Roger musing about Peace with Nature

At my first dental examination in North America the Montrealer with a deep knowledge of the ethnography of decay leaned back from my chair and holding his pick aloft declared, “You have British teeth.” His tone was grave, like a race horse owner looking an old nag in the mouth. My heart dropped because I expected the consultation would confirm my pearly whites were pristine, and when he saw my puzzled look he shook his head. “You were unlucky to grow up in the nadir of British dentistry.” Ugh, he spoilt my day.

After I left his office I cast back to the medical and dental services of my schooldays in the London Borough of Bromley. I rarely visited those halls of humiliation and horror. Boys took off their shirts to line up in the gymnasium for a stethoscope and vaccination. Finally, the school nurse tugged at the waistband above our fly for a cold hand to reach down to check our pinkness, leaving us wondering if her scribbled notes would reach the headmaster if she found something amiss. But our greatest dread was the dental checkup which came round every six months, but mercifully that interval was much longer in childhood than it seems now. Our parents never understood our hostility to these appointments because they grew up before the National Health Service was founded in 1948 and were treated, if at all, in  private clinics. Most people in those days opted for extraction as the cheap option for toothache.

Dental caries was prevalent even in prehistoric times, and a rough diet rapidly wore teeth down until softer foods were eaten in the modern age. But at the end of the Victorian Era caries exploded five-fold after refined sugar entered the diet, including Her Majesty’s whose very sweet tooth enjoyed Battenberg cake, Victoria sponge and Osborne pudding at tea time. Toothache was just a fact of life that had to be shrugged off, and dentists kept their pliers handy like carpenters pulling nails.

I remember family members from that generation leaving their dentures in a fizzy glass of Steradent when they retired to bed. One of my “aunties” had all her teeth extracted by age 16 because she was terrified of the slow, wobbly drill operated by a foot treadle. She had a wonderful smile that was credited to an old Vulcanite denture she had worn for decades. There were no X-ray machines in dental surgeries, nor were surgical gloves worn, nor did boiling sterilizers sterilize, and nothing droll about treatment except the chuckles from laughing gas. A dentist who worked in Glasgow in the early 20^th century recalled half his patients over twenty didn’t have any natural teeth, and fathers sent daughters to him before their weddings to have teeth replaced with dentures “so their future dental healthcare needs wouldn’t be a burden on their husbands.”

After 1948 my boomer generation faced a new breed of dentist that was transitioning to the challenges of a nation whose dental care had been neglected except for the few who could afford private treatment. In the first 9 months of the NHS they were swamped with requests for 4.5 million extractions and the million full sets of dentures ordered ran the national supply dry. Restorative dental work suddenly came into its own, but conservative dentistry was not yet in our vocabulary, and we never heard of teeth magically whitened with paste or straightened with a brace, and anyway they would never look cool in my class.

This won’t hurt, I’m a British dentist

There was no shortage of dental work, but a national shortage of practitioners lasted for years. In 1958 the teeth of only 5% of 12-year-olds were free of decay, a record low point and down by three-quarters on the war years when sweets were scarce and it took a generation to reverse the statistics.  Matters would have been better if we had fluoride in toothpaste or in drinking water in some of our cities, and I don’t ever recall advice about dental hygiene and cutting down on sticky foods and sweets except from mother. But a dentist needs tooth decay for work, like his carpenter friend who needs rotting boards.

We were told we lived in a golden age of dental care, and the mantra rang musically over and over “drill and fill.” Dental surgeries had high-speed drills, mercury amalgam and novocaine. It was, however, tricky for a boy to accept analgesia in case a limp lip betrayed a lack of courage to classmates who would taunt him mercilessly. And no matter how heavy the treatment we couldn’t expect to be mollycoddled with sympathy from our parents and grandparents who had lived through greater tortures in world wars.

The two certainties in our lives were corporal punishment and dental care, and it is hard to say which was the crueler. Dentists were sharp-eyed like woodpeckers and always found something to drill, if not two or three cavities, and filled them as fast as we could jump over a horse in the gymnasium. I am talking of either high skill or reckless driving, perhaps because the man was impatient for the next case trembling outside in the waiting room. He often shouted at me “Keep still, boy!” while leaning over my squirming body in his electric chair with his drill whining like a mad hornet inside my quaking mouth. I didn’t have to wait long holding my breath until he paused to suck out the gritty dentine with a long tube like a lamprey.

Dentists complained they were overworked but in truth it was in their interest because the NHS paid them a piece rate (per procedure), which they claimed was a pittance. A dentist had to be productive to make a good living (mine drove a sexy Jensen), but it was a miserable occupation to work on boys like me, only relieved by thoughts of the happy hour with the carpenter over a pint in the George and Dragon. While British shipbuilding, mining and car manufacturing were heading for extinction, dentistry continued to hum and sales of mercury had never done better since Victorian times. With so much heavy metal in our heads it is a wonder that our jaws didn’t fall slack under the extra weight.

While he was drilling we saw out of the corner of an eye an assistant pouring liquid mercury into a pot of powdered metals to make amalgam to fill the holes. I once asked him if the mercury would harm me because we stopped rolling beads of mercury in our palms from broken thermometers when we learned the Mad Hatter’s story.

The dentist replied memorably with total silence. Perhaps he meant “You insolent boy!” or “He’s an idiot.”

How times have changed. The Day of the Dentist is no longer dreaded and my amiable provider in Virginia takes time to discuss conservation, crowns and cosmetics. Many people reach adulthood today without any cavities thanks to fluoride and dental hygiene. Surely British teeth can now be redeemed from their blackened reputation?

I was musing how dentists have navigated progress towards the perfection of national dentition without making themselves redundant. They shrewdly responded to the growing public pride in a perfect smile, and as British dentists migrated into the private sector like their American cousins they have shown greater business acumen than physicians or surgeons. No matter if caries becomes extinct or if stem cells are used to regenerate new sets of teeth they will always find a reason to be needed. I knew a Scottish farmer whose friend desperately wanted to save his pet sheep that was getting weak when its teeth wore down and could no longer eat a natural diet. The vet had no answer, but his dentist offered to make a set of dentures for the animal. Dentists are an enterprising bunch.

One legacy hangs over from the bad old days—mercury. My dentist is itching to drill and replace it with a modern resin. It’s nice work for him to brush off his old drill, and ought to please the patient, but this one is stalling with questions. Is the replacement less durable? Will I absorb more mercury vapor from drilling than if good amalgam is left alone? By keeping mercury in my head am I saving the environment, at least until the day when it blows off the smoke stack at the crem?  While I continue to ponder an answer I remain one of the heavy metal generation.

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