The Economics of False Teeth (1947)

From the February 1947 issue of the Socialist Standard

The prolonged dispute between the official representatives of the dental profession and the Government over the scale of fees for the supply of dentures to panel patients under the National Health Insurance scheme has brought the art of mechanical (as distinct from surgical) dentistry rather prominently before the public eye. A few days before Christmas Mr. W. J. Brown, M.P., shocked the members of the profession by publishing a statement of some of the main facts relating to the production of dentures and the pay of the producers (Evening Standard, 20/12/46). In the words of Mr Brown, “In the West End you pay anything from 30 to 40 guineas for a set of teeth. In the provinces from 10 to 15. Even under the National Insurance scheme the price is over seven guineas. But the actual cost of the material which goes into a set of dentures is only about 15s. The balance represents the wages of the mechanics . . . and above all, the profit of the dentist. For the mechanic, on an average rate of £5 to £6 a week, will make several sets of dentures in a week’s work.” Here we have a fairly neat summary of small capitalist exploitation in a handicraft.

Artificial dentures, unlike boots and shoes, and clothes generally, cannot be mass produced. There is no such thing as making for stock. Every set of dentures must be moulded to a pair of models taken from impressions of the individual patient’s mouth. Hence there is little scope for machinery in the production of dentures and the capital outlay on a dental workshop is small as compared with that on the normal run of productive establishments. A considerable number of mechanics, financially more fortunate than the majority of their fellows, have set up such workshops, but the provisions of the Dentists Act of 1921 prohibits anyone not on the Dental Register from taking impressions. Hence the mechanic working on his own account can only deal openly with a member of the profession and not with the public directly. He cannot therefore obtain the full market price for his commodity under normal conditions. Moreover, even in this narrow sphere, the middle-man has managed to insert himself, and a few fairly substantial concerns, employing, perhaps, a few dozen of the more poverty stricken mechanics, have claimed their percentage of the dentist’s profit.

As Mr. Brown points out, however, the 1921 Act has not prevented mechanics from repairing and even reconstructing existing dentures, and during the war a regular rash of repair shops has sprung up in most large centres of population. The dental profession have a shrewd and probably well-founded impression that behind the mask of the repair shop a good deal of illegal impression-taking goes on. Hence their desire to wipe out the repair-shops by means of a clause in the new Health Services Bill. Side by side with this effort they are demanding nine guineas as the price of a set of panel dentures (representing about eight hours’ work on the part of the mechanic), to which the dentist himself contributes about an hour of his time, although, of course, it is highly skilled labour. Whatever the outcome of the dispute, the position of the majority of mechanics will remain that of wage-slaves. Their direct or indirect employers are not agitating for higher fees in order to have the pleasure of paying more wages. During the war the small “ sectional organisations of mechanics, inside the larger bodies such as N.U.D.A.W. (and the Society of Goldsmiths, etc., in London), gained official recognition from the associations of professional men. Little serious effort has been made, however, on the part of these associations to compel their members to take mechanics seriously by respecting the terms of the national agreement. A temporary scarcity of mechanics has enabled them to force up wages in an endeavour to meet the rising cost of living. This appears to have reached its limit and even a Trade Union hospital such as Manor House has scrapped the grading scheme and adopted a wage scale which private employers are quite willing to pay. Bemused by the fancied advantages of “nationalisation” (in some form or another), the mechanics’ officials attach more importance to co-operating with their employers on public bodies than to improving their ability to defend their own interests. Under the new National Health scheme the wage-negotiating machinery will remain, as now, under the control of a Joint Council of masters and men with an alleged common interest in “the welfare of the craft” as a guiding idea.

Mr. Brown’s article leaves the reader with the impression that the legalisation of impression-taking by the mechanics would solve the problem; but the general poverty of the major portion of “the public.” (i.e., the working class) makes intense competition either for work or customers more or less inevitable. Any considerable increase of mechanics working on their own account would lead to a considerable number going broke and losing their savings, much as happens in other branches of production, etc., where the small man seems, on the surface, to have a fighting chance. The fight is short and the longest purse wins the day. Attempts to answer Mr. Brown in the columns of the Evening Standard followed on January 1st, 1947.

Lt.-Col. Drury, representing a group of dental surgeons, held up his hands in horror that an M.P. should boast of encouraging a defiance of the law and roundly declared that mechanics had insufficient knowledge of anatomy to take impressions. Unfortunately for the Colonel’s argument, the 1921 Act also placed on the register hundreds of men who, without calling themselves dentists, had for years been operating on mouths (as well as taking impressions) without any college training. These men, obviously, had no more access to knowledge of anatomy than the average mechanic. Further, it is obvious to any layman that taking an impression is not a surgical operation. It still seems to be true that the “professional” section of society are distinguished from the rest of the working class chiefly by their larger conceit.

Eric Boden