New Zealands therapist battles control, too

Training for both positions would seem ideal. But, remember, dental therapists are not allowed to work in private practice ... You can travel to the other side of the world and find the same control issues we see here!

Training for both positions would seem ideal. But, remember, dental therapists are not allowed to work in private practice ... You can travel to the other side of the world and find the same control issues we see here!

Trisha E. O`Hehir, RDH, BS

In early July, I participated in the Dentistry 2000 Conference organized by the New Zealand Dental Therapists` Association. Dental therapist is the new name for dental nurses. How many of you remember doing reports as dental hygiene students on the New Zealand dental nurse? If you weren`t assigned this topic, one of your classmates probably was. To refresh your memory, here`s my view - an abridged, unauthorized history.

Around 1920, as dental hygiene was getting started in the United States, the education of dental nurses began in New Zealand. Both countries faced similar choices. Should the focus be on periodontics or restorative? Should these auxiliaries be employed by government or the private sector?

The North American dental hygienist, of course, is perio based and employed primarily in private practice. New Zealand developed the dental nurse to provide all necessary restorative work for children in government-funded, school dental clinics. Although each school district has a dental officer, the dental nurses work independently within their assigned schools, providing examinations, local anesthesia, restorations, and extractions on both primary and permanent teeth. Being government employees, they are assigned a ranking and never considered a "professional." This has carried over to their education (a minimum of two years), which does not require a bachelor`s degree.

As the dental hygiene profession grew and evolved in North America, dental nurses were subject to the controls and funding of a socialistic government. As funds were cut, so were jobs.

Funding cuts also mean less-than-ideal equipment and materials. Instead of using new materials such as glass ionomer cement to fill early childhood caries, their only choice is to repeatedly place temporary cements. Funding cuts also result in extended recalls for the children. They are no longer are they seen every six months, since the mandate is now 12 to 18 months. It is not surprising that the DMF rate of children in New Zealand is now four times that of the United States!

Although their focus is both prevention and restorative care, they have a reputation for torture, according to the kids. Visits to the school dental clinic often are referred to as trips to the "murder house." Kids nervously wait to be tapped on the shoulder and summoned to see the dental nurse. With limited time and funds, restorative work takes precedence over prevention. Since the government pays for this care, the kids and parents do not value it the way they would if they actually paid for it themselves.

The number of dental therapists has dropped sharply, from several thousand therapists to just over 500 today. With shrinking budgets and fewer positions, it isn`t a very appealing career choice. Although a few men have been trained as therapists, it is even more a female occupation than dental hygiene.

Looking at the 250 dental therapists gathered for the Dentistry 2000 Conference in Auckland, I couldn`t help but see a meeting room filled with dental hygienists had the meeting been held in the United States. One striking difference, however, was the lack of young therapists. The overwhelming majority have been working for 10, 20, or 30-plus years. With more than half the positions cut due to lack of funding, jobs are scarce.

Young therapists are not able to find work after finishing school, so those who choose to stick with dentistry enroll in the dental hygiene program started only a few years ago in New Zealand. (Phebe Blitz, a member of the RDH editorial board, is currently the director of the only dental hygiene program in New Zealand.)

Training for both positions would seem ideal. But, remember, dental therapists are not allowed to work in private practice. So, those with a combined education who want to continue using their skills as a therapist must find work in a school clinic as a dental therapist and another position in private practice as a dental hygienist. Quite surprising, too, is the fact that even though they are trained to use local anesthesia, working as dental hygienists they are not allowed to use their therapist skills. You can travel to the other side of the world and find the same control issues we see here!

The dental therapist program in New Zealand recently moved to the dental school in Dunedin. I assumed it would then become a degreed program, but the dean of the dental school assured me he had no such plans. The program for lab technicians, however, will become a degreed program.

Dental therapists would like the opportunity to work in private practice, but that will take legislative changes. A former dental therapist is currently a member of the government and in the running for the Minister of Health position. It?s a start, but changing the law is not enough. Dental hygiene is having a difficult time integrating into the dental office, since most New Zealand dentists have only one operatory. This makes it difficult, if not impossible, to employ another clinician, therapist, or hygienist. Looks like independent practice is the answer for New Zealand!

Trisha E. O`Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. The Web site for Perio Reports is www.perioreports.com. Her e-mail address is trisha@perioreports. com.

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