A commentary on Fisher W. Compulsory attention to the teeth of school children. Br Dent J 1885; 6: 585-593. Comment 682-683.

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How important/controversial was this paper at the time of publication?

Given Fisher's sensible arguments and his evidence-based approach, it seems hard to imagine that the paper would have been controversial at the time. However, it appears that the data presented was surprising and the ideas controversial.1,2 Interestingly, the most controversial aspect at the time, as reflected in the letter in response, was the concern about training and qualifications of the profession, something that took many decades to resolve.

How accurate have any predictions been?

Many of the points made have now been proven, including the link between oral and general health, the impact of oral health on education and employment, and the importance of well-funded dental care. Perhaps more importantly, Fisher's call to establish regular inspections of schoolchildren's oral health was eventually enacted.

How relevant has the paper been to the development of dentistry/patient care/science?

It is clear that Fisher's epidemiological approach to making his case was well received, as the immediate action of the BDA was to set up a large-scale survey of schoolchildren examining more than 12,000 children over seven years,2 setting a clear precedent for the value of oral epidemiology in the UK and beyond. However, Fisher was seemingly an advocate for action rather than collecting much further data,1 and the real legacy of this paper was to start the movement for a school dental service covering all schools, with Fisher setting up a limited service in Dundee, followed by a school dental service in Cambridge, then a national service developing into the current Community Dental Services.3

What could/would have happened if this paper hadn't been published?

Although there were others at the time who advocated for regular school dental inspections who may have pushed forward plans to set up such services, the data presented in this paper and the arguments were compelling and it may well have been that, without these, any further action would have been slow and fragmented.

Is this issue still relevant to dentistry today?

Whilst regular school inspections in the UK ceased, driven by significant reductions in oral disease prevalence and a lack of supporting evidence,4 children's oral health remains a major issue and the COVID-19 pandemic has exacerbated these problems. One of the important ways of addressing this is to improve dental access for children, although it is unlikely that a school-based approach would be the answer.