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Such cases account mainly for the large number of permanent teeth extracted at
the centres, since earlier attention would probably have saved these teeth from the
forceps. In London this problem is further complicated by the fact that at many
voluntary hospitals a dental department is maintained, and the parent who declines,
for his child, the advice offered by the school dentist can without great difficulty
obtain the emergency treatment which later on becomes necessary. There is also
the factor that the charge made by voluntary hospitals to dental out-patients is
less than that charged to the parent under the Council's scheme.
Whilst the aim of the dental surgeons employed at the Council's treatment
centres is to preserve particularly the permanent teeth during the child's school
life, yet there are still a great number of parents who do not appreciate the value
of conservative dentistry and consider extraction the only method which need be
carried out.
Orthodontics.
No special facilities have hitherto been provided by the Council for dealing with
orthodontic cases. Any requiring such treatment that have been discovered, either
at the inspections in the schools or at the treatment centres, have been referred to
the dental hospitals or the Eastman clinic for treatment. The Council has always
felt that the cost of equipment and staff for a special dental workshop for the purpose
of the school medical service alone was not justified. The position has altered since
the transfer to the Council of the general hospitals under the provisions of the Local
Government Act, 1929. The Council now maintains a special dental workshop
primarily for its general hospitals where dentures and dental appliances are made
by dental mechanics. As an experiment, for 6 months, 3 special orthodontic centres
have been established at the Deptford, Hammersmith and Prunella (St. George-inthe-East)
centres. The children are seen at a special session devoted entirely to
orthodontic work, impressions are taken and the casts are sent to the Council's
dental workshop at St. James' hospital, Balham, where the necessary appliances
are made. These are forwarded by post to the centres, and the children attend
periodically for observation and adjustment of the appliances. The estimated
average cost to the Council of the appliances is 12s., and, during the experimental
period, it has been decided that a uniform charge of 12s. shall be made to the
parents for the whole course of orthodontic treatment including the appliance.
This is in addition to the ordinary dental charge. In necessitous cases the school
care committees are empowered to reduce the charge or to remit it altogether.
The accompanying diagram (fig. 1) shows the growth in numbers of children
annually treated for dental decay from the time that dental treatment of school
children commenced in the first year of the King's reign. The two periods during
which progress was arrested, viz., in 1922 and in 1932-33, were associated with
unemployment and increased charges to the parents.
Charges to
parents.
Under Section 81 of the Education Act, 1921, the Council is bound to make
a charge not exceeding the cost for any medical or dental treatment given under
its school medical arrangements.
The charges prescribed for such treatment to children attending elementary
schools, special schools and nursery schools, and for foundation scholars in aided
secondary schools are substantially lower than the full cost. Parents, who, while
not able to pay the fees of a private practitioner, are able and willing to pay the full
cost of the medical or dental treatment of their children, are enabled to do so.
The Council on 6th February, 1934, decided that, as an experiment for one year
from 1st April, 1934, arrangements should be made for medical inspection and
treatment of students attending the day continuation schools and three junior
evening institutes.
Fee paying pupils at secondary schools may under certain conditions avail themselves
of the Council's school medical and dental treatment arrangements. The
charges for these cases are the full cost as determined year by year. Machinery is
however, in existence whereby reductions or remissions can be obtained where
the circumstances justify such a course.