NOT FOR PUBLICATION 
Bulletin, Periodontal Diseases 
1943 
p> 
1 
JJATIONAL RESEARCH COUNCIL 
Division of Medical Sciences 
Subcommittee on Periodontal Diseases 
Minutes of First Meeting 
19 April 1948 
National Research Council Building 
ATTENDANCE: 
For the Subcommittee: Dr. Henry A, Swanson, Chairman 
Drst Edward L, Ball, Henry Mo Goldman, 
and Raymond E. Johnson, 
Uo S, Army: Lt, Colonel Joseph L, Bernier, D. C., 
Army Institute of Pathology, 
Lt, Colonel Kenneth C. DeGon, D. Co, 
Office of the Surgeon General. 
U, S. Navy: Commander B, H. Faubion, (DC), BuMed. 
Commander Carl A. Schlack, (DC), Naval 
Medical Research Institute, 
U„ Sc Public Health Service: Dr, F, A. Arnold, Jr., National Institute 
of Health, 
Dr, H, Trendley Dean, National Institute 
of Health. 
National Research Council: Mr. Herbert N. Gardner. 
Dr, Swanson called the meeting to order at 10:10 AJL By way of 
introduction, he sketched the background of events leading to the formation 
of the Subcommittee, The Committee on Dentistry had been formed during 1947 
as a result of requests from the Surgeons General for review of the dental 
standards for admission to the armed services., In addition to this primary 
function, the Committee will also share the general responsibility of the 
medical advisory committees of the Council for advising the military services 
and the Veterans Administration on professional and scientific matters, 
especially with regard to the evaluation of proposed research. The Sub- 
committee is one of eight such groups established by th£ parent committee to 
aid in meeting its responsibilities. ; 
At the present time, the Subcommittee has before it two principal problems: 
First, the request of the Veterans Administration for recommendations for a 
five-year program of dental research, and second, the problem of physical 
standards for the armed services, particularly with reference to the place of 
dental standards in a profile system for the classification of manpower. tin, Periodontal Diseases 
p. 
2 
) first item of business was a discussion of the scope and function 
of ti. bcommittee„ Since the chief problem appeared to be the avoidance 
of ovt 'ping of the field of the Subcommittee on Pathology and Trauma^ the 
Chairm ?ad the definition adopted by that Subcommittee at its meeting 
on 9 Fc. ry, as follows: 
"That for the purposes of the functioning of this Subcommittee, oral 
pathology shall be considered to .include diseases and lesions of the oral 
structures caused by disturbances'in growth (including anomalies and'neo- 
plasms), metabolism and nutrition, heredity, infection, and physical, 
chemical, thermal and radiation trauma, except dental caries and lesions 
usually classified as periodontal, and 
"That any lesions of the oral structures resulting from an external 
force shall be considered as traumatic and within the province of this 
Subcommittee, and 
"That the oral structures shall be considered to include the teeth, 
periodontium, maxilla and mandible, oral mucosa, lips, tongue, cheeks, 
palate, floor of the mouth, regional lymph nodes and the temporomandibular 
joint, 
"That it is further recommended that diseases of the dental pulp be 
classified under oral pathology for the purposes of subcommittee function, 
because of the relationship of pulpal diseases to. other pathologic lesions 
of the jaws, 
"That it is recommended that lesions usually classified as periodontal 
not be included within the function of this Subcommittee, because perio- 
dontics is a special field of dental science with available experts, and 
because periodontal conditions are comparable to dental caries in importance," 
In the course of the discussion, some question was raised as to the 
wisdom of attempting to formulate a definition at the present time since 
the Academy would not take final action on the question of classification 
until September, However, after considering several formulations the 
motion was unanimously adopted: 
THAT, FOR THE PURPOSE OF SUBCOMMITTEE FUNCTION, THE TERAI 
PERIODONTAL DISEASES SHALL BE CONSTRUED TO INCLUDE DISEASES 
OF THE PERIODONTAL MEL/BRANE, GINGIVA, ALVEOLAR BONE, AND 
CEMENTUM, OF LOCAL AND GENERAL ETIOLOGY, INCLUDING MINOR 
TRAUMA, AND EXCLUDING NEOPLASMS, PERIAPICAL INFECTIONS DUE 
TO PULP INVOLVEMENT, AND MAJOR TRAUMATIC INJURIES. 
Dr. Swanson added that the function of the Subcommittee, apart from 
meeting such requests as might be referred to it from time to time, would 
be to survey .its field and to make recommendations to the main Committee 
for approval and transmission to the military services, the Veterans 
Administration, and where appropriate, to the Atomic Energy Commission. Bulletin, Periodontal Diseases 
1948 
po 
3 
Drf Goldman inquired whether the services had at present any facilities 
for the training of dental officers in periodontia® 
Lt. Colonel Bernier reported that such training was now being given in 
the Army and that dental officers so trained might be designated as perio- 
donistso He added, however, that this designation does not insure assignment 
as a specialist and also that it may not mean that the officer in question is 
actually fully qualified as a specialist by civilian standards, 
Lt& Colonel DeGon added that the Army uses a graded system of classifica- 
tion within this designation - the grade depending on the degree of qualifica- 
tion* In this way officers who have had only short courses in periodontia are 
distinguished from those more fully qualified® 
He referred also to the nutrition laboratory maintained by the Army in 
Chicago, where new field rations are being tested® The Dental Corps, he 
commented, *is already being charged with some of the funds for operation of 
this laboratory, but is not yet represented on the staff. He felt that it 
would be well for this laboratory to contract with a civilian institution for 
research on periodontal conditions developing on Army rations. He believed 
that an Army dentist should be assigned to this activity but mentioned that 
the personnel problem was a difficult one, 
Lt> Colonel Bernier raised the question as to whether the Army should 
depend upon getting civilians for jobs of this nature, or should start training 
dental officers® There are, he said, no nutritionists in the Army Dental Corps 
at the present time. 
Commander Schlack sketched briefly the variety of research projects in the 
field of periodontal diseases being supported by the Navy. Among these are 
studies of dental calculus, of etching with respect to foods and beverages, of 
masticatory efficiency, of the relation of nutrition to the teeth and supporting 
structures, of endocr.ines and vitamin deficiencies, of salivary conditions in 
relation to caries, of bacteriemias resulting from periodontal treatment, and 
of the use of germ-free animals in the study of periodontal diseases. 
The Naval Medical Research Institute, he reported, has faciltities for 
nutritional studies on animals, but has been hampered by a lack of trained 
technicians for such tasks as sectioning of the teeth. It is hoped that more 
studies will be initiated when technicians have been obtained. 
Commander Faubion said that the subject of periodontia is taught at the 
Navy dental school, primarily in short courses of the post-graduate type. Some 
of these courses run for three or four weeks, while others meet two nights a 
week. These courses'are available to any dental officer who wishes them and can 
be spared from his regular duties. 
On the whole, he said, the Navy strives for general competence in the 
broad field of dentistry rather than specialization, although there are some 
large centers where specialists are used. These, however, are principally in 
prosthetics, or in oral surgery. The Navy has not developed periodontia as a 
speciality. Bulletin, Periodontal Diseases 
1948 
p. 
4 
Dr. Ball reported seeing a large number of men who have never had their 
teeth cleaned during four or five years of sea duty with the Navy, and who 
now come back and get treatment from civilian dentists and ask for reimburse- 
ment from the Veterans Administration. This indicates the importance of 
interesting dental officers in periodontal conditions. 
Lt. Colonel DeGon stated that the Army had felt the lack of periodontal 
treatment during the latter part of the war, and had .nade an effort to get in 
dental officers with a background in this field. It is now trying to interest 
young men in this subject, and also to get some with previous training. The 
courses to be given by the Army will help, but they will be of the refresher 
type and will not qualify a man for a speciality. 
Lt. Colonel Bernier commented on the difficulty of developing specialists 
in military service when the dental officer knows that he will have little 
opportunity to do specialized work after completing his training. 
Dr. Goldman urged the importance of finding out the incidence of perio- 
dontal conditions and the degree to which they influence the development of 
other conditions. For example, to what an extent would adequate periodontal 
treatment reduce the need for oral surgery? As an index of the importance 
attached to periodontal treatment by civilian dentists, he referred to a 
survey in which 38 per cent of the dentists expressed a desire for training 
in periodontia, while only approximately 8 per cent were interested in oral 
surgery. 
Lt. Colonel Bernier said that the Army has recognized this problem and 
will soon request the National Research Council to institute studies of the 
incidence of dental conditions for the guidance of the Dental Corps. 
Dr. Goldman pointed out that such surveys should be made specific for 
age groups, since the Army on the whole deals with a younger group than the 
Veterans Administration. 
Dr. Ball cited cases from his own experience to stress the need for more 
knowledge of periodontal conditions on the part of dentists in Veterans 
Administration clinics, as well as in the services. 
Dr. Johnson agreed that the first necessary step was to see that more 
dental officers received training in periodontia, even through short courses. 
He wished, also, however, to stress the importance of indoctrination of 
military personnel in the proper care of the teeth. Relatively few inductees, 
he pointed out, would have advanced periodontal disease. The great difficulty 
is that the majority are not informed on proper mouth care, or are careless. 
It would not be difficult to give them proper information, since this would 
not require dental officers, but could be done by technicians. 
Commander Schlack reported that the Navy does give training in mouth 
care at boot camp, and has just finished a training film on the subject 
aimed at recruits. Bulletin, Periodontal Diseases 
1948 
p* 
5 
Commander Faubion added that roughly one-third of Navy personnel had 
received prophylaxis in the past year, 
Lt-, Colonel Bernier pointed out that the problem is harder in the Army 
because it has nothing corresponding to the Navy1 s boot camp. He commented 
also that so many training films are being used that they are losing their 
effectiveness.. 
Pro.Arnold observed that the services, like the dental profession in 
general, are inclined to see the problem in terms of caries and pain, and to 
overlook the preventive angle0 They tend, he said, to think of education as 
something which takes time from the basic problem of filling teeth, 
Commander Schlack drew attention to the fundamental problem caused by the 
lack of dental personnel in the services^ It is impossible, he said, to care 
for all conditions occuring in the mouths of Naval personnel*, The problem is 
where to draw the linea The basic question, he said, is what should be consid- 
ered a reasonable level of treatment beyond which the dental officer should not 
be expected to go* 
Lt Colonel Bernier added that it is also important to Imow how many dental 
officers would be needed to accomplish this basic work. 
Commander Schlack observed that with high standards, such as were used 
early in the war, it would take a dental officer almost one full day to complete 
work on the average recruit. The ratio required would be about one dental 
officer to 375 men. When standards are lowered, as they were later in the war, 
the problem becomes overwhelming. 
Drc Goldman discussed his observations of the work at Great Lakes, which 
he had visited during the war. He was impressed, he said, by the fine work 
being done with amalgams and with partial dentures. However, this work was 
often done in mouths which were complete wrecks from the periodontal viewpoint. 
It would have been better, he thought, to do the necessary periodontal work 
than to supply prostheses because many of these men were certain to become 
dental problems again in a year or so, particularly when the abutment teeth 
were involved, as was often the case* 
Dr> Swanson offered a tentative summation of the recommendations which the 
Subcommittee wished to make. 
After further discussion the following motion was unanimously adopted: 
THE SUBCOMMITTEE ON PERIODONTAL DISEASES RECOMMENDS: 
1. THAT AT THE TIME OF THE INITIAL EXAMINATION OF TRAINEES 
BY THE DENTAL OFFICERS ALL CASES BE EVALUATED IN RESPECT TO 
THE CARIES AND PERIODONTAL PROBIEMS SO THAT A DEFINITE 
PICTURE OF ORAL HEALTH SHALL BE OBTAINED, IN THIS LIGHT, A 
MINIMUM OBJECTIVE SHALL BE DETERMINED FOR EACH INDIVIDUAL 
CASE. Bulletin, Periodontal Diseases 
1948 
6 
p* 
2C IN VIET OF THE IMPOSSIBILITY OF COMPLETING ALL DENTAL 
WORK REQUIRED FOR TRAINEES WITH THE DENTAL PERSONNEL 
AVAILABLE TO THE SERVICES, IT IS RECOMMENDED THAT PRIORITY 
IN EXAMINATION AND TREATMENT BE GIVEN TO PERIODONTAL 
CONDITIONS AND CARIES AND THAT EVERY EFFORT BE MADE TO 
DETERMINE WHETHER THE PERIODONTAL HEALTH OF EACH TRAINEE 
JUSTIFIES THE PERFORLiING OF RESTORATIVE AND PROSTHETIC 
PROCEDURES. 
3- TO ACCOMPLISH THESE OBJECTIVES, IT IS FURTHER RE- 
COBIENDED THAT ADEQUATE TRAINING IN PERIODONTIA BE PRO- 
VIDED AT APPROPRIATE LEVELS, SO THAT ALL DENTAL OFFICERS 
WILL BE CAPABLE OF INTELLIGENT DIAGNOSIS AND TREATMENT, 
AND THAT SELECTED OFFICERS WILL BE SUFFICIENTLY TRAINED 
TO ACT IN THE CAPACITY OF SPECIALISTS, INSTRUCTORS, AND 
COORDINATORS, 
Ao THAT THE SPECIALISTS, INSTRUCTORS, AND COORDINATORS IN 
PERIODONTAL DISEASES BE SPECIFICALLY ASSIGNED TO THE DUTIES 
IN WHICH THEY HAVE BEEN TRAINED. 
AS A PREVENTIVE AND THERAPEUTIC MEASURE IN THE CONTROL 
OF PERIODONTAL DISEASE, IT IS RECOMMENDED THAT INDIVIDUAL 
INSTRUCTION IN ORAL HYGIENE BE INTENSIFIED AND MADE AVAIL- • 
ABLE TO ALL PERSONNEL, PARTICULARLY AT THE TRAINEE LEVEL. 
6, IN ORDER THAT TRIS PROGRAM WILL ATTAIN THE DESIRED 
OBJECTIVES, IT IS ESSENTIAL THAT THESE BROAD PROCEDURES 
BE SUPPLEMENTED BY AN ADEQUATE MAINTENANCE PROGRAM 
THROUGHOUT THE SERVICE MAN'S CAREER. 
Commander Schlack discussed the full color photographs of the mouth 
which have been developed by the Navy and proposed for inclusion in the 
medical record as a means of identifying remainsa He suggested that these 
photographs might offer a quick screening method for spotting conditions of 
gingivae, palate, etc,, and that they could be taken by auxiliary personnel 
and reviewed by specialists at their convenience. 
The Subcommittee next undertook to formulate suggestions for the dental 
research program of the Veterans Administration® After considerable discus- 
sion the following list of suggestions was unanimously agreed upon: 
1. Clinical research into the possibility of establishing a clinical 
periodontal index comparable to the generally accepted caries index now 
in use, 
2. A study of the prevalence and incidence of periodontal diseases 
specific for age, sex, and color. Bullet.in, Periodontal Diseases 
1948 
p- 
7 
3 s Histochemical studies of the alveolar bone and soft tissue of the 
periodontium in periodontal diseases^, 
4* The relationship of inflammatory gingival disease and the alveolar 
crest (radiographically) in health and in organic disease0 
5-> Does the clinically healthy gingiva contain inflammatory cells and, 
if so, what role do they play? 
6„ A clinical investigation of the frequency of calculus formation and of 
factors influencing it. 
7o An exploration of the possibility of using tissue smears for diagnosis 
of periodontal diseases, 
8, Relationship of the development of cervical ridges to periodontal 
diseases, 
9. The effect of flattening of contact points on the health of periodontal 
tissue. 
IO, The effect of gingivectomy in the treatment of periodontal disease^ 
llo The therapeutic value of massage in the treatment of periodontal diseasec 
It was suggested that the neuropsychiatric and tuberculosis hospitals of 
the Veterans Administration might be the most convenient place to carry out 
studies of the incidence and prevalence of periodontal diseases As a means of 
determining whethei' or not the findings were influenced by the disease for 
which the patients are hospitalized, it was recommended that the various 
hospital populations be compared with one another to determine whether any 
significant correlations exist. 
After a brief discussion of the problem of dental nomenclature, the 
following resolution was unanimously adopted: 
THAT THE SUBCOMMITTEE ON PERIODONTAL DISEASES RECOMMENDS 
THAT THE NOMENCLATURE APPROVED BY THE ACADEMY OF PERIO- 
DONTOLOGY, BE ADOPTED BY THE FEDERAL, CIVILIAN AND MILITARY 
AGENCIES, 
Following a brief discussion of certain problems with regard to military 
dental personnel, the following two motions were unanimously adopted: 
THAT THE SUBCOLIMTTEE ON PERIODONTAL DISEASES WISHES TO GO 
ON RECORD AS SUPPORTING THE RECOMMENDATION OF THE SUBCOMMITTE 
ON CARLES WITH REFERENCE TO RESEARCH PERSONNEL IN THE ARMED 
SERVICES AND RECOMMENDS FURTHER THAT THE ASSIGNMENT OF 
PERSONNEL TO FULL-TIME RESEARCH BE SPECIFICALLY RECOMMENDED, 
THAT THE SUBCOMMITTEE ON PERIODONTAL DISEASES RECOMMENDS 
THAT THE SUBCOMMITTEE ON PERSONNEL CONSIDER THE PROBLEM 
OF TRAINING AND UTILIZATION OF DENTAL HYGIENISTS IN THE 
ARMED SERVICES. Bulletin, Periodontal Diseases 
1948 
Po 
8 
MrT Gardner reported briefly on the status of the problem of military- 
dental standards, as related to a profile system for the classification of 
manpower 0 This problem had been discussed at considerable length by the 
Committee on Dentistry and by several of the subcommittees0 It was agreed 
by all that some provision should be made for recording dental findings 
independently of the general column on physical condition> Hov/ever, since 
the basic purpose of the profile system is to provide a summary of a man's 
permanent capabilities for determining his ultimate assignment, some 
practicable means must be developed for differentiating between remediable 
conditions, including most dental defects, and permanent disabilities. 
Since it appears that the basic framework of the profile system must be 
agreed upon before the specialized committees can make an intelligent 
contribution, steps have been taken leading to the formation of a central 
committee to include representatives of the medical, dental, and personnel 
branches of the services, of the Office of Selective Service Records, and 
of the National Research Council. 
The Subcommittee decided to await further developments before taking 
action on this subject- 
The meeting was adjourned at 4?O5 P.M»