The launch of the National Health Service on 5 July 1948 changed the pattern of dental treatment in Britain dramatically. The change altered the lives of everyone connected with the provision of treatment.

The roots of the NHS lie in the National Health Insurance Act of 1911, which allowed for the provision of dental treatment for manual workers on low incomes. Fourteen-million adults were members of the approved societies that administered the funds. However, only six to seven per cent claimed any benefit for dental treatment despite dental disease being widespread. This accounted for one-fifth of dentists’ income. Extraction and denture fitting was the main form of treatment and a free health service for all was deemed highly desirable.

The structure of the NHS was established by the 1946 Health Act. The BDA had a number of concerns about the Act. An item-of-service payment system was proposed, following a similar system operated by the approved societies. Some BDA members believed that the fees were too high and might encourage unscrupulous practices. And the Association was worried that the Government could alter fees without consultation and that it wanted to turn all dentists into salaried officers working in health centres. There were also concerns that the prior approval needed before treatments could be carried out was very restricting. The BDA initially advised its members to stay out but within the membership opinions polarised.

By 5 July 1948, it is estimated that just over one-quarter of dentists had signed up. The public was more enthusiastic: the level of demand created by the NHS surprised everyone. Most dentists had previously seen 15 to 20 patients a day: this escalated to up to 100 following the arrival of the NHS. Dentists were working far more than the recommended 33 hours. Some practices opened seven days a week but still had waiting-lists months long and began to turn away new NHS patients. Hospitals, too, saw a rise in dental cases.

Dentists became subject to increased bureaucracy with a long list of treatments that required prior approval from the new Dental Estimates Board (DEB). It was calculated that dentists spent seven hours a week on form filling.

From October 1950, treatment had to be carried out within certain time limits, causing much frantic work that summer. The initial hope had been that there would be less emphasis on prosthetics for older people and more conservative treatment for children. However, the overwhelming demand for dentures prevented this. In the first nine months of its existence, NHS dentists provided over 33 million artificial teeth, a figure that would rise to 65.5 million for the year 1950 to 1951. Extractions still formed a large part of dentists’ work – 4.5 million in the first nine months – but so did fillings – 4.2 million in the same period. It was claimed that the DEB was keener to approve cheap extractions than more-expensive conservative treatment, such as gold inlays and bridges. In orthodontics, removable appliances increased because there was a lack of trained personnel and time to fit fixed appliances

Not surprisingly, the increased workload brought a rise in income for the dentist that far exceeded the £1778 a year envisaged. Scepticism among many dentists faded in the light of an assured income. By November 1948 official figures claimed that 83 per cent of general dental practitioners had signed up. Not all of the converts came from private practice; dental officers’ fixed salaries were raised very little and many left for the healthier rewards of being a general dental practitioner. Filled, full-time dental-officer posts dropped from 921 in 1947 to 712 in 1951. This was bad news for the Government, which had envisaged a wholesale change in the way dentistry was provided and was hoping for health centres staffed by salaried dentists, with mothers and children a priority. In such an unstable climate, recruitment to the profession was difficult with only two applicants to dental school for every three dentists needed. Despite the healthy profits of the initial months, numbers on the Dentists Register actually decreased in the early years of the NHS.

But more people were being treated than ever before, which had been the main objective of the new service but this success came at a huge financial cost. Within two years the Government cut fees three times – without any need for the Minister to consult with the profession, just as the BDA had feared. Dentists’ income fell by 10 or 20 per cent with each cut. This led to a sporadic strike in the north of England.

Despite these cuts, by 1951 it was clear that the NHS was already running out of money. In May, charges for dentures, the first charges of any kind for NHS treatment, were introduced. This led to a huge decrease in demand: from three million a year to one and a half million. This did have the benefit of changing the emphasis towards conservative treatment for children but it further alienated the profession. Further charges for adults were introduced in 1952 and again demand dropped.

By the late 1950s, demand for dentures was declining and an increase in the amount of conservation work carried out was evident. Dentists’ earnings had settled down and recruitment levels began to improve.  Improvements in the process of gaining prior approval for treatment and more advanced dental treatments were being made available on the NHS. All this led to a short period of calm for NHS dentistry.