In Sumnary, essentialiy no dental services are provided outside of tne two urban centers. A traditional lack of fluoride and an increasing consumption of refined sugar has produced an epidemic of dental disease. A systematic program of fluoride application, early detection and treatment, and dietary education is needed to slow down the epidemic. The existing dental Joad staff may be able to handle the additional work through reorganization, but the transportation limitations make this impractical for many atolls. Recommendations 1. Improve the equipment and supplies at Majuro and Ebeye so adequate secondary level dental care is available at each site. 2. Add selected manpower (see section IX) to provide for more effective working ratios. 3. Develop in-service education, either in-nation or abroad, to maintain skills in each area. 4. Incorporate the application, early education assistants dental public detection and into the curriculum and (medex) health functions simple extractions, of fluoride and dietary in-service education for medical and health assistants so these services can be available on outer islands through the regular health network. 2. Physical Therapy The services of a physical therapist are extremely important in the management of some acute and many chronic conditions. As the categories of disease change more and more to that found in industrialized societies with more of the cardiovascular health problems, there is more and more need for physical therapy services. orthopedic disabilities. Services are needed for victims of "stroke" and At the present time there is need of physical therapy for victims of polio with varying degrees of paralysis. and will always be a need for physical injuries to prevent deformity and There is therapy services for traumatic maximize residual function. Many contractures and functional limitations could be eliminated or reduced with appropriate physical therapy begun shortly after injuries or burns. 24