View report page

141
Report of the Medical Officer (Education).
girls were suffering from extensive oral sepsis as the result of the treatment, so that their mouths
were worse than before. There is no branch of dentistry which requires better judgment than the
treatment of school children, but at any age properly sterilized instruments and careful asepsis are
always a necessity. As a hospital house surgeon I have seen a young girl in the early stages of a most
serious constitutional disease beginning in the cheek, and have also removed a large mass of loose and
septic jaw bone with three dead teeth from a middle-aged woman. Both these cases had been
damaged when they had teeth removed some weeks previously by an unqualified operator. Hitherto
no steps have been taken beyond refusing the certificates of unregistered dentists. The time has come
when the Council should issue warnings as to the risks incurred from dentistry at the hands of such
unqualified or untrained persons, of dentists who advertise, or of persons who give themselves out as
makers of artificial teeth without putting forward any pretensions as to dentistry. Suggestions have
been made as to employment for dental treatment of school children of private dentists at their own
surgeries. There would be great difficulty in efficient supervision. The objections better class dentists
would have to the dirty feet of many children in their houses might limit the work to dentists of
inferior professional rank. Friction with parents might occur at the dentists' surgeries and would be
highly objectionable. The general lack of accommodation in the way of waiting rooms or recovery
rooms for large numbers of children might also cause trouble.
Arrangements necessary for a dental centre for treatment of elementary school children ought
not to cost more than £35 a chair for equipment, at the most £50 for a single centre. Laboursaving
devices are required and everything to avoid unnecessary work. There is also a need for
avoidance of red tape and too much clerical work. The German Schulzahnkliniken err in excessively
detailed records and unnecessary forms of all kinds. Their equipment is often very costly, including
expensive mechanical chairs, costly engines, excess of nickel-plating and cut glass. These
things are out of place in elementary school work. For the staff whole-time operators are not desirable.
Whilst here and there an enthusiastic worker might be found they would, as a rule, be unambitious
men who had given up hope of better things, the school work affording no experience of more interesting
work, such as fitting dentures, crowning, or applying bridge work. Dentists are highly paid, assistants
generally obtaining £300 per annum; the rule laid down by the School Dentists' Society of £1 for
a school session is therefore a safe working guide. This corresponds to the salaries of medical inspectors.
It is now possible to outline a scheme for dental provision towards which to work. Centres
for school dentistry will be necessary, costing proportionately less if they can be combined with school
treatment centres; the combination allowing of a greater number of centres and smaller distances to
be travelled. Any charges to the parents means failure in efficiency of the results of the scheme as a
public provision. In London it would be necessary to arrange for a first examination of about 80,000
annually with probably some treatment in 65-70,000 cases. In addition the majority would return
twice or thrice in school life. Dental re-examination in school should take place at the ages 9-10
and 12-13. Allowing for a considerable diminution in cases of caries, through the teaching of
dental hygiene and through the treatment, provision is urgently required for treatment of not less
than 100,000 cases annually, and experience may show that ultimately a considerably greater number
will have to be dealt with.
Ignorance is the chief cause of the neglect of dental hygiene. The removal of this ignorance
precedes any successful work in school. Knowledge may be instilled by talks, lectures, demonstrations,
example, and by affording opportunity and materials for dental care. The first experiments were
sanctioned about three years ago in the deaf schools. The heartiest co-operation was given by the
teachers. Each deaf child has its tooth brush and is taught how to use it. Hard wooden racks
with eye screws are used to put the brushes in, and these are hung outside the building. Toothbrush
drill is taken regularly after dinner. The mouths of the children are much improved, and
this is most noticeable to the teachers who have to instruct the children in speech. The teeth
are also cleaner and the children appear to have realized the need of oral hygiene. The influence
of the school appears also to have extended to the family. The success of this work has led to
its adoption in the schools for the blind, as instruction in personal hygiene is perhaps more wanted
among this class of children than among any others. In the ordinary schools a beginning has been
made in departments in the neighbourhood of centres for dental treatment by lantern lectures to
parents and others. It was found, however, at Barrett-street that without careful school arrangements
for following up the treatment this propaganda was almost in vain (see page 139). Instructions
have been published in the London County Council Gazette for teachers, and a special paragraph
on teeth headed "As good as five shillings a week for life," is in the "Health Hints to Parents,"
which are distributed in large numbers. The ground has to be carefully prepared and the toothbrush
clubs referred to in the last report are a most useful adjunct.
Educational
Propaganda
for Dental
Matters.
Candidates taking up permanent appointments in the school service are examined in the Public
Health department before commencing work. Candidates for scholarships are also required to be
examined before the scholarship is finally awarded. The number of candidates submitting themselves
for a first examination during the year was 6,294. They may be classified according as they are examined
for the permanent service, under special references, or for the award of scholarships.
Examination
of Candidates
.
The first division includes all who work on the staff of the various educational institutions ; these
are teachers and instructors, matrons, nurses, school keepers and caretakers in all classes of educational
establishments under the Council. Appendix VII. gives particulars of the various candidates examined
and the conditions noted as present. The numbers medically examined will not coincide with the
number of appointments, as candidates from the Council's training colleges having been under regular
medical inspection therein are not further examined on entering the permanent service within the year
after leaving college.
Permanent
Service.