1950s Orthodontics

Orthodontic treatment was covered by the NHS when it started in 1948. This led to a huge demand for treatment as previously treatment had been very expensive and out of reach of the majority of people. Although only 100 cases were treated in the first year of the NHS, this had risen to 53,000 by 1953.

The Department of Health decided that treatment using removable appliances were the most cost effective way of meeting the increased demand for treatment. They were cheaper and less time consuming to fit than fixed appliances and, as they were made by technicians, could be fitted by dentists with little orthodontic experience. This was necessary as in 1948 there were only 10 specialist orthodontic practices in the whole of Britain. Acrylic and stainless steel had replaced vulcanite and precious metals in the 1930s, making removable appliances easier to use, cheaper and more effective. Also introduced in the 1930s, the Watkin Welder was much more reliable than the condenser spot welders which had preceded it. It was very popular and had a significant impact on the increased use of removable appliances, as did the Adams clasp which was introduced in 1949. It was the first clasp to provide secure anchorage and its versatility and unobtrusiveness meant it quickly gained popularity.

In October 1950 John Hooper was appointed as the first orthodontic consultant at the Royal Victoria Hospital in Bournemouth. In 1955 Hooper gave a talk to the BSSO about his experiences as the first orthodontic consultant in the National Health Service. He stated that, in his experience, most GDPs were reluctant to carry out orthodontic treatment and were keen to refer patients on. He believed that this was due to a lack of training in orthodontics as well as the difficulties in dealing with the Dental Estimates Board. He suggested that there should be more orthodontic training at an undergraduate level and GDPs should be encouraged to take postgraduate courses. Hooper provided training courses, lectures and advice in diagnosis and treatment planning. Hooper’s appointment determined the delivery model for orthodontics within the NHS and his model for a consultant role was implemented throughout Britain.

Although fixed appliance treatment dominated American orthodontics at this time, it was not as popular in Britain. In 1952, Hooper’s department fitted 502 removable appliances but only 172 fixed appliances. The Edgewise technique had been introduced some years earlier but import restrictions after World War II made obtaining the parts for it very difficult. Instead ripple brackets became popular. These were pressed from strips of stainless steel and welded to band. Watkin’s loop and tube appliance was also in use but as all the parts of a fixed appliance had to be constructed by hand and fitting the appliance could take several hours, fixed appliances were only used when absolutely necessary.