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Journalof Public Health Dentistry

Remarks by Dr. Philip E. Blackerby on Receiving the JohnW. Knutson Distinguished Service Award in Dental Public Health Philip E. Blackerby, DDS, MSPH 930 Don Juan Court Punta Gorda, FL 33950

On July 1, 1933, just a few days after my graduation from dental school, I began a dental internship at the Marine Hospital in Chicago. My fellow intern, beginning his second year, was John W. Knutson. One of the medical interns was Leonard Scheele, later to become US Surgeon General, and one of the junior medical officers was Cassius Van Slyke, later to become director of the National Institutes of Health. Nearly a year later, in the spring of 1934, Knutson and I had applied for examination for commission in the Regular Corps of the US Public Health Service. John passed the exam, with flying colors, and began his illustrious career in the service, rising to the rank of Assistant Surgeon General and Chief Dental Officer. I withdrew my application for the exam when I received an offer from my alma mater to join the faculty as an instructor in oral pathology. John then married the hospital C O s daughter, while I went back home and married my college sweetheart. Despite our divergent career bepnings, however, John and I maintained close contact through the ensuing years. As John’sprofessionalstaturegrew, we were never out of touch-through his famous Hagerstown studies, with Henry Klein, his topical fluoride research, his organization of the service’s Division of Dental Health, his doctorate in public health at Johns Hopkins (the first

L.ft to right: Formerawardee M a x Schoen (2990), Dr. Blackerby, and former awardee Martha H . Fales (7987).

dentist, I believe, and in biostatistics, at that), his chairmanship of the National Health Council, his presidency of the American Public Health Association (again, the first dentist), his professorships in dental public health at the UCLA Schools of Public Health and Dentistry, and his many awards for leadership and professional excellence. John counseled me in the late 1930s, when I started the dental public health program in Tennessee. He served on my first advisory committee when I became dental director of the Kellogg Foundation, in 1945; he called me to active duty, as a reserve officer, for three months in 1946, to help with his planning for the new Division of Dental Health; and he recommended me for a three-month assignment, in 1950, as the first dental consultant to the World Health Organization, to develop a proposal for a dental health unit at WHO. Our friendly arguments and correspondence continued throughout the years, about the pros and cons of teaching and practicing public health dentistry, community dentistry, social dentistry, or what have you. John felt that my proposed department of social dentistry was something of an exercise in semantics. I agreed; but I believed, too, that the suggestion served a further purpose by encouraging greater emphasis on, and better coordination of, ”curricular orphans” (more semantics?) such as public health dentistry, epidemiology, ethics, and the behavioral sciences. John and I served together as founders of the American Board of Dental Public Health, we shared platforms at a good many workshops and symposia around the country, and we even took our families on a joint vacation at the abandoned PHS Quarantine Station in the Gulf of Mexico. As you can see, John and I were personal friends, as well as professional colleagues, so I am doubly pleased and honored to be a recipient of the John W. Knutson Distinguished Service Award in Dental Public Health. I am also very proud but humble to be in the company of such outstanding previous recipients as Dave Ast, Jim Dunning, Don Galagan, Jack Pelton, Dave Striffler, John Frankel, Martha Fales, Bill Jordan, and Max Schoen, all of whom-except for Max Schoen (too young, I suppose)-I have had the privilege of knowing personally and admiring throughout their distinguished careers. I thank all of

Vol. 52, No. 4,Summer 1992

you for the honor and the privilege of being included in this elite group. Well, enough of my personal nostalgia. In the time allotted to me here, I would like to offer a brief overview of developments in dentistry and dental public health over the five-and-a-half decades since I became a neophyte public health dentists in Tennessee in 1936.Water fluoridation, topical fluorides, plaque control, fissure sealants, DMF rates, perio index, ultrasound, high-speed handpieces, bonding, dental implants, and amalgam mercury poisoning were all unheard of in those days, as were AAPHD, NIDR, STDD, DAU, AIDS, and even TV and VCR. Public health dentists relied on PTA talks, newspaper and magazine articles, radio programs, puppet shows, school clinics, teacher training in normal schools, and dentist education in the care of children, all grouped together under the heading of "dental health education." Preventive dentistry was not much more than wishful thinking, along with some prophylactic odontotomy and silver nitrate. Few state health departments had full-timedentists on their staffs, and still fewer had dental members on their state boards of health. At about that time the AAPHD was formed, the ADA established its Council on Dental Health, the APHA's Dental Health Section began to show signs of life, the Good Teeth Council (WrigleyGum) was promoting dental health, the federal government began to make grantsin-aid to start state dental programs, and Trendley Dean and Fred McKay were studying mottled enamel in Texas. Modem dental epidemiology was beginning to crystallize as a scientificdiscipline,and I was noting geographic variations in caries rates among children of east, middle, and west Tennessee-the nearest I ever came to being a researcher! A few years later, around the mid-l940s, the NIDR was established as a part of the NIH, community water fluoridation studies were begun, and the Division of Dental Health became an integral part of the US Public Health Service. Schools of public health began to show an interest in the training of public health dentists, partly because the University of Michigan (i.e., Ken Easlick) in the late 1930shad taken the lead in developing a pioneer graduate curriculum in public health dentistry, and partly because federal fellowships had become available for such programs. Dental schools, however, were showing little inclination to include public health and the other subjects of social import in their courses of study. The dental graduate of that era could hardly be called a socially conscious professional. Dental schoolsstill clung to the traditional 3 R s of Restoration, Removal, and Replacement. In the 1950s fluoridation was the keynote; prevention of dental cariesbecamea truly realistic goal. Public health dentist, visualizing the ideal of a caries-free population, devoted a large proportion of their time to the promotion of fluoridated public water supplies, while battling the

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many crackpots who kept shouting "Rat poison!" Periodontal disease and oral cancer began to receive more attention, as part of the new preventive dentistry. AS the public began to recognized that the dental profession was trying to eliminate the need for its own existence, dentistry gained stature and respect. In addition to its technical genius, long admired throughout the world, American dentistry wasbeginning to show real signs of a social conscience.Public health dentistry was recognized by the ADA as one of the bona fide specialties in dentistry. The American Board of Dental Public Health was organized to encourage better qualifications for public health dentist, and to certify their proficiency in the new specially. The American Fund for Dental Education was reorganized and broadened to become the American Fund for Dental Health, as the only philanthropic, grant-making institution in the field of dentistry. Throughout the 1960s, the sprouting of prepayment dental insurance and the growing need for improved operating efficiency and cost control, together with a manpower shortage, led to significant innovations in dental equipment, greater utilization of auxiliary personnel, better practice management, and increased emphasis on prevention and public education, as well as expanded continuing education programs for the dental profession. Most, if not all, state health departments included qualified public health dentists on their staffs, dental schools began to establish departments of community dentistry, and several schools of public health had expanded their curricula to provide greater emphasis on dental public health. Federal grants became available for starting departments of community dentistry and public health in dental schools, as well as for teaching dental practice efficiency, including more and better utilization of auxiliary personnel, in some cases with expanded functions. Training programs for dental hygienists and dental assistants increased rapidly in number, to help meet the growing demand for their services, with many community colleges initiating such programs to supplement the limited resources of the dental schools. The 1970sand 1980smight be referred to as yo-yo years in dentistry's history, as they were for the nation as a whole. As the economy went throughbooms followed by recessions, dentistry in general had its ups and downs as well. Dental schools, flooded with applicants at first, began to see a sharp drop in the number of potential students as the profession and the public sensed an oversupply of dentists and a possible drop in the demand for dental care, due to the effects of fluoridation in reducing dental caries. By this time, however, the nation's annual expenditure for dental care was approaching $40 billion, as compared to $2 billion in the 1930s;prepayment dental insurance covered about 50 percent of the population, as compared to zero percent in the 1930s,and only 1 percent as recently as 1965. Flourishing dental public health programs, however, began to saga bit as federal support was

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reduced in the 1980s, and dental practitioners suddenly realized that the pattern of practice was showing signsof drastic change toward periodontics, functional occlusion, TMJ dysfunction, oral pathology, oral medicine, implantology, adult orthodontics, and care of the aged and disadvantaged. And public health dentists were broadening their emphasis from canes control and child care to include preventive periodontics, oral cancer, smokeless tobacco, AIDS, hepatitis, and geriatric dentistry. These recent decades have been, indeed, a time of dramatic change; but the future of dentistry in general, and public health dentistry in particular, looks brighter than ever. The ABDPH, with 111 diplomates, was reaffirmed as one of the eight recognized specialties of dentistry, and the AAPHD and the APHA Oral Health Section are thriving, too. As Arthur Dugoni put it, "In another40 years we will look back and reflect that the 1980s

and 1990s were unsurpassed in the development and progress of the dental profession. The changing horizons for service to humankind will be opened remarkably and the opportunities for personal satisfaction and a sense of accomplishmenttruly will reflect what it means tobe part of a learned and respected profession" (1). John Knutson was a truly distinguished member of that profession, and his contributions to dentistry and to the public welfare were many and great. I used to enjoy calling him "a big Swede," and he would always come back with "No ... a big Norwegian!"; but be it Swede, Norwegian, Minnesotan, or American, he was BIG in every sense of the word, and he is sorely missed in public health dentistry. Again, I thank you all. Reference 1. Dugoni AA. The future of the dental profession. J Dent Educ

1985;49(12):795-8.

SCHEDULED DATES OF FUTURE MEETINGS OF THE AMERICAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 1992 October 14-16.. ................ Orlando, FL 1993 November 3-5. ............ San Francisco, CA 1994 October 19-21 ...............New Orleans, LA

Remarks by Dr. Philip E. Blackerby on receiving the John W. Knutson Distinguished Service Award in Dental Public Health.

250 Journalof Public Health Dentistry Remarks by Dr. Philip E. Blackerby on Receiving the JohnW. Knutson Distinguished Service Award in Dental Publi...
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