Inside job

NOT in his wildest dreams did Kieran Fallon imagine, while studying dentistry at Glasgow University, that he would end up spending more than 20 years in jail. Admittedly, unlike most people associated with Barlinnie prison, he does get to come and go as he pleases – but since 1990, Kieran has, on four mornings a week, presented his security pass to staff at Scotland’s biggest lock-up and gone to work on the oral health of the inmates.

Kieran is one of a handful of dentists in Scotland employed by the Scottish Prison Service and as such has a unique perspective of life on the inside. “Not for a minute did I imagine I would end up working there. As with most people, you don’t ever expect to go to a prison, particularly Barlinnie in Glasgow, which has got a bit of a name – or at least you hope you won’t,” he says with a laugh.

But since first crossing the threshold of a prison that has housed the likes of gangster-turned-sculptor Jimmy Boyle and Lockerbie bomber Abdelbaset al-Megrahi – as well as former MSP Tommy Sheridan, who is currently serving three years there for perjury – Kieran, now 56, has never looked back and plans, he says, “to be there a few years yet, until I finally retire”.

Essential dental care only

When he started his part-time role at Barlinnie, Kieran had already been running a practice in a fairly deprived part of Glasgow for eight years, so the needs of the prisoner-patient were not entirely new to him. The concentration of problems, however, was of a different order and the priorities, too, were different, as they still are. “We provide essential dental care to an NHS standard, but we don’t do fancy cosmetics – tooth whitenings, that sort of thing. They have the same rights as people outside but that has to be tempered in some way.”

One reason for this is the heavy workload – Barlinnie houses over 1,500 prisoners, with dental cover on five mornings a week. Another lies in the fact that Barlinnie is a “local prison”. As such, the vast majority of the inmates either are on remand, awaiting trial, or are on shorter prison sentences, around three years or less, and the care is targeted accordingly.

As Kieran explains: “Most of the people we’re seeing, their ‘liberation date’ as they call it, will be in the next year, 18 months, sometimes a bit longer. We say let’s get things stable, let’s get you organised and then you can go and see your dentist when you get out.”

Chaotic lifestyles

For many prisoners, getting things stable involves a lot more than a six-month check-up with a brush and polish. Many are drug abusers on the outside – Barlinnie is the largest single supplier of methadone in Europe with almost a quarter of the inmates taking a daily dose. They often live chaotic lifestyles, involving poor oral hygiene and bad diet. Some are homeless and others face a litany of life stresses in which looking after their teeth comes way down on the list of priorities.

“The level of treatment is often at the stage where it was more than 25 years ago where you’re taking a lot of really bad teeth out and giving them dentures, whereas most of the rest of society have moved on from that,” says Kieran.

In fact, it can be quite a struggle just keeping them free of pain. “Their oral history is often very bad but because they’ve been on strong narcotics, they haven’t felt the pain. They come off the drugs in prison and suddenly are faced with only having pain relief that is not as strong as they’re used to.”

Being in prison can therefore be something of a boon for these men in terms of their dental health, and helping to bring some kind of order to their lives is one of the rewards of a job like this, says Kieran.

Security and health risks

Of course, this being a prison, security is an issue and care must be taken, for example, to ensure that instruments are not pilfered. For while the majority of prisoners are, says Kieran, “all right, some can be quite ingenious about stealing an instrument from a tray to be used for illicit purposes later, particularly something that can be sharpened and used as a weapon”.

At the same time, Kieran is quick to emphasise that while almost all prisoners come in to the surgery unattended by prison guards, he has never once felt or been physically threatened. On the contrary, he says, the apprehension is usually in the other direction. “Some of them come in with battle scars on their faces – if someone drew a knife, you and I would run a mile, but they would not back down from that. Yet coming in to the dentist’s is a big deal for them – they’re often quaking.

“When they’re out of earshot of their friends, the first question will often be, ‘Am I going to need an injection? Is it going to be sore?’ They’re really pussycats by that stage.”

Extra care is also needed as a result of the higher incidence of certain blood-borne diseases, such as hepatitis B and C, HIV and AIDS and even “old-fashioned” diseases like tuberculosis, which he sometimes sees. “The decontamination and sterilisation standard for instruments has to be top-notch.”

Patient trust

As a people-facing job, a dentist’s chair-side manner is a crucially important skill whether you’re practising in millionaires’ row or skid row. But, says Kieran, there is definitely a knack to dealing with prisoners – though being a member of the medical staff does give him an immediate advantage over the guards. “Prisoners are usually quite open because they realise we’re there to help them and they will make use of that. If you’re from the medical centre, they’re quite trusting.”

At the same time, he recognises there is a potential to be manipulated. “They know which buttons to push and what to say. You know, sometimes I’ll give them a bit of a ticking off because their oral hygiene is not as good it should be, and they’ll say, ‘It’s my chaotic lifestyle, sir.’”

Kieran’s approach is therefore to be “light and friendly”, but not too friendly. If asked, for example, as he often is, where he lives or where his practice is, he will answer in the general rather than the specific. And he would certainly never ask them about the reasons for their incarceration. Which is not to say they don’t volunteer such information: “Particularly if they feel they’ve been hard done to or set up, you can start to get the whole story,” he says.

After 21 years, it’s all now in a morning’s work for Kieran, whether he’s dealing with the run-of-the-mill short-term prisoner or those few from the prison’s segregation unit who are brought over in handcuffs. And he’s certainly not phased when he pulls down a prisoner’s lower lip and finds – as he once did – the word ‘SKINS’ tattooed on the inside in homemade fashion.

He may not have envisaged such a long stint “inside” when he mapped out his future at Glasgow Dental School, but the satisfaction and rewards have been plenty.

And to young dentists who, like him, might never have considered this kind of work, he says: “Most young dentists have an image of the glamour end of things and can’t wait to get their first sports car. It’s understandable. But don’t rule it out, particularly if you’re the sort of person who is socially responsible and wants to perhaps make a difference.”

Adam Campbell is a freelance journalist and regular contributor to MDDUS publications