Friday, 19 February 2016

Tooth Hurty ...

I was sitting having a coffee, minding my own business when two ladies of my own age, late 50's, caught my attention. You see, as an ex-dentist, loud conversations where the expressions: "First teeth, What's the point of filling them? Clearly the dentist is just doing it to make money, after all - they fall out anyway!" tend to jar on my ear and leaves me with a serious concern that nothing much has changed in terms of the fundamental ignorance on this issue since I first set out as a qualified dentist in June 1979. In fact the clear prejudice of the speakers was that it was, "just about making money", left me wanting to bang my head on the table in despair.

The current situation across the UK is a child is more likely to be admitted to hospital for a general anaesthetic for multiple extraction of teeth than any other clinical procedure. According to peer reviewed, dental papers in the professional journals, the state of children's teeth (under 16 years of age) in the UK has declined, since 1990, to a level not seen since the mid 1960's in terms of untreated decay and multiple extractions under GA of not just primary teeth but permanent first molar teeth as well.

For dentists 1990 is a key date because this was when the BDA lay down and let the then Tory Government enforce a 'new' contract on the profession, in spite of its rejection, in a ballot, by 68% of the BDA's membership. At the time dentists, like myself, who had sizable numbers of children under their care, warned that the positive impact we were making on improving child dental health would regress under the terms of the 1990 contract, in much the same way as the Junior Doctors are currently pointing out how care will regress in NHS England, at this very moment, to the public of England. The government of the day focused on 'money', again much like their current campaign against the Junior Doctors, but the UK public bought it being about 'money' in 1990, after all everyone knew all dentists had a Porche 911 on the drive, a couple in the garage and were ripping the public off left right and centre, all of course excepting their own dentist, who was a saint and drove a Ford Fiesta or a VW Passat Estate. Funny how folk ignore the evidence of their own eyes and experience to fit their own prejudices that all dentists drive Porche 911's.

So why am I so exercised by these Grannies' comments after all I am now very much an ex-dentist and the fundamental truth is the primary teeth do fall out. The issue they are missing is they do 'fall out' but in a physiologically controlled sequence, over a period of time which is designed to maintain balanced facial growth and create the required space for the permanent teeth to erupt into.

So what?

Well, early loss of primary molar teeth routinely occurs with early loss of the first permanent molar teeth and does three things:
  1. Effects facial bone growth, in simple terms, causing a shortening of the lower jaw, narrowing of the upper jaw
  2. Increases the likelihood of nasal, ear and sinus problems in later life
  3. Delays further eruption of permanent teeth (see bullet point 1 and repeat ad infinitum)
So you now have a child who has experienced the trauma of extractions under GA at five, six or seven, who is inevitably going to require orthodontics to correct the facial growth problem, get their remaining teeth in the right place and will probably face further extractions at age 12 or 13 to 'make room' for the remaining permanent teeth due to the loss or impairment of facial bone growth caused by the first round of extractions. 

Guess what? 

A large percentage of these young people tend not to complete their orthodontic treatment and are 'put off' dental care for life. As a result of the failure to complete the orthodontic phase they may end up with narrow 'V' shaped dental arches and wonky teeth with related gum disease, add in this group has already experienced a high level of dental decay and you eventually have an adult who does not give a shit about their dental health and wants a set of 'wallies' asap. Provision of said 'wallies' being a clinical nightmare due to the impaired and unbalanced facial growth they present with and, as a result, they frequently end up not wearing the dentures supplied then troop around all the dentists in the local area trying to find a decent dentist who can make a proper set of 'wallies' and not the wonky 'Leaning Tower of Pisa' job, like the previous, eejit dentist created. I have seen the plastic carrier bag with umpteen pairs of 'wallies' in them and heeded the implicit warning, referring said patient to a colleague who was, according to me, far better at making 'wallies' than me. Sometimes the only professional act is to duck the issue: call me coward but you would not be the one facing the time, professional and financial cost of a patient complaint by this sort of patient who already has a serious grudge against dentists.

The end result of this saga of umpteen sets of poorly fitting 'wallies' is to see dentists condemned by the same Grannies in fifteen years' time, no doubt sitting at the same table, in the same coffee shop as an yet another example of dentists just making even more 'easy money' out of their 'poor grandchild'. In the meantime their 'poor grandchild' haunts the wastes of the local Ear, Nose and Throat department trying to seek resolution for their mouth breathing or ear ache or blocked sinuses or all three when not searching the internet for a dentist, any dentist, in any nation, who can make them a decent set of 'wallies'.

And all because people think, "First teeth fall out anyway, so what is the point of filling them."


  1. Thanks for that Peter. You filled a gap in my knowledge base, as in, I never knew that. I'm probably not alone in this lack, but I've reached pension age without having to resort to 'wallies'. My enjoyment of food will decrease sharply if that sad day comes.
    Why is this not better known, or understood among the unheeding herd? All the posters in Dentist surgeries seem to concentrate on teeth & gums and there appears to be nothing about why you should retain your first teeth for the reasons you've given.

    Anyway thanks for the post.

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