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instructional staft: probably will be the greatest deterrent to establishing and expanding such programs as have been described.

The staff and commissions of the American Association of Junior Colleges have given considerable attention to the preparation of dental auxiliaries during the last two years. In their opinion, a nationwide approach with effort con- centrated in those states which have strong junior colleges, and in junior colleges which are themselves resourceful will yield excellent returns in the form of a greatly increased supply of dental auxiliaries. The junior colleges are ready to join with the dental profession and other interested agencies to combat such a shortage in dental personnel.

111. EDUCATION IN DENTAL HYGIENE; POTENTIAL IN THE COLLEGE OF LIBERAL ARTS

By Patricia A. McCullough, M.Ed.,* and Laurence E. Gale, Ph.D.**

I I

Public-health dentists and dental hygienists can become influential sources of information during the establishment of educational facilities for auxiliary dental personnel. There are at least three major reasons why they should support the establishment of education in dental hygiene at the baccalaureate level. First, many more dental hygienists are needed. Secondly, dental hy-

ion, and reqnires education that will make professional judg- r future as well as present practitioners. Thirdly, dental

hygienists educated in the setting of a university, will increase the potential nuniber of individuals holding baccalaureate degrees and, hence, available for positions in public health.

Granted, some people think that education in dental hygiene belongs in scliools o f dentistry, wherever possible, and granted that this conclusion is logical and true, there are too few dental schools now and too few proposed for the future to supply the number of dental personnel needed. One inust look, therefore, for the best locations for education in dental hygiene that remain. They seein to be baccalaureate environinents with an emphasis on liberal arts or general education.

The growth of the popiilatioii, alone, will cause the current shortage in dental ii~npo\ver to explode beyond conceivable limits, although the dental hygienist is willing now, as she has been in the past, to accept responsibilities for the care of patients under the direction of the dentist. The dentist of today appears imlike-the dental graduate of 20 to 30 years ago, since he has the advantage of a more liberal education. He is able to treat his patients better 1)ecause he has a inore thorough understanding of the social as well as the basic biological sciences. Today's graduate seeins to have a greater social conscious-

"Head, Department of Dental Hygiene, Idaho State University, Pocatello '"Dean, Idaho State University and Chairman, Division of hledical Arts.

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iiess, in inany instances, liecause of his exposiire to literature, the arts atid other liberalizing influences beyond the narrow confines of science and dentistry.

The dental hygienist must obtain sufficient scientific and liberal education to equip her to accept the responsibilities that have been and will be delegated to her. The idea of a vocational approach to any area of study, requiring re- sponsibility for the health of another individual, should be discarded. A little knowledge in this area, not related to an tinderstanding of underlying scientific principles, could becoine dangerous. The student of today inust be prepared to accept the professional responsibilities of tomorrow.

The dental hygienist was developed as an auxiliary who ~7ould perform prophylactic services for patients and work with school children in preventive oral hyb’ riene. In the beginning, the requirements of local lxxctitioiiers and licensing lioards were used to design curricula.

Since 1947, schools of dental hygiene have follo\vetl a iiiorc coiiipreheiisivc ducational pattern. The American Dental Association’s Couiicil 011 llental Education, serving a s the accrediting Iiody for schools of dental hygiene, I)egaii in 1952 to use ;i set of “hliniiiiiuii Standards” by which to evaluate schools. These “Mininiiitii Standards” developed jointly liy the Council and the Ainericuii Dental Hygienists’ Association, specify that ii course for dental hygienists Iw at the collegiate level, at least two acadeiiiic years in length, and that tlw course lead to a certificate on coiirpletion. Accredited curricula in tleiital hygiene inust include instruction in basic and applied sciences and iii clinical dental hygiene, dental health education, public health, ethics and ecoiioiiiics, speech, English, sociology, and psychology.

Students inust learn to apply basic sciences and dental hygiene cotllpetently in a clinical situation. There is no other way and there is no substitute for living patients. this statement implies that students spend many supervised hours in a professional clinical environment. Clinical practice miist lie based on a thorough understanding of related scientific principles. The dental hygienist’s other major responsibility, that of instructing patients, iiiiist lie based on a thorough knowledge of physiological principles as well as principles which require knowledge of motivation, psychological readiness, factors in- fluencing behavioral change, and current inethods Of instruction in health.

The differences lietween the vocational and the professional approaches t o education iiiay he likened to those Iietweeo diillctl and sharpened instrriiiieiits. Did1 instriiinents will not produce effective resiilts, and, in fact, rrray c t o i i i o i x ~

harm than good. The superficial vocational apliroach to dental hygiene is ii dull instrument and niiist be discarded.

It seeriis that the extent of data available in the basic sciences a d socio- educational matters are working against the clinician, for he iiiiist learn nut only “how” to perform a service, but also “why,” “what,” and “wheii” to per- form It is iiiost important to have confidence that the results of his service will benefit the patient. These knowledges indicate the necessity for a pro- fessional, not a vocational approach to the science and art of dental hygiene. An individual iii a health profession no longer can be taught merely to perforin it mechanical lirocednre. The dental profession and the p b l i c iuust demand that dental hygienists be educated adequately in order to perform their services responsibly.

How does the classical baccalaureate environment meet the demands of educating dental hygienists better? It appears that the university is in thc

Education in dental hygiene began with a vocational approd l .

In effect,

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best position to provide adequate resources which are the strengths of higher education, the resources of facilities, faculties and finances.

Facilities also include classrooms, experimental laboratories, libraries, centers for treating patients in other health services, and supervised housing facilities for students who are young women.

An important facility inadvertently provided by the university is its loca- tion. Coininunity colleges often are located in sinall towns. In fact, one of the objectives of the community college is to provide post-high school education for the local citizenry. Generally, universities are located in metropolitan areas or have large faculties and a body of students. It would appear that a sur- rounding 1mpulation of thirty thousand is a minimiini requirement for estab- lishing a school of dental hygiene for at least two reasons. First, dentists and dental specialists, needed to provide instruction, are close enough to the school to participate in the prograin at least on a part-time basis. Secondly, the Inetro- politan location ensures sufficient patients to provide the necessary clinical experience for students. Each student should see a variety of patients, :it least 50 adult patients \vho require subii~arginal scaling. Experience with pa- tients who rec4uire inore difficult technics is necessary to prepare students for iiractice. Twenty stiidents tiines 50 patients requires one thousand adults as patients per year. Of course, inany patients can be recalled, but a population of 30,000 would be a rriiniiniiin clinical pool of patients for a hypothetical class of 20 students.

The availability of a tinivrwity’s faculty is iniportant not only to students of dental hygiene but to the members of the professional faculty as well. Most universities today have in their structure a College of Liberal Arts w7hose faculty recognizes a role in educating preprofessional and professional students. Most universities also have a Division of Health Sciences in which nurses, pharmacists and other health professionals are being educated. It is logical that health professionals receive the same basic education from as wide a range of instruc- tional personalities as possible. With proper instruction in basic science and a coinpetent professional staff, health-oriented courses in basic science are un- necessary. The miiversity has a faculty prepared to the doctorate level in the l~~uiianities, and in the lxisic and social sciences. These instructors are thor- oughly conversant in their fields and can offer the depth of background necessary to the continuing developiiient of education for dental hygiene.

The Division of Health Sciences in a university provides more than just training in one’s narrow professional area. It is there that students of deIital hygiene have an opportunity to associate with those in other fields. This asso- ciation lirepares the student for closer cooperation between disciplines that provide a complete health service to the public. The awareness of other fields of health is enhanced both by the sharing of classes and by the sharing of expe- riences in the environments of hospitals, clinics for the well child, clinics for speech-aIid-hearing therapy, and in institutions for the care of mentally and physically handicapped patients. These professional experiences cannot be provided or shared with others at the vocational level.

Dentists expect their auxiliaries to maintain a professional attitude and outlook. The academic atmosphere of the university is inore likely to be con- ducive to developing this professional attitude in the student than the vocational environment necessitated in inany community colleges because of lack of fa- cilities, faculties and finances.

Facilities include inore than dental chairs and units.

These facilities are incorporated in most universities.

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Adequate finance, or budget, is one of the major assurances of qiialified personiiel and the necessary facilities in higher education just a s it is in business. All professional educatioii is particiilarly expensive. Educational prograiiis, iiicluding laboratory and clinical sciences, inust be prepared to obtain and maintain equipment, to pay Iirofessional instructors on a level cominensuratc with practitioners, and to provide expenda1)le items for lalioratory-practice.

In dental hygiene, as in dental education, one of the most important con- siderations is the adequate supervision of clinical practice. Clinical cducatiot 1 ,

rather than service, is the goal of a student’s practice. Not only the patients. h i t also the students and the school inust l x protected by strict clinical siipvr- vision. Supervision requires the emldoynient of dentists in addition to instruc- tors of dental hygiene. A clinic for deiital hygienc, cannot lie administered on a self-supporting h i s in coinpetition with tlie pro- fessional services offered 1)y practitioners.

of dental hygienists. graduates will offcr their skills to citizens throughout the state and cost raises a hasic question almut the desira1)ility of attempting to put an expensive professional program in a coiirnirinity collegt,. “Should the coiirniunity college, which receives significant support froiii loc~11 citizens, IE responsible for the edlication of dental hygienists for thc (~i t i rv state?” ‘I’lie answer to this question, logically, is “No.”

In addition to its superior potential for facilities, faculties iind finaiices, tlic university provides greater support for education in dental hygiene in other \\lays. The program in dental hygiene in a university permits recruitment of studcnis from the strata of the college as well as from high school. Of the great nuinl~ers of high school graduates now continuing to college, many entering freshmen have not selected a career. Many are going to college because it is the “thing to do” and perhaps because they have a naive notion that collegiate experience will increase their potential value in the market for workers. Most students in these categories, even if they mature and find themselves, will not return to the collegiate environment to complete a lirogram of dental hygiene. Aca- demically comprtent individuals who lwconie interested in dental hygiene after they mature or after one or two yars in general stitdies should lie afforded tlw opportunity of obtaining a Ixwcalaureate degree. Tlw university not only pro- vides the resources for continued education beyond the certificate-level, h i t i t ensures the potential for lxiccalaiireate education by offering courses, co1lr:giatc in caliber, in the cmriculuin of dental hygiene.

Dentists in piiblic health constantly see the urgent need for dental hygien- ists to provide leadership in the profession and to assrune adniinis trative ant1 consultative positions. Education in dental hygiene in the 1)accalaureate en- vironment helps prepare persons to assume such positions.

Sumn~arizing, w11 increasing population will continue to causc a i i t~xpansiori of the responsibilities of the dental hygienist. Deiital education has not solved the problein of placing inore dentists in positions to alleviate shortages in nian- p v e r . It is reasonable to assume, therefore, that as the responsibilities of thc dental hygienist have increased in the past, they will be increased in the iinliie- diate future. The point has been reached where the limitations of a vocation;il approach to education cannot provide sufficient background for tlie futurc growth and development of the health professions.

The environment of liberal arts a t the baccalaureate level in the university provides the most logical potential of background for present and future educa..

Supervision costs money.

T 7 1 he iniiversity is in the Iwst positioii to finance the 1)rofessiond cdric. ‘i t‘ l o l l

After all,

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tion in dental hygiene. I t provides a faculty, prepared in depth, to offer the level and variety of courses needed by all students in the health-professions and a major part of the necessary facilities are already part of the university’s structure.

Piil)lic-health dentists and dental hygienists frequently counsel representa- tives of local dental associations and educational institutions about the estab- lishment of new schools of dental hygiene. People in piiblic health are in a prime position to influence and upgrade the standards of dental care by insisting that the ediication of dental hygienists keeps pace with the increased responsi- bilities that have and will come. It appears that the professional responsibilities of the dental hygienist cannot be exl‘anded without continued improvement of her ediicational background and this improvement in educational 1)ackgroiind can hest I)e accomplished in the environinent of a iiniversity. (;r;itc-fiil ;ickiiowl(,tlgmeiit is t~xtrntltd to Rliss Elizd)t.tli R t . \Van.iior, 1)eiital Hygicwt Coiisiil- tmt, Division of Ilental h l d i c Hraltli ant1 I<tw)iircr.s, United States Piiblic Hralth Services, f o r l i r ~ v~i l i i~i l ) l ( - ;inti gmeroiis cwntril)iitions to the. contcxt of this p i p c ~ r .

IV. WHAT THE DENTAL SCHOOLS AND THE PROFESSION ARE DOING TO COMBAT THE

SHORTAGE IN DENTAL PERSONNEL

By Reginald H. Sullens*

I I

Of all of t l r r pro1)leirw confronting the dental profession, few have received morc tlisciissioii and consideration diiring the past several years than “What c .an be done to viisiirc for ;in exp;iirdiiig popillation tlie ;ivailal)ility of adeqilate dental care.”

A description of the efforts of thc dental schools in solving this problem, required groping around a bit for sonre means to reduce the job to a manageable size. For example, the presentation of data on the growth of the population, ratios of dentists to popiilation, and historical trends in the production of dental and aiixiliary personnel does not appear essential for the piirpose of this pre- sentation, since the need for expanded capacity has been demonstrated amply. It also seems obvious that any discussion of a shortage in dental personnel-now and in the future-must, in . the final analysis, lie considered in terms of the many variables which require time to consider. Finally, it seems appropriate to reduce the assignment primarily to a discnssion of the activities and planning of the dental schools, with only occasional reference to programs of the profession.

Concentration appears approliriate at first on some of the concerns of the dental schools as they relate to the education of dentists, obviously the ]nos t iinportant function of a dental school. These areas of concern can be divided into three categories, physical facilities, stiidents and tlie programs of teaching.

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OSc\c,rrt;iry. Aiiwricxii Assoc+ition of T1twt;rl Sc.1lools.