The launch of the NHS in 1948 meant, for the first time-ever, that dental care was free at the point of use, dramatically changing people's access to good oral healthcare, their expectations, and their appreciation of looking after their oral health.
The poor state of British teeth had been highlighted at the end of the previous century by the British Army's recruits for the Boer War: of 208,300, there were 6,942 hospital admissions owing to dental causes, of which one third had to be sent home unfit to serve.
In 1948 the nation's dental health was in a worse state than that of defeated and occupied Germany: decay, pyorrhoea, and sepsis were rife. More than three quarters of the population over the age of 18 had complete dentures.
Dentists at the time had concerns about how the new NHS system for dental practitioners would work, and more importantly, how the funding could be sustainable.
An item of service payment system for general dental practitioners was proposed, but the complexities of how this could work and the need for prior approvals and a likely growing mountain of bureaucracy, were felt to have not been thought through.
Members of the BDA were polarised as to whether it was a practical option to join the NHS or not.
When the NHS opened for business on 5 July 1948, we estimate that just over a quarter of practising dentists had signed up to work in the NHS.
Dentistry in demand
The demand for dental care on the new NHS was overwhelming. Dentists went from seeing around 15 to 20 patients a day to over 100. Patients had to be turned away, and hospitals also experienced a rise in cases.
The initial hope had been that there would be less emphasis on prosthetics for older people and more conservative treatment for children. However, the demand for dentures was incredible.
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 1950-1951.
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.
With the rise in work, dentists' incomes also rose, and the NHS became a more attractive proposition. By November 1948, official figures claimed that 83 per cent of practising dentists had signed up.
More people were being treated than ever before, which had been a main objective of the new service, but this success came at a huge financial cost.
Dentists' fears about the sustainability of the service were justified. Within two years of launching the NHS, the government cut the rates of item of service payments three times, and did so without consulting dentists.
By 1951, the NHS was already running out of money. To help alleviate this, charges for dentures, the first charges of any kind for NHS treatment, were introduced causing much debate in government and the public arena and leading to the resignation of Aneurin Bevan, the Minister who had been crucial to bringing the NHS into existence.
Other charges for treatment soon followed, and unsurprisingly, demand for services dropped.
NHS dentistry today
NHS dentistry today looks very different from the way it did in 1948. Modern techniques and technology mean that dentistry today is relatively pain-free, compared to the dentistry of the past.
However, dental anxiety continues to persist, more than 10 million adults in the UK report some level of dental anxiety, with an estimated six million experiencing dental phobia. All dentists are trained to put patients at ease and some also do additional training in techniques to help reassure nervous patients.
Oral health improvements: but more needs to be done
Satisfaction with NHS dentistry is currently at one of the highest levels seen this century, with 85% rating their NHS dental experience as positive.
Recent figures show a small fall in the number of NHS dental patients being seen in England, both for adults and treatment, and in the number of courses of dental treatment. Although oral health appears to be steadily improving for the general population, there are still wide variations, depending on where you live.
Oral health inequalities continue to exist, and there are still wide gaps in oral health outcomes, particularly amongst children.
We believe every child deserves the best start in life and oral health can impact on life chances, as well as physical health, affecting school attendance and ultimately their future career paths – we've called for universal and targeted interventions, to safeguard our children's oral health.
We have also been campaigning for a reformed NHS dental contract that offers the best for both dentists and their patients – the 2006 dental contract is not fit for purpose and we are asking for a new system, one that focuses on rewarding real prevention.
NHS dentistry should be a world leader, ensuring everyone gets access to dental care and good oral health outcomes, wherever they live and whatever their financial situation.