Dental Diseases

Dental Diseases. Contents: Distribution 3. b..............62 Organization of the fight against 3. b...........55 Legislation in the fight against 3. b........ 62 Dental diseases, in the narrow sense of the term--diseases of teeth as a special organ. Usually, however, dental diseases are treated in a more generalized way as pathological processes of the oral cavity of dental origin. In this expanded sense, the corresponding department of practical medicine is understood today--odontology (see), which in fact encompasses not only diseases of teeth, but also diseases of the oral cavity, with all included and directly related to teeth organs and tissues--jaws, lips, cheeks, tongue, glands, muscles, etc. Based on this understanding of dental diseases, state dentistry in the USSR covers the entire field of dentistry, and its task is the prevention and treatment of all diseases of teeth, oral cavity and jaws among the population. Among these diseases, tooth decay (caries dentis) and so-called alveolar pyorrhea (pyorrhoea alveolaris, paradentosis, paradentitis) occupy a central place, leading to mass loss of teeth, disruption of chewing function and nutrition, and as a result--to serious consequences for the entire organism. According to some authors, a number of general diseases--endocarditis, appendicitis, nephritis, rheumatism, etc.--and the entire complex of phenomena of oral infection (oral sepsis) are sometimes directly associated with dental diseases. The fight against dental diseases, oral hygiene, has therefore taken a central place in modern prevention in all civilized countries. The high prevalence of alveolar pyorrhea and especially tooth caries, which in some countries affects 90-95% of the entire population, and the ineffectiveness of individual therapeutic methods to combat these diseases as a mass, nationwide phenomenon--have led to classifying these diseases in a certain sense as social diseases. From this perspective, dental diseases and the fight against them are considered. Most other diseases of teeth and surrounding tissues--pulpitis, pulp gangrene, peri cementitis (periodontitis), periostitis and osteomyelitis of the jaws, etc.--are in most cases a consequence of tooth caries. These diseases, as well as diseases of the gums, oral mucosa, jaws, tongue, lips, salivary glands, are considered separately. Distribution of dental diseases. There is no official systematic statistics on the distribution of dental diseases in any country. However, there are valuable mass surveys of the condition of the oral cavity and teeth among various organized population groups. The most valuable mass examinations have been conducted on school-age children. In Germany, the first surveys were conducted by Parreidt in 1878. Almost simultaneously, similar works appeared in England and Scotland (Cunningham). The richest statistical material, covering about ¹/₄ million people, has been collected in Germany (C. Rose). On the basis of this material, the author was able to prove the direct dependence of the distribution of tooth decay on the hardness of drinking water, i.e., on its saturation with lime salts. An even more extensive summary is given by Kloeser (R. Kloeser); it covers 404,268 examined children from the most diverse countries (Sweden, England, Scotland, Switzerland, Austria, Italy, Denmark, Russia). Among them, carious teeth were found in 380,483, i.e., in 94.12%. The limits of variation range between 43.5% and 100%. Of the author's 12 tables (254,780 children), it can be seen that on average there are 7.19 carious teeth per child, i.e., in this case we can speak of damage to the entire dental apparatus. Of the earliest statistical works in Russia, mention should be made of the examination of children in various cities, conducted during the period from 1900 to 1904 and covering 8,022 students. The incidence of caries among the latter is 82.8%. A statistical survey conducted by the dental department of the People's Commissariat of Health of the RSFSR in 1918-19 on 5,587 Moscow schoolchildren showed tooth decay in 85.7%. In most statistics concerning children, the social factor is almost entirely unaccounted for. Only recently, in connection with the widespread development of social insurance, more attention has been paid to this aspect. In the survey developed by Ya. S. Utstein, this factor is highlighted for the first time, but even here there is no detailed differentiation according to specific professions of parents. Only general professional groups were taken, with children of mental workers ranking first in tooth damage, and children of merchants last. These data should be treated with due caution. As for the distribution of caries depending on gender, no significant difference was found in the surveyed groups. According to Kloeser's data, the ratio between boys and girls is expressed in the figures 7.25:7.20; according to the data of the dental department of the People's Commissariat of Health--in the figures 3.12:2.73. With age, the number of teeth affected by caries increases. Thus, the increase in carious teeth between the ages of 7 and 14 is expressed in the following figures. 7 years

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» According to the all-German statistics (according to Schmidt). 1.6 6.0

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» In relation to other organized groups of the population, the most complete information is available on the prevalence of dental diseases among conscription age groups or military units. The results of such surveys are very discouraging, as they indicate the colossal prevalence of dental diseases even among the most select young people. According to statistical data by Krause, among 12 groups surveyed by various authors comprising 44,000 people, the number of completely healthy dental rows ranges between 3.02% and 7%, while the number of people with carious teeth reaches 93-96.98%. In Russia, the most extensive survey of military units was conducted by M. Kokushin in 1912-13. According to his data, the number of people with affected teeth ranged between 80% and 90%. Among more recent works is a statistical summary by M. Geikin, covering about 1,000 students of the Military Medical Academy, representing a fairly homogeneous group aged 23 to 27 years. Caries affected 99.6% of them. Only 4 individuals had completely healthy teeth. Regarding the condition of teeth among military units of the Red Army, there are scattered partial surveys indicating that the percentage of morbidity among them is significantly lower than among military units of Western European states. This is explained by the mixed national composition of the Red Army, among which there are peoples (Caucasian, Central Asian, some northern groups) with remarkable immunity to dental caries. Social causes of the spread of dental diseases. When speaking of the causes of the progressive increase in dental diseases, one must strictly distinguish between two categories that are qualitatively different and not reducible to each other. The first, which can be conditionally called biological, consists in the fact of continuous accumulation of unfavorable mutational changes for the species in the jaw and dental apparatus, making it little resistant to harmful external influences. The sharp decrease in the role of natural selection in human society puts no obstacles to the spread and accumulation of these pathological changes. The other category of causes lies in the change in living conditions of the population—the transition to cooked food and the associated sharp decrease in vitamins in it (especially vitamins C and D), insufficient use of sunlight by city dwellers, etc. Thus, the large difference in the degree of spread of dental diseases among different races and peoples depends, most likely, mainly on the methods of obtaining and preparing food. According to the famous table by Mummery, the percentage of caries disease ranges between 2.6 among Eskimos and 40.2 among Chinese. According to this table, in the first place are peoples who eat predominantly meat, followed by peoples who eat mixed food (residents of India, Polynesians, Kaffirs, Australians), and finally—as most affected by dental caries—peoples who eat predominantly vegetable food. It is necessary, however, to note that Mummery's table, like a number of similar studies, suffers from excessive simplification and stereotyping and lacks class differentiation. Social and living conditions of individual social classes and professions have an extremely strong influence on the spread of dental diseases. There are numerous works studying the influence of professional hazards of different industries on dental tissues and the oral cavity, both in foreign and Soviet literature. The dental department of the People's Commissariat of Health has compiled, based on data from the People's Commissariat of Labor, a detailed list of industries harmful to the oral cavity and teeth. At present, in connection with the transition of Soviet health care to the principles of dispensary care and prevention, the dental department of the People's Commissariat of Health, together with the State Institute of Stomatology and Odontology, is developing a detailed plan for preventive coverage of the most harmful industries. Only a list of these is given here; for the specific influence of one profession or another on dental diseases, see Teeth—professional diseases. List of harmful industries according to the table of the dental department of the People's Commissariat of Health. I. Mining: extraction and processing of lead, copper, mercury ores. II. Metallurgical and metalworking industry: 1) smelting from ore and casting of lead, mercury, zinc and their compounds; 2) chemical processing of metals: etching, oxidation, galvanoplasty, tinning, nickel plating, galvanizing; 3) production of accumulators; 4) production of files; 5) lead coating and bronzing of cables; 6) enamel production. III. Chemical industry: 1) mirror production—etching; 2) glass production—blowing, etching of glass; 3) production of lead paints (white lead, red lead, lead tetroxide); 4) production of smokeless powder and explosives—nitration and washing; 5) production of fulminating mercury; 6) pharmaceutical factories—use of chlorine, acids, lead, mercury; 7) production of acids—hydrochloric, sulfuric, nitric, chlorine, bleaching lime, soda; 8) factories for smelting mercury. IV. Printing industry. V. Textile industry—bleaching departments. VI. People's communication. VII. Food industry: 1) flour mills, 2) baking, 3) confectionery production. VIII. Beet sugar, sugar refining and starch-glucose production. IX. Paper industry: 1) chlorine departments of paper mills; 2) pulp mills: sulfite departments, acid departments. Statistical data on professional diseases of teeth and the oral cavity are extremely contradictory and often compiled with large errors. Most statistics are based on too small a material, from the comparative evaluation of which no scientific conclusions can be drawn. Thus, in Brack's statistics, there are professional groups represented by 1, 2, 4, 9 individuals. Of all comparative statistical tables, Rose's table has the greatest value, from which some characteristic groups are given here (according to Koelsch). On the forehead Completely Number of ob- forehead when in healthy Profession surveyed came in average teeth found at n persons examined teeth in % Farmers . . 6.4 9.8 Construction workers . ... 7.1 8.1 Production 7.1 5.1 Workers of mental labor. 9.6 2 4 11.8 2.1 Organization of the fight against dental diseases. The preventive fight against dental diseases is a product of recent times. A pioneer in the preventive fight against dental caries in Russia is A. K. Limberg, who in the early 90s published a classic work—'Modern Prevention and Therapy of Dental Caries'—and a number of popular brochures about dental hygiene. At the beginning of the 20th century, the first school dental clinics appeared simultaneously in Germany and Russia, and in 1909 at the V International Dental Congress in Berlin, the International Commission for Public Oral Hygiene was organized, which gave the first impetus to the spread of preventive ideas on an international scale. However, the dominant form of dental care in all countries except the USSR remains therapeutic dental care concentrated in private offices. Public dental care has taken the largest dimensions in America and Germany, where along with a well-developed private practice there is an extensive network of school and hospital fund dental clinics. However, public dentistry is most fully developed at present in the USSR. The following table speaks to the degree of population coverage by dental care in different countries. Number of dentists according to 1925 data (according to Bejach). Country North-Am. United States. Norway...... England and Ireland. Denmark........ France....... Switzerland..... Argentina ...... Germany ...... Austria....... Finland..... Sweden....... Holland ...... Czechoslovakia . . . Italy....... Romania ...... Poland....... India........ Number of residents Number of dentists Per 1 dentist there are residents * In Germany, in addition to dentists, about 12,000 dental technicians are engaged in dentistry. In prerevolutionary Russia, dental care was almost entirely concentrated in private offices. There were only individual public-type clinics in secondary educational institutions and hospitals. After the 1905 revolution, the first beginnings of dental care for insured persons appeared, which in rare cases was organized at factory-plant medical institutions, and in most cases was provided on a contractual basis between hospital funds and private practicing dentists, as is still the case in Germany, where a relatively small number of dentists are fully on public service, as well as in France and a number of other countries. During the imperialist war, the first military dental clinics and hospitals for jaw wounded appeared in Russia. Almost all dental care in Russia was previously concentrated in provincial and county cities. There were no dental clinics in the countryside. By the time of the world war, the number of dentists in provincial cities was distributed as follows. Per 1 dentist came 1st a a In them sewn. according to data from the Central Statistical Committee as of 1/1 1911."

(in thousands) a 22 24 18 5.977,4 2.199,3 1.665 8 1.447,9 Over 5.000 » ..... . 859 436 199 Total . . 11.000,4 Number of dental physicians in county towns and number of population per dental physician is seen from the following table. 5S On 1 dental physician came 1! 1§ In them ngat. according to C. stat. k. k. 1/1 1911 g. (in thousands) In them dental physicians 22 26 55 48 57 736,1 771,4 1.504,4 1.362,9 1.451,4 502 308 398 215 116 Total . . 5.826,2 1,539 To this must be added 178 dental physicians working in various small towns. The total number at this time was 6.480, of which about 60% were graduates of dental schools and about 40% dentists. The dynamics of growth of dental personnel and the change in the ratio between both groups are seen from the following table, from which it is evident that after 1909 the number of dentists begins to fall. Years Number of dental physicians Number of dentists Total 998 1.658 2.978 2.938 1.139 2.231 6.703 6.966 Despite the small number of dental physicians, the rate of treatment for dental diseases occupied a significant place among general medical services in tsarist Russia. Pudkevich conducted in 1909 a questionnaire survey of 258 medical institutions (among them 183 zemstvo, 33 factory and mine, 29 railway and 13 urban), showing that out of the total number of outpatient services of 3.447.465, dental services accounted for 163.886, or 5%. Of the dental care provided to the population, the share of paramedics was 69.4%, of physicians-5.8%; of outpatient clinics with mixed reception of physicians and paramedics-21.3%, of physician reception-1.2%, and of dental physicians-only 2.3%. And at the present time in rural areas, where there are no special dental offices, the main dental care is provided by the district physician or paramedic. Dental care in the USSR after the October Revolution. The October Revolution brought about a revolution in the entire organization of dental affairs. After the issuance of July 11, 1918, of a decree of the SNK on the formation of the NKZdr., dentistry was for the first time included as an organic part in the general system of public health. On August 25, 1918, the Regulations on the dental subsection of the NKZdr. of the RSFSR were issued, according to which its "task is to develop and implement all measures for the reform of dental affairs of the Republic on socialist foundations;". On 17/IX 1918, a resolution "On the accounting of dental and dental-technical equipment and materials" was issued, which was the first step toward the nationalization of all dental warehouses and enterprises and the creation of a material base for the construction of state dental institutions. On 16/X 1918, a circular followed on the organization of local dental organs at med.-san. departments of gubernatorial soviets. On 20/XII 1918, a resolution was issued on the labor duty of medical personnel, including dental physicians and dental technicians. By resolution of the NKZdrava of 26/XII1918 g. ("On the procedure for attracting dental physicians to state service and the requisition of private clinics and offices"), the transformation of private dentistry into a state affair was provided for. The nationalization of private offices and the labor mobilization of dental physicians radically changed the entire character of dental affairs. Dentistry was brought closer to the working masses. The main contingent of dental physicians was redistributed by transferring from large urban centers to the periphery. At the same time, a reform of dental education was carried out. On 1/X 1918, a resolution was issued on the closure of dental schools and on the transfer of the training of odontologists to universities. At medical higher educational institutions, departments of odontology were opened, mandatory for each student. The specialization of odontologists at the present time occurs on the same principles as all other specialties. It takes place at the State Institute of Stomatology and Odontology in Moscow, at the Leningrad Scientific-Practical Stomatological Institute, and at the clinics of the largest odontological departments of medical higher educational institutions. Dentists are equal in all rights with dental physicians. In Ukraine there is a dual form of training odontologists: a) through general medical training followed by specialization, and b) through completion of odontological faculties of medical institutes. Organizational forms of state dental institutions in the RSFSR. Since in their objective, state dental institutions pursue two tasks: a) the fight against diseases of the oral cavity, teeth, and jaws as separate organs, and b) participation through the improvement of the chewing apparatus in the fight against general diseases of the body (the exceptional importance of oral hygiene in tbc, syphilis, gastric disorders, a number of metabolic disorders, etc.), then in constructing the network of dental institutions, health authorities base themselves on two organizational principles: a) the organization of large specialized dental outpatient clinics, and b) the organization of dental offices at general medical institutions.'The former are opened either as independent institutions or are part of other large polyclinics with different specialties. The latter are organized at general outpatient clinics and other medical institutions (hospitals, sanatoriums, dispensaries, etc.). According to their organizational purpose, both types of dental institutions are divided into: a) institutions for general use; b) institutions serving exclusively the insured; c) school-preventive dental institutions; d) institutions serving the rural v population; e) institutions serving the families of workers and employees of transport; f) institutions serving resort patients; g) institutions serving places of detention; h) institutions serving the Red Army, and i) institutions of the Red Cross. Special stomatological and dental outpatient clinics differentiate their work into preventive, therapeutic, surgical, and prosthetic-orthopedic. The work of dental outpatient clinics and offices is regulated by a special provision on state dental institutions. By the end of 1921, on the territory of the RSFSR there were 1.881 state dental outpatient clinics with 2,034 dental physicians, including 1,225 urban with 1,283 physicians and 656 rural with 751 physicians. In addition, 101 dental prosthetic outpatient clinics with 248 technicians were organized.- In 1921, with the transition to the new economic policy and the suspension of nationalization, a spontaneous denationalization of state dental offices began, a mass exodus of dental physicians from the village. The network of state dental institutions sharply decreased. From 1923, a period of organic growth of state dentistry begins. By 1924, the previous figure of dental physicians on state service is almost reached. It is expressed in the amount of 2,009 persons, however rural dentistry reached the figure only of 234 persons. In the following years the picture changes sharply, and for the next three years the following growth dynamics can be stated for the RSFSR. Populated places Number of dental outpatient clinics and offices Number of chairs in them Number of dental prosthetic outpatient clinics and clinics Total Of them school- prevent. Independent At dental outpatient clinics and offices In gubernatorial (oblast, kray, resp.) cities . . . In county towns . In settlements of urban type . In rural areas . 503 505 304 649 62 35 6 1.101 731 350 632 Total, . . . help to the rural population. As for the dynamics of actual achievements in the activities of state dental institutions, these are expressed in the following comparative figures. Years Visits Outpatient visits Total Including insured Total Including insured 2.168.257 3.285,333 3.718,090 4.570,976 1.534,913 2.342,197 2.728,251 3.307,848 6.956,361 5.113,036 10.861,356: 8.110,214 12.519,443; 9.633,422 14.686,273 11.577,650 In recent years, state dental prosthetics has developed significantly, although a large part of prosthetics, especially its cosmetic part, is still in the hands of private practicing physicians. Free prosthetics, provided almost exclusively to the insured, is rendered, according to the standards established by the NKZdr., with a certain loss of chewing function. Complex jaw prosthetics is provided free of charge in special institutions: in GISO, in the Leningrad Stomatological Institute, in the Stomatological Department of the Leningrad Traumatological Institute, in the Moscow Therapeutic-Prosthetic Institute. For 1927 g. the reporting was reorganized, and the statistical material was grouped in a different order. The general picture as of 1/1 1928 g. is as follows (see upper table). The number of dental physicians serving as of January 1, 1928, was 3,489; of which: 1,600 in gubernatorial cities, 913 in county towns, 357 in urban-type settlements and 619 in rural areas. The decrease in the number of rural offices does not show a reduction in dental care to the rural population, since here offices in urban-type settlements are separately listed, which provide mainly dental care to the rural population. As for the dynamics of actual achievements in the activities of state dental institutions, these are expressed in the following comparative figures. Years Visits Outpatient visits Total Including insured Total Including insured Gub. Uezd- Rural Gub. Uezd- Rural Gub. Uezd- Rural centers nye go- mest- o centers nye go- mest- o centers nye go- mest- roda nosti roda nosta roda nosta Number of independent outpatient clinics Chairs in them .... Number of dental offices at general outpatient clinics Chairs in them .... Total dental institutions Number of dental prosthetic laboratories.... Number of dental physicians . Number of dental technicians o For 1927 g. the reporting was reorganized, and the statistical material was grouped in a different order. The general picture as of 1/1 1928 g. is as follows (see upper table). The number of dental physicians serving as of January 1, 1928, was 3,489; of which: 1,600 in gubernatorial cities, 913 in county towns, 357 in urban-type settlements and 619 in rural areas. The decrease in the number of rural offices does not show a reduction in dental care to the rural population, since here offices in urban-type settlements are separately listed, which provide mainly dental care to the rural population. The fall in the number of rural offices does not indicate a reduction in dental care to the rural population, since here offices in urban-type settlements are separately listed, which provide mainly dental care to the rural population. The fall in the number of rural offices does not indicate a reduction in dental care to the rural population, since here offices in urban-type settlements are separately listed, which provide mainly dental care to the rural population.

The degree of development of dentistry is indicated by the following most characteristic figures (see table on the next page). According to this table, the number of artificial teeth manufactured in the RSFSR during the three-year period 1924-26 increased by 169.2%, with the most intensive growth noted in the North Caucasus, where it amounted to 166.8%, and especially in Leningrad, where an unprecedented leap of 462.5% occurred. For 1927, there are no detailed reports on dentistry, although individual data indicate further growth. However, the tables above do not reflect the entire picture of the development of state dental care in the RSFSR. They do not include figures from state dental institutions serving transportation routes, the Red Army, places of detention, resorts, as well as scientific institutes, odontological departments of medical institutions, etc. Transportation in the RSFSR was served in 1924 by 431 dentists, and in 1926 by 750 dentists. If we also include dentists serving the Red Army and other mentioned organizations and departments, then the current number of dentists on state service in the RSFSR will exceed 4,600 people. There are no exact data on the state of state dental care in the union republics, except for Ukraine, where by the end of 1927 state dental care was provided as follows. Dental care: District cities 53, Other populated areas 790, Number of dental offices 43, Dental prosthetic clinics 469, Dentists 11. The total number of dentists on service by the end of 1927 in Ukraine was 1,299 people. Together with other union republics, the total number of dentists on service can be expressed as a round figure of 2,000 people. Thus, the total number of dentists on state service in the USSR by the end of 1927 amounted to about 6,500 people, i.e., it exceeded the number of all dentists practicing before the war, which included dentists from Poland, Finland, Latvia, Estonia, Lithuania, and Bessarabia. This number does not include the reserve of dentists not yet involved in state service. To understand the entire picture of the development of state dentistry in the USSR, one cannot limit oneself to an analysis of the quantitative aspect. Its main distinctive features are radically changed methods of mass work, the shift of the center of gravity to a preventive basis, and the involvement of the broadest working masses in the promotion of public oral hygiene and dental care.

Legislation in the fight against dental diseases. In one form or another, in all civilized countries, including the USSR, certain legislative measures have been established to combat dental diseases. The latter bear a distinct imprint of the political-economic structure of each particular country. In highly developed capitalist countries (in the USA, England, France, Germany with its private practice), civil law, regulating material-legal relations between individual specialists, between them and their exploited auxiliary personnel, as well as between dentists and the patients they serve, occupies a very prominent place in legislation. The laws concern the right to practice, the transfer of practice by sale to another person, the size of fees, etc. But they also concern material compensation for harm caused to a patient in the treatment of dental diseases due to negligence, for improper performance of work (for example, placing crowns or bridges on unsuitable roots, premature prosthetics before final healing of extraction wounds, etc.). These civil laws are particularly detailed in Germany. These laws, such as the Prussian law on dental fees (die Preuss. Gebührenordnung) of 9/IX 1920, are extremely contradictory and leave endless loopholes for their circumvention. As for issues of criminal law in dentistry, they are quite uniform in all countries. They concern bodily injury, including with fatal outcome, due to negligence or insufficient scientific qualification, violation of medical confidentiality, fraud, illegal appropriation of medical title, criminal forms of advertising and competition, etc. In connection with the high development of industry, as well as corresponding social legislation, Germany has established very detailed legislative measures concerning damage to the body, specifically teeth and oral cavity, by various poisons, including professional poisoning. The law provides for the participation of dentists in medical examination and the question of the role and significance of odontology in forensic medicine is detailed. In Germany, laws concerning social dentistry as part of social hygiene and medicine are very detailed. In connection with the growing network of dental institutions, sick funds, and other forms of relations between dentists and social insurance, Germany has established very precise standards for the provision of all types of dental care to various groups of insured persons. As for legislative measures to combat dental diseases in the USSR, they in their general part are entirely included in the general legislation on the protection of workers' health in full accordance with the equal status of odontology with all other medical disciplines. Special laws have been issued in the form of circulars and decrees of the People's Commissariat of Health. Both types of decrees fully correspond to the planned tasks of improving workers' health, with precise accounting of our material resources, availability of personnel, and the social value of one or another production group. In this sense, legislation in the fight against dental diseases in the USSR has a distinctly class character of preferential service for the insured. The most important special circulars of the People's Commissariat of Health on combating dental diseases are as follows. 1. Circular of 10/IX 1923 No. 20 ('On measures to improve dental care'). In this circular, the above-mentioned principle of preferential service for the insured is emphasized, but at the same time the center of gravity is shifted to serving the rising proletarian generation, from which future insured personnel are recruited. Here are also outlined the basic organizational forms of dental institutions, their mandatory connection with general medical institutions, the basic methods of Soviet dentistry, consisting in shifting the center of gravity of the entire fight against dental diseases to prevention, in which systematic sanitation of children's oral cavity occupies a central place. In addition, the circular provides for forms of service for the rural population and the organization of dental prosthetic help for the insured and other population both on free and on a commercial basis. 2. Circular of 2/IV 1925 No. 72 deepens and specifies preventive tasks, extending the preventive principle to all without exception dental institutions, with special emphasis on the need for sanitation of the oral cavity of workers in harmful industries. This circular establishes a mandatory preventive minimum for each dental clinic of 8-10 fillings per day; special days or hours for preventive work are introduced, etc. 3. A special detailed instruction was issued in 1923 to combat caries of teeth among school-age children with the aim of systematic sanitation of their oral cavity according to the system of Professor Kantorovich. 4. Circular of the People's Commissariat of Health of 19/X 1925 No. 205 on dental prosthetic help for the insured, containing norms for the supply of free prostheses to insured persons upon loss of a certain number of teeth. The circular also regulates the release of gold for free prosthetics. Complex (jaw) prosthetics according to the circular is performed for insured persons free of charge in cases of jaw trauma, malignant tumors, sinusitis, etc. Circular of 12/IX 1926 No. 101 regulates dental prosthetic help for military personnel on equal terms with the insured.

The degree of development of dentistry is indicated by the following most characteristic figures (see table on the next page). According to this table, the number of artificial teeth manufactured in the RSFSR during the three-year period 1924-26 increased by 169.2%, with the most intensive growth noted in the North Caucasus, where it amounted to 166.8%, and especially in Leningrad, where an unprecedented leap of 462.5% occurred. For 1927, there are no detailed reports on dentistry, although individual data indicate further growth. However, the tables above do not reflect the entire picture of the development of state dental care in the RSFSR. They do not include figures from state dental institutions serving transportation routes, the Red Army, places of detention, resorts, as well as scientific institutes, odontological departments of medical institutions, etc. Transportation in the RSFSR was served in 1924 by 431 dentists, and in 1926 by 750 dentists. If we also include dentists serving the Red Army and other mentioned organizations and departments, then the current number of dentists on state service in the RSFSR will exceed 4,600 people. There are no exact data on the state of state dental care in the union republics, except for Ukraine, where by the end of 1927 state dental care was provided as follows. Dental care: District cities 53, Other populated areas 790, Number of dental offices 43, Dental prosthetic clinics 469, Dentists 11. The total number of dentists on service by the end of 1927 in Ukraine was 1,299 people. Together with other union republics, the total number of dentists on service can be expressed as a round figure of 2,000 people. Thus, the total number of dentists on state service in the USSR by the end of 1927 amounted to about 6,500 people, i.e., it exceeded the number of all dentists practicing before the war, which included dentists from Poland, Finland, Latvia, Estonia, Lithuania, and Bessarabia. This number does not include the reserve of dentists not yet involved in state service. To understand the entire picture of the development of state dentistry in the USSR, one cannot limit oneself to an analysis of the quantitative aspect. Its main distinctive features are radically changed methods of mass work, the shift of the center of gravity to a preventive basis, and the involvement of the broadest working masses in the promotion of public oral hygiene and dental care. Legislation in the fight against dental diseases. In one form or another, in all civilized countries, including the USSR, certain legislative measures have been established to combat dental diseases. The latter bear a distinct imprint of the political-economic structure of each particular country. In highly developed capitalist countries (in the USA, England, France, Germany with its private practice), civil law, regulating material-legal relations between individual specialists, between them and their exploited auxiliary personnel, as well as between dentists and the patients they serve, occupies a very prominent place in legislation. The laws concern the right to practice, the transfer of practice by sale to another person, the size of fees, etc. But they also concern material compensation for harm caused to a patient in the treatment of dental diseases due to negligence, for improper performance of work (for example, placing crowns or bridges on unsuitable roots, premature prosthetics before final healing of extraction wounds, etc.). These civil laws are particularly detailed in Germany. These laws, such as the Prussian law on dental fees (die Preuss. Gebührenordnung) of 9/IX 1920, are extremely contradictory and leave endless loopholes for their circumvention. As for issues of criminal law in dentistry, they are quite uniform in all countries. They concern bodily injury, including with fatal outcome, due to negligence or insufficient scientific qualification, violation of medical confidentiality, fraud, illegal appropriation of medical title, criminal forms of advertising and competition, etc. In connection with the high development of industry, as well as corresponding social legislation, Germany has established very detailed legislative measures concerning damage to the body, specifically teeth and oral cavity, by various poisons, including professional poisoning. The law provides for the participation of dentists in medical examination and the question of the role and significance of odontology in forensic medicine is detailed. In Germany, laws concerning social dentistry as part of social hygiene and medicine are very detailed. In connection with the growing network of dental institutions, sick funds, and other forms of relations between dentists and social insurance, Germany has established very precise standards for the provision of all types of dental care to various groups of insured persons. As for legislative measures to combat dental diseases in the USSR, they in their general part are entirely included in the general legislation on the protection of workers' health in full accordance with the equal status of odontology with all other medical disciplines. Special laws have been issued in the form of circulars and decrees of the People's Commissariat of Health. Both types of decrees fully correspond to the planned tasks of improving workers' health, with precise accounting of our material resources, availability of personnel, and the social value of one or another production group. In this sense, legislation in the fight against dental diseases in the USSR has a distinctly class character of preferential service for the insured. The most important special circulars of the People's Commissariat of Health on combating dental diseases are as follows. 1. Circular of 10/IX 1923 No. 20 ('On measures to improve dental care'). In this circular, the above-mentioned principle of preferential service for the insured is emphasized, but at the same time the center of gravity is shifted to serving the rising proletarian generation, from which future insured personnel are recruited. Here are also outlined the basic organizational forms of dental institutions, their mandatory connection with general medical institutions, the basic methods of Soviet dentistry, consisting in shifting the center of gravity of the entire fight against dental diseases to prevention, in which systematic sanitation of children's oral cavity occupies a central place. In addition, the circular provides for forms of service for the rural population and the organization of dental prosthetic help for the insured and other population both on free and on a commercial basis. 2. Circular of 2/IV 1925 No. 72 deepens and specifies preventive tasks, extending the preventive principle to all without exception dental institutions, with special emphasis on the need for sanitation of the oral cavity of workers in harmful industries. This circular establishes a mandatory preventive minimum for each dental clinic of 8-10 fillings per day; special days or hours for preventive work are introduced, etc. 3. A special detailed instruction was issued in 1923 to combat caries of teeth among school-age children with the aim of systematic sanitation of their oral cavity according to the system of Professor Kantorovich. 4. Circular of the People's Commissariat of Health of 19/X 1925 No. 205 on dental prosthetic help for the insured, containing norms for the supply of free prostheses to insured persons upon loss of a certain number of teeth. The circular also regulates the release of gold for free prosthetics. Complex (jaw) prosthetics according to the circular is performed for insured persons free of charge in cases of jaw trauma, malignant tumors, sinusitis, etc. Circular of 12/IX 1926 No. 101 regulates dental prosthetic help for military personnel on equal terms with the insured.