School Dental Service
The introduction of the state-funded School Dental Service (SDS) in 1921 was a world first, prompted by concerns about poor dental health. Staffed entirely by female dental nurses, the service was available free to primary schoolchildren. The first 'draft' of dental nurses was recruited in 1921. They trained in a temporary school next to Government Buildings in Wellington, and graduated in mid-1923.
In the early years of the school dental service, rural dental nurses encountered children who had never had any dental care. One nurse described treating 60 children in a single day after they were driven to the clinic in the principal’s truck. She extracted four permanent teeth and 44 baby teeth.
The first school dental clinic was set up in Hawke’s Bay in July 1923. The Department of Health required school committees to provide clinics for their schools. While some were purpose-built, many were not, and the conditions the ‘pioneer dental nurses’ found themselves working in varied. By 1927 the government introduced a subsidy to help schools fund clinics and, by 1941, was solely funding clinics. The SDS was popular and efficient, and extended to native schools, private schools and country districts.
Dentists were divided on the need for dental nurses, despite the support of advocates for public provision of dental services, such as Norman Cox and John Saunders of the New Zealand Dental Association. Those opposed included Henry Pickerill, dean of the New Zealand Dental School, who saw dental nursing as lowering standards.
The ‘murder house’
For primary schoolchildren, few sights provoked more fear than the appearance of a fellow student with a note summoning you to the dental clinic or ‘murder house’, as it became commonly known, due most likely to fillings being done without the use of local anaesthetic during the early days of dental care.
Many dentists doubted women’s strength and suitability for the work. They were opposed to state control of dentistry and the subsequent loss of professional independence it represented. Their prejudices were countered by the expectation that dental nurses would be cheaper to train, would be better at dealing with children and would leave the profession to marry (making them less of a threat to dentists). Dental nurses were also under the supervision and direction of a public health dentist.
For women, dental nursing provided a rare opportunity for a semi-autonomous career. It attracted many educated and mature students who soon proved their abilities on the job, often in isolated parts of the country. One of these nurses was Grace Rood, who was working in her clinic at the Waipawa sub-base when the 1931 Hawke’s Bay earthquake struck. She later set up a clinic at Pōrangahau, where she had no electricity, and used a primus stove to sterilise her instruments and boil water.
Success and expansion
The SDS would be a much-studied template for similar services overseas. Under the Labour government of Michael Joseph Savage from 1935, the service was expanded and dental nurses given extra responsibilities. A new Dominion Training School opened in Wellington in 1940, with further schools opening in Auckland in 1952 and Christchurch in 1956.
Dental care and public service
Perle Hera Rakapa Taiaroa of Ngāi Tahu was one of the first fully qualified Māori dental nurses. She worked as a bonded dental nurse in New Plymouth from 1928 to 1931, before she married Ngāi Tahu leader and political activist Frank Winter. She later became vice-president of the Wellington section of the Pan-Pacific and South-East Asia Women’s Association, president of the Pōneke branch of the Māori Women’s Welfare League, and vice-president and treasurer of its Wellington district council.
By the fiftieth anniversary of the SDS in 1971, some 1,341 school dental nurses were working in 1,297 clinics, taking care of 582,964 preschool and school-age children. In 1923 the first group of dental nurses had completed 78.6 extractions for every 100 fillings; by 1970 this had reduced dramatically to 2.8 extractions per 100 fillings.
In spite of the efforts of the SDS, in the 1970s, a World Health Organization international oral health survey, and a further national survey, found that New Zealand children and adults had heavily-filled teeth and a high percentage of adults still lost all their teeth. As a result, the SDS implemented a new preventive and diagnostic regime designed to reduce the number of fillings.
During the 1980s dental nurse numbers dropped as school rolls fell, more women returned to work after having children, and women were drawn into a wider range of professions. Dental nurse training centres closed in Auckland and Christchurch.
In the early 1990s dental nurses became known as dental therapists and in 1994, they were joined by dental hygienists who began to train at Otago Polytechnic. In 2004 the Health Practitioners Competence Assurance Act brought registration for both dental hygienists and dental therapists. For dental therapists, this meant that they were no longer limited to working for the SDS but were able to work in private practice as well.
Community Oral Health Service
In the 1990s the SDS changed from a national service, run by the Department of Health, to a fragmented service administered by a succession of different governing and funding bodies. There was a greater focus on community health, integrated dental hospital-based services and Māori health providers. However, the rapid changes in social and economic policy and series of structural reforms during the 1990s had a negative impact on school dental services and children’s oral health worsened during this time.
Reviews of the SDS in the early 2000s noted that the service had deteriorated further. As well as worsening oral health statistics for children, facilities and equipment were run down, and the dental therapist workforce was ageing and experiencing shortages.
In 2006 the Labour government produced a new strategic vision with the aim to improve oral health for all New Zealanders (‘Good Oral Health for All, for Life’). This meant major changes for SDS, with the government investing millions into building and outfitting new clinics and mobile clinics, and building up the workforce (including employing dental assistants) to provide an effective Community Oral Health Service (COHS) focused on prevention of dental disease.
In recent years COHS data has shown that the oral health of children is improving once more but that there are still significant inequalities in oral health between groups of children, with Māori and Pasifika children having worse oral health than other children.