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125
Dental Work.
The total number of children including secondary school children which the Council undertake
to look after in respect of teeth is approximately 23,000. The Board of Education state that for
23,000 school children dentists should be employed in the proportion of 1 to 5,000, i.e., 4.6 dentists
should be employed. At the present time the Council employ 3.6 dentists for the 23,000 school children
under their control. It is reckoned that the remaining 0.4 dentist is employed in connection with
mothers and children under 5. In this connection it should be observed that confining our attention
only to the public elementary schools, in 1933, the dental surgeons inspected all the children in these
schools in that year, but in 1936, they inspected 15,833 out of 19,845 on the roll or 80 per cent., instead
of 100 per cent., as required by the Board of Education. It should be observed, however, that in
Willesden only 34 per cent. of the school children actually requiring treatment receive it and, therefore,
if the present 3.6 dentists employed in school work alone were brought up to 4.6 it would only
encompass the work now to be done without improvement in the rate of acceptance of treatment which
is urgently necessary. It has been reckoned that if all children requiring treatment accepted such
treatment, 1 dentist would be able to deal with not more than 3,000 school children.
Extract from Annual Report of Chief Medical Officer of Board of Education for 1929, p. 60—
"The Dental Staff required for a complete service would depend then upon what is understood
by the word 'complete.' According to existing standards, found by averaging the results
for the country as a whole, the number of children who would be expected to attend for treatment
if every child was inspected annually would be approximately 2,000,000. But in a fully-developed
service these numbers would be nearly doubled. The average output of the whole-time school
dentist has remained practically constant for a number of years, the number of children treated
being approximately 2,300 yearly. This is a rather high figure which includes about 400 casual
cases; it would necessarily be reduced if the standards suggested by Mr. Pitts—the cutting
out of fissures, conservative work on certain temporary teeth and the use of orthodontic measures
on occasion—were universally adopted. To give really adequate treatment on these lines to
1,500 children (allowing sufficient time for inspection) would represent a full year's work.
To complete a School Dental Service, inspecting every child annually, offering treatment to
all who will accept, and carrying out all the necessary conservative and other treatment, would
therefore necessitate, at the present time, a total staff of about 1,300 dentists (i.e., about 1 to 4,000
of the school population) an increase of about 800 on the existing numbers. As the work developed
and measures for educating the parents and children were increasingly successful, the numbers
attending the clinics would steadily increase to a stage at which they would include nearly all
those referred for treatment, and a school dentist, instead of being able to deal with 4,000 children,
would be able to undertake the care of 2,300 only. For this, the final and really complete state
of the School Dental Service, the employment of more than 2,100 whole-time dentists would be
required, 1,600 more than at the present time. The annual cost of dental services, including
the salaries of dentist and attendant, travelling expenses and the running expenses of the clinics,
may be roughly estimated at £850 for each whole-time dentist. On this basis, the additional
cost of a complete service would be £680,000 at the present time, rising steadily to about £1,400,000.
Whatever may be said for or against a complete scheme of this magnitude and cost, it is certain
that the present scheme covers less than half the ground."
In the circumstances it will be noted that it is very difficult to separate completely the provisions
under 10 relating to dentistry and 13 relating to dental mechanics and orthodontic work in the estimate
of the Medical Officer of Health dated 2/4/37.
The basis of the additional dental work at Health Centre (2) is the addition of two dental
surgeons. At the present time there is one dental surgeon employed and he has 8,084 school children
to look after, approximately 2,000 expectant and nursing mothers and, approximately, 4,000 children
between 1 and 5. The addition of one dentist only would not enable this work to be done properly
if it is aimed at getting more than 34 per cent. acceptances of children for treatment as should obviously
be the case. A second dental surgeon would make up this deficiency in inspection and treatment and
he would also have time to deal with the provision of dentures and the regulation of teeth in young
children as already outlined. From this, 1 think it will be again noted that the provision for dental
work which is included in the plans and estimates is by no means excessive provision and is likely
to be insufficient over a number of years.
(Incidentally, it should be observed that one dentist at Health Centre (1) endeavours unsuccessfully
to cope with 5,010 school children, approximately 1,000 expectant and nursing mothers and
approximately 2,000 children under the age of 5, while 2 dentists at Health Centre (3) similarly
endeavour to cope with 9,275 school children, approximately 2,000 expectant and nursing mothers,
and 4,000 children between 1 and 5.)
General.
In connection with the proposed plan for new Health Centre (2) it should be observed that the
only provision which is made in the plan and estimates, which is a general provision for the whole of
Willesden, is the X-ray department. At the present time certain X-ray work is done by the Middlesex
County Council, certain other by the Willesden General Hospital, some by the Royal National
Orthopaedic Hospital and some ringworm cases by private arrangement with the Council's Specialist
at his private surgery.