Dental TherapyThe New Zealand Scene

Dr Lyndie Foster Page BSc BDS MPHDental Public Health SpecialistTaranaki District Health BoardNew Zealand

New Zealand

4 million people

1.5 million in Auckland

Māori people are the tangata whenua (indigenous people)

15 percent of the NZ population

History

NZ government noted the appalling state of soldiers teeth in WWI

Survey showed 90% of NZ’s children required dental care

Introduced trained women into primary schools to educate children and families on healthy living and nutrition and provide treatment

World first

1921 SDS began with “dental nurses” entering the workforce 2 years later

School Dental Nurses

Presently HPCA Act 2004 Therapists registered

Workforce shortage nationally

Employed in public sector

Facilities not meet standards to practice modern day dentistry

Increase in wages and professional status

Review of child and adolescent oral health

1990–2004 Prevalence of DecayPercentage Decay Free

0.0

1 0.0

20.0

30.0

40.0

50.0

60.0

1 990 1 991 1 992 1 993 1 994 1 995 1 996 1 997 1 998 1 999 2000 2001 2002 2003 2004

Y ear

5-year -olds

Y ear 8

1990-2004 Severity of DecayDecayed, Missing, and Filled Teeth

0.00

0.50

1 .00

1 .50

2.00

2.50

1 990 1 991 1 992 1 993 1 994 1 995 1 996 1 997 1 998 1 999 2000 2001 2002 2003 2004

Y ear

5-year -olds

Y ear 8

Access Outcomes 5-year-olds nationally 95-

99% seen annually till year 8 of school

Early enrolment

Projects running to improve preschool access to Maori and low-SES families

Data analysed at ethnicity/SES/fluoride exposure level

2003 Public Health Advisory Committee report showed that the SDS reduces oral health inequalities but they return in the early 20s

Reduced acute sequelae from early enrolment, early detection, prevention and intervention when needed

Dental Therapy Training Two training institutes in NZ

AUT University Bachelor of Health Sciences in Oral Health 2002 Bachelor of Health Sciences in Oral Health 2006

(hygiene/therapy) intake numbers doubled Plan to introduce Adult Scope into degree in future

University of Otago Diploma in Dental Therapy Bachelor of Health Sciences (Dental Therapy) 2002 Bachelor of Oral Health 2007 (hygiene/therapy)

Safety Therapists were not registered until 2004

PDO (dentist) was responsible for standard of care prior to this date

No cases against PDO’s and only one case of a therapist’s standard of care has been investigated but not pursued

Complaints occur with any health professionals

DCNZ national competencies for therapist to ensure ongoing high standards of care

Currently 500-600 therapists

NZ Dental Therapy Scopes of practice DCNZ Subset of the practice of dentistry

Commensurate with a dental therapist’s approved education, training and competence

Provide oral health assessment, treatment, management and prevention services for children and adolescents up to age 18

Disease prevention and oral health promotion and maintenance are core activities

Dental therapists and dentists have a consultative working relationship which is documented in an agreement

My Role

Clinical governance and support

Continuing professional development

Clinic visits

Health promotion/prevention

Dental advisor for DHB

Ministry of Health steering group for improving oral health for children

Hospital Clinician

Future in NZ Joint dental therapy and hygiene degree

Adult scope of practice

Working in private/public

More Maori/Polynesian and male therapists

Team working environment

More involved in public health policy

Thank you