Extracting Data on Dentistry

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.”

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