Poor teeth prompt brush-up of services

Children's deteriorating teeth and outdated equipment have forced the Government to plan a reorganisation of state-funded dental services.


Details and costings are not expected for three months but Health Minister Annette King says she wants new community dental clinics to provide for many preschoolers, adolescents and, crucially, low-income adults, for whom few state-funded dental services are available.

The Dental Association yesterday panned Ms King's scheme, saying existing services needed to be adequately funded.

But some in the dental sector expect the reorganisation and associated changes to the training of dental therapists to help overcome the dental therapy crisis and improve the nation's oral health.

The community clinics would be staffed by dentists and dental therapists. The therapists, most of whom are permitted to treat only children and adolescents, could do straightforward work on adults if their training was extended.

After decades of improvements, oral health plateaued in the 1990s in young children and worsened in 12-year-olds.

While almost all primary schoolchildren are seen by school dental services, only half of preschoolers aged 2 1/2 to 5 are enrolled, down from 70 per cent in the 1980s.

Only an estimated 60 per cent of adolescents make use of state-paid treatment by dentists and fewer than half of dentists will do state work on teens, since they consider the fees too low. Teenagers who go untreated risk losing all their teeth by the late 20s.

Routine patients at primary schools are meant to be seen every year, but in some areas have to wait 18 months because of the shortage of therapists.

The number of therapists, formerly called dental nurses, has halved in the past two decades to fewer than 600. Most are aged over 40. Experienced therapists' salaries are about $40,000.

The Government faces a bill of tens of millions of dollars to upgrade school clinics since many of the country's 1100 clinics do not meet modern health and safety standards. Mobile clinics are becoming increasingly popular.

The Auckland University of Technology is trying to address the therapist shortage by doubling course places to 40 next year, when it also intends to add dental hygienist training to the course. Hygienists, who clean and scale teeth, can earn twice as much.

AUT is also exploring teaching therapists to treat adults.

Ms King was unable to say when the Government would extend subsidised treatment for low-income adults.

"The whole direction includes having comprehensive dental care from young children right through to adults in an affordable way."

When asked how it would be targeted at poor adults, since the Government was scrapping the Community Services Card, she said that had not been worked out, but it could start with beneficiaries.

Dental Association executive director Dr David Crum said: "Until the Government commits to funding oral health properly none of this is going to be achieved. A good example of that is the basic and essential services for children now being provided by McDonald's [in Northland by a charity funded mainly by the fast-food giant]."

But Dr Callum Durward, a children's dentist at the Greenlane Clinical Centre and AUT lecturer, said the planned service and training changes could significantly improve adolescents' and low-income adults' teeth, although more water fluoridation and oral health education were also needed.

The Government spends $115 million a year on dental care, including $17 million of ACC-funded treatment.

State-funded dental care for adults is more limited than medical care. It includes ACC treatment for accident victims, emergency treatment and funding for Maori providers.

Children's teeth

* Children's dental health improved in the decades before the 1990s but then plateaued in 5-year-olds.

* In 1994, 50 per cent of 12-year-olds were free of dental decay, but this fell to 45 per cent in 1999.

* At Greenlane Clinical Centre in Auckland children commonly have up to 10 teeth extracted under general anaesthetic as they are too rotten to fill.

* Several children a year have all 20 of their primary teeth pulled out.