Two-thirds of New Zealanders would have no objection to appropriately trained dental therapists providing dental care for all ages, a survey commissioned by the dental therapy profession found.
Currently New Zealand’s about 1000 dental and oral therapists are only allowed to provide dental care services for children up to the age of 18. But across the Tasman and in the UK therapists can provide basic dental care to adults – and therapists here are arguing that allowing appropriately trained therapists to offer adult care could help make dental care accessible to more Kiwis.
Late last year former Prime Minister Helen Clark added to the debate by calling for more accessible and affordable oral health care to New Zealanders who cannot afford regular check-ups and tweeted that dental therapists could play a key role.
Arish Naresh, chair of the New Zealand Dental & Oral Health Therapists’ Association, said it commissioned Colmar Brunton to carry out an independent survey to see whether there was public support for the association advocating for New Zealand therapists to be trained and allowed to offer adult care.
The survey of 500 New Zealanders found that two-thirds (66%) had no objection to dental and oral therapists, with appropriate training, providing dental care for all ages. The highest support was from the 24-34 year-old age group (73%) and Naresh said this was the age group who were found in the 2009 Oral Health Survey to have “worrying levels of dental disease” and low attendance rates, with even lower attendance rates in 18-24 year-olds.
Also 67 per cent of respondents were open to dental and oral health therapists providing oral health care for the elder in residential aged-care facilities. Naresh said a 2012 survey of older people’s oral health found that 61 per cent of people in residential care had untreated decay in one or more teeth and the association believed therapists could make a valuable contribution in this area working as part of oral healthcare team alongside dentists, dental hygienists, dental technicians and dental assistants.
Naresh said the survey findings had convinced the association that advocating for the development of educational ‘bridging’ programmes to support dental therapists and oral therapists to obtain an adult scope was not only important to members but was also supported by two-thirds of New Zealanders. He said the survey findings would be shared with key stakeholders – including the two training schools, the Dental Council, the Ministry of Health, district health boards and the other professional associations.
Late last year Health Central reported Dental Association chief executive Dr David Crum saying he believed dental therapists should be prioritising fighting for better resourcing for New Zealand children’s poor oral health rather than being able to provide adult care. He said if more of the limited dental therapist workforce moved into adult care it would just dilute the workforce available to provide school dental health services.
Naresh said there were system issues that needed to be addressed when it came to the DHB workforce; as under the new dual scope, oral health therapists were unable to use both scopes if employed by DHBs and were also able to earn a higher salary in the private than public sector. Naresh – who is Director of Allied Health and Technical services at Tairawhiti DHB, manages the DHB’s dental services and works part-time for a private dental practice offering dental care to adolescents – said in time he believes DHBs should move out of public dental health services which could be provided by primary health organisations or iwi providers.
Currently the vast majority of the just under 1000 dental and oral therapists work for district health boards providing free school dental health services up to the age of 13. Therapists can work with adolescents up to the age of 18 but the vast majority of free dental health care for adolescents is offered by dentists in private practice.
Since 2008 oral health degree graduates have been trained in the dual oral therapist scope which basically contains both the dental therapist and dental hygienist scopes. But while oral health therapists can scale the teeth of adults there is an age restriction – just like their single scope dental therapist colleagues – that means they cannot diagnose and treat cavities or carry out similar dental therapy care in anybody aged 18 years or older. Across the Tasman dental therapists with a postgraduate qualification can provide basic dental care for all ages.
Naresh said AUT carried out a pilot bridging programme last year to allow therapists to provide adult care and the University of Otago was also looking to develop a programme. He said both universities had increased intakes to their oral health degree programmes with about 50 first year students at Otago and 38 at AUT.
Dental health professional roles:
- Dentist: The Dental Council defines the practise of dentistry as “the maintenance of health through the assessment, diagnosis, management, treatment and prevention of any disease, disorder or condition of the orofacial complex and associated structures within the scope of the practitioner’s approved education, training and competence”.
- Oral Health Therapist: Oral health degree graduates from 2008 have a new dual scope which basically contains both the dental therapist and dental hygienist scopes. Including diagnosing and treat dental cavities for patients up to the age of 18 and carrying out dental hygienist treatments on adults (including scaling).
- Dental Therapist: Scope of practice that evolved from the original school dental nurse role which includes oral health promotion, diagnosing and treating dental cavities for patients up to the age of 18 and extracting baby teeth.
- Dental Hygienist: Scope of practice is largely focused on the prevention and non-surgical treatment (e.g. removing tartar) of periodontal disease.
- Dental Assistant: Assistant trained to support dentist in their practice