Dental Therapy The New Zealand Scene Dr Lyndie Foster Page BSc BDS MPH Dental Public Health Specialist Taranaki District Health Board New 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 24% of 0-14 are Maori

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 Teachers spent more time on dealing with children in pain than teaching

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 Decay Percentage Decay Free

1990-2004 Severity of Decay Decayed, Missing, and Filled Teeth

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 Data between the 5-year-olds and 12-year-olds showed reduced ethnic and socioeconomic gradients, illustrating the effectiveness of school based services in improving children’s oral health and reducing oral health inequalities

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 20 therapist 3 adult scope

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