History
of the American Association
of Public Health Dentistry
The American
Association of Public Health Dentistry (AAPHD)** was founded in July 1937
in Atlantic City, New Jersey, by a group of state dental directors [1]. This
event followed by two years one of the most significant milestones in the
history of dental public health, the Social Security Act passed by Congress
in 1935 [2]. This law not only established old age benefits and unemployment
compensation, but for the first time provided for extensive federal aid to
states for various health and welfare activities. For example, Title V of
the Act authorized federal grants for maternal and child health services,
services for crippled children, and child welfare services. Dental services
at the time often were part of divisions of maternal and child health in state
health departments, but increasingly they became divisions of dental health
in their own right. This Title resulted in a rapid growth of administrative
units responsible for dental health activities. For example, in 1934 only
14 states had such units and all together they employed only a total of eight
full-time dentists; by 1941, 38 states had identifiable dental health units
that employed a total of 154 full-time dentists.
In view
of the foregoing, it is not surprising that the unwritten objective of the
founding group in 1937 was to provide a forum to discuss the mutual problems
of directing state dental public health programs. Membership in the early
years of the Association was limited to state dental directors, their assistants,
and Public Health Service dental consultants who worked closely with "state
health authorities."
In 1941,
the first scientific publication devoted solely to public health dentistry
was published by AAPHD and continues today as the Journal of Public Health
Dentistry.
Early
in 1943, the constitution and bylaws were revised to state clearly that "The
objectives of the Association are to promote dental public health, maintain
the ideals of organized dentistry in public dental projects, and afford opportunity
for constructive discussion of administrative problems." The Association's
policies in carrying out its objectives were to maintain a close relation
with the American Dental Association, establish a similar relation with the
American Public Health Association, improve training of personnel, and promote
aids for administration at all levels of public health practice.
A second
major milestone for public health dentistry occurred during the years of World
War II which saw vast expansions in dental service for armed forces all over
the world. The importance of dental health and being dentally fit was approached
from the broad point of view that encompasses the care of total populations--the
approach that is so valuable in public health work. Through the teamwork necessary
in larger clinics, some of the groundwork was prepared for the group programs
of the present and future.
Another
major development in the 1940s was the pioneering state in the field of voluntary
prepaid comprehensive dental care. Association members played key roles in
the development of pre- and postpayment mechanisms providing access for the
public to the private sector for comprehensive dental care, where many had
previously received only emergency care or none at all.
Certainly
one of the most significant milestones having broad implications for dentistry
and dental health in general occurred in 1945 with the initiation of water
fluoridation on a trial basis in the two cities of Grand Rapids, Michigan
and Newburgh, New York. These two projects were accompanied by intensive medical
and dental appraisal for a period of 10 years and clearly established the
efficacy, safety, and economy of reducing the incidence of dental caries through
community water fluoridation, particularly in children. The American Association
of Public Health Dentistry was one of the first health organizations in the
country to affirm its support of community water fluoridation (October, 1950)
as an effective public health measure. Association members were active not
only in the research activities which identified fluoride as a decay-preventive
agent and establishing optimum levels, but also in promoting fluoridation
throughout the nation. State and local dental directors by virtue of their
positions and familiarity with local conditions were particularly effective
in this endeavor. The opportunity which was available through AAPHD to pool
knowledge and strategy played a particularly important role in the drive to
bring the benefits of fluoridation to a large portion of the population through
community water fluoridation, and professionally and self-applied modes of
application.
The American
Association of Public Health Dentistry is the sponsoring agency of the American
Board of Dental Public Health [3]. The association between the two organizations
began at the end of the decade of the 40s, when in 1949 an editorial appeared
in the Bulletin of the American Association of Public Health Dentists on "Specialty
Boards in Dental Public Health." Dentists representing AAPHD and the
Dental Health Section of the American Public Health Association had been discussing
the pros and cons for the development of a board for the specialty of dental
public health. The American Medical Association, on the recommendation of
physicians of the American Public Health Association, had recently established
a Board of Preventive Medicine and Public Health, and the time seemed appropriate
for public health dentists to organize.
The groundwork
for the development of a board for dentists in public health was developed
at the Annual Meeting of the American Association of Public Health Dentistry
in October, 1949. The board was incorporated in 1950, and the House of Delegates
of the American Dental Association approved dental public health as a specialty
of dental practice in 1951. Because both AAPHD and the Dental Health Section
of APHA were active in the founding of the board, the first examining board
consisted of members of both organizations and joint sponsorship was established.
Joint sponsorship resulted in he nomination by one of the cosponsors in one
year of a slate from which a new member of the board would be selected and
the next year the other cosponsor would provide the nominees. This created
some confusion for the Council on Dental Education and the Commission on Dental
Accreditation which never quite knew with which group to deal or with both.
Consequently, in 1976, the American Association of Public Health Dentistry
became the sole sponsoring agency of the board, a role that it has had ever
since.
In 1960,
institutional members were invited to membership, thus making the AAPHD truly
representative of almost every group of dentists active in dental public health.
The greatest milestones in the 60s occurred in 1966 with the enactment of
Medicare (Title XVIII of the Social Security Act) and Medicaid (Title XIX)
followed the next year by the "Partnership for Health" Act (P.L.
89-749). Although Title XVIII had very limited dental benefits, Title XIX
did include dental benefits for the disadvantaged of the country. The "Partnership
for Health" legislation created a network of comprehensive health planning
agencies which strengthened state and local dental programs. For example,
a significant number of the states' comprehensive health planning agencies
identified dental concerns among their first ten priorities--perhaps because
of the required consumer representation.
AAPHD
at that time was in the forefront of programs for care of the chronically
ill and aged, fluoridation incentives, implementation of prepayment for dental
care, administration of Title XIX dental care benefits, and comprehensive
planning for dental health programs in state and local jurisdictions.
The most
recent membership expansion occurred in 1977 and included as voting members
"qualified dental health professionals," but with the proviso clearly
spelled out in the bylaws " . . . that voting on any matter whatsoever
pertaining to the American Board of Dental Public Health must be restricted
to members who are dentists."
AAPHD
membership today truly fulfills the requirement that a sponsoring or parent
organization be reflective of the recognized special area of dental practice.
The broad area of responsibility of dental public health requires an equally
broad-based representation of dental health professionals. Over the years,
there have been many more events which might be considered milestones in dental
public health and the Association has reacted characteristically, opposing
programs which appeared to be against the interest of improving the oral health
of the public and enthusiastically supporting and helping to administer new
programs which promised more efficient or effective ways of providing dental
care benefits.
Through
the years it has been effective in protecting the dental interests of the
public and, at the same time, of dental public health agencies, programs and
personnel. Its chief contributions, it would seem, are: first, to serve as
a medium of professional exchange of information, scientific and otherwise,
both through its annual meeting and its publications; second, to serve as
a liaison with national, constituent, and component dental societies; third,
to continue to gain and maintain the recognition and stature of public health
dentistry; fourth, to sponsor the American Board of Dental Public Health;
and fifth, to provide dental public health consultation to other professional
associations, particularly the American Dental Association's councils, bureaus,
commissions, conferences, committees, publications, and staff.
*
Modified from Draft "Application for Continued Recognition of the Specialty
of Dental Public Health" to be submitted by the American Association
of Public Health Dentistry to the American Dental Association, 1986.
** Originally named the American Association of Public Health Dentists,
the present name was adopted in 1983. By 1944, membership in the Association
had expanded to include, as associate members, directors of local dental
programs and dentist members of boards of health. The Association enlarged
its scope and responsibilities again in 1948 when voting membership was
extended to include dentists in local programs.
