View report page

157
government remuneration for their routine services for these patients, all of whom are
under 16 years of age. The cost of appliances and/or specialised treatment is borne by the
parents (for example, orthodontic treatment is not available free).
In New Zealand the cost of all dental treatment over the age of 16 years is borne by the
patient—it is not State-aided—a difference in the ' National' dental service in Britain and
New Zealand surely not less important than the utilisation of dental nurses or auxiliaries.
In New Zealand the efforts of most dental practitioners are deliberately deflected or
attracted to treatment of the under 16's on a State-paid scale of fees basis. Treatment,
mainly for the younger children, is also available in many schools at the hands of dental
nurses. In Great Britain at present the attraction or deflection of general dental practitioners
is towards the adult section of the general public and most dentists are so busily employed
undertaking work for these patients that relatively few children can gain access to their
surgeries. Parental apathy produces at some school treatment centres only a meagre acceptance
of or demand for treatment and gives a false picture of sufficiency of dental services,
which is construed by the unenlightened or complacent as a satisfactory state of dental
affairs. The mouths of the rising generation, although for the present probably free of gross
dental faults, are riddled with dental caries which, if left untreated, will lead to heavy
demands on the general dental service in the not too distant future, as well as to an undermining
of the younger people's health and efficiency. If the experiment now under way in
this country to train dental auxiliaries for two years and then utilise them in the dental treatment
of children is pronounced successful and their use in the local health authorities service
of the future is contemplated, it will be necessary, in addition, to make drastic changes
in the present general dental service organisation. Many more dentists than are at present
forthcoming will still be required to undertake ' difficult' treatments in the mouths of
children whom the auxiliaries have been unable to render completely dentally healthy.
It is quite erroneous to assume that dental auxiliaries could supplant dental surgeons in the
school service. Auxiliaries could in fact give support only if the dental surgeons are prepared
to undertake deliberately only the more ' difficult' work and to accept the results of the
auxiliaries' efforts. Much will depend on what is intended exactly by the auxiliaries' working
under the supervision and direction of a registered dental practitioner' as laid down in
the experiment now being conducted.
A similar form of assistance with ' easy' dental work was tried out a few years ago by
the training and use of dental hygienists who, like the now intended auxiliaries, were
restricted in the scope of their treatment by law. The hygienists were permitted in their
operative work only to scale and clean teeth. In clinic services, such as are run by local
health authorities for a widely spread catchment area, it was soon found that from the
hands of the hygienist came a stream of' clean ' but otherwise untreated mouths for which
necessary further treatment was frequently not available owing to shortage of dentists.
A dentist could not keep pace with a hygienist. Her output of patients still to be rendered
dentally fit required the additional services of six or seven dentists; as had in fact been
established in the Royal Air Force dental service where the use of hygienists originated.
Hygienist services in civilian fields have been found useful in hospitals where their assistance
in the general hygiene of bedridden patients—as well as perhaps with specific dental
patients—sometimes justifies their employment.
The contemplated use of dental auxiliaries is an improvement on the concept of the
hygienist, but until there is further definition of' simple ' and ' difficult' work in children's
mouths it is not possible to foresee how a dentist (supervising) can keep in step with his
auxiliary or auxiliaries.
Year after year since 1948, against the complex and changing background of dental
effort and experimentation, local health authorities have struggled to keep alive their
dental service and to make effective their various policies aimed at the ultimate provision
of a comprehensive and efficient school dental service, but in very few authorities have they
been able to even maintain their pre-1948 level.