courage dental schools to teach prevention and to establish departments of preventive dentistry. However, when the division’s funding was later eliminated, virtually all of the participating dental schools either eliminated these departments or collapsed them into others.1

In the 1960s, the federal government also sought to improve access to oral health care through expansions and innovations in the oral health workforce. For example, the Health Professions Educational Assistance Act of 1963 provided the first federal support for dental education (Diefenbach, 1969).2 The act (and later amendments) improved the financial base of existing dental schools, initiated new school construction, and sought to produce nearly 1,000 additional dental graduates within only a few years. In addition, the Health Manpower Act of 1968 provided even more funding to improve and expand training programs under Title VII of the Public Health Service Act.3

At this time, DHEW began to estimate the status of the dental workforce as part of its estimation of the health workforce (NCHS, 1968). DHEW was also actively involved in promoting workforce innovations (e.g., the use of nondentist personnel) such as dental auxiliary utilization, otherwise known as four-handed dentistry, and dental school-based training in expanded auxiliary management (TEAM) programs (Gladstone and Garcia, 2007; Johnson, 1969). These educational initiatives were designed to spur the adoption of team care in dentistry, with each member of the dental team working up to the capacity of his or her training, in order to provide more care at less cost. The Indian Health Service embraced the team care concept and demonstrated the effectiveness and efficiency of dental assistants in expanded functions in several sites, then expanded their utilization wherever it was practical (Abramowitz and Berg, 1973). In addition, an early innovation to integrate dental and nondental health care professionals is noted in the creation of craniofacial teams—in 1962, the National Institute for Dental Research funded the first multidisciplinary study of cleft palate at the University of Pittsburgh Health Center (NIH, 2010).

In an article appearing in the June 1969 issue of the American Journal of Public Health and the Nation’s Health, Dr. Viron Diefenbach, then director of the Division of Dental Health of the Public Health Service, asserted that the 1960s would be remembered as a time of astounding scientific advances, and also one in which public policy began to address the striking inequalities in access to health care (Diefenbach, 1969). Specifically, he

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1 Personal Communication, A. Horowitz, University of Maryland, September 14, 2010.

2 Health Professions Educational Assistance Act of 1963, Public Law 129, 88th Cong., 1st sess. (September 24, 1963).

3 Health Manpower Act of 1968, Public Law 490, 90th Cong., 2d sess. (August 16, 1968).



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