How British Dentists Created Heavy Metal Generation

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 20th 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
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.

alice

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.

Next Post: Autumn Leaves have Fallen

Voice of the Lobster

There was one lobster left in the tank when I left the restaurant. I felt sorry for the lonesome crustacean, but sadder for its late companions whose carapaces lay empty on customers’ plates. I had no reason to feel guilty because there was steak on my plate, and I never had to look a cow in the eye at the exit. But somewhere in the depths of memory the tortured voice of a lobster was calling in Wonderland. 

Alice in Wonderland: Voice of the Lobster

Lobster
Lobster on Death Row

In Alice, the Lobster was a spineless coward, but lobsters are monarchs on restaurant menus, and lobster thermidor is a stately dish that takes a lot of preparation and is reserved for customers with deep pockets for special occasions. In the upside-down world of the Monty Python troupe, however, it was served in a seedy café and crowned with spam:

Mr. Bun: What have you got, then?

Waitress: Well there’s egg and bacon; egg, sausage and bacon; egg and spam; egg, bacon and spam; egg, bacon, sausage and spam; spam, bacon, sausage and spam; spam, egg, spam, spam, bacon and spam; spam, spam, spam, egg and spam; spam, spam, spam, spam, spam, spam, baked beans, spam, spam, spam and spam; or lobster thermidor aux crevettes, with a mornay sauce garnished with truffle paté, brandy and a fried egg on top and spam.

Spam meat
What a lot of Spam

Until I drafted this post I was under the impression that ‘thermidor’ was a word that described a method for cooking lobsters, or had a connection with a well-known manufacturer of kitchen appliances (Thermador). Wrong on both counts! The name can be traced back to a day in 1894 when a Parisian restaurant served a special lobster dish to celebrate the opening of Thermidor, a new play by Victorien Sardou at the Comédie Française. Thermidor was named after a summer month in the French Republican calendar when the Thermidorian Reaction took place, Robespierre was overthrown, and the Reign of Terror ended.

But thermidor will always remind me of peering through a cloud of steam over a cooking pot to watch a live lobster dance in the bubbling water.

Alice in Wonderland" Lobster Quadrille

I have often wondered (and always will) whether it is cruel to cook crustaceans alive? It’s a question that has been hovering around boiling point for a very long time, and the answer depends on whether animals can feel pain.

Alice in Wonderfland
The Lobster in Alice’s Adventures in Wonderland. Illustrated by Sir John Tenniel

The Lobster could tell Alice what it felt like to be boiled, but she would still be left wondering because pain is a subjective experience that can’t be shared like other senses. Two people watching the same sunset or listening to the same rock band can expect to have the same experience, but pain is a private experience. When a nurse asks patients to estimate the degree of surgical pain on a scale up to 10 everyone understands what zero means, but we never know in any objective sense if their intolerable pain (10) is the same in ourselves. And, besides, the measure of pain medication needed is often different.

Pain may be pain but is not all the same. It can be acute or chronic, physical or psychogenic, nociceptive or neuropathic, somatic or visceral, localized or referred. And nuances are gated by mechanisms in the spinal cord that affect ascending pain signals to the brain. Have you, for instance, ever wondered why rubbing a bruised knee makes it feel better?

Saying we have empathy with someone who is suffering is kindly meant, but strictly nonsense because we cannot truly share the pain. And if we find this a slippery subject between members of our own species how much harder it is to understand in another species.

Pain is physiological as well as psychological, but it verges on the philosophical. René Descartes (1596-1650), the father of modern philosophy, had a view of animal pain that we no longer regard as enlightened, and has been used to justify animal cruelty. In saying, “…there is no prejudice to which we are all more accustomed from our earliest years than the belief that dumb animals think,” he was avowing that animals are mere mindless automata, and ipso facto cannot experience pain.  But not everyone agreed, even in those days. Michel de Montaigne (1533-1592) wrote about our responsibility towards ‘brutes.’ “There is a certain respect, and a general duty of humanity, that attaches us not only to animals, who have life and feeling, but even to trees and plants. We owe justice to men, and mercy and kindness to other creatures that may be capable of receiving it. There is some relationship between them and us, and some mutual obligation.”

Compassion grows as knowledge deepens, but controversy continues. As arguments about the consciousness of apes continue, can we ever know what a lobster feels? We should avoid putting too much faith in science because although it is very successful in revealing biological mechanisms and reactions it is rather ineffective at interrogating how animals feel. Lobsters have a primitive ‘brain’, nerves coursing the length of the body from peripheral sense organs, and endogenous opiates and some other chemical mediators of pain that we possess. More significantly they avoid hot water and nasty chemicals, but does this behavior mean they are in pain or just hacked off? It’s a serious question for lobsters, and something we try to avoid.

The late Julia Child was a celebrity chef and a kindly-looking woman. She merrily taught millions of TV viewers how to boil lobsters alive, and I have no doubt that she would have been horrified if it was found to be torture. Doubtless she would then have advised killing the animals humanely by jabbing them with a knife behind their eyes to the brain before cooking. But while uncertainty remains her recipe stands.

Peter Singer, author of Animal Liberation, challenges our complacency: “So even if there is some room for doubt about the capacity of these animals (crustaceans) to feel pain…they should receive the benefit of the doubt.“ I don’t agree with all the declarations made by the Australian philosopher, but I admit his ethical consistency is impeccable. On the only occasion we were at dinner together I remember there were only plants on his plate, and no lobster tank at the restaurant door.

Next Post: A Grain of Satisfaction