First Research Study of RDH

Oct. 11, 2013
I just received a document titled "Report of Five Years of Mouth Hygiene in the Public Schools of Bridgeport, Connecticut," written by Dr. Alfred C. Fones, of course.

by Christine Nathe, RDH, MS

I just received a document titled "Report of Five Years of Mouth Hygiene in the Public Schools of Bridgeport, Connecticut," written by Dr. Alfred C. Fones, of course. The report was published April 18, 1921, and Dr. Fones apparently presented it to the Convention of the Connecticut Dental Hygienists' Association in Bridgeport on May 24th of that year.

The first school-based dental clinic began operation in 1914. Before implementing the clinic, Dr. Fones interestingly pointed out a major health issue that affected school children: "If otherwise, a ten year old boy's body appears normal, we ask him to open his mouth. Here we find teeth covered with green stain, temporary and permanent teeth badly decayed, possibly fistulas on the gum surface showing an outlet for pus from an abscessed tooth or teeth, and decomposing food around and between the teeth. Here at the gateway of the system is a source of infection and poison that would contaminate every mouthful of food taken into his body, no wonder that the child suffers from an auto-intoxication which produces eye-strain, anemia, malaise, constipation, headaches, fevers and many other ailments." Dr. Fones proceeds to reveal that "medical inspectors in public schools find that decayed teeth outrank all other physical defects combined."

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Does this sound similar to what we know today? It is interesting to note that many feel that we just now realized that oral infections can contribute, or may be linked, to systemic infections. This is not new science. The premise of this connection, in many ways, is how Dr. Fones convinced others of the importance of dental hygienists' role in society. In fact, he stated that "this movement (of dental hygienists in the schools) would be a powerful aid in the prevention of dental decay, infectious and communicable diseases."

Fones discussed the four distinct parts to the first school-based dental clinic.

  1. The exam and prophylactic treatment or the actual cleaning and polishing of the children's teeth
  2. Toothbrush drills and classroom talks
  3. Stereopticon (slide projector) lectures for children in the higher grades
  4. Educational work in the home by means of special literatures for parents

Does this sound similar to what we do today? Indeed, this plan is very similar to the distinct parts of existing school-based dental clinics.

In order to show whether the plan was effective in preventing and reducing disease, Fones implemented an evaluation method. Again, doesn't this sound similar to what we do today? The dental hygienists collected data on the condition of the mouths of children and also included a control group of older children who had never had a school-based dental clinic in younger years. Data showed a reduction of 34% of dental decay in permanent teeth. Additionally, Fones noted that the excessive consumption of sugar was an issue and that malocclusion is one of the most noticeable defects aside from dental decay. One especially engaging statistic that Fones found was that only three children out of a hundred with teeth were entirely free from dental caries. He also noted the relationship between bacterial infections and communicable diseases to oral infection.

This report is important to the profession and to practicing dental hygienists, particularly those interested in pursuing or already working in the schools. Many of the educational, literacy, promotional, and evaluative methods and techniques are still applicable today. Also, this report can be used as a landmark study of the utilization of dental hygienists as outreach workers, focusing on a particular setting, with which we can seriously increase access to underserved populations. RDH

CHRISTINE NATHE, RDH, MS, is director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of "Dental Public Health Research" (, which is in its third edition with Pearson. She can be reached at [email protected] or (505)272-8147

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