The New Zealand Dental Services
THE dental service for the Royal New Zealand Navy provides a sharp contrast to that for the Army and the Air Force. It is hoped to show that the fault did not lie with the New Zealand Dental Corps, whose every effort was to give the same service to all branches of the armed forces. The fact remains that the Navy was not prepared to accept that service except under conditions of its own making, and the result fell short of the ideal. There was already a dental service in the Royal Navy before the war but, if this was considered sufficient by the Admiralty, it was but a cipher to the needs of the New Zealand Division of that service. The dental needs of that force were identical with those of the other two services, and the spasmodic attention of a handful of dental officers attached to ships or shore stations merely scratched the surface of the problem. The New Zealand Division was suckled on the traditions of the Royal Navy, whose dental service had been in existence since 1915. In support of these statements it is therefore fair and reasonable to examine the position as it existed in New Zealand in 1933.
The only dental examination of candidates for entry into the New Zealand Division of the Royal Navy was carried out by a medical officer. Physical and medical standards were laid down by the Naval Board in July of that year in a pamphlet entitled ‘Instructions for Surgeons and Agents’. There was only one reference in that pamphlet to dental matters:
Candidates under the age of seventeen should have twenty one teeth present either sound or capable of efficient repair, and those over seventeen should have twenty two. They should have some molars and incisors in good and efficient occlusion on both sides of the mouth. Where teeth are only capable of efficient repair and the candidate does not intend to have the defects made good prior to final examination, acceptance for entry will be subject to his undertaking to have the necessary treatment effected at his own expense.
This was meaningless and it is difficult to understand on what grounds the arbitrary assessment of the number of teeth was based. page 69 After the age of twelve the full complement of teeth is twenty-eight, and after the eruption of the third molars or wisdom teeth, not normally present at the age of seventeen, the full number would be thirty-two. Granted that a boy of sixteen should have at least twenty-one of his twenty-eight teeth present in good occlusion to qualify, why, when one year older, should he have twenty-two? It must also be remembered that the decision was not made by a dental officer. It was neither fair to the medical officer, nor the candidate, to expect a decision on such false premises.
In 1934 it was recognised that all was not well and the Naval Secretary wrote to the Commodore commanding the New Zealand Station:
I am directed to request that the standard of dental fitness required of candidates for entry in the New Zealand Division of the Royal Navy and the routine for the examination of candidates may be reviewed, and a report furnished as to the suitability or otherwise of the present arrangements.
It is desired to maintain as high a standard as practicable and consideration of requirements in ‘Instructions for Surgeons and Agents’ section 11 paragraph 12 (c) should be directed towards determining whether they are fair and reasonable from the point of view of the general standard of dental fitness in New Zealand.
The opinion of the Director of Dental Services, Lieutenant-Colonel B. S. Finn, DSO, should prove of value.
Apart from the excellent suggestion that expert advice be sought from the DDS, there was also a suggestion that the regulations be brought more in line with those dealing with entry into the Royal Navy and the Royal Marines, where no candidate could be rejected for dental reasons without prior examination by a dental officer.
The New Zealand Division consisted of ships on loan to the Government from the Royal Navy, manned partly by the Royal Navy and partly by New Zealanders. Conservative dental treatment was provided at the public expense to all naval and Royal Marine personnel and to officers and men of the Naval Reserve Forces while training in His Majesty's ships and shore establishments of the New Zealand Division. This was carried out by civilian dentists, who were appointed as Naval Dental Surgeons and Agents. In the various out-ports these agents worked at a standard scale of fees and in Auckland, the Naval Base, they were paid at a flat rate per annum. The system, which incidentally had been in force in England before 1915, was unsatisfactory, so, in 1935, the Naval Board asked the New Zealand Government to co-operate with the Admiralty in maintaining a dental officer with the New Zealand Division. A satisfactory graduate was to be selected and sent to England for commission as Surgeon-Lieutenant (D) in the Royal Navy, with the understanding that he would return for service with the New Zealand Division and come under the direction of the DDS.page 70
This was an important decision. It recognised the need of the New Zealand Division for a dental service but bowed in conciliation to the traditional organisation of the Royal Naval Dental Service, which was hopelessly inadequate to cope with New Zealand conditions. As Surgeon-Lieutenant (D) the officer came under the control of the Royal Naval Medical Service, but while serving with the New Zealand Division he was subject to direction from the Director of Dental Services of the New Zealand Forces. Lieutenant-Colonel Finn was not fully appointed as DDS until 1939 but acted as DDS at the time of the dental officer's appointment. He was an army officer receiving a very small honorarium from the Navy and had little official authority, and what little there was needed the utmost tact to administer in His Majesty's ships. Somewhat naturally, the commanding officer of a ship did not welcome interference with his direction of his dental officer per medium of his medical officer, as was the custom in the Navy. With equal justification, the DDS, having regard for his responsibility to the Naval Board, felt that he should have some say in the management of the dental service to the Navy. Mutual tolerance and understanding were essential. They were not conspicuous. In justice to the DDS, he had no intention to usurp the powers of the commanding officers and was entirely distinterested in the internal economy of the ship to which his dental officer was attached. ‘His control was limited to technical matters. He was, however, vitally interested in the dental health of the ship's company, for which he had a responsibility to the Naval Board. He had to equip the dental officer to establish and maintain dental health, and had a right to expect co-operation from the commanding officer to that end. He made it perfectly clear that for discipline the dental officer was under the sole direction of the commanding officer, but that the DDS expected full reports of the dental health of the ship's company direct through the commanding officer, and not per medium of the medical officer. If this had been borne in mind by all concerned the service would have been happier and more efficient.
This was a decided improvement on past arrangements and worked reasonably well under peace conditions, when the movements of the flagship could be foretold with some accuracy, but there were drawbacks. A dental officer permanently attached to a cruiser was restricted in his activities with other ships or shore establishments. This was recognised by the DDS, as can be seen by his letter to the Royal New Zealand Air Force when a dental service for that force was being considered:
Personally I do not favour the establishment of the dental officer on a cruiser permanently for obvious reasons, but circumstances prohibited the installation of a shore dental clinic at the base where the dental officer would normally be stationed, transferring periodically to either of the cruisers for duty. Provision is made in the plans of the new base sick quarters for a modern dental clinic to cope with all classes of dental work and, when erected, it is hoped that perhaps an increase of staff on the station may be effected which will allow all naval personnel to be catered for, having their own prosthetic laboratory and dental mechanic, X-ray plant and facilities for major surgical operations etc. Treatment at the public expense by civilian dental surgeons will be confined to an occasional extraction or repair.
The naval base was situated at Devonport, Auckland, in the name of HMS Philomel, an obsolete vessel moored there for use as accommodation and training. The dental clinic in the sick quarters did not materialise but, some time later, a dental department was established in the entrance hall of the squash courts. The Squadron Dental Officer came ashore in August 1939 into these poorly designed and inadequately lighted quarters to work to the best of his ability. There was no prosthetic laboratory and all dentures had to be processed by the Naval Dental Surgeon Agent in Auckland. This was the only service dental treatment, as in ports other than Auckland civilian dentists were used.
This was the position at the outbreak of war. It was in conformity with the policy of the Royal Navy, where dental officers were carried afloat only in capital ships, aircraft carriers and in one ship in each cruiser squadron. With a high dental standard on enlistment, such a service could only expect to drift with the tide, but with the standard in New Zealand, it was submerged in a torrent. With war came a rapid expansion of the Navy from the only source available, New Zealand citizens, and enough has already been said about them to realise that most of them were dental cripples. The Royal Australian Navy, faced with similar conditions, had already increased its service to one dental officer to each cruiser, but New Zealand continued to drift, with the exception of providing a dental section from the page 72 Army for the training station, HMS Tamaki, on Motuihi Island in the Auckland harbour.
A serious problem then arose in the two cruisers employed on detached duty far from their base. They were dependent on casual dental attention in such ports as they might visit for fuel. Such visits were of short duration and only the more urgent cases could be treated, with a complete lack of continuity of treatment. A report from HMNZS Leander in February 1941, after ten months’ detached service, showed that although 336 cases had been attended to in this manner, the work was piling up and routine examinations were out of the question. The commanding officer wrote to the Naval Secretary as follows:
The routine under which the cruiser in New Zealand waters now operates is not known but presumably facilities for dental treatment ashore are less frequent than in peace time. Even when lying in a naval base, the presence on board of a dental officer would result in an appreciable reduction in the time lost from training and important ship work. The possibility of the ship being ordered abroad at short notice is a further factor in favour of the proposal, while a dental officer possesses qualifications which would be of real value in action. The necessary accommodation can be made available provided that the ship is not carrying a flag.1
The general dissatisfaction was crystallised into action by the emphasis of this report, and on 17 March 1941 the DDS wrote to the Naval Secretary:
With reference to the dental condition of the sea-going personnel I have to report that present arrangements are not efficient nor are they economical.
1 In other words, the Admiral's sea cabin could be used.