Alida Baxter

Renowned London journalist and author

View from Soho,

Adventures in the

Tooth Trade

One of Pam Ayres' best loved poems is Oh I wish I'd looked after me teeth. But not everybody had a choice in the matter. To my mind, the great tooth divide isn't between people who treat their molars to chocolate brazils instead of a toothbrush, and those who floss their way to perfection. It's a generation gap between the sort of dentists I was dragged to in childhood, and the super de luxe kind around these days. At one time nobody knew about flossing, and there was no such thing as a dental hygienist.

My first recollections of anything to do with teeth are of the Dental Hospital which was then on the South Side of Leicester Square. Like the Windmill Theatre, it had stayed open throughout the Second World War, but that was the only resemblance to a venue famous for its nude girls. Nobody went to the Hospital for light relief.

Children, all as terrified as me, sat with their mothers in a waiting room and listened to the terrible screams coming from inside the surgery. I wasn't the only one to be bundled up and taken home by an overwhelmed parent, but when the toothache got beyond bearing, I had to go back, glad to discover that the problem couldn't be solved by drilling (the reason for the screams) but now meant an extraction. A mask was put over my face, and the next thing I knew I was vomiting into the gutter outside the building (always the after-effect of gas). The same thing happened a few times. I so dreaded the dentist that I would only admit to an ache when the tooth was past saving, and the mask and the gas were the inevitable resort. If I was lucky, the sickness came on quickly, and I was allowed to lie on a couch and use a bowl.

The dentists and nurses weren't unkind, they just didn't believe in pain relief for children if they were only having a tooth filled. Nor was there much talk about tooth cleaning, although my mother was determined about brushing, being of a generation most of whom were condemned to false teeth.

In the first half of the twentieth century, it wasn't uncommon for people to be treated to having all their teeth removed, when they left school perhaps, or started work. It was seen as a kindness they'd be spared so much agony and dentures were universal. Old, abandoned sets used to be piled in bowls in the windows of junk shops all over London , right up into the nineteen sixties.

It should be remembered that before 1948 there was no National Health Service to cover the cost of dentistry, so you simply might not be able to afford it. (Although charges for NHS dental work were introduced in 1951, they were still minimal.) And parents and grandparents would have had memories of terrifying practices. Soho was lucky as far as standards were concerned a Dental Hospital had been established in Soho Square in 1860, and moved to Leicester Square in 1874, and these were regulated places. But it had only been in 1860 that the Royal College of Surgeons had introduced a licence in Dental Surgery, and it was 1878 before a register of dentists was set up, for which qualifications were required.

All of which sounds OK, until you find out that in fact any quack could still set about somebody's teeth, provided they were careful how they described themselves, and it didn't become illegal for them to do so until 1921.

That's presumably why having a toothache in Victorian times could mean not its removal, but having it sawn off at gum level! Yes, really what a treat that must have been. No wonder there was such widespread use of laudanum.

And although dentures of one kind or another had existed for ages (George Washington was famous for his horrible wooden set) and even porcelain false teeth had been had been around for some time, there was a thriving business in the real teeth of the poor, well into the nineteenth century young boys and girls parted with their perfect teeth for money, and dentists put them into the empty gums of the rich. The young Emma Hamilton was reputedly on her way to have her pretty teeth extracted and implanted elsewhere when someone suggested that using other parts of her anatomy might be a less painful way of accumulating wealth.

But to return to my childhood in the nineteen fifties, having had enough of my vomiting in gutters, my mother found a different dentist for me when I was about eleven. His surgery was in Soho , and his picture had been in the paper because he was also a conjurer and apparently enchanted children by doing tricks to beguile them, between his gentle approaches to their gleaming teeth.

Off we went, and the dentist didn't do conjuring tricks but said I had an overcrowded mouth and started taking my teeth out. He had to extract so many that after the first visit I discovered a pressing need to go to the lavatory as soon as we arrived, and would not come out. After much rattling of the door handle, I was eventually persuaded to emerge and over a short time was relieved of thirteen teeth. Nothing wrong, we were told, there were just too many of them. With a lot of gaps in my mouth and no mention of the braces that had been rendered essential, I went to secondary school and didn't visit a dentist again until I was fourteen.

I don't know how I summoned up the courage to go voluntarily to a man so universally feared, or why I chose to do it, but I was going through my swot/good girl phase. Like a lamb galloping into the slaughterhouse, I scurried to the school dentist's chair. You should have had braces, he snarled at me, probing and prying about. Terrible bite, but it's too late to do anything about that now. (In fact a good dentist told me years later that fourteen is a perfect age for corrective orthodontics.)

I didn't have gaps any longer (Heaven knows where all the teeth had come from, but loads had grown back). Unfortunately the new ones had holes. But holes meant fillings, fillings meant drilling, and the school dentist adored that. He didn't have the high-speed kind of drill that everyone to-day takes for granted; he had the slowest drill on earth, and bored on and on into cavities that were agony just to touch. I stared at a pot plant and silently told myself that no dentist would ever hurt me this much, ever again. I was right, but I still don't understand why I endured it.

And the school dentist's methods could only be described as odd. After an eternity of drilling, he would put in a temporary filling. He would then send me away, only to drill it all out again on some future occasion while I dripped with sweat and studied the pot plant, when he might finally allow me to have the permanent filling. Occasionally one temporary filling was only replaced by another, putting off the end of the treatment yet again. This duplication of effort on his part and misery on mine was repeated all over my mouth. Sometimes I was sent off for the whole of the school holidays with temporary fillings, which were about as useful against ice cream or hot soup as tissue paper, and I'd spend weeks rearing back from food and drink.

Then came the memorable occasion when he told me I possessed a tooth that he wouldn't bother to try and save if I were older. And he said I had to have somebody with me, for company after the appointment. If I thought this meant the return of gas, or a fabled pain-killing injection, I was wrong. But I hadn't really thought that I knew him too well. His only concession was not giving me a temporary filling; he used permanent amalgam straight away. And I understood about the company, because my legs buckled when I stood up. But he broke the spell then. Or perhaps it was listening to him being nice when he talked to my mother, and told her what a good patient I was. I got it then dentists were only nice if you were an adult.

So I wasn't just an adult when I next saw a dentist, I waited till I was in my twenties. Let someone hurt me now and I'd sock him! Particularly as I was paying. A friend had recommended me to a man in Bond Street , so adored by his patients that they travelled long distances to see him. This happens frequently now, but it was unheard of then. All I had to do was to walk down Conduit Street to consult him, and I was ready for anything. One snarl and but there was no snarling, and what I wasn't ready for was the kindness I was met with. An injection for the slightest filling, and something to numb the gum so even that didn't hurt. A high-speed drill that made short work of appointments, and not one single temporary filling. Even his nurse was friendly.

This dentist took out my wisdom teeth so deftly I didn't know they were gone till he told me, did root canal work after I'd broken a tooth, and experimented with hypnotism to see if it was as effective as an injection at relieving pain. It simply made me feel happy.

We discussed straightening my teeth a bit, but he said I might find it difficult to put up with because I had a tongue thrust, which sounded like something out of a sex advice manual. It actually meant that on the rare occasions my mouth's closed, my tongue rests over my bottom teeth and pushes my upper teeth outwards. Stopping that'd drive you mad, he said frankly. No wonder I skipped to my check-ups I had the nicest dentist in the world.

If only the rest of my life had been as good as that. The years passed and my relatives needed to be looked after. Having survived cancer, my mother suffered from trigeminal neuralgia, a really appalling pain in the jaw and down the face. She had a temporomandibular arthrogram, a specialised scan, which showed that her jaw had been so distorted by arthritis the nerves were being pinched in a vice of bone. The poor woman was in agony, but by the greatest good luck she was seen by UCH's dental specialists. Back in the nineteen eighties, University College Hospital had several departments and small hospitals attached to it, in nearby streets like Mortimer Market. So, kind intelligent men experimented with ways to help her. First with cortisone injections, which were wonderful for a while but didn't last, and then with a special kind of medication not ordinary pain-killers, but something that worked specifically on nerves. Hard to forget how caring they were, and I never will.

But meanwhile my days were split between her and my aunt, and everything else was forgotten. Dental check-ups? I hardly had time to wash. The one time I managed to see him, my dentist boggled: Your gums are bleeding! I'd always been so good at brushing, and didn't I realise that because of my gums my teeth were travelling sideways? But I didn't need any fillings, and I rushed back to being a carer.

By the time that phase of my life was over, my gums made me look as though I spent my nights biting the throats of my victims and turning them into the undead. I'd have been in Twilight if it had been invented, and I didn't have a straight tooth in my head. Sympathetically, a friend told me that exactly the same thing had happened to his wife when she was looking after her mother, and she'd had braces on her teeth for three years now, since the age of fortyeight!

My wonderful dentist had moved, then retired, and someone else had taken over his practice. Hesitating about making an appointment with anyone I didn't know, I asked about charges and the phone fell from my nerveless fingers. What??? For a check-up??? What had happened to the cost of dentistry, since I'd last paid for it? As it turned out, a Hell of a lot. How much would it cost then, if I needed a filling? After I'd hung up, I went and looked in the mirror and told my gums they were going to meet the National Health.

But I wasn't a candidate for a Dental Hospital , I just needed an NHS practice. And I wanted a recommendation. This wasn't just a big ask, apparently, it was colossal. Everybody knew dentists they could recommend, but they were all private. This seemed to result in wonderful teeth, but remortgaging houses and sending children to school barefoot in snow drifts. Then there were people who knew NHS dentists, but were cagey about recommendations. So cagey they told stories that made childbirth without anaesthesia sound preferable. Failing to discover there was actually an NHS dentist in my own area, I ended up trekking to North London which, for someone in Soho , means asking whether you need a visa.

And I should have turned around as soon as I saw the premises. They weren't exactly filthy, but they weren't very clean either. I will draw a veil over what happened to me, except to say that it involved procedures I didn't need and not the procedures I did, the sort of ache I hadn't had since childhood and the extraction of an innocent tooth. I hadn't paid much, and I'd got even less.

And yes, of course I know I was just extremely unlucky, but it's undeniable that good NHS dentists are as scarce as hens' teeth now (which isn't remotely funny), and the ever-increasing private sector beckons like a cross between a loving mother and an extremely expensive houri. It isn't financially attractive for good dentists with years of training and specialisation behind them to work for the NHS sometimes it isn't even economic. In the centre of London , where overheads are mind-boggling, entire chains of practices which once offered NHS treatment have closed.

We're returning to the age before 1948 when the state of your teeth depended not on whether you looked after them or not, but on whether you could afford to go to a dentist. And in the present state of the economy, I can't see this changing, though of course it ought to.

Meanwhile, too scared to go back to the wilds of North London, I threw savings to the winds and took my vampire mouth with its crooked teeth, and the new gap in them, to a private practice in the West End that everybody recommended.

Yes, it cost money, but I had session after session with a hygienist who nearly drowned me with a whirling spray, reminded me of what I'd forgotten, taught me a lot I hadn't known, and left me with gums that have been sensational ever since. The gap was dealt with expertly, though for a sum that left me shaking, and when that practice changed hands I followed the trail of recommendations to another, even nearer to Oxford Street , where I've had incredibly good treatment.

My present dental surgery is as welcoming as it's efficient. I've been saved from further tooth loss, having had a persistent, dreadful abscess: my root canal work was carried out by a friendly specialist with so many qualifications I'm amazed he can stand up, and this was followed by an intricate operation, but I have never, ever been hurt. My confidence in the care I receive is total, and I just wish I hadn't neglected my mouth while I was a carer. I've got dental insurance, and I need it, but I also need teeth!

For those who look like me there have been extraordinary advances in dental technology. You can have implants which haven't been taken from the dead or the poor, you can have veneers, you can have your teeth straightened even though you're an adult you can transform yourself in ways that would have been impossible a generation or so ago, but, just like plastic surgery, it costs an eye-watering amount of amount of money.

I'm not in that league financially, so until I win the Lottery I'll settle for taking care of the crooked teeth I have left. And as far as I'm concerned, my scrupulous, concerned dentist, his specialist colleague, the expert hygienist and the entire caring staff are worth every cent.

If you're lucky enough to have access to a good NHS dental practice, hang on to it with all your strength. You are one of an ever-dwindling band that I fear I may see dying out completely.

© Alida Baxter

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