She’s
never drilled into a throbbing molar,
but Dr. Lois Kushner Cohen CW’60 holds honorary membership in the American
Dental Association. Forty years ago she helped pioneer a field that has
contributed greatly to oral and craniofacial health: the sociology of
dentistry.
Now
the associate director for international health at the National Institute
of Dental Craniofacial Research—which is part of the National Institutes
of Health—Cohen began her career gathering data about how social, cultural
and economic factors shape the delivery of dental care and disease development.
When
Cohen graduated with a bachelor’s degree in sociology from Penn and a
Ph.D. in sociology from Purdue University, many government agencies were
recruiting social scientists to evaluate public programs. She was recruited
as a sociologist by the federal government’s Public Health Service into
their Division of Dental Health.
One
of the first issues she studied in the 1960s was the reluctance of dentists
to screen patients for oral cancers. She found that dentists at that time
felt inadequately trained to detect these cancers. “They were not trained
to deal with soft-tissue diseases and the prospects of life-threatening
conditions, so it was not in their mindset to look for these diseases.”
Cohen’s findings shed light on the potential for improving the curriculum
of dental schools. She also researched community reluctance to accept
water fluoridation, providing information for the design of more effective
public-awareness campaigns which could address the public’s fears and
reach community decision-makers.
“It
wasn’t easy being a Ph.D. (or a woman in a man’s field) in a world of
dentists,” Cohen says, “but they could accept me perhaps, because I had
a unique set of skills which were not so available at the time among the
dental community.” The Public Health Service developed graduate training
programs to teach dentists how to become social scientists. She adds that,
“We’re just now observing women enter into the dental profession in greater
numbers. Gradually these women will have an impact on the profession itself
as well as the services which the profession can deliver.”
Today
Cohen helps the NIH, which supports biomedical and behavioral research
of all kinds to “globalize its portfolio” of dental and craniofacial research
investments, ensuring that internationally networked teams of investigators
are addressing research questions which require international collaboration.
Her work took her recently to the World Dental Congress in Paris as well
as the International Conference for Health Research for Development in
Bangkok.
Many
developing countries in which the major diseases are prevalent do not
have a scientific workforce to address these problems on their own, Cohen
says. Some of those diseases “quite honestly, can cross borders and be
transported by airplanes to other countries, such as our own. Many of
these issues are of global concern and require the expertise of the global
scientific community.”
Take
noma, or oral gangrene, for example, an infectious disease which often
attacks the face, then kills its victims. It mainly strikes malnourished
children who live in unsanitary environments. Most cases are found in
Africa, but some cases have been observed in the United States, as well.
To
better understand oral cancers as well as cleft lip and cleft palate,
researchers need to analyze caseloads in places such as Southeast Asia,
where those conditions are more prevalent.
As
people consume more bottled water, which often contains no fluoride, Cohen
has become concerned with finding the optimal ways to deliver fluoride
to prevent dental decay. Studying fluoride-delivery “vehicles”—such as
milk and salt—in selected other countries may shed light on this problem,
she says.
In
the late 1960s Cohen worked with the World Health Organization and other
countries to conduct two international studies comparing the “effectiveness
and efficiencies” of different oral health-care systems. But as far as
having a national dental health-care program which covers everyone, she
says, “I’m afraid we’re still as far away as national health care.”
Though
oral health has improved tremendously in this country over the past several
decades, Cohen says, the Surgeon General’s 2000 Report on Oral Health
reveals “an increasing disparity between those who have utilized dental
services and have good oral health, and those who have not. Our objectives
for the nation are really focused on reducing those health inequalities.
“The
exciting news,” Cohen says, “is that it is becoming more apparent to the
scientific and health communities, and subsequently to the general public,
that the mouth is indeed part of the human body.” Organisms that enter
the mouth can travel throughout the body, and may be linked to cardiovascular
diseases, stroke and diabetes. Conversely, she says, systemic diseases
may have “oral manifestations which might serve as useful clinical indicators
of pathologies hidden elsewhere in the body. The mouth is a mirror of
health, and that is a concept today.”