THE WAGE-EARNER'S TEETH
By OUR MEDICAL CORRESPONDENT
ALETTER addressed to the Editor of The Spectator has been passed on to me, as raising a question which calls for extended discussion. " Many things in our land which cry out for improvement," says the writer, " are being lost sight of, and one of the most important of these is the people's teeth, which none of our ardent reformers seem to think about at all. They are none the less of vital importance to our race. In this village, which, I have no doubt, is like many others in this respect, the young people start losing their teeth before they are twenty, and it is an exceptional thing to find anyone of forty without false teeth."
All that, unfortunately, is profoundly true, and it is well that attention should thus be drawn to the situation. For though during the last thirty years there has been a great deal of fruitful research into the structure and growth of teeth, the nature of caries or decay, and the effects upon each of such important factors as the vitamin and mineral content of diet, a great deal still remains to be learned. We do not yet know, for example, why children of the same family, brought up on the same, often liberally varied, meals, should in some cases have sound teeth, needing very little attention, and in others a tendency to the appearance of local decay.
Nevertheless, very much can be done by regular and skilful attention ; and a great advance was made towards improving the nation's teeth when dental inspection, often followed by treatment, was instituted in the State and rate-aided schools. This could be endorsed by any doctor whose duty it has been to examine large numbers of young people between the ages of 14 and 16 during the last thirty years. Taken as a whole, their teeth are in far better condition than were those of their predecessors of the last generation.
But the dental position after those ages—at any rate as regards the bulk of the wage-earning population—is gravely less satisfactory, save in a few exceptional groups ; and there is little doubt that a considerable amount of avoidable illness under the headings of dyspepsia, rheumatism and general malaise and lack of fitness is directly or indirectly ascribable to decayed and neglected teeth. For this, various causes are responsible. One of these is the reluctance of a very large number of people—and not only wage-earners—to visit a dentist or dental hospital until absolutely driven to do so by pain or severe illness, by which time it is often too late for the dentist to be able to do more than make extractions and advise the wearing of dentures. This reluctance is often due to the quite erroneous belief that modern conservative dentistry—scaling and filling—is a painful process. On the contrary, it is quite definitely a pain-saving procedure. But it is also, to a very great extent, due to lack of proper local facilities.
For the poorer wage-earner, unless he happens to live in a city where there is a dental school, dental hospital, or a general hospital large enough to possess its own dental department—and there are not very many of these—there are no facilities at all for conservative dental treatment on a hospital basis. It is true that, under the National Health Insurance scheme, workers included in this may belong. to an approved society which provides dental benefits out of its surplus funds. But those funds are often insufficient to meet demands in any one year ; and experience has shown that, e when they are sought and are available, it is too often only to the costs of what is known as end-treatment—the wholesale extra of teeth and the provision of dentures—and this frequently at age when regular conservative attention and treatment might ha kept the majority of the patient's teeth sound.
Nor is it always easy for the wage-earner, even if he can aft the fees—though this could often, no doubt, be done if educa • and foresight had done their work—to find a readily avails dentist, especially in rural districts and smaller industrial toa Here, again, there are various contributory factors to the pr undesirable position. Prior to the Dental Act of 1921 there no Registgr of qualified dentists, as there was of doctors. Since year no dentist can be admitted to the Register unless he has under gone a prescribed course of education and passed certain recogni examinations. All dentists, however, who could in 1921 show they had been in practice for a -certain number of years, admitted to the Register, whether or not they held these qualification Since many of them were men of great skill and experience, was a fair arrangement. But it did mean that there was a v considerable variation, at that time, in the technical education professional standards of existing dentists. And it also meant tha in many areas, there were relatively few dentists who regular practised—or were called upon to practise—conservative treat= to more than a comparatively small extent.
This position has no doubt improved in the last twenty years. Bu the fact still remains that too many young dentists, leaving the schools with considerable skill and keenness, have found themseir in industrial practices where they have had the most restrict opportunities of maintaining their skill and increasing their efficieno They have too often been driven, in their own phrase, to becom little more than denture-mongers. Instead of being a regular reso they have found themselves regarded as a last resort—due not onl to the financial status of their clients, but to a legacy of cast prejudice and apathy.
But, even if it were otherwise, there are probably not enou dentists at present to go round. On the usually calculated basis a clientele attending for regular six-monthly or annual conservativ inspection and treatment, from 1,50o to 2,000 provide full wor for any one dentist. But, at the present moment, according to figur recently quoted in The Lancet, there are only about 14,0oo dentin in the country, of whom fewer than 5,000 are under 4o years of age and the relatively small entry of new students has been giving ca for great anxiety. The reasons suggested for this are the cost dental education—probably a good deal more than that required fa engineering, architecture and various other scientific employmen and to a certain inferiority of social standing at the end of it. would seem to be a curious anomaly that a skilled specialist deal with the nation's teeth should be held in less social regard than on dea'ng with its eyes, ears or throats ; and it is to be hoped that, the inevitable readjustment of social values after the war, th anomaly will disappear.
To this rather gloomy picture there are a few bright exceptions For some years before the war the standard of dentistry in all th three Services was commendably high ; and it is to be expect that many men, when the war is over, will be coming back I civilian life with a new regard for their teeth and what mode dentistry can do for them. The Metropolitan Police Force is al a shining example of what can be done by an adequately equipped dental staff. When this was established at headquarters, a few Years ago, the response—especially among the younger members of the force—was so great that, in spite of rapid additions to the number of dentists, there was a long waiting list of voluntary apnlionts for attention. A few large industrial concerns which had provided dental facilities for their staff had also met with a similar experience' But to solve, from a national point of view, what is an admittedli serious problem, two steps 'would seem to be urgently needed Firstly, measures should be taken to ensure that regular conservative dental treatment is available for everybody at a reasonable cost. partly by means, perhaps, of some contributory scheme ; and thi5
old be accompanied by an educational campaign. The habit of ularly attending the dentist should become as taken-for-granted as ttendance at the barber's. Secondly, every effort should be made °recruit and assist suitable entrants to the dental schools, on the (Rinds that dentistry is a skilled profession of immense value the nation and also a profession in which there is an acute present d prospective shortage. No two measures, taken in conjunction, d probably do more to improve the national health and its Donal aesthetic standards.
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