Speaking to Health Central after a conference address, former health minister Dame Annette King, a former school dental nurse and tutor, said she thought dental therapists had worked under the supervision and control of another profession – dentistry – and the Dental Council for too long.
King addressed the combined New Zealand Dental and Oral Health Therapists Association (NZDOHTA) and New Zealand Dental Hygienists Association (NZDHA) held over the weekend in Christchurch.
“There’s no way that nurses or midwives, or occupational therapists or pharmacists – or any of the rest of the professions would have tolerated that,” she said. “Because it’s been a predominantly female profession – and we’ve been a passive profession – they haven’t pushed forward for it.”
She said dental therapists, and the new scopes of dental hygienist and oral therapist, should put a case for their own standalone council to Health Minister Dr David Clark.
“If they become their own registered profession, they could then set the competencies and set their scope of practice, which must include the oral health approach to older New Zealanders,” said King. “I’ve never understood why dentists feel so threatened by an auxiliary service – there’s more than enough work for everybody.”
The comments by King, who was Minister of Health from 1999 to 2005 under Helen Clark, and Labour health spokesperson and deputy leader from 2014 to 2017, follow Clark’s own call last year for a major push on the right to affordable dental care for adults and the “key role” that dental therapists could play in making dental care more available.
Arish Naresh, chair of NZDOTHA, told Health Central that King’s challenge had given the therapy professions “some really good food for thought” as setting up its own registration body wasn’t something it had really focused on before.
He said dentistry was the largest of the oral health professions covered by the Dental Council and while there was progress for the auxiliary professions, there were always delays. An example of this is the new oral health therapy qualification that has been around since 2008 but took until 2017 to become recognised because of dentist opposition.
King told the conference that when she was invited in 2001 to celebrate 100 years of the registration of nurses it had rankled her – that 80 years after the establishment of the school dental service – that dental therapists (including former school dental nurses like herself) were still not a registered profession. This had changed with the passing of the Health Practitioners Competence Assurance (HPCA) Act 2003 under her watch which allowed dental therapists to become a registered profession for the first time under the new Dental Council.
“It probably was a compromise that dental therapists came under a one (Dental) Council because of the difficulty negotiating under the Act at that stage. And of course, the Council today is made up of dentists, dental hygienists, dental therapists and dental technicians.
“I have to put it out there to you that maybe the time is right for dental therapists, dental hygienists and the new oral therapists to look at their own registration body,” King told the conference.
“Maybe you are ready to have your own so you have your own control of your organisation, of your training, your own standards….
She said about 75 new therapists were graduating a year with oral therapy degrees, with the oral therapist scope (which combines the dental therapy and hygiene scopes of practice) gaining formal recognition last year. But at the same time, dental therapists were an ageing workforce and numbers were reducing by about 44 a year over the last five years. She said standalone dental therapy was expected to cease as a profession in New Zealand in the near future.
She noted that the new broader oral therapist scope had not been supported by the New Zealand Dental Association as it said it was concerned that the new scope might result in confusion over roles by the general public.
“In my view, it is time that the Dental Association acknowledged that there is room for other practitioners in this space. It is not about the number of other professionals – it is utilising the skills, the training and the expertise that we have in New Zealand for the benefit of all New Zealanders.
“It is not about patch protection. It is about collaboration and integration and working together but recognising the unique skills that come with each of those professions.
She said the demand for affordable oral health care far outstripped the current ability to provide.
King quoted the 2012 older person’s health oral survey which found ‘concerning levels’ of untreated decay; with 61.3 per cent of people in residential aged care and 42.3 per cent living in their own homes with untreated decay in one or more teeth. Smaller but significant percentages also had untreated root decay, heavy plaque, calcium deposits and ulcerated lesions.
She said it was not a problem that was going to go away, with baby boomers like herself retiring with heavily filled teeth held together with a “lot of amalgam, wire and whatever else”, unlike their parents who had had dentures.
“For me, this is an area that is open for the work of an auxiliary workforce in New Zealand – for dental therapists, dental hygienists and oral therapists – an opportunity to service in an affordable way the adult population in New Zealand.
“And in my view it is time that oral health is once again a priority in New Zealand,” said King, who had championed the re-opening of training of dental therapists with new degrees launched in the mid-2000s in AUT and University of Otago.
Awards presented at conference:
Dental Hygienist of the Year: Anna Holyoake
Dental Therapist of the Year: Barbara Dewson
Oral Health Therapist of the Year: Sam Carrington
Dame Annette King Award for Leadership and Excellence in Dental and Oral Health: Arish Naresh