From the archive: Dental nurses mentioned in 1950s BDJs

These letters to the editor were published in the British Dental Journal in November 1954 (Volume 97) and February 1955 (Volume 98).

TIME-AND-MOTION STUDY

Sir, Mr Fraser's letter in the issue of November 2 comes as a breath of invigorating fresh air in the almost unrelieved gloom of present-day operative practice.

In a very small and unscientific way, I have applied this study to my own methods, and have come to similar conclusions.

One firm of British manufacturers of dental equipment have been making a unit which is at least part of the answer before the last war, but they had so little of the courage of their convictions that they neither advertised, displayed, nor mass-produced it. I had to get the unit in question from a competing firm which had one on display.

Well-trained and efficient chairside attendants are essential to any surgeon.

I believe that we all agree that any investigation must show that well-trained and efficient chairside attendants are essential to any surgeon. These girls are not being trained where they should be - in the schools - in significant numbers. On enquiry, I find that the schools have considered such training, and have rejected it on the grounds of expense. To be efficient, a chairside attendant should have at least eighteen months' full-time training, and no practitioner can do this. The first school to institute such a course will earn the gratitude of the profession.

My own time-and-motion study has so far concentrated on the conservative operations only. I find that operating from behind and slightly to the right of the patient, using the compressor rather than a chip syringe, the latter being only a palliative and inefficient, for every cavity of group of cavities I cut, including inlays, crowns and bridges, I do the following:

The chair with the patient having been positioned properly -

• 1. Take two steps forward, reach over the patient for the handpiece, which was pushed out of the way to let the patient sit down

• 2. Two steps backwards and a shuffle to get into position for the operation

• 3. Open the cavity

• 4. Two steps forward, bend over the patient to reach the bottle

• 5. At least one step backwards and a shuffle to get into position to use bottle

• 6. Use it

• 7. While the patient rinses, forward again and lean over the patient to return the bottle to its place. Reach for the handpiece, which had to be pushed out of the way to let me past. Two steps back and a shuffle to return to operating position.

This performance is repeated every time I want anything from the unit on the patient's left. If the unit is in the 'forward' position, the nightmare is worse, two steps become at least three, and reaching and bending are increased in extent. Is it any wonder that Mr Fraser says that an expert would be aghast? I am exhausted, and have backache every night. I wonder if the profession realises that every wasted minute is worth a minimum of 1s. and the aggregate of this in a week loses each one of us about £5?

On the other hand, if the unit - not just bits of it - complete with engine, is set on the right of the patient, correctly angled, each part of it is in the correct position for my right hand to drop on it, with movement only from my shoulder. The saving in motion alone is enormous, in time considerable, and in energy unbelievable.

I feel so strongly about this that if the BDA or any other interested organisation accepts Mr Fraser's suggestion to institute an investigation, I shall be prepared to serve on it if required, give evidence, or help in any other way I can.

Yours faithfully,

P. L. McCallion, Altrincham, Cheshire

THE TRAINING OF THE DENTAL NURSE-SECRETARY

Sir, in connexion with Mr McCallion's letter may I observe that people nearly always get what they deserve.

If dental surgeons ask for a trainee, either to save money - very false economy - or because they wish the nurse to know no other method than their own, they must take the consequences. Very few really teach their girls anything - in a busy practice they just have not the time - so the girls do things without knowing why they do them. That does not make for intelligent service, and further it is a trifle ridiculous to expect they shall be of use to one person only; even dentists are mortal, if the dentist dies is the nurse then to retire?

Nurses are trained in schools for those who want them. Unfortunately they are not trained as secretaries at the same time; they never see a NHS form and know nothing of book-keeping. This is unfortunate for dentists who only want a staff of one. It is the more unfortunate as the great majority of dentists themselves know absolutely nothing of the business side of running their practice, keeping accounts, a wages book, and PAYE, but how many dentists are prepared to pay a good salary for somebody efficient who knows all chairside work, can deal with X-ray films, and book-keeping, can compose a letter and generally cope with any situation that may arise, apart from being interested in the work? The vast majority wish to pay less than a copy typist receives.

Certainly the nurse must be adaptable, able to work with anybody as required, and the dentist should appreciate the fact that the more she knows the more use to him and be prepared to pay for experience. The 12 months' training, which Mr McCallion mentions, really would not amount to a month's training at the outside. What is it but snatches in odd moments, and the busier the practice, obviously the less training, the busy practice being the one which most needs somebody trained.

I may say that two dental surgeons to whom I spoke on this point thoroughly agreed with me.

Yours faithfully,

'Dental Nurse-Secretary', Hampstead, NW10

Recently there appeared a scale of salaries for dental attendants which is woefully inadequate.

THE POSITION OF THE DENTAL NURSE

Sir, recently, there appeared, as the result of a Whitley Agreement, a scale of salaries for dental attendants which is woefully inadequate. It will result in a lower grade of person being willing to take up this important work. It is very important work, for by their efficient help a dentist is able to do far more work. They are indeed invaluable to us. Now I understand that they were inadequately represented on the staff side of the Whitley Council and the result is that unqualified nursing auxiliaries in hospitals are being offered a much better scale of remuneration. This is a scandalous state of affairs and the whole matter should be reopened at once. If these girls have no organisation powerful enough to defend their interests then the PDO Group should demand to represent them. If nothing is done it will be a disgrace to our profession.

Yours faithfully,

H. D. Hall, Feltham, Bognor Regis