The New Zealand Dental Services
Dental Services for the Territorial Force
Dental Services for the Territorial Force
In May 1940 a programme of intensive training for the Territorial Force was begun. Territorial units went into camp at various times and in various places throughout the country. Racecourses and show-grounds were usually used, but there was also the permanent camp at Waiouru which catered especially at this time for Territorial page 52 training. The men underwent a course of three months' continuous training in camp and in the field and by May 1941 over 30,000 had been trained under this scheme. The scheme was quite independent of the training of troops for overseas service which was going on at the same time in the mobilisation camps, and the 30,000 mentioned above was additional to the 23,483 trained and despatched to the New Zealand Expeditionary Force during the same period.
From what has been said of the dental condition of the recruits for the Expeditionary Force, it can be understood that at least an emergency dental service had to be provided for the Territorial troops if they were to be under continuous training for three months. The treatment was limited to the relief of pain and to other dental operations which would retain the soldier on duty and enable him to carry on during his period of training. It included the extraction of teeth for the relief of pain or a septic condition, the insertion of dressings to relieve pain when extraction was unnecessary, the repair of broken artificial dentures and the treatment of diseases or neglected conditions of the gums by the removal of accumulated calculus and by other prophylactic measures. In addition to this treatment, a further duty of the dental officers was to educate all ranks in the importance of oral hygiene and care of the teeth by individual instruction where necessary, by short lectures on the subject, and by arranging with commanding officers to draw attention to the matter in standing and routine orders. A complete dental examination of all troops in camp was to be carried out and this was to be recorded on the usual dental history chart, NZ361, which was then to be attached to the personal file of the soldier concerned. The object of the examination and charting was to find out the amount of treatment required should the soldier be called for general service requiring dental fitness.
The method of providing this limited service was by field dental sections at the various camps and a permanent dental section at Waiouru Camp. The field sections comprised one officer and one or more other ranks, with equipment limited to a field surgical pannier and field dental chair. On arrival they established themselves in any available accommodation, tented or otherwise. The limited service authorised and the limited personnel and equipment to carry it out did not warrant the permanent attachment of a section to all the numerous camps in the country with the exception of Waiouru. It was usual to attach a section long enough to carry out the examinations and any necessary urgent treatment, then withdraw it and reattach it about a month later. The personnel and equipment were provided by the camp dental hospitals, which in this respect assumed the role of NZDC depots. The Principal Dental Officer of the mobilisation camp, acting in the capacity of Principal Dental Officer page 53 of the district with the authority of an Assistant Director of Dental Services, made all the detailed arrangements for the Territorial camps to be treated other than the decision when and where the dental section should be attached, which was made by the DDS. As the ADDS was in the terms of his appointment responsible to the DDS for the dental fitness of all mobilised personnel in his district, it is suggested that the decision as to when and where a section should be attached would have been better made by him than by the DDS, whose knowledge of local conditions was second-hand. The reluctance of the DDS to decentralise command appears as a weakness in an otherwise excellent organisation.
Up to the end of 1941 these field dental sections had operated in Territorial camps in Whangarei, Avondale, Ellerslie, Alexander Park, Cambridge, Te Aroha, Rotorua, Wanganui, Waverley, Foxton, Palmerston North, Napier, Dannevirke, Tauherenikau, Addington and Forbury Park. In some cases where the camps were near a mobilisation camp or Air Force station, the troops could be sent there for treatment.
In spite of these arrangements it was soon apparent that members of the Territorial Force were being sent to private practitioners in nearby towns for treatment. This was no doubt due to the fact that sections were not permanently attached and, owing to the limited scope of treatment, emergencies were bound to occur in their absence. It was the obvious course to take when the NZDC had not the staff to cope fully with the situation, but this was not the view taken by the authorities. In January 1941 a circular memorandum was sent to all dental practitioners informing them that the NZDC was attempting to provide all necessary urgent treatment for Territorial troops while in camp, and pointing out that any of these men seeking treatment were responsible for all fees incurred and that these could not be claimed from the State. The NZDC did its best to give extra service—for instance, one section moved for several months on a circuit covering camps at Palmerston North, Dannevirke, Wanganui and Foxton, visiting each twice weekly—but this was a severe strain on its resources and was still inadequate. The position was most unsatisfactory. There was very little urgent work coming within the scope of the NZDC, and what there was could not be timed to coincide with the visits of the sections. To use sections capable of a big output of work to deal with occasional emergencies was uneconomic.
In July 1941 there was a complete reversal of policy and it was decided that, apart from Waiouru and camps close to permanent dental sections of the Army or Air Force, all necessary urgent treatment for Territorial troops would be carried out by private practitioners in the nearest town. The DDS nominated the practitioners page 54 to whom the soldiers would be referred by the camp medical officer. The soldier himself paid the fee but received a refund from the Army by handing the receipt to the adjutant of the camp. These instructions and the maximum fees recoverable by the soldier for various types of treatment were incorporated in a circular memorandum sent out from the Adjutant-General to all camps and dental practitioners concerned.
Under the original plan it had been intended to examine and chart all Territorial troops under training, retaining the forms for future reference. In January 1941 this was discontinued as it was considered that sufficient data had been acquired, and that to continue the procedure was a waste of time for the NZDC and an interference with training programmes. The annual report on the dental services for the year ending 31 May 1941 shows that the number examined during that year was 11,215 and that the dental condition was similar to that of recruits for the 2 NZEF, except that to make them dentally fit more fillings but fewer dentures would be needed.
Further information about the dental condition of the young men of New Zealand was obtained in August 1941 when the 18-year-old reservists were being called up in the Territorial ballot for training. The Director-General of Health asked for a survey of the dental condition of these men in the 18–19 age group. He said that particular attention was being paid to their medical condition to find out the number fit for service and the reasons for rejecting those not fit. In conjunction with this he wanted to find out the relative dental fitness of the group and, in particular, the number wearing artificial dentures. The examinations were carried out in September and the results were staggering: 2020 were examined, and for every 100 of these, 540 fillings, 103 extractions and 10·2 dentures were required. Of every 100 men examined, 7·1 were wearing full upper and lower dentures, 13·2 were wearing full upper or lower dentures and 4·3 were wearing partial dentures. Thus 24·6 per cent of these men at 18 to 19 years of age were wearing an artificial denture of some kind.
During the last three months of 1941, owing to the threatening position in the Pacific, large numbers of Territorial troops were fully mobilised, becoming known as embodied cadres of the Territorial Force. Being fully mobilised they were to receive full treatment from the NZDC. They went into camps at Whangarei, Avondale, Rotorua, Palmerston North, Forbury Park and Wingatui. Dental sections had to be permanently attached to these camps, with full equipment and facilities for carrying out all surgical and prosthetic treatment. At all these camps, with the exception of Palmerston North, the sections consisted of one officer and one or two other ranks, and accommodation was sought in some existing hut or building where running page 55 water and good light were available. At Palmerston North, where the camp was in the Show Grounds, a temporary dental hospital was established in an existing building to provide accommodation for 6 officers and 11 other ranks. The majority of the embodied cadres at this camp were to be dispersed to other camps and a concentrated effort was made to make them dentally fit before this happened.
Another group was also mobilised at the end of 1941, the National Military Reserve. This meant that the NZDC in early 1942 became responsible for the dental health of a large portion of the male population of New Zealand. With the best will in the world, the achievement of complete dental fitness for all these men was impossible with the staff available. There had to be some rationing of work and the standard of treatment for the Territorials and the National Military Reserve had to be reviewed. The two groups presented different problems: the former had a dental condition similar to that of the men called for overseas service and the latter, being drawn from a much older age group, consisted in the main of denture wearers.
The first undertaking was to remedy septic conditions by the removal of roots or irreparable teeth and to treat any oral lesion so as to place the oral cavity in a reasonably healthy condition, being careful not to reduce the masticatory efficiency below a workable minimum. No organised attempt, however, was to be made to achieve complete dental fitness. Prosthetic work was limited to the repair of existing dentures. To quote the DDS in a memorandum to PDOs and OsC dental sections dated 13 January 1942:
It is to be remembered by all concerned that, if a man who has been mobilized from civil life and is thus otherwise medically fit, presents with a hopeless carious condition of teeth or is fully or even partially edentulous, and claims that he does not possess artificial dentures or is wearing dentures and requests remodelling, he will have to carry on as he did before mobilization. He obviously managed to assimilate three meals a day, maintained his working efficiency in that state and was physically fit, so he can continue to carry out his military duties until the situation is stabilized, especially when one considers that the daily rations are similar, if not in some cases better, than those to which he is accustomed.
On 21 February 1942 instructions were given to chart the dental condition of all ranks and to proceed with any necessary treatment, giving priority to the 18–25 year-old Territorial group. The others, including the National Military Reserve, were eventually to be provided for. In the meantime their urgent requirements were to be met by the NZDC, with the assistance of the selected private practitioners in the scheme inaugurated in December 1941.
As the troops were even more scattered over the country than in 1941, it was even more important that the NZDC should devise a method of treating them wherever they were so as to interfere as page 56 little as possible with the general defence scheme. This led to the formation of Mobile Field Dental Sections, and these will now be described in detail as part of the district organisation.