clothing both for the elementary and secondary school levels and for boys and girls. Table 12 gives the percentages of cities reporting each type of practice.

Table 12.-Percent of school systems reporting_varying extents to which clothing is removed during a medical examination

Clothing is removed more extensively during the medical examination of elementary school boys than for any other group. The combined percentages for "stripped to the waist," "shoes and stockings removed and stripped to waist," and "entirely stripped," are as follows: elementary school boys, 50.9 percent; elementary school girls, 42.5 percent; secondary school boys, 45.0 percent; and secondary school girls, 33.7 percent.

The large cities more frequently have policies on the matter of removal of clothing during examinations than do small cities. These cities also practice more complete removal of clothing than do the smaller cities.

As regards "no set school policy" in relation to the removal of clothing during a medical examination, the percentages are: elementary school boys, 34.4 percent; elementary school girls, 37.4 percent; secondary school boys, 44.9 percent; and secondary school girls, 46.7 percent.

Teacher Referral of Children with Suspected Defects or Health Problems

Information on the extent and type of established methods whereby teachers may refer children with suspected defects or health problems are here presented. Table 13 and table 26 supply information on this topic.

Most school systems in the United States report some type of referral method. Many report more than one method. The percentages are as follows: "to school health service," 85.3 percent; "through family to family physician," 42.4 percent; and "to others." 5.2 percent.

Table 13.-Percent of school systems reporting various established methods whereby teachers may refer children with suspected defects or health problems

By city groups, corresponding percentages range for "to school health service" from 95.2 percent for Group I to 81.8 percent for Group IV; for "through family to family physician" from 47.4 percent for Group II to 41.5 percent for Group IV; and "to others" from 7.6 percent for Group II to 4.1 percent for Group III.

By regions, referral "to school health service" ranges from 96.0 percent in New England to 77.2 percent in West South Central. Referral "through family to family physician" ranges from 54.7 percent for South Atlantic to 31.3 percent for Mountain. Referral by "other methods" varies from 16.0 percent for Pacific to 0.0 for Middle Atlantic.

The Dental Examination

The dental health examination is considered to be a regular part of the school health service program. Information is here presented on the following related topics: the number of dental examinations required of each pupil; individuals making the dental examination; the followthrough by the school and the dentist; community methods of providing needed dental care for those who cannot afford to pay for such services; and services through which sodium fluoride treatment of the teeth can be obtained.

Number of Dental Examinations Per Pupil

A summary of the number of dental examinations required of each pupil enrolled in school, including preschool, is presented in table 14. More detailed information is shown in table 27.

Table 14.-Percent of school systems reporting varying numbers of dental examinations required of each pupil enrolled in school, including preschool

The cities in Group IV represent a 50 percent sampling. Therefore, in order to weight Group IV correctly when computing the percentages in totals for "United States," the number of cities in each column of Group IV has first been doubled. This procedure has also been followed with other tables related to the second questionnaire when determining the final percentages for geographical regions and for the United States.

United States. The number of dental examinations required of each pupil while enrolled at school was reported as follows: no examination, 41.1 percent; 1 examination, 8.1 percent; 2 examinations, 2.9 percent; 3-4 examinations, 10.3 percent; 5-6 examinations, 14.1 percent; 7-8 examinations, 6.2 percent; 9-10 examinations, 2.6 percent; 11-12 examinations, 13.2 percent; and 13-14 examinations, 1.5 percent.

Nearly 25 percent of the school systems require seven or more dental examinations, which means that these examinations are being given annually in many of these cities.

There were 616 school systems which indicated that they did not make dental examinations of each pupil. Information was requested from these systems as to whether provisions are made by the school for the dental inspection of those children not examined by a private dentist. "Yes" was checked by 40.7 percent. The percentages by groups are: Group 1, 65.2 percent; Group II, 42.8 percent; Group III, 44.4; and Group IV, 35.1.

City population groups. The rank for the plans most often reported is as follows:

Group I.-11-12 examinations, 17.8 percent; 3-4 examinations, 14.3 percent; 5-6 examinations, 16.7 percent; and 7-8 examinations, 13.1 percent. Group I ranked lowest in the percentage of "no" dental examinations with 27.4 percent of the cities so reporting.

Group II.-5-6 examinations, 15.7 percent; 3-4 examinations, 14.2 percent; 11-12 examinations, 13.7 percent; and 7-8 examinations, 7.1 percent. About one-third (32.7 percent) of the cities reported "no" required dental examinations.

Group III.-5-6 examinations, 16.7 percent; 9-10 examinations, 29.0 percent; 11-12 examinations, 15.8 percent; and 7-8 examinations, 9.2 percent. Slightly over one-third (36.4 percent) of the cities in this group do not require dental examinations of all pupils.

Group IV.-5-6 examinations, 12.7 percent; 11-12 examinations, 11.9 percent; 1 examination, 10.2 percent; and 3-4 examinations, 10.0 percent. Nearly one-half (45.1 percent) of the cities do not require a dental examination.

Regions.-Middle Atlantic with 90.6 percent has the highest percentage of cities requiring one or more dental examinations and New England is second with 63.6 percent. The lowest numbers are reported by Pacific with 42.3 percent and Mountain with 34.8 percent.

Information in regard to the number of examinations ranking highest in each region is as follows: New England, Middle Atlantic, and West North Central, 11-12 examinations; East North Central, East South Central, and Mountain, 3-4 examinations; and South Atlantic, West South Central, and Pacific, 1 examination.

Personnel Who Make School Dental
Examinations

Consideration is here given to the personnel who make school dental examinations in those school systems which reported having such examinations. A summary of this topic is presented in table 15. Similar information by regions and city groups is given in table 28 on page 56.

In the 950 cities reporting that they provide for dental examinations of each pupil, the examinations are made by various individuals, expressed in percent, as follows: dentists, 89.2 percent; dental hygienists, 25.7; and others, 68.9 percent.

School doctors and nurses are those most frequently mentioned under "others". Also mentioned are: family doctor, State dentist, health teacher, health commissioner, county health officer, and summer clinic. Table 15.-Percent of school systems reporting personnel, by type, who make school dental examinations

NOTE.-Many school systems reported more than one type of personnel.

The cities in Group IV represent a 50 percent sampling. Therefore, in order to weight Group IV correctly when computing the percentages in totals for "United States," the number of cities in each column of Group IV has first been doubled. This procedure has also been followed with other tables related to the second questionnaire when determining the final percentages for geographical regions and for the United States.

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Extent of Follow-Through by School in
Regard to Dental Supervision

It is also essential that, in addition to making dental examinations, there be plans for follow-through by the school to see that children obtain dental supervision and care following the examination, or independently of the examination.

The schools were asked to indicate (1) the extent to which they carry out such a follow-through to see that the children visit a dentist at least once annually for dental supervision and care, and (2) the extent to which a report is made to the school by the dentist of such visits. The summaries to these two questions are shown in table 16. The information by groups and regions is given in table 29 on pages 57 and 58.

Table 16.-Percent of school systems reporting varying extents of followthrough by the school to see that children obtain dental supervision and

The follow-through to obtain dental care. There were 1,123 cities, or 69.3 percent, which reported a follow-through by the school to see that the children visit a dentist at least once annually for dental supervision and care. This information is further analyzed as follows:

United States: Data in regard to those reporting this procedure shows: "regularly," 47.5 percent; "occasionally," 21.8 percent; and “no provision," 30.7 percent.

City groups: The range by city groups for those reporting "regularly" is from 79.8 percent for Group I to 40.3 percent for Group IV. For "occasionally," the range is from 13.1 percent for Group I to 23.7 percent for Group IV. For "no provision," the range is from 7.1 percent for Group I to 36.0 for Group IV.

Regions: The two regions having the highest percentages of cities reporting "regularly" are Middle Atlantic with 70.7 percent and West North Central with 59.4 percent. The two regions with the lowest percentages are: West South Central with 28.1 percent and Mountain with