In New Zealand, dentists, dental therapists (previously called dental nurses), dental hygienists, oral health therapists and dental technicians are the chief providers of dental care. Dental care is delivered by a mixed state and private dental service model; children and adolescents up to the age of 18 years have free dental care but adults must pay for their own care (although some funding is available for emergency treatment).
It’s a gas
Dentists J. W. Tatton in Nelson, Herbert Rawson in Wellington and Benjamin Throp in Dunedin made their own nitrous oxide (laughing gas) for pain relief in the 1870s, long before it was commonly used by dentists internationally and in New Zealand.
Māori and oral health
The main oral-health problem faced by the early Polynesian arrivals in New Zealand was tooth decay around the age of 40. When New Zealand’s temperature dropped around 1500 AD, and competition for food resources increased amongst a growing Māori population, the early, softer diet of kūmara, yams, fish and birds changed. Fern root and shellfish were more frequently consumed. This increased the level of wear on teeth – which were usually flat by the time Māori were in their 20s – but tooth decay largely disappeared.
In the 19th century Māori often had better teeth than Pākehā, because they had less access to sugar and they ate less frequently during the day. Their oral health, however, appeared to deteriorate rapidly when they adopted more ‘westernised’ diets. By the mid-1930s the Dental Officer for the Native Schools observed that there was now very little difference between Māori and non-Māori children’s teeth: ‘Both were equally bad.’1
An extractive industry
Pākehā New Zealanders in the late 19th century often had poor teeth and gums, and many people used mouthwashes to avoid bad breath. Ineffective dental powders and pastes were also marketed to settlers.
Toothache made people desperate for treatment, with some even resorting to treating themselves. Frank Throp, one of Dunedin’s early dentists, described asking an old Scotsman who had extracted his teeth. He was surprised to learn that the old man had taken them out himself ‘…wi’ a hammer and a chisel, same as we do for a hoss.’2 For others, necessity prompted trips to the dentist, doctor, chemist or even the blacksmith, where decayed teeth were usually extracted rather than repaired.
Intrepid unqualified dentist
Margaret Caro, born of Scots parents near Nelson in 1848, worked for 16 years as a dentist in South Canterbury mining and farming communities with her husband, Dr Jacob Selig Caro. She was more than 1.8 metres tall, and rode long distances to provide medical and dental care, including extracting teeth, setting bones and stitching wounds. In 1881 she was the first woman listed on the Dentists’ Register in New Zealand. She did not appear to have any formal qualifications.
Early dentists were skilled practitioners, trained under an apprentice system. They sometimes combined dentistry with shopkeeping and dispensing medicines and remedies. An exception was John Davis, who established a dental practice in Auckland in 1841. He had partly completed a medical degree from Cambridge, England. Apart from a few pioneering women dentists such as Margaret Caro and Amy Johnston, dentists were almost exclusively men.
Less pain, more gain
Initially dental equipment was primitive and limited. Only a hand-operated drill was available and there was no local anaesthetic for pain relief so dentists rarely filled teeth. However, six major technological advances revolutionised dentistry from the 1870s.
- From 1876 the foot-pedal-operated dental engine enabled drilling of cavities.
- Adjustable dental chairs increased the range of operations a dentist could perform.
- Cheaper and improved filling materials became available, including gutta percha from Malaysian rubber trees, amalgam, gold and porcelain.
- Vulcanite (vulcanised rubber) was used in the manufacture of false teeth.
- Coal gas provided heat and energy for a wide range of dental work.
- Nitrous oxide became available for safe administration of pain control, enabling a wider range of operations.
Dentists were now able to offer a variety of services and were no longer merely considered 'tooth-pullers'.