The New Zealand Dental Services
It has already been pointed out that 50 to 60 per cent of New Zealand troops were wearers of artificial dentures of some kind. These were easily lost or broken and in some cases were a convenient excuse for malingering. With all these men potential casualties, it can be seen that the prosthetic department of the Dental Corps was highly important in the service organisation. Apart from dealing with the casualties when they occurred, the policy of the Corps was to keep the supply of artificial dentures to a minimum. This, of course, applied chiefly to partial dentures which, with certain exceptions, were only supplied where there was a definite masticatory insufficiency without them. Too many partial dentures were worn in the kitbag as it was, so unless the patient was cooperative or a dental cripple, it was a waste of time making them. A rule was therefore laid down which allowed wide discretionary powers but protected the dental officer from the odium engendered by his refusal to make luxury partial dentures. No denture of fewer than six teeth was to be made except on the express instruction of the Principal Dental Officer or officer commanding a dental section. While fully realising that the psychological aspect had to be con- page 113 sidered to keep a man healthy in mind as well as body, and that appearance played a big part in this, essential treatment could not be sacrificed on the altar of aesthetics. On the other hand, an officer or NCO would be in serious difficulty on the parade ground with even one of his front teeth missing. In practice, therefore, no man was left with unsightly gaps unless he was quite satisfied to remain that way or had been in that condition in civilian life and had not thought fit to provide himself with a partial denture. Also, so obvious a dental defect was a poor advertisement for the Corps, even if its correction did little to increase masticatory efficiency. The discretionary powers were therefore usually used, even if they elicited an audibly gruff but secretly sympathetic reprimand from the DDS.1
All dentures were made for utility under hard conditions and the aesthetic considerations, while being far from neglected, had to be secondary to this. They were all made of vulcanite, although a certain amount of acrylic resin was available for repairs to dentures of other materials. To produce efficiency and conserve time, the workroom staff in the larger hospitals worked on the chain system. One or two prosthetic officers were appointed and the calling up of denture patients and organisation of the workroom were the result of consultation between them and the senior dental mechanic.
One of the greatest prosthetic difficulties was provided by those men who came into camp with septic mouths requiring extensive extractions. In the early stages of the war, when every man was urgently needed to build up the Division in the Middle East, the Dental Corps was instructed that no member of the forces who was otherwise medically fit was to be debarred from going overseas or withdrawn from a reinforcement because of a dental disability. The average time that an echelon or reinforcement would be in camp, i.e., from date of mobilisation to embarkation for overseas, was two months. It was quite impossible to extract all the teeth and expect the mouth to be healed sufficiently for the construction of dentures of any degree of permanence in so short a time. It was also undesirable that men should go overseas without any teeth or with their mouths in a septic condition. The instructions to dental members of medical boards examining recruits did not anticipate any but the dentally fit being allowed to leave the country and, even then, were sufficiently contradictory to be confusing. (See Chapter 3.)
The situation was met by a compromise. The teeth were extracted as soon as possible after arrival in camp, as long a time as possible being left for absorption to take place. Before embarkation dentures were made on the understanding that they would have to be remade overseas when further bone absorption had taken place. Many of page 114 these were made under extremely difficult circumstances on bulbous, irregular alveolar ridges, but some degree of masticatory efficiency was obtained. A list of all men in this category was sent with the draft so that they could be examined on arrival. Although a modification of this technique might have been more satisfactory, many excellent results were got by this method, and it is certain that even this temporary standard of dental fitness was preferable to the septic conditions on arrival in camp.
Taking everything into consideration, the results obtained in New Zealand for the men going overseas were very good and the highest standard of dental fitness was produced in the time available. There was, however, another problem connected with men who required multiple extractions. Some of them, after having had their extractions, were discharged from the forces instead of going overseas. The Army recognised a liability to provide these men with dentures. Sometimes it was not possible to do this before discharge; for example, the man might be transferred to a public hospital. In these cases the Officer in Charge of Sick and Wounded made the necessary arrangements for him to be treated when available. In most cases the work was done at a camp dental hospital, but occasionally a man had been sent home, perhaps to an isolated district, before the work could be done for him. To bring him to camp, feed and board him and return him home was a considerable expense, and it was recommended that in these cases the work should be done by a civilian dentist at the public expense. The suggested fees were lower than those agreed upon when civilian dentists were treating First Echelon troops. They were:
Full upper or lower denture, £5.
Partial (including first tooth), £1 10s.
Each additional tooth, 7s. 6d.
Unexpected opposition was encountered from the Ministers of Defence and Finance who considered the fees too high. The Minister of Defence suggested that the hospital boards might do the work more cheaply, but on consulting the Minister of Health was told that all the hospitals were too fully occupied with their own work. Apparently the fact that the man would have to be brought from his home to the hospital, fed, boarded and returned home was omitted from the calculation of the cost. Fortunately the argument, which lasted from March to December 1940, ended without the necessity for a decision, as every relevant case was meanwhile attended to in a camp dental hospital and great care was taken that no future case could possibly fall into that category. There is no evidence that the private practitioner was consulted as to whether his patriotism would have prompted him to undertake the work at a financial loss, or at least at a nominal fee.page 115
With so many dentures made for the troops, precautions had to be taken to see that proper care was taken of them. The following was therefore put in camp and routine orders on frequent occasions:
All ranks are warned that they are liable to be charged with the cost of replacements of artificial dentures lost through neglect. Dentures must always be removed and put in a safe place before going swimming or when sickness from any cause is likely. Particular care must also be taken during respirator drill and night exercises. Failure to carry out the above is the direct responsibility of the soldier concerned.
Where the loss or irreparable breakage of a denture originally supplied to an officer, soldier, airman or rating, either at his own or at the public expense, could be shown to have been due to any culpable act or omission on his part, he was placed under deductions of pay for the cost of the new denture. Under service conditions these costs were assessed at:
Each full upper or lower denture, £2 10s.
Each partial upper or lower including first tooth, 10s.
Each additional tooth up to twelve teeth, 3s.
Each case was referred by the dental officer to the relevant commanding officer, together with all information for his decision regarding liability. There was always the right of trial by court martial. Deductions were entered in the paybook and published in orders.
From the amount of emphasis laid on the provision and maintenance of artificial dentures, it can be seen that New Zealand troops are to a large extent dependent on an adequate dental service. It is doubtful if before the war this fact was fully appreciated and it is hoped that the experience of the war will not allow it to be forgotten. There is much truth in the statement by Bernard Shaw towards the end of the last century: ‘When you have the toothache the one happiness you desire is not to have it. When it is gone you never dream of including its absence in your assets.’
1 Confirmed by personal conversation between the DDS and author, 5 January 1949.