Dental Therapy The New Zealand Scene

1. Dental TherapyThe New Zealand Scene Dr Lyndie Foster Page BSc BDS MPH Dental Public Health Specialist Taranaki District Health Board New Zealand

3. New Zealand • 4 million people • 1.5 million in Auckland • Māori people are the tangata whenua (indigenous people) • 15 percent of the NZ population

5. 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

6. School Dental Nurses

7. 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

8. 1990–2004 Prevalence of DecayPercentage Decay Free

9. 1990-2004 Severity of DecayDecayed, Missing, and Filled Teeth

10. 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 Access Outcomes

11. 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)

12. 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

13. 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

14. 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

15. 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

17. Thank you