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/. Soc. Occup. Med.

(1988) 38, 41-43

Occupational Dentistry: A Review of 100 Years of Dental


Care in the Workplace
G. P. FEAVER
Dental Surgeon, Marks & Spencer, p.I.e.
Honorary Secretary, Association of Industrial Dental Surgeons

Summary cluster of dental schemes being started in the early


The first industrial clinic was established 100 years ago. Since then, 1900s mainly by chocolate and confectionary manufac-
occupational dentistry has developed and evolved to take account of turers (Fig. 1). Rowntrees in York, for example, had
the changing needs of the working environment and the altering provided a medical service since early 1904 and, after a
patterns of disease. A high standard of preventatively orientated care
short time, the doctor is recorded as saying 'If you can't

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can be offered to staff at their places of work and companies that
provide such facilities can benefit from a significant reduction in time afford to employ both a dentist and a doctor, I advise
lost through dental causes. you to get rid of me and provide a dentist for so much
of the illness is due to faulty teeth that I really think his
services are more necessary than mine'. A full-time
Introduction dentist was appointed later in that. year. The doctor did
The provision of medical facilities in-the working en- not lose his job!
vironment is well established. Less common than occu-
pational medical practice, but also well established, is
the provision of dental treatment facilities at the work- Development
place. It is well recognised that a large proportion of Industrial dentistry continued to develop between and
the population either never visits a dentist or only seeks during the wars with notable schemes being set up by
emergency treatment. One way to encourage greater Marks and Spencer in 1935 and the English Electric
dental attendance is the provision of easily accessible Group of Companies in 1943, the latter being a re-
surgeries in the workplace (Nuffield Report, 1980). sponse to the urgent need of their many workers en-
This takes on even greater significance wheri one con- gaged on priority war work at that time (Thomas,
siders that it has been estimated that up to 12 million 1961). In 1948, the National Health Service conferred
working days may be lost in the United Kingdom the right to free dental treatment on everyone in the
through dental causes each year (Feaver, 1985). Pro- United Kingdom. The availability of free dentistry
viding dental facilities at work has the effect of drasti- removed one of the original and basic factors which
cally reducing the time spent away from work for dental brought about industrial dentistry but, at the same
treatment (Wege, 1985). time, it introduced a source of funding which made a
dental service attractive to employers not previously
involved. It become permissible for a dentist to practice
Historical Background in the N.H.S. under his own name and to assign the
Industrial dentistry is not new and it has followed the fees to the employing company. With the subsequent
same direction as occupational medicine. The first re- development of the Welfare State, occupational health
corded industrial dental clinic was established by the services in general were encouraged to expand by
Great Western Railway Medical Fund Society over various government reports (Dale, 1949).
100 years ago in 1887. Also in 1887 a series of newspap- After the Second World War, rebuilding of city
er articles condemned the very poor working conditions centres with large office buildings allowed companies to
that existed in match factories in the United Kingdom.
The workers, mainly girls, suffered from a high inci-
dence of phosphorous necrosis of the jaw, so-called
'phossy jaw'. The government commission which was
set up to investigate the matter revealed the appalling
dental state of the workers and showed that yellow
phosphorous caused necrosis of the bone in the pre-
sence of sepsis. The recommendations that followed
included compulsory dental examinations for em-
ployees plus insistence on personal and oral hygiene. A
two-chair dental clinic was established in Bryant and
May's London factory.
Concern for the health of the employees affected by
an industrial process was one factor in the birth of
industrial dentistry. There was also the possibility that
the dreadful state of dental health of the workers might
affect the quality or the purity of the product. This Fig. 1. An example of an early dental surgery circa 1914 (Courtesy
factor, coupled with acts of philanthropy, led to a Wills Collection of Tobacco Antiquities).
1988 Buttcrworth & Co (Publishers) Ltd
0301-0023/88/010041-03 $03-00
42 OCCUPATIONAL MEDICINE (1988) VOL. 38/NO. 1/2

consolidate and house their Head Office staff in single education and the provision of regular fluoride mouth-
units. Their employees therefore travelled long dis- rinses in their washrooms. All these preventive mea-
tances to their family dentist and the so-called green sures can be varied to take account of any particular
field sites developed for new factories were by defini- firm's special needs. Although most treatment is car-
tion remote from existing dental practices. All of these ried out under the N.H.S., there are occasions when
factors combined to interest a new type of employer in certain treatment not available (such as posterior com-
industrial dentistry. Funding was available from N.H.S. posite restorations and certain cosmetic treatments)
sources and employees were concentrated in units large can be provided at a modest charge to the patient.
enough to justify the employment of a Company dentist One further important aspect of an occupational
who could save valuable time otherwise spent by work- dental practice is the screening service which it can
ers travelling to a dentist near their homes. Companies offer to staff who may not otherwise visit a dentist. One
providing a dental service were seen to be caring em- particular category comprises the edentulous who, in
ployers and a dental service became part of the remun- good health and with satisfactory dentures, may have
eration and welfare package (Wege, 1985). little cause to seek medical or dental advice. Although
A number of large companies have for many years the most common tumour-like swellings of the mouth
provided such dental treatment facilities for staff at are inflammatory overgrowths such as denture granulo-
work and a significant proportion of the adult working ma, the most important are carcinoma. The incidence
population is currently served in this way and, although of oral carcinoma is low at around 2 per cent of all

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occupational dental services are better known amongst malignant tumours in the United Kingdom but early
the larger organizations, there have been other in- treatment is the main factor affecting the survival of
stances where groups of smaller companies have joined patients; the prognosis can only be improved if the
together locally to share the advantage of a common disease is recognised early. Unfortunately nearly 60 per
dental practice. cent of patients with intra-oral carcinoma have adv-
anced disease when treatment starts (Cawson, 1978).
Oral health screening offers the opportunity for early
The Comprehensive Dental Care Service diagnosis and is a very valuable part of overall health
At one typical occupational practice in London, where care, which can be viewed in the same context as breast
there are approximately 4500 employeees, a comprehen- screening and cervical cytology.
sive dental treatment service is provided for the benefit The availability of dental treatment facilities at the
of staff. Treatment is carried out under the N.H.S. with workplace, therefore, offers clear advantages to all
staff paying the statutory contribution. The dental prac- concerned. For patients, there is a conveniently located
tice staff includes two full-time dentists, one part-time practice, offering comprehensive dental care; for the
dentist, one full-time oral hygienist, one part-time oral dentist there are few of the economic restrictions
hygienist, five dental nurses and one secretary. There encountered in an N.H.S. practice but many of the
are four well-equipped surgeries with relative analge- benefits of regular salaried employment; and for the
sia, useful in the sedation of nervous patients, available company, the tremendous saving of time that would
in each. In addition, there is a panoramic X-ray otherwise be lost and the provision of a tangible staff
machine and an oral hygiene area where patients can be benefit. Most occupational medical officers and person-
given instruction on a one-to-one basis. Approximately nel managers would agree that they sleep easier when
70 per cent of the staff regularly use the facilities they have a contented and healthy workforce. The
provided. There is complete clinical freedom and the occupational dentist is very much on their side. As a
majority of treatment is carried out under the N.H.S. salaried employee of the company, he is free to orga-
As most dentists employed in industry are salaried, and nize his practice to best serve the particular needs of his
are therefore not relying upon the item of service fellow employees, whether they are off-shore oil work-
system for remuneration that generally operates in the ers, air crew frequently abroad, food technologists or
Health Service, a high standard of preventive care can desk-bound Head Office staff. Personnel managers are
be delivered. also aware of the increasing expectations of employees
Dental health education can be utilized to the max- for a healthier, better working life and in this too the
imum effect within the framework of an occupational occupational dentist can make a valuable contribution.
practice, and an integrated approach to overall health It is appropriate to stress the importance of the occupa-
education can be developed for the benefit of staff. An tional dentist working in close cooperation with the
extension of the oral hygienists' role may include talks other disciplines in the field of occupational health and
and discussions with groups of workers involving in- not to view the dental service in isolation. An inte-
teresting and amusing presentations to further their grated approach to overall health care at work involv-
understanding of dental health in particular, whilst also ing the dentists, doctors, occupational nurses, and
helping to formulate attitudes to healthy living in physiotherapists where available, is an effective way of
general. The dental team can have a valuable part to improving the well being of the staff and maximizing
play in health promotion in giving, for example, dietary the resources of an occupational health department. As
advice and counselling on the effects of smoking. Prior- mentioned earlier, the dental team can have a valuable
ity groups, such as expectant mothers, can also be given role to play in health promotion but as important is the
advice on dental health. In some organizations, particu- clinical input offered by an occupational dental practice
larly in the food manufacturing industry, there may be as part of a team approach in caring for the staffs well
groups of employees involved in the regular tasting of being. The availability of multi-disciplined expertise
food products. Special measures can be instituted for within an occupational health department is of great
this high-risk group as, for example, targeted health value in the prevention and treatment of a variety of
OCCUPATIONAL DENTISTRY: A REVIEW OF 100 YEARS 43

conditions encountered in everyday practice as well as membership and recent years in particular have seen a
in the broader discussions with personnel managers. growing interest from overseas. Indeed the Association
For the staff who work in an occupational health de- can now claim members in every continent and the
partment, there is the added enjoyment of being part of employing companies concerned are as equally
a team fulfilling a vital role which is valued by the diversefrom Marks and Spencer to the Bank of Eng-
Company it serves. land in London, and from the Heineken Brewery in
In uncertain economic times, hard-pressed em- Holland to Jos E. Seagram and Sons in New York.
ployers may question the necessity for dental facilities The Association of Industrial Dental Surgeons will
at the workplace and, in the past, industrial dentistry continue to provide information for companies con-
does seem to have been largely at the mercy of external sidering on-site dental schemes and will remain a focal
forces. Its protection must be in the service offered to point of interest, expertise and information for its
both management and patient. Most dentists recognise members and will continue to hold scientific meetings
the need for a preventatively orientated practice. Poss- specifically designed to interest and educate them in all
ibly the dentist in industry is better placed to effect this matters relating to occupational dentistry. It will also
mode of delivering dental care and, in most occupa- continue to believe in the value of the high quality
tional practices, use of ancillaries with the emphasis on dental care which its members provide at the workplace
prevention is already well-established. In a highly com- for many thousands of employees throughout British
petitive world, overhead costs are subjected to closer industry.

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scrutiny than ever before and the fact that many of our
most competitive and successful companies still value
an in-house dental service is encouraging in such chang- Conclusion
ing times. The ability to change with these times, and From its earliest days, occupational dentistry has been
possibly to anticipate trends, is the mark of a successful shown to have an important role to play in the overall
company and applies no less to the successful practice provision of occupational health care. After 100 years
in industry. of dental care at the workplace, occupational dentistry
remains in good health with an excellent prognosis.
It is a powerful testimony to the value of occupation-
Oral Health Screening and Inspection Service al dentistry that companies internationally known for
Whilst the comprehensive care service described above their attention to costs and profitability are the keenest
is ideal for the large office building or factory, it is supporters of their company dental services. The hope
clearly neither practical nor cost-effective for a retail is that, by the continued development and expansion of
company with large numbers of units spread through- such facilities, increased dental attendance may be
out the country. One example of a cost-effective encouraged and a significant decrease in the number of
approach provides for visiting dental practitioners to working days lost through dental causes may thus be
offer examinations and advice to staff on a regular achieved, together with the consequent improvement
basis, any treatment required being carried out by a in the staffs well being.
dentist of the employee's choice. Under a scheme
pioneered by Marks and Spencer p.I.e., the Company
arranges for a dentist to visit each of its stores at REFERENCES
regular intervals as part of a targeted screening Cawson R. A. (1978) Essentials of Denial Surgery and Pathology, 3rd
service. All new staff are seen, together with those Edition. Edinburgh: Churchill Livingstone, p. 323.
considered to be in high-risk categories. Oral hygienists Dale Committee Report (1949) Industrial Health Services London:
also attend to give advice as part of a broader role in HMSO.
overall health promotion. Feaver G. P. (1985) Dentistry at work. Dental Advertiser and Hygien-
ists' Forum 45, 10.
Nuffield Report (1980) The Report of a Committee of Inquiry into
Dental Education, Chairman: Professor T. C. Thomas. London:
The Association of Industrial Dental Surgeons Nuffield Foundation, Chap 7, para. 31, p. 82.
The Association of Industrial Dental Surgeons (Royal Thomas D. A. (1961) Industrial dentistry within the english electric
group of companies. The Dental Magazine and Oral Topics 78,
College of Surgeons of England, Lincoln's Inn Fields, No. 1
London WC2A 3PN) was founded in 1961. Since then, Wege P. J. (1985) The sponsored practice. General Dental Practice,
there has been a steady growth in the Association's Part B 1.3, P. 01.

Requests for reprints should be addressed to: G. P. Fcaver, Honorary Secretary, Association of Industrial Dental Surgeons, Marks & Spencer
p.l.c, 47 Baker Street, London W1A 1DN.