Story: Dental care
Page 4 – Dental nurses to dental therapists
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 set 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. It was one of 25 clinics built that year for graduates from the two-year training programme in Wellington. Remote areas were serviced by mobile clinics. The service was popular and efficient, and extended to 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, head 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. It was often a child’s first encounter with non-accidental pain.
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.
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.
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 built in Auckland in 1951 and Christchurch in 1959.
By 1941 all eligible students up to standard four (year six) were being treated. Concerns over the service’s effectiveness were raised when the teeth of soldiers serving in the Korean War were inspected and decay was revealed, but by the early 1970s the health of children’s teeth had improved. There were fewer fillings and extractions. By this time about 60% of pre-school children and 95% of primary schoolchildren were registered with the service.
In the 1980s dental nurses became dental therapists, with an increased emphasis on oral health education and prevention – a role change that signalled their success. Their numbers dropped as school rolls fell, the workforce aged, and women were drawn into a wider range of professions. Dental-nurse training centres closed in Auckland and Christchurch.
In the 1990s the SDS changed from a national service run by the Ministry of Health to a fragmented service run 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. In the early 2000s, 90% of children still received free dental care. Dental therapists were joined by dental hygienists in both public and private practice.
Revival of the SDS
The SDS was rejuvenated in 2006 after evidence of worsening decay in pre-schoolers’ teeth and poor dental health among those on low incomes. This encouraged extra spending on early enrolment and preventative and educational services. The SDS was renamed the Community Oral Health Service. In the early 21st century it provided treatment and advice for children from birth to age eight.