Continued from preceding page
helpful. The segments that were identified as .most helpful, however, were test taking, note taking, memorization, and study contracts, in that order. Eighty-four percent of the students indicated that they continued to use all or some of the techniques, 11 percent discontinued using them, and five percent did not respond. Fifty-four percent stated that they had noticed an improvement in their grades with less study time, 16 percent said there was no change in their grades, and 30 percent did not respond. When asked, "What other services were provided by the staff other than academic reinforcement?" 80 percent of the students indicated that the encouragement and support of the staff was important. These students noted that the staff helped them in examining attitudes about school, with other problems which affected their studies, and in gaining confidence in themselves. Eleven percent of the students indicated that they only received instruction in the techniques of academic reinforcement. Fourteen students added that they would recommend the program to others. Only one student commented that the techniques were not helpful.
Discussion Although it is often assumed that preprofessional and professional students know how to study, studying is like any other behavior; study habits and techniques must be learned. Instruction in learning how to study could expedite the studying-learning process and allow students to spend their time more efficiently. These techniques are not remedial; they are tools to assist the students in doing a better job in their academic pursuits. Instructors in academic reinforcement programs need to be carefully selected and trained. An instructor who is not judgmental is extremely important, since the meanings of grades and study habits are unique to each individual and discussion of them may arouse sensitivity and emotionality. Learning new study techniques and approaches from staff members who are caring, supportive, and understanding is important in the student's receptivity to, and use of, academic reinforcement techniques. Instructors of academic reinforcement do not have to know course content to teach the techniques. However, the application can be most effective if faculty and peers, who are familiar with
course content, also know academic reinforcement techniques. Indeed, academic reinforcement techniques could assist the faculty in improving the organization of their lectures and tests. Not all students need, nor will all benefit from, academic reinforcement techniques. The results of this study indicate, however, that academic reinforcement is an important student support service which should be made available to all health science students and offered as an optional part of the
curriculum.
Acknowledgements This project was supported by Robert Wood Johnson Foundation Grant No. 2422 and NIH Health Professions Special Project Grant No.
06-D-000008-03.
Literature Cited 1. Ray9or A, Wallace J: Guide to
McGraw-Hill Basic Skills System. New York, McGraw-Hill, 1970 2. Carman RA, Adams WR: Study Skills: A Students' Guide for Survival. New York, John Wiley, 1972 3. Pauk W: How to Study in College, ed 2. Boston, Houghton Mifflin, 1974 4. Maddox H: How To Study. Greenwich, Conn, Fawcett, 1963 5. Willey MS, Jarecky BM: Analysis and Apnlication of Information. Privately printed,
Dental Health Problems of the Geriatric Population Clifton 0. Dummett, DDS Los Angeles, California
A topic seldom considered and even more rarely discussed among the dental components of the health professions is presented. The dentist's preoccupation with hosts of dental treatment problems has left little time for considering the perplexities of aging, critical illness, or dying or dead patient's relatives. Community dentistry has now forced upon our consciousness the fact that perhaps the subject is one which must not be avoided, if we are to fulfill completely our professional obligations to the public. Current estimates of the percentages of the American people who are over 65 years of age range between 10 and 11 percent of the entire population. Demographers predict that by the year 2000, one out of every eight persons Presented to the Section on Community Medicine of the 83rd Annual Convention and Scientific Assembly of the National Medical Association, Washington, DC, July 30-August 3, 1978. Requests for reprints should be addressed to Dr. Clifton 0. Dummett, PO Box 77006, Los Angeles, CA 90007.
182
will be at least 65 years of age, and by the year 2030, 17 percent of the US population will be "aged." Many of the disease processes which occur in the younger population also occur in the aged, but generally these occur with greater frequency, more severity, and probably run longer courses. This is especially the case with the so-called chronic diseases, of which many oral diseases are representative. As is the case with the vast body of
medical information, increasing dental knowledge confirms the fact that oral health problems of senior citizens vary from those of their juniors because of the fact that the reactions of the aging stomatic system to inevitable disease processes are plainly different. During these advanced periods of human development, the metabolic processes influence general tissue reactions, usually detrimentally, and Continued on next page
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 2, 1979
Continued from preceding page
these in turn play a part in the oral tissue responses to trauma, reduced function, and other impairments of the normal state of the individual.
Oral Care of the Aged Oral care of senior citizens probably should be considered in the same context as oral care of terminally ill patients. It is no secret that the general and oral health care of senior citizens have traditionally left much to be desired. Twenty-eight years ago, this author initiated a survey of the dental health status of patients on the custodial wards in the Veterans Administration Hospital, Tuskegee, Alabama, which was at that time a 2,300-bed hospital for patients with psychiatric and neurologic disorders. Generally, these were older persons, and the oral examinations revealed appalling conditions. The mouths of the majority of these patients displayed obvious personal and professional neglect. Oral malhygiene and soft-tissue inflammations were conditions most frequently observed. Today we are seeing similar conditions in many nursing homes, some of which have been featured in the newsmedia. The US House of Representatives Select Committee on Aging published a report in 1976, and, on the matter of dental care, it said: Dental problems such as tooth decay and periodontal disease are so widespread among the elderly that half of all persons over 65 years of age . . . are without any natural teeth . . . 6.2 percent have neither natural teeth nor dentures, and 30 percent have dentures which are ineffective and which require refitting or replacement . . . . The elderly, the population segment which most needs dental care, receives less dental care than the rest of the population. Elderly people use considerably fewer dental services and see dentists 33 percent less frequently than other segments of the population . . . . 71.8 percent of the edentulous elderly population has not even visited a dentist in the past five years.' Better oral hygiene can be accomplished for a majority of patients with poor oral sanitation, even if restorative
and replacement procedures may be difficult. The difficulties stem from the complicated oral mucosal changes which are more frequently seen in persons of advancing years. These
changes include complete and partial anodontia, atrophic glossitis, xerostomia, cheilitis, hyperkeratosis, acute ulceromembranous stomatitis, traumatic ulcers, alveolar atrophy, lessened histoelasticity, and tardy recuperation of traumatized intra and extraoral tissues. Much has been written about the psychosocial problems of senior citizens. Loneliness has been given as much attention as the physical disabilities usually associated with the aging process. From the dental viewpoint, the loss of natural dentition is probably the most obvious occurrence. The esthetic loss has as great an impact on the person as the impaired dental function. There are many technical difficulties associated with the fabrication of dentures for extremely resorbed ridges, and there is often lack of functional success. As a result, dentists have not been enthusiastic about placing dentures in aged patients. Many agree with physicians who have often remarked that it is possible to eat without teeth, as there are so many foods prepared for edentulous people. The psychological and physiological aspects of the aging process are closely intertwined, and health professionals have a duty to render those services which would make life as comfortable as possible under the existing circumstances. The concept of "oral care" is an allinclusive one, embracing both therapy and solicitude. It can be defined as the diagnosis, prevention, and treatment of oral disease and disability, with a concomitant expression of a conscious concern on the part of the therapist for the anxiety, pain, and suffering of the patient in question, and of his or her immediate family.
Clinical Services Rendered Oral care of senior citizens and of patients in terminal illness consists of much dental intervention, but, even more, conscious concern, In the former, the most important services which can and should be instituted are the maintenance of the highest degree of oral hygiene, and the preservation of maximum functioning of the oral apparatus. In senior citizens who are in reasonably good general physical health, den-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 2, 1979
tal intervention will be called for and should be instituted under circumstances similar to those for younger patients. Because thresholds of tolerance to pain and sensitivity tend to lessen with advancing years, elderly persons should not be exposed to sustained and lengthy periods of operative procedure. Greater use of analgesics would probably be advisable, and consideration should be given to longer spacing of appointments necessitating extensive procedures. In the hospital setting, with patients either in intensive care or under conditions of total physical disability, the functions of oral comfort and hygiene are accomplished by nurse, aide, dental hygienist, and dentist all working cooperatively, and coordinating dentooral procedures within the general medical treatment plan. Periodontics and endodontics are the specialties most frequently called upon in extensively disabling circumstances. The relative inability of patients to use the oral structures properly, combined with the soft dietary regimen, the lowered tissue resistance, and general oral stagnation are all factors which promote greater susceptibility to infection, ulceration, pain, and oral fetor. The success of instituting periodontal procedures is dependent upon the extensiveness of the procedures and the patient's condition, so that very often periodontic treatment may have to be limited to oral irrigation, periodontal hydrotherapy, and those phases of oral medical therapeutics which involve the application of medicaments. Exodontia and minor oral surgery will be necessary when there is pain from extensive dental decay and abscesses. Such procedures must be carefully evaluated in view of the patient's condition, and the utmost care should be exercised if and when procedures become mandatory. Major oral surgery is a clinical service which requires very special considerations and consultations. So much depends upon whether it is to be performed on a critically ill person, or if a patient becomes critically ill as a result of extensive oral surgery.
Continued on next page
183
nance of scrupulous cleanliness of the oral cavities of very sick persons. These considerations then, encompass the vast majority of clinical services which general dentists and the dental departments of hospitals can and should render to senior citizens and to hospitalized, seriously ill persons. It is in the areas of "conscious concern" that dentists and their auxiliaries should be able to offer some additional services, many of which have either been taken for granted or have not yet merited serious consideration.
Continued from preceding page
Restorative dentistry is another oral health service deserving of consideration. Generally speaking, in seriously ill patients, palliative procedures are advocated. The most humane procedure would be the placing of temporary restorations following removal of as much carious material as possible. The essential point is that great care should be exercised in not subjecting patients to the personal rigors which many restorative dental procedures require. Insofar as prosthodontics is concerned, the primary services rendered in patients with dental prostheses would include cleaning, polishing, and adjusting the appliances. Replacing defective teeth and clasps of dentures are additional operations which may be accomplished. Care of the oral soft tissues and oral comfort are, however, the most important considerations, and involve the removal of debris, soft-tissue massage, treatment of minor ulcerations, lacerations and abrasions, and the mainte-
* ..; . ... .:: =
..
. .. ~;
~~
Community Dentistry's Contributions Community dentistry is involved with the elements of technical proficiency, the biological sciences, and social sensitivity. It is with the last of these elements that there is a special concern. The specialty is that facet of a health profession engaged in equipping dentists and dental auxiliaries with skills which will enable them to be socially sensitized, scientific practitioners on an interacting population of varied
~
~
~
~
~
~
~
individuals with common interests living in a particular area. To be socially sensitive, dentists must be able to adhere to the maxim of treating patients rather than teeth. As is the physician in community medicine, the dentist is being called upon to regard the patient in his total environment, rather than merely in terms of his dental complaint. Assistance in modifying that environment whenever necessary is an important additional function of the medical team of which the dentist is an integral member. Community dentistry is prepared to render substantive contributions to this facet of oral care of senior citizens and terminally ill patients. It would seem that a very high degree of social sensitivity is involved, for instance, in making a consciously futile visit to the sick patient's bed. The overwhelming emphasis upon dentistry's technology has left very little room for identification with these Continued on next page
.........
EQIOTENT TO ASP'IRIN
REGULAR STRENGTH sEntiatedL-3that mg for mg TYLENOL provides effective linically
analgesia equivalent to aspirin
1 Roundtable on Analgesics. Patient Care (Feb.) 1972. p.21. 2. Lasagna. L. D:ata on File. McNeii Laborato'nies, 1974. 3. Goodman. L.S.. and Gilman, A. eds. The Pharmacological
TeBassofTpeutics,ed. 5, New York,The MacmillanCompany
1975 p344
ctmnpe
325 mg tablets
acetaminophen
The logical 1st choice
Do not exced recommeded dosage. Both aspinn and acetminophen in brge overdoses can cause srious advere effects.
3
5 m
a lt
in non-R x analgesia
.....
..
:.FO INC
ISE PT,
.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.......
..........
C
EXTRA-STRENGTH TYLENOL
|..two 500 mg units (1000 mg) of acetaminophen produced significantly |greater analgesia than did two 325 mg units (650 mg) of acetaminophen...:I
|4 Hoplunson. J.H IlI. etal: Cuir Ther Res 16194 (March) 197 @
MceN 1978
Do noJt extceed retcommnde
|acetaminophen
The |logical 1 st choice
dosage. Both aspirin and cetaminophen in large ovrdoses can cause serious adverse effects.
Continued from preceding page
exercises in "conscious futility." There has been so much of the feeling that after dentists have completed a technical service their work is done, and they can relinquish further responsibility to the patient. The one feasible way out of the dilemma is for the dentist to join with nurse, physician, and minister in feeling and expressing a genuine concern for hopelessly sick persons. Communicating with families of terminal patients is no more the sole responsibility of the nurse or physician or minister than is health the special domain of the medical doctor alone. The particular health professional member to whom the patient or his family relates is a much more valued contact than was formerly believed. The number of cases in which excellent rapport has been achieved between patient and dentist is large, and would suggest the exploration of just what solace could be rendered and empathy achieved under dire conditions of per-
500 mg capsules
in analgesia non-Rx
McNeil Consumer Products Company Fort Washington , PA 19034 taoN
sonal trouble, sorrow, sickness, and need. Because there have been qualitative changes in the kinds of general medical and surgical care which critically ill patients have been receiving over the past ten years, it is estimated that there has been a significant reduction in mortality rates. By and large, technological advances in equipment and sophisticated instrumentation have made these reductions possible. But much of the improvement has been due to the medical, nursing, and other health personnel to whom a large share of monitoring responsibilities has been delegated. Community dentistry has a vital interest in auxiliary education and utilization, and has stimulated investigation into expanded duties. M\utually cooperative exchanges should be explored and should result in improved care.
complishments, there is still a lingering reluctance to confront many of the problems of life and death. It is anachronistic that we should still speak of dying in dignity, and the dignity of death, and putting a person away in style, while we seem to be increasing the indignities perpetrated in life, and have little hesitation in inflicting violence one upon the other, and being rather brutal in our interpersonal relationships. It has been suggested that much of the contemporary emotional and physical disruptions may be the result of an unrealistic attitude towards aging, critical illness, dying, and death. In stimulating a greater understanding of the inevitability of these conditions and their ramifications, we might be able to assist in appreciating the difficulties of living and, thereby, ease some of life's burdens.
Conclusion
Literature Cited
It is unfortunate that despite the long road we have traversed in scientific ac-
1. Report of the US House of Representatives Select Committee on Aging. Washington, DC, US Government Printing Office, 1976, p 12
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 2, 1979
185
helpful. The segments that were identified as .most helpful, however, were test taking, note taking, memorization, and study contracts, in that order. Eighty-four percent of the students indicated that they continued to use all or some of the techniques, 11 percent discontinued using them, and five percent did not respond. Fifty-four percent stated that they had noticed an improvement in their grades with less study time, 16 percent said there was no change in their grades, and 30 percent did not respond. When asked, "What other services were provided by the staff other than academic reinforcement?" 80 percent of the students indicated that the encouragement and support of the staff was important. These students noted that the staff helped them in examining attitudes about school, with other problems which affected their studies, and in gaining confidence in themselves. Eleven percent of the students indicated that they only received instruction in the techniques of academic reinforcement. Fourteen students added that they would recommend the program to others. Only one student commented that the techniques were not helpful.
Discussion Although it is often assumed that preprofessional and professional students know how to study, studying is like any other behavior; study habits and techniques must be learned. Instruction in learning how to study could expedite the studying-learning process and allow students to spend their time more efficiently. These techniques are not remedial; they are tools to assist the students in doing a better job in their academic pursuits. Instructors in academic reinforcement programs need to be carefully selected and trained. An instructor who is not judgmental is extremely important, since the meanings of grades and study habits are unique to each individual and discussion of them may arouse sensitivity and emotionality. Learning new study techniques and approaches from staff members who are caring, supportive, and understanding is important in the student's receptivity to, and use of, academic reinforcement techniques. Instructors of academic reinforcement do not have to know course content to teach the techniques. However, the application can be most effective if faculty and peers, who are familiar with
course content, also know academic reinforcement techniques. Indeed, academic reinforcement techniques could assist the faculty in improving the organization of their lectures and tests. Not all students need, nor will all benefit from, academic reinforcement techniques. The results of this study indicate, however, that academic reinforcement is an important student support service which should be made available to all health science students and offered as an optional part of the
curriculum.
Acknowledgements This project was supported by Robert Wood Johnson Foundation Grant No. 2422 and NIH Health Professions Special Project Grant No.
06-D-000008-03.
Literature Cited 1. Ray9or A, Wallace J: Guide to
McGraw-Hill Basic Skills System. New York, McGraw-Hill, 1970 2. Carman RA, Adams WR: Study Skills: A Students' Guide for Survival. New York, John Wiley, 1972 3. Pauk W: How to Study in College, ed 2. Boston, Houghton Mifflin, 1974 4. Maddox H: How To Study. Greenwich, Conn, Fawcett, 1963 5. Willey MS, Jarecky BM: Analysis and Apnlication of Information. Privately printed,
Dental Health Problems of the Geriatric Population Clifton 0. Dummett, DDS Los Angeles, California
A topic seldom considered and even more rarely discussed among the dental components of the health professions is presented. The dentist's preoccupation with hosts of dental treatment problems has left little time for considering the perplexities of aging, critical illness, or dying or dead patient's relatives. Community dentistry has now forced upon our consciousness the fact that perhaps the subject is one which must not be avoided, if we are to fulfill completely our professional obligations to the public. Current estimates of the percentages of the American people who are over 65 years of age range between 10 and 11 percent of the entire population. Demographers predict that by the year 2000, one out of every eight persons Presented to the Section on Community Medicine of the 83rd Annual Convention and Scientific Assembly of the National Medical Association, Washington, DC, July 30-August 3, 1978. Requests for reprints should be addressed to Dr. Clifton 0. Dummett, PO Box 77006, Los Angeles, CA 90007.
182
will be at least 65 years of age, and by the year 2030, 17 percent of the US population will be "aged." Many of the disease processes which occur in the younger population also occur in the aged, but generally these occur with greater frequency, more severity, and probably run longer courses. This is especially the case with the so-called chronic diseases, of which many oral diseases are representative. As is the case with the vast body of
medical information, increasing dental knowledge confirms the fact that oral health problems of senior citizens vary from those of their juniors because of the fact that the reactions of the aging stomatic system to inevitable disease processes are plainly different. During these advanced periods of human development, the metabolic processes influence general tissue reactions, usually detrimentally, and Continued on next page
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 2, 1979
Continued from preceding page
these in turn play a part in the oral tissue responses to trauma, reduced function, and other impairments of the normal state of the individual.
Oral Care of the Aged Oral care of senior citizens probably should be considered in the same context as oral care of terminally ill patients. It is no secret that the general and oral health care of senior citizens have traditionally left much to be desired. Twenty-eight years ago, this author initiated a survey of the dental health status of patients on the custodial wards in the Veterans Administration Hospital, Tuskegee, Alabama, which was at that time a 2,300-bed hospital for patients with psychiatric and neurologic disorders. Generally, these were older persons, and the oral examinations revealed appalling conditions. The mouths of the majority of these patients displayed obvious personal and professional neglect. Oral malhygiene and soft-tissue inflammations were conditions most frequently observed. Today we are seeing similar conditions in many nursing homes, some of which have been featured in the newsmedia. The US House of Representatives Select Committee on Aging published a report in 1976, and, on the matter of dental care, it said: Dental problems such as tooth decay and periodontal disease are so widespread among the elderly that half of all persons over 65 years of age . . . are without any natural teeth . . . 6.2 percent have neither natural teeth nor dentures, and 30 percent have dentures which are ineffective and which require refitting or replacement . . . . The elderly, the population segment which most needs dental care, receives less dental care than the rest of the population. Elderly people use considerably fewer dental services and see dentists 33 percent less frequently than other segments of the population . . . . 71.8 percent of the edentulous elderly population has not even visited a dentist in the past five years.' Better oral hygiene can be accomplished for a majority of patients with poor oral sanitation, even if restorative
and replacement procedures may be difficult. The difficulties stem from the complicated oral mucosal changes which are more frequently seen in persons of advancing years. These
changes include complete and partial anodontia, atrophic glossitis, xerostomia, cheilitis, hyperkeratosis, acute ulceromembranous stomatitis, traumatic ulcers, alveolar atrophy, lessened histoelasticity, and tardy recuperation of traumatized intra and extraoral tissues. Much has been written about the psychosocial problems of senior citizens. Loneliness has been given as much attention as the physical disabilities usually associated with the aging process. From the dental viewpoint, the loss of natural dentition is probably the most obvious occurrence. The esthetic loss has as great an impact on the person as the impaired dental function. There are many technical difficulties associated with the fabrication of dentures for extremely resorbed ridges, and there is often lack of functional success. As a result, dentists have not been enthusiastic about placing dentures in aged patients. Many agree with physicians who have often remarked that it is possible to eat without teeth, as there are so many foods prepared for edentulous people. The psychological and physiological aspects of the aging process are closely intertwined, and health professionals have a duty to render those services which would make life as comfortable as possible under the existing circumstances. The concept of "oral care" is an allinclusive one, embracing both therapy and solicitude. It can be defined as the diagnosis, prevention, and treatment of oral disease and disability, with a concomitant expression of a conscious concern on the part of the therapist for the anxiety, pain, and suffering of the patient in question, and of his or her immediate family.
Clinical Services Rendered Oral care of senior citizens and of patients in terminal illness consists of much dental intervention, but, even more, conscious concern, In the former, the most important services which can and should be instituted are the maintenance of the highest degree of oral hygiene, and the preservation of maximum functioning of the oral apparatus. In senior citizens who are in reasonably good general physical health, den-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 2, 1979
tal intervention will be called for and should be instituted under circumstances similar to those for younger patients. Because thresholds of tolerance to pain and sensitivity tend to lessen with advancing years, elderly persons should not be exposed to sustained and lengthy periods of operative procedure. Greater use of analgesics would probably be advisable, and consideration should be given to longer spacing of appointments necessitating extensive procedures. In the hospital setting, with patients either in intensive care or under conditions of total physical disability, the functions of oral comfort and hygiene are accomplished by nurse, aide, dental hygienist, and dentist all working cooperatively, and coordinating dentooral procedures within the general medical treatment plan. Periodontics and endodontics are the specialties most frequently called upon in extensively disabling circumstances. The relative inability of patients to use the oral structures properly, combined with the soft dietary regimen, the lowered tissue resistance, and general oral stagnation are all factors which promote greater susceptibility to infection, ulceration, pain, and oral fetor. The success of instituting periodontal procedures is dependent upon the extensiveness of the procedures and the patient's condition, so that very often periodontic treatment may have to be limited to oral irrigation, periodontal hydrotherapy, and those phases of oral medical therapeutics which involve the application of medicaments. Exodontia and minor oral surgery will be necessary when there is pain from extensive dental decay and abscesses. Such procedures must be carefully evaluated in view of the patient's condition, and the utmost care should be exercised if and when procedures become mandatory. Major oral surgery is a clinical service which requires very special considerations and consultations. So much depends upon whether it is to be performed on a critically ill person, or if a patient becomes critically ill as a result of extensive oral surgery.
Continued on next page
183
nance of scrupulous cleanliness of the oral cavities of very sick persons. These considerations then, encompass the vast majority of clinical services which general dentists and the dental departments of hospitals can and should render to senior citizens and to hospitalized, seriously ill persons. It is in the areas of "conscious concern" that dentists and their auxiliaries should be able to offer some additional services, many of which have either been taken for granted or have not yet merited serious consideration.
Continued from preceding page
Restorative dentistry is another oral health service deserving of consideration. Generally speaking, in seriously ill patients, palliative procedures are advocated. The most humane procedure would be the placing of temporary restorations following removal of as much carious material as possible. The essential point is that great care should be exercised in not subjecting patients to the personal rigors which many restorative dental procedures require. Insofar as prosthodontics is concerned, the primary services rendered in patients with dental prostheses would include cleaning, polishing, and adjusting the appliances. Replacing defective teeth and clasps of dentures are additional operations which may be accomplished. Care of the oral soft tissues and oral comfort are, however, the most important considerations, and involve the removal of debris, soft-tissue massage, treatment of minor ulcerations, lacerations and abrasions, and the mainte-
* ..; . ... .:: =
..
. .. ~;
~~
Community Dentistry's Contributions Community dentistry is involved with the elements of technical proficiency, the biological sciences, and social sensitivity. It is with the last of these elements that there is a special concern. The specialty is that facet of a health profession engaged in equipping dentists and dental auxiliaries with skills which will enable them to be socially sensitized, scientific practitioners on an interacting population of varied
~
~
~
~
~
~
~
individuals with common interests living in a particular area. To be socially sensitive, dentists must be able to adhere to the maxim of treating patients rather than teeth. As is the physician in community medicine, the dentist is being called upon to regard the patient in his total environment, rather than merely in terms of his dental complaint. Assistance in modifying that environment whenever necessary is an important additional function of the medical team of which the dentist is an integral member. Community dentistry is prepared to render substantive contributions to this facet of oral care of senior citizens and terminally ill patients. It would seem that a very high degree of social sensitivity is involved, for instance, in making a consciously futile visit to the sick patient's bed. The overwhelming emphasis upon dentistry's technology has left very little room for identification with these Continued on next page
.........
EQIOTENT TO ASP'IRIN
REGULAR STRENGTH sEntiatedL-3that mg for mg TYLENOL provides effective linically
analgesia equivalent to aspirin
1 Roundtable on Analgesics. Patient Care (Feb.) 1972. p.21. 2. Lasagna. L. D:ata on File. McNeii Laborato'nies, 1974. 3. Goodman. L.S.. and Gilman, A. eds. The Pharmacological
TeBassofTpeutics,ed. 5, New York,The MacmillanCompany
1975 p344
ctmnpe
325 mg tablets
acetaminophen
The logical 1st choice
Do not exced recommeded dosage. Both aspinn and acetminophen in brge overdoses can cause srious advere effects.
3
5 m
a lt
in non-R x analgesia
.....
..
:.FO INC
ISE PT,
.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.......
..........
C
EXTRA-STRENGTH TYLENOL
|..two 500 mg units (1000 mg) of acetaminophen produced significantly |greater analgesia than did two 325 mg units (650 mg) of acetaminophen...:I
|4 Hoplunson. J.H IlI. etal: Cuir Ther Res 16194 (March) 197 @
MceN 1978
Do noJt extceed retcommnde
|acetaminophen
The |logical 1 st choice
dosage. Both aspirin and cetaminophen in large ovrdoses can cause serious adverse effects.
Continued from preceding page
exercises in "conscious futility." There has been so much of the feeling that after dentists have completed a technical service their work is done, and they can relinquish further responsibility to the patient. The one feasible way out of the dilemma is for the dentist to join with nurse, physician, and minister in feeling and expressing a genuine concern for hopelessly sick persons. Communicating with families of terminal patients is no more the sole responsibility of the nurse or physician or minister than is health the special domain of the medical doctor alone. The particular health professional member to whom the patient or his family relates is a much more valued contact than was formerly believed. The number of cases in which excellent rapport has been achieved between patient and dentist is large, and would suggest the exploration of just what solace could be rendered and empathy achieved under dire conditions of per-
500 mg capsules
in analgesia non-Rx
McNeil Consumer Products Company Fort Washington , PA 19034 taoN
sonal trouble, sorrow, sickness, and need. Because there have been qualitative changes in the kinds of general medical and surgical care which critically ill patients have been receiving over the past ten years, it is estimated that there has been a significant reduction in mortality rates. By and large, technological advances in equipment and sophisticated instrumentation have made these reductions possible. But much of the improvement has been due to the medical, nursing, and other health personnel to whom a large share of monitoring responsibilities has been delegated. Community dentistry has a vital interest in auxiliary education and utilization, and has stimulated investigation into expanded duties. M\utually cooperative exchanges should be explored and should result in improved care.
complishments, there is still a lingering reluctance to confront many of the problems of life and death. It is anachronistic that we should still speak of dying in dignity, and the dignity of death, and putting a person away in style, while we seem to be increasing the indignities perpetrated in life, and have little hesitation in inflicting violence one upon the other, and being rather brutal in our interpersonal relationships. It has been suggested that much of the contemporary emotional and physical disruptions may be the result of an unrealistic attitude towards aging, critical illness, dying, and death. In stimulating a greater understanding of the inevitability of these conditions and their ramifications, we might be able to assist in appreciating the difficulties of living and, thereby, ease some of life's burdens.
Conclusion
Literature Cited
It is unfortunate that despite the long road we have traversed in scientific ac-
1. Report of the US House of Representatives Select Committee on Aging. Washington, DC, US Government Printing Office, 1976, p 12
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 2, 1979
185
