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MONDAY, JULY 12, 1971


Washington, D.C. The subcommittee met at 2 p.m., pursuant to notice, in room 6202, New Senate Office Building, Senator Edward M. Kennedy (chairman of the subcommittee) presiding.

Present: Senators Kennedy (presiding), Hughes, Pell, and Beall.

Committee staff members present: Dr. Charles O. Cranford, professional staff member and Jay B. Cutler, minority counsel to the subcommittee.

Senator KENNEDY. The subcommittee will come to order.

About 4 months ago this subcommittee began hearings on the health crisis in America. These hearings were held both in Washington and in several cities throughout the country. Many witnesses came forward to testify and tell of their problems with our health care system. From this multitude of witnesses, one general theme was clearthere exists an enormous gap between the health needs of our people and the delivery of essential health services.

The delivery of dental care offers no exception. It is appalling that two-thirds of the children of low-income families have never been to a dentist and that in a country as wealthy as the United States, access to dental care is still determined more often by economic status than by need.

During our field hearings in Chicago, we saw black children from low-income families receiving dental care in the Miles Square Neighborhood Health Center. For many of the children, it was the first opportunity to visit a dentist. And, I believe it is safe to say, without a federally sponsored program such as the one we saw, their chance of receiving dental care would be extremely poor.

This is especially distressing because of the nature and prevalence of dental disease. Irreversible damage to the teeth and other oral structures is almost certain to occur if treatment is not received at a very early age-irreversible damage that will affect the child for the remainder of his life.

We know the value of disease prevention. Among the most heralded advances in modern medicine have been those that prevent a dreaded disease from striking our population.

Dental decay also can be prevented. Scientists have discovered ways to prevent most forms of dental disease. We do not need to wait

for additional breakthroughs before we begin to conquer dental decay. The gap that now exists between dental needs and services is definitely a gap in the delivery process, and it can be closed.

The shortage of dentists and their auxiliary personnel is well known. Therefore, we must apply the resources we have in the most efficient manner possible. Other countries have recognized these facts and have acted long ago to establish dental programs for schoolchildren. New Zealand has had a school dental program since 1921. It is not surprising that they are an acknowledged leader in the delivery of dental services, having also utilized auxiliaries in effective ways that are, as yet, not a part of our dental care delivery system.

Despite our scarcity of dental manpower, we are failing to recruit military service veterans, who have had years of experience as dental corpsmen, into the civilian dental care system. Over 1,000 of these young men and women are being lost each year to some other civilian occupation.

Water fluoridation is accepted by all major health organizations as an effective and inexpensive means of decreasing the incidence of tooth decay. Many communities have already fluoridated their water supplies and many more are planning to do so.

In some cases, lack of public funds is delaying this action. Only a few days ago an article in the Boston Globe stated that 31 communities in my home State of Massachusetts, having completed all the legal steps to accomplish fluoridation are now only waiting to raise the funds needed to install the necessary equipment. Federal grants are needed to assist communities to provide this important public health measure.

The Nixon administration has consistently slighted appropriation requests for dental programs. Even today, the administration has declined to come and present testimony on S. 1874. Legislation enacted in 1968 to assist in financing dental care for young children has been given only token support. S. 1874 seeks to provide dental services for our children who have been so long neglected. We cannot permit such deprivation to continue unchallenged.

I will include in the record at the end of my remarks the text of S. 1874 and a copy of a letter from HEW dated July 9 received in my office over the weekend, which indicated that the Department would not be able to appear.

Our charge is clear. We must move quickly to act on this important bill introduced by the distinguished senior Senator from the State of Washington. Senator Magnuson has once again seen a substantial national health problem, and in keeping with his keen understanding of the health needs of the American people, has taken appropriate action by introducing S. 1874, the "Children's Dental Health Act of

(The text of S. 1874 and the letter referred to follow :)



S. 1874


May 14, 1971 Mr. Magnuson introduced the following bill; which was read twice and referred

to the Committee on Labor and Public Welfare


To provide for the establishment of projects for the dental health

of children to increase the number of dental auxiliaries, to increase the availability of dental care through efficient use

of dental personnel, and for other purposes. 1 Be it enacted by the Senate and House of Representa

2 tives of the United States of America in Congress assembled,

3 That this Act may be cited as the "Children's Dental Health

4 Act of 1971".


Sec. 2. The Public Health Service Act is amended by

6 adding at the end thereof the following new title:






"SEC. 1001. (a) There are authorized to be appropri

4 ated $5,000,000 for the fiscal year ending June 30, 1972;

5 $15,000,000 for the fiscal year ending June 30, 1973; $30,6 000,000 for the fiscal year ending June 30, 1974; $50,000.


7 000 for the fiscal year ending June 30, 1975; and $70.8 000,000 for the fiscal year ending June 30, 1976; which 9 shall be used by the Secretary to make grants to the health

agency of any State (or political subdivision thereof) or to 11 any other public or nonprofit private agency, organization, 12 or institution to pay for part of the cost of the carrying ont 13 (on a planned and systematic basis) by such agency, orga14 nization, or institution, of one or more comprehensive proj15 ects for dental care and services for children of preschool 16 and school age. Any such project shall include such com17 prehensive corrective, followup, and preventive services (in18 cluding dental health education), and treatment as may be 19 required under regulations of the Secretary.

"(b) Grants under this section shall not be utilized to


21 provide or pay for dental care and services for children

22 unless such children are determined (in accordance with

23 regulations of the Secretary) to be (A) from low-income

24 families, or (B) unable, for other reasons beyond their con

25 trol, to obtain such care and services.


1 "(c) Grants under this section may be utilized for the 2 conduct of research, demonstrations, or experimentation 3 carried on with a view to developing new methods for (A) 4 the prevention, diagnosis, or treatment of dental problems, 5 (B) the payment of dental care and services, or (C) the 6 utilization of dental health care personnel with various levels 7 of training; except that not more than 10 per centum of any

grant under this section shall be so utilized.


“(d) In making grants under this section, the Secre10 tary shall accord priority to projects designed to provide 11 dental care and preventive services for children of preschool 12 age and school age children who are in the first five grades

13 of school.



15 "SEC. 1002. (a) There are hereby authorized to be 16 appropriated $2,000,000 for the fiscal year ending June 30, 17 1972; $3,000,000 for the fiscal year ending June 30, 1973; 18 $4,000,000 for the fiscal year ending June 30, 1974; 19 $4,000,000 for the fiscal year ending June 30, 1975; and 20 $2,000,000 for the fiscal year ending June 30, 1976; which 21 shall be used by the Secretary to make grants to States, 22 political subdivisions of States, and other public or nonprofit 23 private agencies, organizations, and institutions to assist them 24 in initiating, in communities or in public elementary or sec25 ondary schools, water treatment programs designed to re

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