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“What is the Matter with Dentistry in St. Louis?” by Clarence O. Simpson, 1916

Clarence O. Simpson was a prominent dentist, educator, and author in the fields of radiography and diagnosis in the first half of the 20th century.  Born in Hindsboro, Illinois in 1879, Simpson was graduated from the Chicago College of Dental Surgery in 1902.  He then entered Barnes Medical College in St. Louis, Missouri, where he received his medical degree in 1906.  From 1903 to 1916 Simpson was professor of Dental Anatomy, Histology, and Operative Dentistry at Barnes Medical College; he later served as professor of Radiodontia at the Washington University School of Dentistry from 1926 to 1936.  Simpson served as president of the St. Louis Society of Dental Science in 1910, president of the St. Louis Dental Society in 1918, and president of the Missouri State Dental Association in 1923-24.  This paper was first read before the St. Louis Dental Society on October 12, 1915.  It was then reprinted, with the responses from other prominent St. Louis dentists, in the March 1916 issue of the Dental Review.

by Clarence O. Simpson, M.D., D.D.S., St. Louis, Mo.

In the discussion of this subject there is no intention to maliciously criticize or to gratify personal grievances, but rather to crystallize, present and analyze some complaints of the factors which seem to be impeding the progress of dentistry in this city, hoping benefit may be derived from the vivisection.  The essayist claims no superiority, freely admits his deficiencies, and the only motive is to assist in making the practice of dentistry in St. Louis more attractive, efficient and remunerative.

Believing a straight line is the shortest distance to any point and a deep incision is required to remove a malignant growth, facts are stated plainly without evasion or palliation.  Conditions and procedures, not individuals, are considered, and while certain characters may be suggested to you by the text, perhaps the other fellows are thinking of you.  Many of the accusations apply to dentistry everywhere, but more forcibly here, where we are familiar with conditions and interested in correcting the evils.  It is believed half of this audience will admit the truth of the arraignment, and for the other half – the hind quarters – they are the butt of the remarks.

The paper is designed only as a preliminary outline of the indictment, the battery of specially engaged and prepared talent who will discuss the paper are expected to furnish the evidence upon which to base your conclusions.  Through conservatism, local pride, or personal interests which are not conducive to the general welfare of the profession, some of them may disagree with the fundamental idea and many details of the paper.

To logically ask what is the matter with dentistry in St. Louis, proof should be presented that something is the matter.  In the earlier history of dentistry St. Louis claimed men such as Black, McKellops, Judd, Forbes, Eames, Spalding, Keith, and Park, men of wide reputation whose names are prominent in the pioneer days of the profession.  How many names would a real honest-to-goodness “who’s who” in dentistry give St. Louis today?  We have men whose ability, ideals and operations are rarely excelled; but they are so modest, lazy, or overworked that they exist in selfish obscurity.  They do not clinic, write, or attend society meetings, and are doing nothing for the advancement of dentistry except in the limited sphere of their practice.  The proper application of their talent and influence would improve local conditions, and their reticence is a greater detriment than the misdeeds of those less capable.  This policy long retarded the development of dentistry, and were it not for the many notable exceptions who have labored unselfishly, it would be fifty years behind its present state.  Another class, many of whom deserve a “call,” is our imposing array of ex-presidents, who after having been honored by the society retire to the seclusion of the Altenheim.  After soliciting members, cajoling their committees, “salving” their secretary, and having a “glad hand” for everyone to promote the success of their administration, at the time when their experience would be most valuable, they disappear from the haunts of men as completely as Charlie Ross or a defeated candidate on the prohibition ticket.

A list of authorities on dental subjects, or even contributors to the current literature, shows lamentably few local contemporaries.  At the last four meetings of the National Dental Association and the fiftieth anniversary of the Illinois State Dental Society, which were the most important meetings during this period, 191 Chicago men have been on the programs as clinicians, not including 240 in the progressive clinic at the anniversary meeting, most of whom were from Chicago, which would bring the total to 431.  New York, more than 800 miles from all these meetings, except one, has supplied 75; Cleveland, 58; New Orleans, over a thousand miles away, has given 11; Atlanta, almost as far, 21; while the following cities, having no advantage in location and not ranking in importance with St. Louis: Kansas City, 34; Milwaukee, 28; Buffalo, 24; Detroit, 22; offer an unfavorable contrast to the 42 from a city of the size and geographical position of St. Louis.

In regard to essayists and discussers on the literary programs the comparison is less gratifying: Chicago, 60; New York, 40; Philadelphia, 30; Kansas City, 23; San Francisco, 22; Cleveland, 21; Boston, 17; Atlanta, 16; Cincinnati, 15; Detroit, 10; and down the list until St. Louis, with but seven, is reached.  This must be some indication of the demand for, and the participation in the important meetings of the country by, St. Louis dentists; since no better manifestation of interest and co-operation in the development of the profession can be determined than the active participation in society meetings.

In the investigation of society work the following statistics compiled from correspondence with the respective secretaries show the record of this society in comparison with that of other cities:

Society and City
Dentists in City
Members in Society
Average Attendance
Other Societies
Chicago Dental Society, Chicago
Five branches with average attendance of 75. Several study clubs.
First Dist. Dental Society, New York
Allied council, 350 members. Bronx County, 70 members.
Academy of Stomatology, Philadelphia
Four other societies.
Second Dist. Dental Society, Brooklyn
Kings County Society, 250 members. Last year had study clubs of 25 each in bacteriology, root canal work, and pyorrhea.
First Dist. Dental Society, Detroit
No record of other societies.
Odontological Society, Pittsburgh
Pittsburgh Dental Club, 75 members. Post-Graduate Study Club, 125 members.
San Francisco Dist. Society, San Francisco
One other society of 50 members.
Cleveland Dental Society, Cleveland
Fraternity Study Club, 30 members. Round Table Study Club, 15 members.
Cincinnati Dental Society, Cincinnati
Another society, 25 members.
Milwaukee Dental Society, Milwaukee
Three other societies of 20 to 30 each.
Kansas City Dental Society, Kansas City
Two study clubs of 20 each.
Kings County Dental Society, Seattle
Seattle Dental Study Club, 13 members. Washington Dental Study Club, 12 members. Puget Sound Dental Study Club, 12 members.
Denver Dental Association, Denver
Farrell Study Club, 25 members.
Rochester Dental Society, Rochester
Study Club, 15 members.

The meetings of this society and the Missouri State Association too rarely produce essayists from their own membership.  To arouse interest it has been considered essential to obtain outside talent, and when local men have been on the program they have not been accorded the deserved attention or deference.  This arises partly from the fact that the men may not have the prestige from original work or have not given sufficient study to the subject to demand respect, but more from the attitude of the members who are prone to depreciate such efforts and either do not attend, or listen with a spirit of criticism and ridicule.  This not only minimizes the effectiveness, but discourages subsequent attempts.

A marked contrast is offered by some city and state societies whose policy of developing material within their society makes it unnecessary for them to seek elsewhere for talent.  The basis of this plan is encouragement, co-operation and appreciation of their fellow-members by inviting them to contribute to the program, and these men, esteeming the expression of confidence in them, freely expend the time and labor required to prepare something worth while.  When the matter is presented it is usually praise-worthy, but whether it is or not, it receives the highest commendation, both loud and long.  The result is stimulation to additional and greater achievements for the individual, an auto-induced elation and satisfaction to the members of the society and the general spreading of an impression, that these men are doing big things, and these societies are extremely fortunate in having such men; while other societies afflicted with hypermetropia such as ours are trying to secure the services of some of these artificially grown luminaries to enhance their meetings.

A personal acquaintance during the past fifteen years with some of the present crop of scintillating dignitaries whose names are a fetish in dental circles impels the conclusion that they attained their “perch on the peg” by lifting on their boot straps, while the real source of energy was a vigorous pull on the trouser-seat by the “home guard.”  This criticism does not apply to the many men who through exceptional ability and diligence merit the reputation they have gained, but is mentioned as an example of what persistent “boosting” and “bazoo blowing” can do.  A marked contrast is the scheme of action in this city, where it is necessary for men to go away from home to find appreciation, and if there should be an echo of applause return it is promptly muffled.  A favorite “wheeze” of some St. Louis dentists when visiting other cities, upon receiving the inquiry, “How is my friend, Dr. Wind, in St. Louis?” is to reply, “I don’t know the gentleman; never heard of him.”  Decidedly clever, but never known to procure you anything here or hereafter.

The advancement in dental practice in the past few years has been remarkable because more varied, earnest, scientific investigation is being directed to dental problems than ever before.  In the past, a few men with the true scientific trend have labored and perfected much which has been assimilated into recognized practice, but now from all quarters new theories are being exploited, new methods proposed, and new products offered.

We have had the introduction and development of the casting process, the most revolutionary innovation in the history of dentistry, the results of ingenuity, experimentation, and study of men whom we are content to crudely imitate.  We have the opportunity to utilize and add to this knowledge, yet the prevailing practice in St. Louis is the use of home-grown casting machines with dependence in Divine Providence and Snow Boy copper cement, which sterilizes while you eat.  We have a new era in pyorrhea treatment with the problems presented in the use of vaccines and the alleged specifics to eradicate the scourge, yet what has St. Louis contributed, except for ammunition?

We have reached, the millennium of painless dentistry, under which shell is the little pea, analgesia, zonatherapy, or conductive anesthesia?  In these St. Louis ranks with the “rankest,” having received “stable information” that this was a practice builder, that there was some easy money waiting to be spent in this game.  Preceded by impressive advance notices, a Nitrous Oxid Wizard came to lead us, Moses-like, into the promised land of prosperity and twilight sleep.  The picture was too alluring to resist, so we sat at the master’s feet to learn the technic of analgesia, hypnotism and salesmanship.  A year later when analgesia had served its purpose for ethical advertising, and like Goldberg, we asked, “What are you going to do with it?” with a presumption rivaling that of J. Rufus Wallingford, a return engagement in conductive anesthesia was played to capacity.  There still remains a course in zonatherapy on which to get a toe hold for those who are not “gun shy.”

Radiography has done more to show up “short order dentistry” than all the cotton root-canal fillings held before the victim’s eye or old bridges held under their nose, yet with all the barber shop operating rooms and sporting house reception rooms, no radiograph equipment has been installed by St. Louis dentists.  Preferring to let sleeping dogs lie so long as they do not lie about us, and with the excuse of “what you don’t know won’t produce insomnia,” we continue to practice “by ear.”  When complications arise which bring to our patients visions of flowers they will never smell and the “pussy-footed” funeral director, we send them out to the professional “flimmer” much as the South Side bride wends her way in an open hack to the photographer.

Prophylaxis or preventive dentistry with the misleading slogan of “a clean tooth never decays” seems the ultimate “why not now?”  There is hardly another city in the country which has not its corps of “white wings” who are helping to keep the city clean where it needs it the most.  In St. Louis we are still “plugging” them, “capping” them, and giving them the “once over” at watch-cleaning rates.  A young man who maintained an office for two years recently closed it for more profitable employment, with the explanation that it required money to practice dentistry, and he was going to make enough to practice another year.  Certainly displaying a commendable love for his profession and confidence in his own ability.

If anyone was sufficiently optimistic, how much capital would be necessary to specialize in prophylaxis in St. Louis, depending upon the profession for support?  But if one had the money, why become as popular as a skunk at a lawn party – open a bank instead.  Imagine the primrose path in prophylactic or pyorrhea work, visualize the collection of junk, the ill-fitting crowns, the “self-collecting” bridges, the “hangover” fillings and the “meat holes” which would appear to thwart one in the herculean task.  The situation calls for diplomacy and magnanimity, treatment cannot conscientiously be instituted under the adverse conditions, nor can the patient be referred back to the dentist with instructions to remove the restorations, which have recently been placed with great pride and eclat.

In prosthesis, one of the most neglected and despised branches of practice, our record is no better.  The improved methods of taking impressions and the anatomical arrangement of teeth have been taught and demonstrated, but seemingly passed overhead in St. Louis.  The mail order laboratories, with their ridiculous price lists, which produce 95 per cent of our artificial dentures, and will construct a fourteen-tooth bridge from a finger print or an artificial leg from a photograph, report their tranquility undisturbed by the advent of a face bow.

We now have dental amalgam manipulation standardized with possibilities in amalgam restorations never before attained, within reach of all who care to acquire and conform to the technic, yet a periscopic reconnoiter shows an unrippled surface of amalgam obsolescence.  The local union, of the Amalgamated Brotherhood of Ball Burnishers, is true to the principles of the adjacent anatomical structures for matrices and cotton pellet finishing.  As for the reproduction of typical occlusal form in restorations, it is so rare that on one occasion when it was attempted the patient returned to have it repaired, saying she thought Dr. Slocum’s inlays were much better because they felt “more slickery” to her tongue.

So we could continue “ad nauseam” on the lack of progress and deficiencies in dentistry.  The colossal egotism and self-deception which permits the majority to dispense their services to the trusting public year after year without the assimilation of a new idea or the adoption of an improved method would be ludicrous were not its effect so extensive and pernicious.

The perfecting of efficiency in industrial lines has been developed by specialization, by having a man or a group of men to make a part or perform a step toward the formation of the finished product, which has resulted in increasing the output, perfecting the detail, and improving the skill of the workmen.  While the practice of dentistry is not analogous to the manufacture of an automobile or the operation of a railroad, in the study of efficiency we may advantageously apply some of the methods which have reached the highest degree of development in these pursuits.  The progress in medicine has resulted from specialization, limiting study and practice to certain branches; surely the practice of dentistry is too complex to secure the best results by individual efforts in general practice.  The varied character of the operations demand versatility rarely found in one man even though all branches were equally attractive to him, which is unusual, and proficiency was attempted in each.

In the development of specialization the dental profession has been notably slow, the men who first attempted to limit their practice to a particular branch encountered much opposition and have never received the support of which they are deserving.  Patients are often discouraged from consulting a specialist and dentists too often accept the exaggerated reports of alleged atrocities at the hands of specialists, which include everything but mayhem and arson, and express disapproval without knowledge of the facts.

Negligence, incompetent diagnosis and advice concerning orthodontic treatment, is so prevalent that the orthodontists are handicapped by the profession at large, with whom they are working in a common cause and from whom they naturally expect active cooperation.  No effort is required to ascertain the accuracy of this statement; evidence of it is obvious.  In families, financially able and desirous of proper care, children with incipient and even advanced cases of malocclusion make periodic visits to the family dentist without attention being called to abnormal conditions.  The family dentist even when questioned too often evades it with the statement that it will probably correct itself, proposes to put on a “brace” to pull the tooth in, or sometimes the forceps to pull the tooth out, and depreciates the value of expert consultation with “Oh, a specialist would charge you a thousand dollars for that work.”  Perhaps he would, and the service would be worth it from any viewpoint, but the cold-blooded statement without the honest, intelligent explanation which should accompany it, is calculated to prevent further interference with his omniscient sway.  It might be interesting but deplorable to know what proportion of orthodontic cases come to the specialist through the influence of the family dentist as compared to those originating from the observation, interest, and inquiry of the laity.

The crown of thorns, which has been the distinguishing characteristic of the exodontist, when examined discloses similar despicable motives and acts.  They have begun a limited practice to a serenade of “cat-calls,” accused of being a failure in general practice, and ridiculed for their presumption.  Instead of being welcomed and encouraged in their commendable endeavor to relieve general practice of this undesirable and unremunerative feature, they have been ignored by many, sent the cases which had baffled the repeated attempts of others, and thankfully received by a few.  Even now, after the specialty is well established, more by the appreciation, advertising, and demands of the public than by the profession, there remains much ill-concealed opposition and disloyalty.

After successful results in extremely difficult and hazardous operations their fees are questioned, not confidentially but publicly, sometimes to the extent of encouraging patients to repudiate them.  If complications which are often unavoidable arise, the general practitioner too often develops a sympathetic and critical pose which has never been a part of his repertoire in his own treatment of patients, and sometimes is the instigator of serious trouble.  Capital punishment should be prescribed in the code of ethics for men who fail to protect the reputation of a specialist to whom they have referred a patient, since some men are amenable to no higher standards of professional conduct than the letter of the law.

The indifferent support given specialists has been justified by complaints of no gain in service and larger fees than the general practitioner has ever obtained, of the arrogant and businesslike methods of specialists, and their lack of cordiality and deference to patients.  A fine line of conversation for a profession which has accomplished so little in impressing the laity with the importance and value of its services.  The average patient is greatly in need of discipline, and since it is evident the invertebrate dentist does not cultivate a dignified demeanor becoming his station, but grovels in the dust at the dictation of his clientele, let us preserve a discreet silence while others do for us what we should have done long ago.  A tactful air of courtesy, affability and gentleness towards patients should never degenerate into the servility of a negro waiter, the haggling of a huckster or the familiarity of back-fence gossip.  The public will never regard our time valuable while we permit it to be wasted in “coffee klatsching,” nor can we ever command respect while we apologize for and explain each procedure, and escort our patients to the elevator or street.

There has been too much shopping and too many family histories narrated by patients and too much time spent by dentists listing their wealthy patients, relating their miraculous achievements, and exploiting some new method or appliance which the patient is led to believe original and exclusively used.  According to authentic reports the cast inlay was invented by numerous local men, nitrous oxid analgesia was featured by others as a personal triumph, silicates were represented as “something new I am using” as recently as this month, emetin treatment has been used almost as much for self-exaltation as pyorrhea, and desensitizing paste (literature and removable labels notwithstanding) was compounded by several local Munchausens who cannot make a good mix of cement.

A monologue by a professional man on the character and quantity of his clientele or how much money he is making, to intelligent people is suggestive of “Abe and Mawruss” in the cloak and suit business or a small boy boasting of his Dad.  A dictograph exchange with connections to the operating rooms of some very dignified and ethics-prating dentists would supply enough material to put, on a night shift of the St. Louis Dental Society’s committee on ethics and “ejection.”

The majority of us are too narrow between the eyes to get a focus on the trend of the times, too engrossed in each of the many diversified operations attempted to get a perspective of the entire denture and the contiguous soft tissues.  We are neither serving the public to the best advantage nor working to our own best interests in trying to “spread eagle” the field, having in no phase of practice attained the proficiency demonstrated by men concentrating their efforts to a limited field.  We are loath to admit anyone knows more about any branch of dentistry or can perform any dental operation better than we.  We are opposed to letting a restless dollar get out of our offices, and advocates of the sentiment, “a bird in the hand gathers no moss,” when it probably would increase our income and enhance our reputation to advise expert consultation for many of the cases we now treat.  Satisfied at being able to attract a crowd, we are blocking traffic with our imitation of a “one-man band,” trying to play all the instruments at once and make enough noise to discourage any solos, but only succeeding in making ourselves ridiculous to those who recognize good music.

While it is the belief of the essayist, that the average character of dental operations performed in this city is inferior to that of other similar communities, it is impossible to substantiate it by evidence, in the absence of which, discussion would be a matter of personal opinion, and futile.  However, the statement that the average character of dental operations performed anywhere is so far below the existing standards of practice that it is a disgrace to the profession, a betrayal of public confidence, and likely to provoke the wrath of God, is made after due deliberation and with proper regard for the gravity of the charge.  The examination of ten or a hundred people chosen at random will convince anyone who is familiar with the possibilities of modern dentistry, or who for comparison cares to apply the requirements as stated in late text books by authorities on the various subjects.

We are constantly advised to extend leniency for mitigating circumstances that judgment be tempered with mercy until a doubt may well arise as to whether the merciful justice is not being imposed upon through a feeling of security from exposure.  Such fervid appeals have been made for mutual protection and unqualified immunity that it has suggested the preparation of a soft spot for the landing of some one who was riding a reputation with gutta-percha inlays and cement tuck pointing.  There is no chance of mistaking the imperfection of operations conscientiously attempted for the careless, dishonest, “easiest way to get by” methods practiced by those deserving little charity.  The time-honored excuses of incorrigible patients and inability to give better service for the fee received, are possible to correct.  The real reasons of not being capable of better operations and having no desire to improve is the vulnerable side where criticism should not be withheld nor censure spared.  On this score St. Louis dentists are criminally negligent; opportunities for gaining knowledge and skill being ignored, ridiculed, and assailed.

Papers of immense practical value have been read before this society to an audience, the size of which would discourage a street faker, or a dog fight, and not composed of the men who were most in need of instruction.  The attendance at meetings is but one phase of our indifference, the study of text-books and the improvement of technic offers even a wider field for development; yet little individual effort has been manifested in St. Louis and no organized groups are striving for the benefits which are being derived from the study, technic and research clubs in other cities.

The only subject which arouses general interest is that of fees or something which seems promising in immediate financial gain.  The record meeting of this society in point of numbers was the disappointed gathering of mysterious strangers who were attracted from their evening hours for a radius of a hundred miles to hear the recent paper by one of the original exploiters of the emetin treatment.  They were disappointed on hearing a conservative scientific review of the subject when they had anticipated inside information on a quick and easy way to commercialize the treatment of pyorrhea.  Dissatisfaction at the low fees is general and a spirit of unrest is evident from the interest manifested, but what of the methods employed to increase them?  A principle of successful commercial advertising is not only attracting attention and making sales, but that the product must have a sound economic value by which the advantage is maintained and the cost of advertising made a profitable investment by a permanent increase in business.

It is a difficult problem to materially increase fees unless the service is correspondingly improved.  A few men have acquired a lucrative practice under favorable circumstances or through exceptional business ability in conducting a “dispensary,” but generally the large fees have been obtained for superior services.  In trying to establish a standard of fees by calculation of investment and cost of production, the incentive for self-development is eliminated and professional service lowered to the plane of a mercantile transaction, in which cost, overhead expense, and a margin of profit determines the selling price.  This is but a small part of the value of dental operations, since it does not, consider the vital factors of efficiency and skill, upon which the quality of the service and its benefits to the patient depends.  This is an objectionable feature of trade unions with a fixed wage scale, which discourages ambition and obliterates individuality, reducing the superior workman to the level of the incompetent.  While it is true dental fees in general are too low, the more intelligent and commendable course of increasing them by acquiring more knowledge and skill, performing better operations and making the service worth more, should be advised.

Dental fees are not regulated by an Interstate Commerce Commission, but have been established by, and are under the absolute control of the profession, who by concerted action could change them at will.  This recalls the characteristic lack of co-operation among dentists in the antagonism displayed toward the men who receive large fees.  These men are vilified at every opportunity by those less successful, who, unable to perceive that every hundred-dollar fee makes the ten-dollar fee easier, tell patients they are overcharged when there is nothing to gain and an inevitable loss.  The valuation placed on a satisfactory service by the producer influences the estimation of that service by the public, and when the despicable detractor “horns in” with disparaging remarks, intended to promote selfish interests and destroy confidence in others, his “pin-head” policy acts as a boomerang.  To discerning people it suggests his inability to duplicate the operation or appreciate its superiority, and exposes his “dollar down and a dollar per week” standing.  Like other prevalent evils, this is hard to eradicate, since those addicted to it are of a mental caliber which cannot comprehend its folly and inconsistency.  The compensating feature, however, is, the successful man is enhanced by the procedure while the envious failure has only increased his difficulties.

Any philanthropically inclined individuals having the laudable desire to supply low-priced dentistry to the indigent should be encouraged, but to people who maintain automobiles, patronize the florist and the caterer, the dentist who “pulls” the bargain counter stuff is being played for an “easy mark.”  Money doesn’t care who has it, and there is no great affinity between wealth and brains.  There are many wealthy families so deficient in refinement, culture, and “class,” that the use of the tooth brush has been discovered simultaneously with the shaking off of the Saturday night bath habit; families who have fallen into a wine income but still retain the “growler” taste.  They deface a harmless street with a residence combining all recognizable styles of architecture with cubist touches, and resembling a hybrid of an eleemosynary institution and a Polish church.  The feminine representatives “doll up” like animated Christmas trees, affect a “gasoline solarium,” put on a few Bradley-Martin balls, and subscribe for a box at the opera; but still believe having teeth cleaned removes the enamel, and attach the same relative importance to having a tooth “fixed” as removing an obstruction from the toilet trap.  So they find the cheapest “tooth plumber” in the neighborhood who puts on another “washer” or “wipes a joint,” at “scab” prices.  These people, with a plebeian love for display, lavish money on the crude extravagances and frivolities; but through ignorance are satisfied with the poorest dental attention and its effect upon their physical welfare.  They would feel disgraced without modish and expensive wearing apparel; while the care given their teeth, which contributes far more to their appearance, places them on a level with those who are dependent upon clinics and can afford nothing in the way of dental repair but the cheapest of necessities.

Our greed and petty jealousies have done more to keep the profession from its just desserts than all other influences combined.  There is a pack of “four-flushing” confidence workers who have “boobed” the dentists in this town for years; preying upon our cupidity and fear to exact businesslike terms, these prosperous appearing male “crooks” and “baby-stare Janes” change their dentists as often as necessary to avoid payment, while we continue to welcome their coming and permit their departure without a warning to others.

If there were more business instinct and unselfish principle in this society we could maintain a credit bureau for the protection of the members, which would brand these “short sports” and “dead-beats.”  The retail merchants, as lenient as they are, in extending credit, have found this compulsory.  The department stores, by encouraging “payments on account,” carrying a continuous balance, advertising “purchases will be charged on next month’s bill,” and physicians who can treat an entire neighborhood and prosper if they collect half, have corrupted the public sense of moral and financial obligation until prompt collection by the dentist is resented.  They feel justified in discounting our bills, or paying small monthly installments with “King’s ex” during the vacation and holiday periods and time out for good behavior or additions to the family.

Our limited capacity, the great expenditure of time, labor and material in production, and the restricted facilities for enforcing payment after the service is rendered, necessitates a stricter credit system in the future; we have the power to dictate terms and are largely to blame for existing abuses.  If we were not so desirous to monopolize practice and get the other fellow’s patients, fees would be higher, collections easier and our prestige greater.

If conditions in St. Louis are not what is expected of the fourth city of the country with the first dental college and the first dental society in the West, dental laws more stringent than the average, and a board of dental examiners which has practically eliminated the advertising faker, what is the explanation?  St. Louis surely offers as good opportunities as other cities; its population is largely composed of middle class people in comfortable circumstances who are popularly supposed, to make a desirable clientele.  It is financially sound, not dependent on one or a few industries, little disturbed by national depressions, and its transient population is insignificant; in fact, it would seem to offer a favorable field in which to establish and conduct a model dental practice.  People of this character should have adequate dental attention and pay commensurate fees, which would result in the highest standards of practice, and prosperity for the dentists.  The local dental supply dealer know, but cannot diplomatically admit, what the manufacturers say without hesitation, that St. Louis is one of the poorest territories in the country for the sale of new appliances and expensive equipment.  The select list of “slow pay” dentists on the books of the two supply houses which have been forced to close during the past few years indicates a woeful lack of either prosperity or honesty in the profession.

Instead of economic reasons, the explanation might be offered that insufficient education of the public along dental lines was responsible for conditions.  It is true educational opportunities in the oral hygiene campaign, dental inspection in the public schools, and free dental infirmaries have not been utilized as in other cities, but how can the public be educated by uneducated dentists?  It is improbable a member of the school board or city council would become very enthusiastic about public dental service from association with his dentist, who had little knowledge of what had been accomplished elsewhere, or could offer no argument for such needs.  A school teacher cannot secure information for classroom instruction from a dentist who is unable to describe the correct manipulation of a tooth brush, and talks of “gooms” and “stomach” teeth.  Parents and children, as they learn the truth, are not likely to acquire a high regard for our calling from one who tells them pyorrhea is caused by salivation, dental caries come from an “acid stomach,” and grinds the occlusal surface and places a crown (?) on every molar attacked by proximal decay.  No; about as favorable prospects exist for producing a hemorrhage from a turnip, as the promotion of public instruction by the average dentist.

If, as has been suggested, dentistry as commonly practiced is greatly inferior to the approved standard, there must be more direct causes than the economic or educational status of the community.  The personnel of the profession would be logically considered as an important factor in establishing the relative proficiency, but personal observation and sentiment do not furnish an exact or impartial basis for judgment.  If there is any deficiency in the technical qualifications and education of dentists, the college which prepared them must assume the responsibility.  This brings the query, why should there be five dental schools in Missouri and fifty in the United States?  Surely, the extensive craving for a career in dentistry, from either a humanitarian or a mercenary inducement, does not warrant their existence, and the inexorable law of supply and demand must apply to dental colleges.  Not necessarily implying that the schools are improperly conducted or the teachers have not conscientiously endeavored to perform their duty, but a dental department cannot be profitably conducted without students and an over-supply of colleges results either in a shortage of students or an unnatural stimulation of the demand.  Instead of being able to select and cull the “rah rah” material, instincts of preservation force the colleges to accept all those who can qualify on the lax and easily evaded entrance requirements.  Graduation from high school is largely a matter of serving time, and does not determine the amount of education assimilated and far less the aptitude of the student for a vocation.  The demand for students to supply the colleges has resulted in a mass of unprepared youth being drawn out of industrial lines, for which they were better suited, into the study of dentistry.  A vast number of so-called dentists are not adapted to the character of the work and have not had the proper preliminary education; with this handicap no system of special training can make them proficient, and the commercialization of dental education has intensified the abuse.

The public is affected most by the lack of skill and scientific attainment in these “misfits,” but the greatest detriment to the profession comes from their deficiencies in character, honor, and ideals.  Axiomatically a silken purse cannot be created from a sow’s auditory appendage, nor can a consummate professional gentleman be developed from a lad whose hereditary characteristics and early environment have preordained him for a chorus man, a porch climber or a hod carrier.

A dental department of a state university, the only dental school in the state, recently dropped thirty men from the freshman class at the end of the first semester.  These men had qualified for entrance, yet were not suitable material for the training they sought, a fact which could be determined in three days, instead of three years.  It is hardly an irrelevant coincidence that the proficiency of the dentists and the standard of dental practice in that state is equaled by few, but if a dean of a St. Louis school should so far betray its interests he would be promptly escorted to the Arsenal Street “resort for deep thinkers.”

Another objectionable tendency in the dental schools is the recruiting of their faculties from their own graduates, which limits progress and the interchange of theories.  Inbreeding will as effectually demoralize a dental college as a kennel, and produce the same results in the progeny.  The rivalry among the local colleges has formed cliques, with more alma mater than “all together” proclivities, but this prejudice is inconspicuous when compared to some of the vendettas which have flourished among us for years.  In fact, the integrity and fidelity of the younger men has been questioned, when they demurred at taking the “bloody oath” of allegiance to the cause and “nursing the grouch” for another generation.

When these personal feuds, “small town” jealousies and selfish interests are fused into a synthetic sentiment of common welfare, local conditions will improve.  If we will discard the overworked hammer and look upon the state seal of Kentucky, with its motto, “United we stand, divided we fall,” our gall bladders will eventually resume their normal size.  When we learn there is no competition in honest, competent dentistry, many of our perplexities, which are only delusions, will dissolve into thin air.  When we begin consistent efforts to increase our knowledge and skill, our daily tasks will become less burdensome, and our failures will blossom into redounding successes.  When we develop unusual proficiency in the department of our greatest aptitude and become sufficiently energized to “break into the big league,” that elusive thing called reputation will come to some of us.

Then, and not until then, will St. Louis cease to be a “whistling post” or a “tank town” in dentistry, and become a Mecca for the pilgrimages of those seeking the miraculous and demanding the utmost.  Long before that time the problem of commensurate compensation will have adjusted itself, and St. Louis will have attained international recognition for the superiority of its achievements in dentistry and the prosperity and culture of its dentists.


•  Discussion of the Paper on “What is the Matter with Dentistry in St. Louis?”


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