Dentists and nurses to vie for patients

By MARTIN JOHNSTON, health reporter

Dental nurses will be allowed to set up in competition with dentists to provide some services if a proposal before the Dental Council is adopted.

The nurses, now known as dental therapists, are pushing to be freed from the supervision of the more highly qualified practitioners.

Some in dentistry say the competition will cut costs and expand treatment for the poor.

But the dentists' interest group, the Dental Association, says it will increase the risks of harmful mistakes on patients.

Dental therapists work mostly in the school clinics of district health boards, where they are under dentists' supervision.

Legislation passed last year is changing the state control of many health workers. Dental therapists will have to register with the Dental Council which, with the help of its dental therapists board, is now designing what their "scope of practice" will be.

The board favours therapists working independently to provide basic care for children and adolescents, a consultation document circulated by the council says.

The document also suggests therapists could be allowed into adults' mouths "in a team situation with a named dentist".

And it canvasses preventing therapists "short term" from moving into the private sector, which they would otherwise be allowed to do under the new law.

The restriction is said to be designed to stem further losses from the already understaffed school dental service.

But the Commerce Commission has raised concern about the loss of competition and the council admits to "serious concerns" about the risk of court action.

Dental Therapists Association president Vicki Kershaw yesterday declined to comment on the draft scope of practice, because she did not want to be seen to be "leading members", despite the closing date for submissions being last Friday.

The School and Community Dental Services Society's chairman, Dr Callum Durward, said allowing therapists to set up in private practice and expanding their opportunities to treat adults might help reverse the job's long-term decline - and improve the nation's teeth.

Many poor people, especially Maori and Pacific Islanders, could not afford regular dental care and suffered the consequences, he said.

"Dental therapists may be able to provide basic treatment at a lower cost."

But Dental Association executive director Dr David Crum said the new law was about public safety.

"It is not about creating solutions to attract applicants to an ailing Government-funded workforce."

Therapists' qualifications, experience and abilities would not change under the new system, so nor should the requirement that they be under a dentist's supervision.

If therapists wanted to practise independently they should do the five-year dentist training, rather than the three-year therapist course.

Even if therapists set up independent practices, he doubted their fees would undercut dentists because they would face the same business and equipment costs.

A Commerce Commission manager, Jan Compton, said it had advised the council to be careful not to breach the Commerce Act by lessening any potential competition in a market involving therapists and dentists.

Dental therapists' salaries range from $28,000 for new graduates to $40,000 for the experienced.

The number of therapists has nearly halved, to around 600, in the past 20 years.

Many children face treatment delays and Otago University is unable to attract enough New Zealanders to fill its therapist course so tops it up with foreigners.

Dental costs


SOUTH AUCKLAND

A Mangere practice charges $70 for a check-up and x-rays.

$115 to $225 for white fillings, depending on size and complexity.

NORTH SHORE

$120 for check-up and x-rays at one practice.

$150 to $350 for white fillings.