15 Sep The History of Dentistry: Dentistry in the RAF
Tooth-ache at 20,000 feet? No thanks!
The RAF was formed in 1918, merging the Royal Flying Corps and the Royal Naval Air Service into an independent organisation. Twelve years later, its operations and deployments meant it needed its own dental service. The RAF Dental Branch was formed in 1930.
The War for Oral Health
At the start of the 20th Century, the state of British teeth was so bad it was actually threatening the survival of the British Empire. During the Boer War in South Africa, 69,553 recruits who had a medical inspection. Of these 4,400 were not accepted by the Army due to “loss or decay of many teeth.” And of 208,000 troops that served in Africa, 6,900 were hospitalised for dental reasons. The War Office was so alarmed it contracted four dentists to treat these troops. They became the first paid dentists to serve the British army.
Governments of the time were stunned into action. They introduced a number of measures, including health and dental services within schools to improve the health of future recruits.
WW1 started in 1914, and the Army began recruiting dentists. By the end of hostilities in 1918, there were 850 dentists in France and Belgium looking after the teeth of the vast British and Empire Army.
Start of the RAF Dental Branch
The RAF Dental Branch was formed in 1930 as the importance of air power grew. By 1935 it was clear that the RAF needed to expand rapidly in response to developments in Europe. At the time, the RAF was served by 16 dental officers with permanent commissions, 29 with non-permanent/reserve commissions and 51 civilian practitioners.
At the time, dentures were very common, even amongst young and otherwise fit servicemen and women. The handful of RAF Dental Technicians (known as Dental Mechanics) dealt with a very high workload.
The RAF quickly recognised the need for ‘Dental Clerk Orderlies’ to support dentists in the surgery and with admin. They were soon renamed as ‘Dental Surgery Attendants’ and performed similar duties to a modern Dental Nurse.
It wasn’t long before the Dental Branch created its own Dental Training Establishment at RAF Halton in Buckinghamshire. This was the initial entry point for dental officers and for the training of Dental Clerk Orderlies and Dental Mechanics (and later, Dental Nurses).
For the RAF, the provision of dental services was critical. Throughout WW2, the service was always short of highly trained pilots and aircrew. The slightest dental problem could cause agony in an unpressurised aircraft flying at 20,000 feet or higher, rendering that crew member unfit for duty.
The Battle of Britain
By the outbreak of WW2, members of the RAF Dental Branch were stationed at all the larger air bases. In mid-1940, the German army and navy were planning an invasion of southern England.
Hitler’s air force (the Luftwaffe) started a bombing campaign to eliminate the RAF. This would pave the way for the planned invasion of Britain. An operational RAF made an invasion would be impossible as landing craft and troops were too vulnerable to air attack.
Between 10th July and 31st Oct 1940, the RAF lost 1,542 aircrew killed and 422 aircrew wounded. But the careful deployment of meagre resources by the British commanders preserved the RAF’s strength while disrupting German attacks.
Even with 14,281 civilians killed, and 20,325 injured, the RAF stood firm. It inflicted unsustainable losses on an exhausted Luftwaffe and stopped it achieving its objectives. By mid-autumn, the weather made it impossible for an invasion force to cross the channel. The German army turned East towards Russia. Britain was saved.
A major turning point in WW2, the action quickly became known as ‘The Battle of Britain’. This was Hitler’s first significant defeat.
Throughout the battle, the RAF Dental Branch worked alongside other medical teams to keep both pilots and hard-worked ground crews fit for duty.
Sick bags and Hygienists
‘Dental hygienists’ were first trained in America as early as 1913. They came to the fore in Britain because of high levels of periodontal disease during WW2. The Royal Air Force was at the forefront of their introduction.
The need for improvements in oral health led to the creation of a course for dental hygienists at RAF Sidmouth in 1943. Each 16-week course trained selected Dental Surgery Attendants to scale and polish teeth, and to educate patients.
The work of these RAF hygienists helped ensure the availability of bomber crews for the latter part of the war. This was critical to the success of the infamous ‘1,000 bomber raids’ over Germany’s major cities, which might require as many as 8,000 pilots and aircrew to be available for duty.
The first civilian school for hygienists followed in 1949 at the Eastman Dental Clinic in London. The 1957 Dentists Act introduced hygienists as the UK’s first post-war civilian ancillary workers to legally provide oral care.
One technical development that reduced the workload on the Dental Branch was the introduction of sick bags for aircrew. Apart from the grim prospect of having to fight for your life sat in your own vomit, aircrew suffering from air sickness had previously run the risk of losing their dentures. The simple sick bag meant that dentures could be recovered, avoiding replacement. This greatly reduced the workload of the RAF’s dental laboratories.
The Desert War – make-do and mend
The RAF conducted its North African air operations largely with single and two-seat fighters. Though fewer crew members were involved than in Northern Europe, work in Africa placed its own unique demands on the Dental Branch.
Spitfires and Beaufighters flying from Malta constantly intercepted German transport aircraft and supply ships as they crossed the Mediterranean. Hurricanes and Tomahawks harried German tanks and artillery, often flying from make-shift desert bases.
The battlefront ebbed and flowed along the North African coast. The Western Desert campaign and, therefore, demanded mobile dentists. Some were equipped with surgeries converted from ambulances. This identified the need for purpose-built mobile surgeries in later campaigns, such as the D-Day landings of 1944.
Meanwhile, dentists in Malta often had to find suitable facilities amongst the rubble of bombed towns.
In both locations, dentists often ‘upgraded’ treadle operated drills and other equipment with parts salvaged from damaged aircraft. They quickly repurposed wiper motors, hydraulic pumps and generators to ease the stress of working in high temperatures.
Post-War and Modern Day
The RAF Dental Branch has continued to develop since the end of WW2. The RAF posted dental specialists to all of its hospitals. And while new technologies placed new demands on aircrew, they also offered RAF dentists better equipment and improved treatment options. The RAF Dental Branch has often pioneered and popularised these. For example, during the war years, the RAF Dental Branch helped make penicillin and other antibiotics a regular part of dental treatment. These have now become a part of everyday civilian dentistry.
The pioneering nature and extremely high standards of the RAF Dental Branch established a need for the inclusion of specialist hospital dental services within the fledgeling NHS. The RAF’s preventative approach has helped reduce dental problems within both service and civilian life alike. People now have a greater understanding of oral health as a result of this work.
The RAF still trains nurses, technicians and hygienists, and recruits both newly qualified and experienced dentists as commissioned and reserve officers. They now work alongside civilian dentists and nurses as part of the Defense Dental Service, providing dental care to personnel based at RAF establishments (and their families). Their predecessors’ work has had a huge impact on British oral health, just as the service they supported kept Britain independent in 1940.
Pearl and A Bit of Dental History
We have decided to add a ‘history’ category to our blog page. Starting with this article – published on ‘Battle of Britain Day’, 15th September – these articles will look at a range of historical events and developments in dentistry.
The ultimate defeat of Hitler’s Nazi Germany in 1945 was in no small part due to the RAF’s pounding of German infrastructure during the latter part of the war. But that would never have happened without victory in The Battle of Britain. And there is little doubt the fitness for duty and comfort of RAF crews and technicians that allowed them to do their job was down to the service’s excellent medical and dental branches.
To commemorate the casualties (RAF, civilian and Luftwaffe) of the Battle of Britain, we are making a small donation to the Royal Air Force Association ‘Wings’ appeal which raises funds to care for former RAF personnel – including former members of the RAF Dental Branch.
A letter from a reader
Just to say I have just found your article whilst searching the internet for more info on the Dental Branch and found it most interesting.
My late father (Sgt Alex. J. Duncan) served in the RAF during WW2 in the Dental Branch. For quite a while this was in Freetown, Sierra Leone.
And yes as your article says he told us it was most important that aircrew did not have tooth problems whilst flying.
Here are pictures of him helping the dentist and the surgery in Freetown.
Hope these are of some interest to you.