleaning and extracting of teeth was often performed by individuals with little or no medical training.

Ancient men and women worked hard to alleviate dental pain . As early as 1550 b.c., the ancient Egyptians documented their interest in dentistry in the Ebers Papyrus, a document discovered in 1872. The Papyrus listed various remedies for toothache, including such familiar ingredients as dough, honey, onions, incense, and fennel seeds .

The Egyptians also turned to superstition for help preventing tooth pain. The mouse, which was considered to be protected by the Sun and capable of fending off death, was often used by individuals with a toothache. A common remedy involved applying half of the body of a dead mouse to the aching tooth while the body was still warm.

The Greeks offered a variety of conventional and unconventional dental therapy. One of the more illustrious dental pioneers was Hippocrates (460–375 b.c.), whose admonition to do no harm continues to be a central goal of medical practice. Hippocrates said that food lodged between teeth was responsible for tooth decay, and suggested pulling teeth that were loose and decayed.

Hippocrates also offered advice for bad breath. He suggested a mouth wash containing oil of anise seed and myrrh and white wine. Other ancient Greeks took a more superstitious approach, with some depending on the mythical power of the mouse to protect their teeth. A recipe for bad breath from the fifth century b.c. called for a range of ingredients including the bodies of three mice , including one whose intestines had been removed, and the head of a hare. The ingredients were burned and mixed with dust and water before consumption.

The Etruscans, who lived in Tuscany, Italy, between approximately 1000 and 400 b.c., also made great advances in dentistry. They are often cited for the sophistication of their gold crowns and bridges. One bridge which has been preserved included three artificial teeth attached to gold bands, which hooked around the natural teeth. The artificial teeth were actually real teeth taken from an immature calf, then divided in two.

The Romans built upon the Etruscan knowledge of dentistry and took seriously the challenge of keeping teeth healthy. Celsus, a Roman writer who lived about 100 b.c., wrote about toothache, dental abscesses and other dental ailments. For toothache, which he called "among the worst of tortures," he suggested the use of hot poultices, mouthwash, and steam. He also suggested using pain-killers such as opium. The Romans also made bridgework.

Clean teeth were valued by the Romans, and affluent families had slaves clean their mouths using small sticks of wood and tooth powder. Such powders could include burned eggshell, bay-leaves and myrrh. These powders could also include more unusual ingredients, such as burned heads of mice and lizard livers. Earth worms marinated in vinegar were used for a mouth wash, and urine was thought of as a gum strengthener.

The Romans, like individuals in many other cultures, believed that worms in the teeth caused pain. A vast well of superstition can also be found concerning the premature appearance of teeth. Babies born with one or more teeth were considered dangerous in Africa , Madagascar, and India, and were at one point killed. In contrast, the ancient Romans considered children born with teeth to be special, and children were often given a name, "Dentatus" in reference to their early dental development.


Non-western advances

Cultures outside Western civilization also focused on the teeth. The Chinese were the first to develop a silver amalgam filling, which was mentioned in medical texts as early as a.d. 659. The Chinese also developed full dentures by the twelfth century a.d. and invented the toothbrush model for our contemporary toothbrushes in the fifteenth century. Dental advances also flourished in the Islamic culture, which emerged around the spiritual and political power of Muhammad (570-632) and his followers. Innovators drew from the translated works of Aristotle, Plato, and Hippocrates, whose work was translated by Egyptians with links to Greece.

Mohammed's teaching called explicitly for the maintenance of clean teeth. Clean teeth were seen as a way of praising God, and he was reported to say "a prayer which is preceded by the use of the toothpick is worth 75 ordinary prayers." Dental powders, mouth wash, and polishing sticks were used to keep teeth clean.

Dental surgery advanced greatly with the teaching of Albucasis (936-1013), a surgeon whose extensive writing about surgery in the Al-Tasrif influenced Islamic and medieval European medical practitioners. He described surgery for dental irregularities, the use of gold wire to make teeth more stable, and the use of artificial teeth made of ox-bone. Albucasis also was one of the first to document the size and shape of dental tools, including drawings of dental saws, files, and extraction forceps in his book.

As the Islamic world moved ahead in dentistry, European dental practice was overwhelmed by the superstition, ignorance, and religious fervor of the Middle Ages. Scientific research was discouraged during the medieval era, which stretched from the fifth to the fifteenth century. Suffering and illness were widely considered to be punishment from God. Knowledge of dental anatomy and treatment did not advance during the Middle Ages, though the range of superstitious dental treatments flowered.

One fourteenth century therapy called for eating the brains of a hare to make lost teeth grow again. Charms made of stone, wood, or paper devoted to a religious figure were believed to ward off disease. Religious officials suggested prayer as the best protector.

The practice of dentistry during the Middle Ages was generally limited to the pulling of teeth that were decayed or destroyed. This task initially fell to barbers, who also performed minor surgery in England in the fifteenth century and were called barber-surgeons. Transient tooth-pullers, who traveled from place to place, also made money extracting teeth.


From counting teeth to replacing them

By the end of the fifteenth century, the emphasis on obedience to authority was changing, in part under the influence of advances such as the discovery of the printing press in 1436. Dentistry benefitted from the new spirit of inquiry. Contemporary thinkers, such as anatomist Andreas Vassalius (1514-1564) challenged classical ideas about dentistry. One indication of the stagnation of independent thinking was Vassalius's successful challenge of Aristotle's belief that men had more teeth than women.

Ambrose Pare (1510-1590), a Frenchman trained as a barber surgeon, gained fame as one of the great medical and dental surgeons of the era. His work resembled the work of a contemporary oral surgeon, focusing on the removal of teeth, the setting of fractured jaws and the draining of dental abscesses. He published extensively, documenting methods for transplanting teeth and for creating devices that held artificial teeth made of bone in place using silver or gold wire.

The eighteenth century saw many significant advances in dentistry, many of them inspired by the work of Pierre Fauchard (1678-1761). By the year 1700, Parisian dentists such as Fauchard were considered members of a distinct profession, complete with an examining board for new dentists. Fauchard's work is best known through his writing about the profession in the 1728, two-volume, Le Chirurgien Dentiste, a 863-page tome. In the book, Fauchard explained how to fill teeth with lead or gold leaf tin foil, and various types of dentures. He also told how to make crowns from ivory or human teeth, how to straighten teeth, and how to protect teeth against periodontal damage.

Fauchard also took aim at some of the dental superstitions of the day, which included the erroneous belief that worms in the mouth played a role in tooth decay. His information was not all accurate, however, and Fauchard did suggest the use of urine as a mouth wash.

Another great eighteenth century finding was the development of porcelain, glazed white clay, as a substance for false teeth. Prior to this time, ivory was commonly used. Carving ivory was time consuming and difficult. The first porcelain teeth were developed by M. DeChateau, a French druggist, and M. Dubois De Chamant, a dentist.

DeChateau was frustrated that his teeth had discolored due to the chemicals he tasted while mixing substances for customers. After noticing that the chemicals never discolored his porcelain mortar and pestle, DeChateau decided that porcelain teeth would save him embarrassment and unhappiness. Gaining the help of DeChamant, the two men discovered a way to effectively fit and create a pair of false teeth made of porcelain, gaining a patent on the teeth in 1788.

The nineteenth century saw the development of many dental tools and practices that would be the bedrock for twentieth century dentistry. Many of the great advances were made by Americans, who emerged as great dental innovators. The world's first dental school, the Baltimore College of Dentistry, opened in 1847, providing an organized curriculum to replace the apprenticeship system.

At the start of the century, false teeth were available to only the affluent. They were made of porcelain, which was not expensive. But they needed to be fastened to plates made of gold or silver, which were costly. The successful vulcanization of rubber in 1830 by American Charles Goodyear brought cheap false teeth to the masses. Now false teeth could be attached to vulcanized rubber, and dental laboratories emerged everywhere to keep up with the demand.

The development of anesthesia in the United States was a technological breakthrough which revolutionized surgical and dental practice. Many innovators experimented with the use of gases in the eighteenth and nineteenth centuries. Joseph Priestley, a British cleric, invented nitrous oxide, or laughing gas, in 1772. The substance caused euphoria, then sedation and unconsciousness.

Though researchers explored the application of nitrous oxide and ether in the early nineteenth century, the gases were not used for anesthetic purposes until the 1840s. Physician Crawford Williamson Long, a Georgia physician, first used ether to remove a tumor from a patient in 1842. Dentist Horace Wells used nitrousoxide on patients having their teeth pulled in 1844.

But dentist William Thomas Green Morton is widely credited with the first public display of anesthesia, in part because of the great success of his public demonstration and in part because of his canny alliance with influential physicians. Morton successfully extracted a tooth from a patient anesthetized with ether in 1846 in Boston.

Ether, nitrous oxide and chloroform were all used successfully during tooth extraction. But these gases were not effective for many other procedures, particularly those which took a long period of time to complete.

A breakthrough came in the form of the drug cocaine , an addictive drug derived from coca leaves which was highly valued in the nineteenth and early twentieth centuries for its pain-killing power. In 1899, cocaine was first used in New York as a local anesthetic to prevent pain in the lower jaw. Cocaine was effective but habit-forming and sometimes harmful to patients. The development of procaine, now known as novocaine, in 1905 provided dentists with a safer anesthetic than cocaine. Novocaine could be used for tooth grinding, tooth extraction and many other dental procedures.

Development of a drill powered by a footpedal in 1871 and the first electric drill in 1872 also changed the practice of dentistry.

Another major discovery of the era was the x ray by William Conrad Roentgen of Germany in 1895. The first x ray of the teeth was made in 1896. At the time, there was some skepticism about x rays . The Pall Mall Gazette of London railed in 1896 about the "indecency" of viewing another person's bones. William Herbert Rollins of New England reported as early as 1901 that x rays could be dangerous and should be housed properly to prevent excess exposure. Contemporary dentists continue to use x rays extensively to determine the condition of the teeth and the roots.


Modern dentistry

Cavities and fillings

The great nineteenth century advances in dentistry provided dentists with the tools to repair or remove damaged teeth with a minimum of pain. The hallmarks of dentistry in the twentieth century have been advances in the preservation of teeth.

The success of these efforts can be seen in the fact that more older Americans retain their teeth. For example, the number of Americans without teeth was 18 million in 1986, according to the Centers for Disease Control. By 1989, the number had dropped to 16.5 million. Children also have fewer dental caries, the technical name for cavities. While nearly three quarters of all 9-year-olds had cavities in the early 1970s, only one-third of 9-year-olds had cavities in the late 1980s, according to the Centers for Disease Control.

But many dental problems and challenges still exist. The two most common types of oral disease are dental caries and periodontal disease, Rowe reports. Dental caries stem from the destruction of the tooth by microbial activity on the surface. Dental caries occur when bacteria forms a dental plaque on the surface of the tooth. Plaque is a deposit of bacteria and their products which is sticky and colorless. After the plaque is formed, food and the bacteria combine to create acids that slowly dissolve the substance of the tooth. The result is a hole in the tooth which must be filled or greater damage may occur, including eventual loss of the tooth.

Many different strategies exist to prevent dental caries. These include the reduction of sugar consumption. While some foods, such as starches, do not digest completely in the mouth, other foods, such as sugars, break down quickly in the mouth and are particularly harmful. Tooth brushing also helps reduce plaque. Other preventive techniques, such as the use of fluoride and sealants, are also helpful.

Fluoride was recognized as early as 1874 as a protector against tooth decay. Great controversy surrounded the addition of fluoride to the public water supply in many communities in the 1950s and 60s, as concerns were raised about the long-term health affects of fluoride. While controversy on the issue remains in some areas, public health experts suggest that fluoride has greatly improved dental health in young and old people. The number of cavities are reduced 65% in areas in which water is fluoridated.

Another advance was the development of sealants for children in the late 1960s. These sealants, made of a clear plastic material, are typically added to an etched tooth surface to protect the tooth from decay. They can protect teeth from cavities for up to 15 years. They are generally used on the chewing surfaces of back teeth, which are most prone to tooth decay. Sealants are currently recommended for all children by the American Dental Association.

Regular dental check-ups are used to monitor teeth and prevent dental caries from growing large. Contemporary dentists typically examine teeth using dental equipment to poke and probe teeth and x rays to see potential dental caries before they can be seen easily without aid. To detect problems, x-ray beams are focused on special photographic film placed in the mouth. The x rays create a record of the tooth, with the film documenting dental cavities or other problems in the tooth.

The process of fixing dental caries can be a short procedure depending on the size of the cavity. Small cavities may require no anesthesia and minimal drilling, while extensive dental caries may require novocaine or nitrous oxide to dull the pain and extensive drilling. Typically the process of filling a cavity begins with the dentist using a drill or a hand tool to grind down the part of the tooth surrounding the dental carry. The dentist then shapes the cavity, removes debris from the cavity, and dries it off. At this point a cement lining is added as to insulate the inside of the tooth. The cavity is filled by inserting an amalgam or some other substance in small increments, compressing the material soundly.

Teeth are usually filled with an amalgam including silver, copper , tin, mercury, indium, and palladium. Other materials may be used for front teeth where metallic fillings would stand out. These include plastic composite material, which can be made to match tooth color .

Controversy about the possible safety hazards of mercury in amalgam fillings led some Americans to have their amalgam fillings removed in the early 1990s. While mercury is a proven toxic chemical, there is no proof that mercury in amalgam fillings causes disease, according to the American Dental Association. Still, some experts suggest that dentists seek alternatives to mercury to combat potential problems and fear linked to mercury exposure.


Tooth replacement

Teeth that have large cavities, are badly discolored, or badly broken often are capped with a crown, which covers all or part of the crown, or visible portion, of the tooth. This can be made of gold or dental porcelain. Dental cement is used to keep the crown in place.

Bridges are created when individuals need some tooth replacement but not enough to warrant dentures, which offer more extensive tooth replacement. These devices clasp new teeth in place, keep decayed teeth strong, and support the teeth in a proper configuration. Missing or damaged teeth may lead to difficulty speaking and eating. Like bridges for rivers or streams, dental bridges can be constructed many different ways, depending on the need and the area that needs bridging. There are cantilever dental bridges and many other types. Some are removable by the dentist, and may be attached to the mouth by screw or soft cement. Others, called fixed bridges, are intended to be permanent.

Dentures, a set of replacement teeth, are used when all or a large part of the teeth must be replaced. New teeth can be made of acrylic resin or porcelain. Creating a base to set the teeth in is an ambitious undertaking, requiring the development of an impression from the existing teeth and jaws and the construction of a base designed to fit the mouth exactly and not add errors. Contemporary dentists generally use acrylic plastics as the base for dentures. Acrylic plastic is mixed as a dough, heated, molded, and set in shape.

Gum disease and bad breath

Gum disease is an immense problem among adults. The more common gum diseases, gingivitis, can be found in about 44% of all employed Americans 18–64. Periodontitis can be found in at least 14% of this group, though it and gingivitis is far more common among older people. Gingivitis is the inflammation of gum tissue , and is marked by bleeding, swollen gums. Periodontitis involves damage to the periodontal ligament, which connects each tooth to the bone. It also involves damage to the alveolar bone to which teeth are attached.

Untreated periodontal disease results in exposure of tooth root surfaces and pockets between the teeth and supporting tissue. This leaves teeth and roots more susceptible to decay and tooth loss.

Periodontitis and gingivitis are caused primarily by bacterial dental plaque. This plaque includes bacteria which produce destructive enzymes in the mouth. These enzymes can damage cells and connective tissue . To prevent gum disease from forming, experts suggest regular brushing, flossing and removal of bacterial plaque using various dental tools. Regular mechanical removal of plaque by a dentist or hygienist is also essential.

Periodontal surgery is necessary when damage is too great. During this procedure, gums are moved away from bone and teeth temporarily to allow dentists to clean out and regenerate the damaged area.

Another less serious dental problem is halitosis, or bad breath. Bad breath can be due to normal body processes or to illness. Halitosis early in the morning is normal, due to the added amount of bacteria in the mouth during sleep and the reduced secretion of saliva, which cleanses the mouth. Another normal cause of bad breath is when one is hungry. This occurs because the pancreatic juice enters the intestinal tract when one has not eaten for some time, causing a bad smell . Certain foods also cause bad breath, such as garlic, alcohol , and fatty meat, which causes halitosis because the fatty acids are excreted through the lungs.

Halitosis can also be caused by a wealth of illnesses, ranging from diabetes to kidney failure and chronic lung disease. Dental problems such as plaque and dental caries can also contribute to bad breath. Treatment for the condition typically involves treating the illness, if that is causing the problem, and improving oral hygiene. This means brushing the tongue as well as the teeth.


Orthodontics: the art of moving teeth

The practice of orthodontics depends on the fact that the position of teeth in the mouth can be shaped and changed gradually using pressure . Orthodontia is used to correct problems ranging from a bite that is out of alignment, to a protruding jaw, to crowded teeth. Typically orthodontia begins when individuals are in their early teens, and takes about two years. However, with the development of clear plastic braces, adults are increasingly likely to turn to orthodontia to improve their appearance, and make eating and talking more comfortable.

The process may require some teeth to be pulled. The removal of teeth allows for the growth of other teeth to fill the newly-vacant area. Braces are made up of a network of wires and bands made of stainless steel or clear plastic. The tubes are often anchored on the molars and the wires are adjusted to provide steady pressure on the surface of the teeth. This pressure slowly moves the tooth to a more desirable location in the mouth and enables new bone to build up where it is needed. Orthodontia can also be used to help move the jaw by anchoring wires to the opposing jaw.


A look forward

Laser beams are already used in dentistry and in medical practice. But lasers are currently not used for everyday dentistry, such as the drilling of teeth. In the future, as laser technology becomes more refined, lasers may take the place of many conventional dental tools. Using lasers instead of dental tools would cut down on the opportunity to be exposed to blood-borne illness, and reduce damage to surrounding tissue.

Researchers also are exploring new ways to treat periodontal disease, such as more specific antibacterial therapy and stronger antibacterial agents. Many researchers also see a stronger role for fluoride in the future, in addition to its current presence in many public water supplies. Some dentists advocate the use of fluoride in sealants. A 1991 study reported that a sealant including fluoride reduced tooth irritation for some individuals with sensitive teeth.

While dentistry has made immense progress since days when a dead mouse was considered high dental technology, there is still progress to be made. Future challenges for the dental profession include continuing to reduce tooth loss and decay due to neglect and the aging process.


Resources

books

Aschheim, Kenneth W., and Barry G. Dale. Esthetic Dentistry:A Clinical Approach to Techniques and Materials. 2nd ed. St. Louis: Mosby, Inc., 2001.

Hupp, James, and Larry J. Peterson. Contemporary Oral andMaxillofacial Surgery. 4th ed. St. Louis: Mosby, Inc., 2002.

Proffit, William, and Henry W. Fields. Contemporary Orthodontics. 3rd ed. Chicago: Year Book Medical Publishing, 2000.

Roderick, Cawson, and William Binnie, Anderw Barrett, and John Wright. Oral Disease. 3rd ed. St. Louis: Mosby, Inc., 2001.

periodicals

Gift, Helen C., Stephen B. Corbin, and Ruth E. Nowjack-Raymer. "Public Knowledge of Prevention of Dental Disease." Public Health Reports 109, 397. (May-June 1994).

"What Will the Future Bring?" Journal of the American DentalAssociation 123. (April 1992): 40-46.


Patricia Braus

KEY TERMS

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Abscess

—An enclosed collection of liquefied tissue, known as pus, somewhere in the body.

Bridge

—Replacement for a missing tooth or teeth which is supported by roots or natural teeth.

Gingivitis

—Gum inflammation

Vulcanization

—A process in which sulfur and raw latex are combined at a high temperature to make rubber more durable.

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