Trendley Dean as the first dental research scientist (NIH, 2010). Dr. Dean examined the epidemiology of communities that presented with “mottled enamel” (i.e., fluorosis), but further research also suggested a benefit from fluoride in community drinking water on the prevalence of tooth decay. In 1944, a Dental Health Section was established for the first time within the Department of Health, Education, and Welfare (DHEW), predecessor to the modern-day HHS, under the Bureau of State Services, predecessor to the today’s Health Resources and Services Administration (HRSA) (National Archives, 2010). In 1945, Grand Rapids, Michigan, with the support of Dr. Dean and the NIH, became the first city in the world to add a controlled level of fluoride to its community water supply (NIDCR, 2010f). On June 24, 1948, President Harry Truman signed Public Law 80-755, the National Dental Research Act, and thereby created the National Institute for Dental Research, predecessor to the current National Institute for Dental and Craniofacial Research (NIDCR), as well as the National Advisory Dental Research Council (NIH, 2010). By 1950, the results of the first 5 years of the Grand Rapids study confirmed that optimal water fluoridation was a safe, effective, and economical method for helping to prevent dental caries, and the Public Health Service adopted a policy of encouraging community water fluoridation (Lennon, 2006).

The 1960s

Strengthened by the success of the water fluoridation studies, by the mid-1960s, oral health care’s position in the federal bureaucracy expanded when a Division of Dental Health (later called Division of Dentistry) was established within DHEW. Its director served as dental advisor to President Johnson’s Office of Economic Opportunity, the agency responsible for administering programs such as Head Start (Diefenbach, 1969). The division administered a variety of programs centered on dental education, the dental workforce, dental caries prevention, and the use of fluorides. The work of the Division of Dental Health might be considered the first major oral health “initiative” conducted by the federal government.

At this time, programs such as Head Start discovered that oral health care was one of the services most requested by impoverished families (Diefenbach, 1969). Social Security Amendments of 1965 and 1967 required the inclusion of dental care in its program and also allowed for the development of special projects aimed at the oral health of children (Coker, 1969). At the same time, the advancing scientific understanding that tooth decay and periodontal disease are bacterial infections that can be controlled through preventive measures brought a growing sense of optimism that the prevalence of these conditions could be radically reduced over time. Through funding incentives, the Division of Dental Health sought to en-



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