School dental health clinics are on the way out under a $40 million revamp to the public care of children's teeth.
The Government yesterday announced the establishment of new Community Oral Health Service centres which it said would be better equipped and more accessible than current school dental clinics. Some facilities will also offer services to under-18s and adults.
It follows a decline in children's oral health, with the number of five-year-olds with decayed, missing or filled teeth continuing to rise. In 2004, only 52 per cent of five-year-olds were free of decay.
The new service is the centrepiece in the Government's plan to reinvest in oral health.
"Community-based clinics will not just provide treatment services, but will also be an outreach base for all oral health promotion activities," said Health Minister Pete Hodgson.
"The clinics will be larger, better equipped, and open for more hours, during more days of the year. In hard to reach areas, mobile clinics and mobile surgical buses will ensure that oral health care is available for all children and young people."
Its primary focus will be on oral health promotion and treatment for children up to Year 8.
Some facilities will also offer services to adolescents.
Like the existing school service, the new facilities will be staffed by dental therapists and dental assistants. Larger facilities will have an on-site dentist who can perform more complex procedures.
Some existing school clinics could be retained and refurbished to become a Community Oral Health Services centre.
But Dr Barrie Pratt, president of the Dental Health Foundation, questioned whether the clinics needed to go at all.
"The clinic system at the moment is quite workable. It needs re-equipping but is it that obsolete after it's updated? I'm not so sure. There's no guarantee that the other system is going to deliver more coverage of dental treatment in New Zealand.
"I do like the idea of dental therapists treating these children. I'm not so sure they're quite capable of treating the secondary schools."
Dental Association executive director Dr David Crum welcomed the Government's strategy.
"Overall, we believe this is an important first step, and are encouraged by the attention the issue is being given."
But the association was not yet convinced that community, rather than school-based services, would work, he said.
Dental Therapists Association executive officer Ngaire Mune said the strategic vision was a "positive move toward better oral health for all New Zealanders".
Which of the country's 1100 school dental clinics will be replaced, and which will remain, is still being assessed by the District Health Boards.
They are expected to submit their plans to the Ministry of Health from November this year.
The first new facilities will open their doors next year, but the "re-orientation" of oral health services is expected to take several years to complete.
In the meantime, oral health services for children will continue to be available through the school clinic.
Special focus on Northland
Public health authorities in Northland believe the new strategy is especially important for the region, where oral health among young people is the worst in New Zealand.
Statistics from last year show that only 31 per cent of under 5-year-olds in Northland have teeth with no holes (caries).
Maori children are the worst affected, with only 14 per cent remaining caries-free by the age of 5.
Funding available under the strategy for capital investment and operational costs would allow the Northland District Health Board to increase oral health services and offer better access to dental care, said the board general manager for service development, funding and Maori health, Kim Tito.
The board plans to work closely with providers in public, private and Maori health sectors to look at options that improve access to dental services for young people.
Northland DHB dental adviser Dr Neil Croucher said that when oral health was good, people generally felt good, looked good, ate well and did well.
Poor oral health was likely to result in infections, pain and sleepless nights, with rotten or missing teeth reducing chances of succeeding in education and employment, he said.