NHS dentistry: past, present and future

NHS dentistry: past, present and future

Professor of Dentistry Nairn Wilson CBE, an eminent dental academic, author and teacher, shares his memories of early NHS dental care in the first of a two-part blog.

Following World War II and before the introduction of the NHS, oral health was typically poor and dentists were often consulted only when dental pain or discomfort necessitated a dreaded and, for many, difficult to afford visit to the dentist, especially if you wished to pay the additional charge for a local or general anaesthetic.

An exception, in many parts of the country, was the father of the bride generously paying for his daughter to have all her teeth extracted and replaced with complete dentures, thereby saving the new son-in-law the burden of providing dental care for his wife. This was at a time when pregnancy, which often occurred within a year or two of marriage, was thought to result in softening of the teeth causing costly to treat, if not untreatable tooth decay.

The inclusion of dentistry in the new NHS, with no charges or criteria for eligibility for comprehensive dental care, resulted in what was viewed at the time as a “tsunami of demand” for dental care. Thirty-three million dentures were provided in the first nine months of the service. Queues of patients outside dental practices were common.

Dentists quickly recognised to be ‘doing very nicely’ as NHS practitioners, were criticised for failing to meet expectations of, for example, new teeth for holidays or Christmas. They also soon became a popular focus of music hall humour: ‘Where do dentists visit the most? The bank!’

My father, who became a single-handed practitioner in my mother’s home town of Kilmarnock, Ayrshire, following his demob as a commissioned dental officer in the RAF, had vivid memories of the introduction of the NHS. Initially, it was a bonanza consuming much more of the NHS budget than ever expected. However, things quickly changed with the introduction of patient charges in 1951. My father considered it right and proper that NHS architect Nye Bevan and the future Prime Minister Harold Wilson, resigned from the cabinet in protest at the introduction of charges for dentures and spectacles.

According to my father, NHS dentistry started down a slippery slope, albeit slowly at first, when patients not only became ‘paying customers’, but aggrieved users of the service, having to pay for treatment they felt they deserved, and should have been free of charge, given various forms of increasing taxation. “More tax on pay, beer and fags, AND pay for your teeth!”

Early memories of my father’s practice include my first experience as a patient, having suffered some trauma to my front teeth thanks to the exploits of my older brother.

My parents decided, in contrast to the other three dentists in the town, which had a population of around 30,000 (i.e. one dentist per 7,500 people with high levels of dental disease), that they would settle for a relatively modest house in a quiet location and a separate dental practice immediately opposite the gates of one of the town’s major manufacturers. The other dentists had the more typical arrangement of living above the practice in a property where home and practice were combined.

My father’s surgery  which he continued to use until he retired in the mid-1970s, was basic but multifunctional, becoming the theatre for procedures under general anaesthesia, principally multiple extractions and the fitting of immediate dentures – rotten teeth out, new teeth in – three afternoons a week.

The surgery smelt strongly of Dettol, in which hypodermic syringes and forceps were stored, and eugenol, used in the preparation of cements – this was the smell of the dentist.

BIOGRAPHY

Emeritus Professor of Dentistry Nairn Wilson CBE is an eminent dental academic, author and teacher. He recently retired after a career spanning nearly 50 years. His roles included President of the British Dental Association, Professor of Restorative Dentistry and Dean and Head of King’s College London’s internationally renowned dental institute, Deputy Vice Principal (health) of King’s College London and Clinical Director of the University of Manchester’s Dental Hospital. He has received numerous awards for his contributions to dentistry.

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