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25
In considering the question it must be remembered that in London there has
been a system of progressive dental care of the children which has been in operation
for 18 years, and that there has never been experienced any shortage of dentists in
London for the work. The school treatment centres to which dental departments
are attached are provided by voluntary committees who appoint and direct the
dentists employed; the Council reserves to itself the approval of the dentists and
the right of inspection. Certain of the dental surgeons appointed for treatment by
the dental committees are also appointed dental inspectors in the schools by the
Council. At present there are 64 such dental inspectors, and there is provision
(which is annually increased) for the treatment of 144,100 children per annum.
All children in the schools are inspected by the dental inspectors at the ages of 6,
7, 9, 10 and 11 (in the other age groups they come under inspection by the school
doctors). It has not always been possible in the past for the school dentist to
complete his rota of inspections within the year, but special attention has been
directed to this point and failure is now the exception rather than the rule. Parents
are invited to the dental inspections and instruction in dental hygiene is given by
the dental inspectors by lectures to the parents and by individual talks. The dental
inspector is accompanied at his inspections by an assistant care organiser who
undertakes some of the clerical work and the making of appointments at the dental
centres. In the case where the parent does not attend, a form is forwarded, when
treatment is required, for the parent's signature. Failure to respond is attended to
by the members of the school care committees who are entrusted with the followingup
of the cases. At the treatment centres the dentist is assisted by a fully trained
nurse who is a member of the Council's school nursing staff.
The London
system of
school dental
inspection
and
treatment.
The provision of facilities for treatment has hitherto almost equalled the desire
of the parents to take advantage of them, but at the present time the educational
advance as regards appreciation of the need of dental treatment is in some areas a
little ahead of the provision. In these areas when the waiting lists become unduly
long, they are reduced by the provision of additional sessions. The ideal of
continuous dental treatment for all children needing it will eventually require the
present provision in London to be very largely increased, but this will be one of the
problems of the future.
The provision of dental hygienists or dental nurses, whichever they are called,
must be viewed from two aspects (1) in the treatment centres, (2) in the schools.
Treatment Centres.—In the treatment centres the Council already provides fully
trained nurses or nursing sisters, some of whom have been engaged in the work for
many years. Their work is confined, however, to non-professional duties in the dental
sense, i.e., the care of and sterilisation of instruments, holding the children, handing
the instruments to the dentist, cleaning up, clerical work, etc. It is possible that if
each dentist were provided with a dental hygienist, more professional help would be
given and the dental work might be more expeditiously performed. It might be
considered whether the school nurses should not be trained to do the more professional
work. There is, as yet, no suggestion as to the salary a fully trained dental hygienist
would command, but it is hardly likely to be so disparate from that of the school
nurse as to effect any economy in this respect, and it must not be forgotten that the
use of dental hygienists or school nurses for even minor dental work is almost certain
to arouse opposition on the part of the dental profession. The presence of a fully
trained nurse would still be necessary on "anaesthetic days."
Schools.—In the schools the services of the dental hygienist would be mainly
of a propagandist character, but only experience in this country can demonstrate
either a positive or negative value.
It must be pointed out that the "leakage" between inspection, and treatment
is greater in the case of dental disease than in that of any other kind of ailment; that
in spite of all endeavour, at the best, not more than 67 per cent, of children found on
inspection to require dental treatment actually receive it; and that no means should
be neglected which promise a more rapid improvement than at present obtains. It
is probable that much of the difficulty experienced arises from the fears of the children