Dame Margaret Seward – an important influence in the development of UK orthodontics

While there have been obituaries elsewhere describing the remarkable achievements of Dame Margaret Seward CBE, BDS(Hons), DDSc, DDS, FDSRCS Eng (1935-2021) here we describe those which have benefitted UK orthodontics but which are less well known. Her contributions were recognised by an Honorary Membership of the British Orthodontic Society and later that of its affiliate the Orthodontic National Group which came into being to cater for the interests of Orthodontic Nurses and Orthodontic Therapists.

In the late 1960s the newly independent British dental profession was regulated by a General Dental Council (GDC) whose Education Committee required dental students on qualification to be “competent in all aspects of dentistry”.  While postgraduate orthodontic qualifications were by this time available from the Royal College of Physicians and Surgeons of Glasgow, and the Royal College of Surgeons of England, these were only required by those wishing to apply for specialist hospital appointments. There was no requirement for dentists, even those who limited their practices to orthodontics, to hold one.  As a consequence at this time, all treatment plans for orthodontic cases undertaken within the General Dental Service (GDS) of the NHS had to be approved by the Dental Estimates Board of England which was advised by an appointed hospital consultant. GDS fees for orthodontics and other items of service were determined by the Board’s negotiations with the Dental Rates Study Group of the British Dental Association. Similar independent systems existed in Scotland and Northern Ireland. None of the then five orthodontic associations had any input to any of these discussions. The result of this was that GDS orthodontic treatment was almost entirely carried out using removable appliances, while the fees for fixed appliances were so low as to discourage their use.  Indeed, even within the hospital service, there were very few cases being treated with full upper and lower fixed appliances at this time. Consequently the standard of NHS orthodontic treatment within Britain was wholly inadequate and was regarded by many overseas specialists as laughable.

Dame Margaret’s contributions 
Into this muddle arrived the remarkable Margaret Seward who had qualified in 1959 at the London Hospital Dental School and it was fortunate for UK orthodontics that a fellow student in her year was the charismatic David DiBiase. In 1962 Margaret gained her FDSRCS(Eng) and married the then Senior Registrar in Oral Surgery at the London who was later to become Professor Gordon Seward CBE, Dean of the Faculty of Dental Surgery of the Royal College of Surgeons of England.  During the next 10 years Margaret gained wide experience of hospital and community dentistry, and published several papers on teething the first significant work on the subject since that of Thomas Fayre of 1553. Her MDS degree, a higher doctorate of the University of London, was the first to be achieved by a woman.

As there were no maternity leave arrangements at the time, when Gordon and Margaret had decided to start their family Margaret had to step off the dental career ladder. Her subsequent difficulty in getting back to dentistry led to her lifelong campaign for better support for women dental graduates.  Her letter to the British Dental Journal (BDJ)  in 1973 proposing that there be a “women dentist’s retainer scheme” gained support from Desmond Greer Walker of the British Postgraduate Medical Federation. This led ultimately to the scheme being underwritten by Edwina Currie, the then Minister of Health, with it finally coming into being in 1985. Today, as a direct result of her efforts, half of those on the U.K. Dentists Register and more than half those on the GDC’s Specialist List for Orthodontics, are women.

It was fortunate for UK orthodontics that in 1966 her husband Gordon, now a highly experienced and respected Reader in Oral Surgery at the London Hospital, had been told that he would never be appointed to a chair without taking leave to gain experience in leading centres overseas. This resulted in his visits to Canada and the United States, and later their joint trip to Singapore, Australia and New Zealand where they had both been impressed by the value of the expanded role of the New Zealand dental nurse. This, and Margaret’s Council of Europe Fellowship to study such training in Holland caused her to write in 1978 to George Gibb, the then Chief Dental Officer and England and Wales, suggesting that experiments be undertaken to asses the value of the expanded duty dental auxiliary to the U.K , something which was still resolutely opposed with the cry “dilution of the profession”.

In 1976 Margaret, now with two small children, was elected to the GDC and three years later became the first woman editor of the BDJ, a task she undertook with her usual vision, professionalism and energy, turning it from loss to profit and to it becoming the world’s leading dental journal. Later she would become the editor of the International Dental Journal with equal success. Both gave her a voice with which to begin to influence national dental events. In 1973  (BSSO) had submitted a report to the GDC recommending the introduction of  a dental ancillaries for orthodontics. Sadly no action was taken by the Council on the matter even though  similar requests were being made in Australia at the time. As a result no further progress was made for the next fifteen years.

In April 1987 Margaret, who by this time had become Chairman of the GDC’s Dental Auxiliaries Committee, was invited (we suspect by David DiBiase), to address the annual meeting of  the BSSO in Birmingham. In this she explained the various stages which would have to be gone through before the GDC would agree to sanction the establishment of orthodontic auxiliaries.  Her subsequent crucial role in  bringing this about has been described previously. Now there are currently nearly 700 Orthodontic Therapists on the GDC lists. At the same meeting, Margaret pointed out  that if the membership of the then 5 orthodontic societies could agree to support a single candidate at a future GDC election, this would ensure that the specialty would acquire an influential voice on the Council. This ultimately came to pass in 1996 following the unification which brought into being the British Orthodontic Society.

In 1993 Margaret  assumed Presidency of the BDA  and a year later was elected President of the GDC;  this was shortly after the General Medical Council and the GDC had been found to be in breach of  the European Directives on Medical and Dental Specialist Training. It resulted in the publication the Chief Medical Officer’s  “Calman Report” on UK  specialist medical training 22  soon followed by the “Mouatt Report” on dental specialist training of 1995. The problem for the UK was that  while the “Competent Authority” in each profession was its respective Council, specialist training in the UK had been regulated for many years by the Royal Colleges, moreover by now  specialist dental masters degrees of UK  Universities had been accepted as “ addition dental qualifications” by the GDC. Margaret’s role as GDC President in achieving what became known as “the accord” between these competing interests, resulted in compliance with the EU Directives and the successful introduction of UK dental specialist lists in 2002 to the satisfaction of all parties. A tribute to this achievement was paid to Dame Margaret on the occasion of her retirement from the GDC by Tom Macadam a long serving member:

“Here were the combined force of the universities, Colleges and the profession all pulling in different directions. Could it be done or was failure the only option ? Only some eight years later has the initial work of 1990 (The Distinctive titles Working Party) been completed. Under your guidance the proposal passed through the Council and all parties were placated. It is a far from easy task to achieve anything worthwhile in this Council and this was of major importance.”

But Margaret’s work was far from over. In 1999 the Prime Minister Tony Blair had announced, much to everyone’s surprise, that by September 2001 anyone who wanted NHS dental care would be able to receive it, and the DoH subsequently affirmed its commitment to improving access to NHS dentistry in the new NHS plan.
In September 2000 the Parliamentary Health Select Committee’s report  “Modernising NHS Dentistry: Implementing the NHS Plan” was published,  and Margaret was now persuaded to accept the appointment as the first woman Chief Dental Officer of England and Wales  (2001-2003) with  the specific role of  implementing the new dental strategy which contained much she had worked for in her previous appointments. Her “Dental Modernisation Steering Group”  affectionately also known as “Dame Margaret’s Gang”  soon set to work.

Typically, for a woman of such energy, Margaret never really retired. Completing her distinguished professional career in 2003 (which would have resulted in a peerage but for a change of government) she retained her directorship of “Better opportunities for Women“ while also taking on the Chair of the Editorial Board of Women in Dentistry, the Presidency of the Bournemouth and Poole Medical Society and Patronage of  “Dorset Victim Support” and probably much else we do not know about. Her book ”Open Wide – Memoir of the Dental Dame” is recommended to anyone with an interest in dental history for it contains over 550 eminent dental and political names in a fascinating behind the scenes  account of the development of the dental profession over more than 50 years. At the same time it confirms the appropriateness of the motto which Margaret chose for her Coat of Arms to which she was entitled on gaining her DBE in 1994. This was adopted from that of Latymer School for Girls of which she had been Head Girl, later becoming Chair of its Board of Governors  – “She who endures conquers”.

Chris Stephens

Sophie Riches