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History of Dental Public Health in North Carolina / 1856-2010

N.C. Oral Health Section – Celebrating over 90 years of service to North Carolinians.

1856 – The first state Dental Society in the nation was founded in North Carolina

1877 –  North Carolina’s State Board of Health established.

1908 – The first scientific paper suggesting the need for dental education of schoolchildren was presented to the North Carolina Dental Society.

1910 – A permanent Oral Hygiene Committee established by the Dental Society.

1918 – Dr. George Cooper, State Board of Health, urged N.C. Dental Society to action on behalf of acute dental needs among schoolchildren; he also added oral hygiene to the public health agenda.

Dental society endorsed dental health program for schools.  They sought and received special funds from the state legislature to establish what is now known as the N.C. Oral Health Section, the first dental public health program in the nation.

Dr. Cooper employed six dentists and six nurses to work in the schools.

1919 – First dentist, Dr. E.J. Tucker, appointed to the State Board of Health.

1921 – First dentist, Dr. J.C. Johnson, employed to work for the State Board of Health at the state level

Purpose of dental program in the schools was fixed: Relief of pain and suffering and education on good dental health.

1929 – Ernest A. Branch, DDS, became the State Dental Director.

1931 – Division of Oral Hygiene created by the State Board of Health.

State law passed placing a private dentist on all local boards of health.

1934 – The N.C. Dental Society conducted a Mouth Health Survey. Of those surveyed, 54.3 percent had never seen a dentist.

1935 – Dr. Branch started the famous Little Jack Puppet Show which for 30 years visited schools all over the state educating students on dental health.

1936 – The Institute of Public Health Dentistry was established in the UNC-CH School of Medicine, another national first, for training dentists working in public health.

1941 – A new Oral Hygiene Building, with equipment to process dental health education materials, built on the State Public Health campus.

1949 – Charlotte, N.C. became the first city in the state to fluoridate public water supplies.

1950 – UNC-CH School of Dentistry was established.

Federal grants were made available to match North Carolina funds, to employ dentists in more counties.

1959 – Ernest A. Pearson, Jr., DDS, MPH, succeeded Dr. Branch as State Dental Director.

1960 –  A scientific survey of dental disease in North Carolina was conducted. This survey, mapped by Drs. John T. Fulton and John T. Hughes, was the first comprehensive state dental survey in the nation and the data from it became the basis for all future state dental health planning.

With a US Public Health Service grant, Dr. Pearson employed a trained health educator, Rebekah S. Bowden, to organize 36 statewide oral cancer seminars.

1965 – The Dental Public Health program established a Dental Public Health Residency training program, one of the first in the country.

1966 –  Following a national fluoridation conference, North Carolina held its own conference in Greensboro to give momentum to community fluoridation.

1969 – The North Carolina Citizens Committee for Dental Health was established. It lobbied successfully for funds from the Legislature to match local funds to buy fluoridation equipment.

The rural school water system fluoridation program began.

1971 – Research identified a new, previously unknown enemy of dental health, plaque, and produced methods for combating the problem.

The N.C. Dental Society passed resolutions advocating a strong preventive dental program.

A Task Force for Community Preventive Dental Health Education was established by the N.C. Dental Society.  The task force consisted of representatives  from the N.C. Dental Society, dental public health, community college training programs and the UNC-CH Schools of Dentistry and Public Health.  All dental public health personnel were trained in plaque control and directed to initiate plaque control programs in local health departments. Private practice dentistry and dental public health worked together to teach new plaque control techniques.

1972 –  Preventive dentistry (plaque control) workshops were conducted across the state by the task force for all North Carolina dentists, dental hygienists and dental assistants.

Dental public health employed its first four dental hygienists to teach preventive dental health in counties.

Home Economics Extension agents and club leaders were taught the new preventive techniques in regional sessions.

First countywide fluoridation started in Anson County.

N.C. Dental Public Health was awarded the American Dental Association’s first Preventive Dentistry Award.

First fluoride mouthrinse program started in Robeson County schools.

1973 – The N.C. Dental Society, N.C. dental public health, allied agencies and institutions launched a 10-year plan designed to reduce dental disease by specific percentages, using a variety of approaches.

The NC General Assembly passed a Preventive Dentistry Bill providing extra funds for rural school water fluoridation and employment of more dental hygienists.

Encouraged by dental society leaders, the N.C Department of Public Instruction agreed to a new, much stronger, preventive dental program for the schools. The resulting coalition of dental, educational, and public health formed the Steering Committee for Preventive Dental Education in North Carolina schools.

1974 – “A Teacher’s Guide to a Preventive Dental Health Program in North Carolina Schools” was developed by the N.C. Dental Health Section under the sponsorship of the Steering Committee for Preventive Dental Health Education in Schools.

1975 – The General Assembly again approved a Preventive Dentistry Bill, adding additional staff for the field.
Revision of N.C. public health laws required the state to provide residency training in dental public health.

1976 – The Kellogg Foundation funded a follow-up epidemiological study of the Fulton-Hughes 1960 survey, “Natural History of Dental Disease in North Carolina” to determine progress of the preventive activities.

1977 – The Kellogg study revealed much progress in reduction of dental disease, especially among schoolchildren over 15 years of age. Data also showed increase in reported amount of periodontal disease among some groups.

The N.C. General Assembly approved additional funds for dental public health staff.

1979 – George G. Dudney, DDS, MPH succeeded Dr. Pearson as State Dental Director.

1980 – N.C. Dental Society and dental public health staff conducted preventive dental health workshops for Dental Board of Health members.

First edition of “Framework for Dental Health Education” for use by teachers was published and distributed. This guide provided comprehensive lesson plans and resources for school teachers from pre-school through grade six.

1983 – The first statewide “Children’s Dental Health Month Contest,” was co-sponsored by the N.C. Dental Society, N.C. Department of Public Instruction and N.C. Dental Public Health.

1984 – All Dental Health Section staff dentists were trained in the application of the new occlusal sealants.

1985 – The Dental Health Section was awarded a three-year grant from the Kate B. Reynolds Health Care Trust to conduct a new statewide oral health survey (the third since the 1960's), and to develop 20 videocassettes for use by classroom teachers.

1986 – The General Assembly, with strong support from N.C. Dental Society leaders and others, approved a new bill to add positions to the Dental Health Section field staff.

1987 – Statewide School Oral Health Survey completed in May: 6,674 students from 292 schools were examined by trained staff.

1988 - A yearlong 70th Anniversary Celebration, “Thanks for the Smiles” was conducted to report progress in preventive dentistry, recognize partners and plan for the future. Activities included: statewide educational exhibits, N.C. State Fair exhibit, and N.C. Symposium recommendations to continue public/private cooperation and recommendations for the Division’s program planning.

1989 – C. Jean Spratt, DDS, MPH succeeded Dr. Dudney as State Dental Director.

Tooth Surface Index of Fluorosis (TSIF) epidemiological survey in Asheville pediatric dentistry practice found higher than expected levels of mild fluorosis.

The Dental Health Section developed comprehensive Infection Control and Hazardous Materials manuals.

American Dental Association selects “N.C.  Super Smiles” as the first place winner of the Samuel D. Harris National Children’s Dental Health Month State Program Award.

1990 – 70th Anniversary Symposium findings published in Journal of Public Health Dentistry, Volume 50, Number 2, Special Issue 1990.

The National Toxicology Program peer review process of fluorides in Research Triangle Park (NC) reaffirms the importance of the appropriate use of fluorides.

1991 – The 1986-1987 North Carolina School Oral Health Survey Monograph was published and distributed nationwide. Major findings included: Caries decline continues; 80 percent of decay filled; 85 percent of remaining decay is pit and fissure; sealants underutilized; 80 percent of remaining decay is in 25 percent of North Carolina children.

The Dental Health Section clinical resources become dedicated entirely to prevention with emphasis on sealant promotion and projects across the state.

1992 – A series of traveling dental health educational exhibits was developed covering 10 oral health topics. All 10 topical exhibits were made available to section staff and health educators across the state.

Dental objective included in the Healthy Carolinians 2000 Statewide Coalition: “Increase the percentages of children and youth whose permanent teeth are free of dental decay.”

1993 – The N.C. Dental Society Access to Care/Medicaid Liaison Committee was established with Dental Health Section representation.

A five part sealant initiative began with emphasis on: 1) School-based sealant demonstration projects 2) Sealant exhibits 3) Media campaign 4) Public-private sealant projects 5) “Ask Us About Sealants” point of purchase campaign.

1994 – A Dental Public Health Residency project involved a scientific study to evaluate the effectiveness of the school water fluoridation (SWF) and fluoride mouthrinse (FMR) programs.  Study results indicated that, with the increasing availability of community water fluoridation, the rural school water fluoridation program was no longer necessary (OR was now a redundant program?) and was discontinued.

1995 – North Carolina held a national symposium on the current issues of fluoride action, effectiveness and utilization.

Madison County Oral Health Intervention Project, designed to evaluate effectiveness of sealant programs in a “real life” public health setting, demonstrated that targeting first and second graders as well as high-risk children increased the effectiveness of sealants.

Standardized dental screening techniques were developed to provide statistically valid assessment of decayed and filled teeth within each county.

Statewide sealant media campaign initiated. Two PSAs produced and all staff trained in using the media.

1996 – Steve Cline, DDS, MPH succeeded Dr. Spratt as State Dental Director.

Statewide implementation of standardized Kindergarten and 5th grade dental screening assessment.

In October 1996, the Section hosted a workshop on community dentistry that was attended by many local health directors and other community leaders interested in improving access to dental care. As a result, a number of local coalitions were established to focus on developing additional Safety Net Dental Clinics. The Section followed up this initial workshop with a second workshop in July 1998 focused specifically on establishing and operating a public health dental clinic.

Boards of Health workshops on sealant program and the value of dental sealants conducted throughout the state to assist local board of health members, dentists and health directors.

1997 – Last major N.C. community water system serving over 10,000 people, Hendersonville, was fluoridated.

1998 – Seal the State in ‘98: Dental Public Health 80th Anniversary observance is a statewide sealant initiative to prevent decay through increased utilization of dental sealants.

January 8-9: National “Seal the State in ‘98” Symposium.

February 6: Community-based sealant projects conducted in all 100 counties of the state.

1999 – Rick Mumford DMD, MPH succeeded Dr. Cline as State Dental Director.  The Dental Health Section name was changed to Oral Health Section.

Oral Health Section provided increased technical assistance and support to local health departments and non-profit organizations in establishing local dental clinics across the state. The Section produced a resource manual and a set of fact sheets to enhance our technical assistance with clinic start-up. This work helped in the establishment of an Access to Care Dental Net across the state.

“Smart Smiles” three-year grant begins. Pilot program for physicians to place fluoride varnish on the teeth of very young children to prevent dental decay.  This became the model that is now known as the Into the Mouth of Babes program.

N.C.  Dental Practice Act was amended to allow trained public health dental hygienists to work under direction of a licensed dentist, as opposed to working under direct supervision of a licensed dentist.

2000 – The Into the Mouths of Babes (IMB) partnership with medical professionals began to provide oral preventive services, including fluoride varnish, for Medicaid infants and toddlers.

2001 – National Institute of Dental and Craniofacial Research (NIDCR) grant money used to evaluate the effectiveness of fluoride varnish in the Smart Smiles Program.

2002 – Due to budgetary shortfall and lack of current effectiveness data, the School Fluoride Mouthrinse program is discontinued. A stronger emphasis will now be placed on sealants for caries prevention in school age children.

N.C. Oral Health Section promoted National Children's Dental Health Month through a collaborative campaign with the North Carolina Dental Society titled “I’m Too Cool for Cavities”.

2003 – Oral Health Section worked in partnership with the N.C. Dental Society, N.C. Dental Hygiene Association, and N. C. Dental Assisting Association as part of the first annual National Give Kids A Smile Day, 2/21/03.

2004 – The 2003-2004 N.C. Statewide Dental Survey, funded by the Center for Disease Control (CDC) to evaluate the effectiveness of the North Carolina State Preventive Dental Health Program, was completed. Over a period of several months, 8,000 school children in nearly 400 classrooms participated. Statewide dental surveys, first done in 1960, are repeated about every 15 years. The data generated by these surveys form the basis for planning future dental public health initiatives.

2005 – Rebecca King, DDS, MPH succeeded Dr. Mumford as State Dental Director.

In April 2005, the N.C. Oral Health Section hosted the 2005 North Carolina Oral Health Summit. This Summit provided a forum where state public health policymakers, state dental professionals, local public health officials, and interested citizens could address identified oral health access to care issues in North Carolina.

2007 – Based on data from the 2003-2004 N.C. Statewide Dental Survey, the Oral Health Section re-established the fluoride mouthrinse program in elementary schools with the highest rates of dental disease.

2008 – The Oral Health Section celebrated its 90th anniversary during the 2008 Statewide Oral Health Educational Conference.

2009 – In response to state legislative bill SB 188, the Oral Health Section hosted a special care advisory group to formulate a plan to improve access to dental health care for special care populations in the state.

2010 – The Special Care Oral Health Services: A North Carolina Commitment, Report from the Special Care Dentistry Advisory Group was presented to the N.C. Public Health Task Force, the N.C. Public Health Study Commission, and the N.C. Commission on Aging.  Legislators introduced and are considering three bills based on the recommendations from the report.  Other organizations are considering the recommendations.

The N.C. Oral Health Section published its first annual report to highlight the services provided by the section to the public.