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It will be observed that 9,358 children out of 14,954 inspected or 62.6% were found to require
dental treatment. Of the 9,358 found to require dental treatment 6,268 have been followed up by
the Health Visitors. (It should be noted that the " follow up " by the Health Visitors is limited
to one visit.) Of the 9,358 children in need of treatment 1,026 have made application for forms at
the Clinics, but only 410 of these forms were returned and only 325 of these were found to be eligible
for treatment. Of the 325 eligibles 277 received treatment at the Clinics up to 31st December, 1923.
In addition 286 cases were stated to have been treated at Hospitals or Dentists' Surgeries. This
means that as a result of all the dental inspection, clerical notices, and visitation by the Health
Visitors only 563 out of 9,358 or 6% of the children requiring treatment received the same up to
31st December, 1923.
Principles of a Dental Scheme.
It is often thought that a hard and fast line can be drawn separating preventive and curative
medicine. As a matter of fact generally no such demarcation can be made, and a good example
of the close relationship between preventive and curative medicine is the striking success of the
Ringworn Clinic of the Council which has now been in operation for more than 10 years. When
this Clinic was opened on 30th August, 1913, there were many school children in Willesden suffering
from Ringworm. The Dermatologist attended weekly and had always a waiting list of cases. The
waiting list has gradually disappeared and now the attendance of the Dermatologist has been reduced
from weekly to fortnightly. At this Clinic cases have always received early and prompt treatment
without any restriction whatsoever, the Council and the Education Committee in fact encouraging
the children to attend. In addition all suspicious cases noted at head inspections at the schools
by Health Visitors have been at once referred to Dr. Haldin Davis, the Council's Dermatologist,
for verification as to Ringworm and for treatment as might be required. The result of this work of
detection and early treatment has been that the cost of this Clinic has been well repaid by a large
reduction of Ringworm cases and improved health, by an increase of grant owing to less loss of school
attendance on account of Ringworm cases—there were 513 cases in 1914 and only 250 in 1922—and
now by an actual reduction of Clinic expenses.
Similarly the object of a Dental Scheme should be dental inspection as now carried out followed
up by prompt and efficient treatment. The object of treatment should be to remove all dental
caries, to treat the gums as may be necessary and to render the mouth and teeth clean and sound and
free from oral sepsis. When this work has been accomplished the mouths of the children should
be kept clean. They should be re-examined if not within 6 months certainly within 12 months
again so as to have any further caries which has exhibited itself at once removed. The prompt
eradication in this way of dental caries and oral sepsis from the mouths of school children would
not only prevent many teeth which now become infected from infection, but would also thereby
diminish ultimately, as in the case of Ringworm, the amount of dental work to be undertaken bv
the Local Authority. But great as may be the direct financial advantages to be derived from the
ultimate operation of a dental scheme on a sound basis they are hardly comparable to the great
benefits to health accruing from healthy teeth and gums and a clean mouth generally. In this
connection I may properly quote from the 1922 Annual Report of the Chief Medical Officer of the
Board of Education, page 81, as follows:—
"146. Year by year there is fuller appreciation of the far-reaching effect of oral sepsis.
Such sepsis may be due to a variety of conditions but principally to tonsillar and dental disease.
Caries of the teeth, pyorrhoea, apical sepsis, or ill-fitting dentures have a remarkable influence
in producing such septic conditions. The evils of a septic mouth may affect the whole body,
dependent in degree upon the virulence of the infecting organisms, the amount of toxic
absorption, and resistance of the patient, concurrent diseases, and secondary infections. The
category of disease which may follow such dental sepsis is indeed a formidable one, and includes
both general and local conditions. Dr. Beddard has attributed 90 per cent, of the cases of
rheumatoid arthritis to infection arising from the teeth, and Sir W. Willcox estimates 72 per
cent, of fibrositis and arthritis to be due to the same source. Dr. Cotton, of Trenton, New
Jersey, U.S.A., has shown that the effective treatment of patients suffering from functional
mental disease in the State Hospital is dependent upon the removal of septic infection. The
average of discharges as cured from 1908 to 1917 was 38 per cent. But when treatment was
concentrated on the removal of oral sepsis from 1919 to 1922, the percentage of cures rose
to 87 per cent. ' All toxic functional mental disease,' writes Dr. Cotton, ' is due to sepsis,
and most of such cases exhibit signs of oral sepsis as the dominant factor.' He claims that
on this ground, school medical inspection and treatment is the means of stamping out functional
mental disease.
"147. Broadly speaking, it is obvious that the danger of dental disease begins in
childhood, and it is admitted that dental sepsis is widespread among school children. Early
in the history of the national organisation of school medical inspection it became clear that
the Board of Education and the Local Education Authorities must make provision for dental
inspection and treatment. . . ."