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unfit dentally. At first in some areas treatment was concentrated on extractions of teeth and
cleansing of the worst mouths but in the better services, as money and staff became available,
treatment was extended to embrace a growing measure of conservative treatment. The
ratio of teeth conserved to teeth extracted is a fairly reliable indication of the efficiency and
quality of the dental service offered. In a proper service the number of teeth extracted
should be small indeed in comparison with the number conserved.
The factor of personal cost to meet a dentist's bill was a potent one in deciding parents to
accept' clinic ' treatment and much benefit accrued to the children. In early days there was
substantial opposition to acceptance of ' fillings and it is due largely to the advice and
persuasion of the earlier school dentists that this opposition has been almost completely
eliminated. Dental care, as distinct from mere dental treatment, began to loom up as a
probability—preventive treatment rather than mere pain relief—and many local health
authorities planned to expand their dental services on which the public were making everincreasing
demands. In 1948, however, the second part of the background changed. Most
private dental surgeries quickly became nominally ' free ' treatment centres under the
National Health Service and the financial barrier to treatment fell. Increasingly large
numbers of patients clamoured for dental attention. The forebodings of the British Dental
Association were realised. Dentists were swamped. Many patients were requiring and
requesting artificial dentures and there was little possibility of relatively unremunerative
child patients displacing valuable adult ones.
At first all treatment was free but later (to curb demand and perhaps prevent abuses)
measures were introduced by which partial cost was borne by the patient. These measures
slowed down general patient demands, reduced the demand for artificial dentures and
increased the amount of conservative treatment given. This did little, however, to divert
dentists' efforts to children's needs; the younger children, at least, still being unremunerative
in comparison with their elders. It should also be noted that while some aspects
of children's dental treatment may be regarded in some quarters as ' easy ', the handling of
children and the persuasion and enlightenment of mothers needs much time, skill and
patience. Few general dental practitioners have the experience and aptitude of the school
dental service careerist. Many dentists advise parents to continue to seek dental treatment
for their children at the ' school clinic '. Alas! in many quarters where formerly there had
been an efficient clinic staffed by an experienced school dentist they found the dentist gone
and a closed door. The school dentists left in large numbers to join their professional
colleagues in National Health Service general practice.
Since 1948 the background against which local health authorities struggle to maintain
a school dental service—as struggle they must since the obligation to do so is laid upon them
by statute—the background has changed.
Comparatively little obvious dental distress remains in the schools. Personal cost is no
longer an obstruction to obtaining treatment, but a new factor has arisen. In former days
parents in many instances accepted readily dental service for their children at the school
treatment centre when, following an inspection at school, they were notified that treatment
was required. Now that alternative sources of free treatment are available elsewhere,
many parents indicate that they intend to seek treatment ' privately'. No doubt the
intention is honest and is carried out properly by many parents, but unfortunately it is also
a fact that many parents carry their intentions no further than speech. Treatment at the
school clinic is evaded and is not replaced by early treatment elsewhere. Children are
neglected dentally until pain supervenes, when extraction is usually the sequel. The number
of extractions is rising again in the school service and conservation work is falling. Dental
inspection of the children in schools is growing increasingly abortive so far as subsequent
early treatment is concerned and inspections are growing less frequent and less systematic as
staff dwindles. Children's dental care falls between the two stools of organised school dental
service and parental intention to have treatment' privately '. The sooner the two stools are
re-fashioned to form a solid structure the better. All children should have a regular