The New Zealand Dental Services
Appointments for Treatment
Appointments for Treatment
Appointments could not be made haphazardly and a number of factors that had not concerned the dental officer in private practice had to be considered. These were:
The training syllabus and camp routine orders had to be consulted. For example, it was inadvisable to make appointments for men whose companies were needed for rifle practice on the range or who were ‘Duty Company’.
The total time for treatment had to be estimated. Those needing multiple extractions had to receive priority so that as long as possible could be allowed for the mouth to heal before fitting artificial dentures.
It was necessary to estimate how long each course of treatment would take. Except in special circumstances, it was inadvisable to keep a man in the chair longer than an hour at a time. On the other hand, the greater number of times the man had to attend the more time he was away from his training, and the more time he wasted in going to and from the hospital and in waiting his turn for treatment. Also, time was wasted in the hospital in sterilisation of instruments. As much work as possible had to be done at each appointment consistent with a high standard of operative work and the patient's welfare.page 106
Enough of different classes of work had to be called up to keep all departments of the hospital fully occupied.
Considerable tact was needed in convincing unit commanders that the time spent in the promotion of oral health in their men was not wasted in comparison with their general training. When it was seen that the Corps policy was to interfere as little as possible with training and duty, there was seldom any friction and most unit commanders became valuable allies.
In every body of men there was the ‘old soldier’ who welcomed the dental parade as an excuse to evade unpleasant duties. Appointments therefore were all made through the unit orderly room and an appointment and dismissal form, stating time of arrival and departure, was used.
Appointments were not made with individual dental officers except in such cases as ‘Trench mouth’, when continuity of treatment was desirable.
In the bigger hospitals it was customary to use one officer to do most of the extractions in the early stages and another to specialise in the prosthetic work so as to keep the mechanical staff fully occupied. The remaining officers would then concentrate on the filling work, which constituted the bulk of the work.
In the Air Force there were other factors to be considered. The officer in charge of each dental section had to evolve his own system to get a steady flow of patients without interfering with training or duties. This was not easy and called for careful arrangement of work by the dental officer and willing co-operation from officers commanding flights and sections on the station. In the mobilisation camps soldiers were made available in groups, but on air stations individual appointments had to be made. Fortunately all dental sections had telephones. Where extractions were necessary the weather had to be considered, so that an interval in the flying programme could be used to advantage. Unfortunately the medical officer was often working to the same plan and wanted the same period for his inoculations. On the other hand the extractions were few, most of them having been done during the period of preliminary training at Levin or Harewood. Another factor was that it was found that, while the average soldier tolerated dental treatment better than the average patient in civilian life, in the Air Force the reverse was the case. Men undergoing intensive courses of technical or flying training, or engaged for long hours on aircraft maintenance, did not tolerate dental treatment with the same equanimity. Filling operations took longer, local anaesthesia was more often necessary and appointments had to be shorter.page 107
On the average the treatment required by the aircrew trainees involved about 400 fillings per hundred men, which was practically the same as in 2 NZEF, but the number of extractions and dentures was lower. Only young men of a comparatively high educational standard were accepted for aircrew and most of these had received continuous and complete dental treatment during adolescence. On the other hand, as has already been pointed out, the examination of these mouths demanded more care and the conservative treatment took longer. It was also more important to detect and eliminate root infection in men who were destined to fly at high altitudes, when those defects, dormant under normal conditions, were likely to show up. The men were also at the most susceptible age for caries and for complications from impaction or incomplete eruption of the third molars. It was extremely important that men who would shortly be engaged in operational flying in Europe should be free from all dental complications.
Before going into details as to how the treatment was carried out, it is well to state what was offered and how it was received. The DDS in his instructions to all dental officers stated:
The same care and attention to patients and the same high standard of dental treatment should be observed as would normally be expected in a high class dental practice.
This was the highest standard that could be set and in most cases it was fully appreciated, but there were some cases where it was looked on with suspicion. The cases were remarkably few but, as they constituted a problem which must inevitably occur, however high a standard is offered in the future, they must be considered.