Some of the more senior readers of Navy News have written to the editor in praise of the care they received from Navy dentists – citing the fact that they still have most of their own teeth half a century later.

Those comments have been welcomed by Surgeon Commander (Dentist) Michael Gall, who said he believes that the Navy continues to offer the prospect of rewarding and challenging careers for dental officers, hygienists and dental surgery assistants, as well as top-class care – which can only be good news for Service patients.

Dentists place a high priority on preventive care, which is of particular significance for sailors on long overseas deployments, often without an embarked dental team.

Healthy teeth and gums are a good starting point, and the majority of dental care in the Navy is provided in shore clinics or satellite caravans on a jetty, but dentistry is also provided at sea and in operational environments ashore.

Medical teams are routinely on hand to deal with commonplace dental conditions such as fractured teeth and wisdom tooth infections – but what happens when more serious problems arise?

The identification and treatment of rarer mouth disorders becomes complicated if they arise during a long deployment, when there is no dental officer present.

These days, embarked medical staff or dental officers can use communications tools to consult with land-based colleagues; tele-medicine allows rapid exchange of clinical pictures via e-mail, for example.

In a classification system being refined by the Forces, patients are rated on a scale of low to high risk, establishing how frequently they must be examined, and such risk assessment for individuals and units helps in planning the deployment of embarked teams.

Ships such as carriers and assault ships carry fully-equipped dental surgeries, but the needs of personnel in smaller warships such as frigates and destroyers are more likely to be met using portable dental equipment set up in the sick bays.

And with many modern naval operations involving ships working as a group, someone serving in a minehunter, for example, could be transferred to a larger sister ship for treatment.

Such seagoing dentistry ensures fewer man-hours are lost as patients avoid the need to transfer ashore for care, and can be available for work much more speedily.

The recent Iraq conflict required the deployment of dental teams from all three Services, and post-Telic reports have been generally complimentary.

“Naval dental support was an extension of normal peacetime provision and standard operating procedures were proven robust,” said Surg Cdr Gall.

“Navy dental teams worked at sea and ashore in support of the amphibious operation. Some dental officers provided routine primary dental care, while others, serving with 3 Cdo Brigade, deployed in their war role in the Regimental Aid Post.”

Surg Cdr Gall acknowledged that some of the dental personnel who deployed were comparatively junior. Sea survival training was arranged at short notice and broader military training, including weapon-handling was delivered en route – under the Geneva Convention, medical and dental officers may be armed to protect patients in their care.

“Dental teams ashore provided both emergency and routine dental care,” said Surg Cdr Gall. “Portable dental units were set up in tents, where the dusty environment and operational tempo periodically compromised clinical ideals.

“Troops were under constant threat of attack and had to be able to dress in a gas mask within nine seconds – and both patients and clinicians were forced to abandon treatment for a shell scrape in the expectation of imminent attack.”

Dental awareness and expectations within the UK population are higher than ever, and this trend is mirrored in the Forces.

In the 1930s, extractions and fillings were the bedrock of dental care, and Surg Cdr Gall said a recent scientific paper favourably compared the longevity of amalgam fillings placed by military dental officers with those placed in the NHS and private sector.

“It implies we are doing at least one of the basics well,” he said, “but dentistry is becoming increasingly consumer-led, with a growing demand for aesthetic dentistry.”

Navy dental care remains free at point of delivery, irrespective of ability to pay – but there is a sting in the tail for Navy patients, as the cost of dental care for those who leave the Service and join a civilian dentist’s list can be a nasty shock.

With Naval dentists able to call on the support of the established network of consultants and clinical specialists, and a referral system for surgical dentistry and the like, there is little evidence of RN patients leaving current care arrangements for the private sector, suggesting they are happy with the care provided.

High clinical standards are practiced; with high mobility in the Forces, there is constant peer review, where other dental officers review the quality of previous treatment, a marked contrast with the general dental services where peer review is not as wide because patients do not tend to move between different dentists in the same way.

Facts and figures:
• There are 63 RN dental officers, five of whom will be at sea at any one time
• There are 114 RN ratings, including dental hygienists; five are at sea at any one time
• Five RN dental officers are attached to the Royal Marines
• Every year there are 20-26 dental nurses in training
• Four foreign exchange posts are available in the USA, Brunei and Germany (Army)
• Six RN dental officers have earned the Green Beret
• Around 22,000 fillings are completed in the RN every year
• 360 dentures are made every year
• 1,400 teeth are extracted every year
• 450 referrals are made to specialists every year