Promoting Māori oral health
A positive outcome of the 1990s ‘health reforms’ was an increase in Māori health providers who were able to secure contracts to provide services for Māori, including oral health services. These providers are owned by Māori, are operated under kaupapa Māori (Māori ideology and practice), and offer a whānau ora (family health) approach to care.
Other Māori initiatives, such as Te Mahi Niho Hauora ki Rātana Pā, a dental health project at Rātana Pā using a Māori community health worker, School Dental Service (SDS) equipment and a contracted dental surgeon, succeeded in making oral health a community concern. Such initiatives have resulted in improved oral health, lessened distrust of dentists, and improved self-esteem and employment prospects among those receiving treatment.
In 1995 Te Aō Marama, the New Zealand Māori Dental Association, was founded in response to evidence that Māori children had more decayed and missing teeth than non-Māori children, and were less likely to be enrolled in the SDS as pre-schoolers. Māori adolescents were less likely than non-Māori adolescents to use the free dental benefit scheme. Māori adults had more decay and missing teeth, but often could not afford dentist visits.
Education and training
While the New Zealand Army had trained dental hygienists from 1974, the first course for civilian dental hygienists only began in 1994. With the exception of a dental therapy course at the Auckland University of Technology (AUT), from 1999, education for dentists, dental therapists, dental hygienists and dental technicians, was centralised at the University of Otago in Dunedin.
The old and the new
In the 21st century Dunedin remained the home of New Zealand’s principal dental school, whose most recent premises were built in 1961, adjacent to the medical school. A new clinical services building will open in Dunedin in 2019 and the existing dental school building will be refurbished by 2020 to accommodate increased numbers of dental students and the addition of dental technology and oral health therapy students.
Further changes in 2006 saw the dental therapy and dental hygiene scopes of practice combined into oral health degrees, offered by AUT (2006) and the University of Otago (2007). Initially, oral health graduates had to register with the Dental Council of New Zealand in both the dental therapy and dental hygiene scopes of practice. From November 2017 they have been able to register in their own oral health therapy scope of practice. Clinical dental technicians are now able to care for patients directly by completing a postgraduate qualification at Otago.
Since the mid-1970s more women have become dentists and dental technicians, joining what had been overwhelmingly white middle-class male professions, and while dental therapy and dental hygiene were predominantly female professions, males now also choose to become oral health therapists. Those entering study in the dental and oral health professions are a more ethnically-diverse group than previously, and increasing the Māori and Pasifika workforce is a priority.
Prevention and enhancement
The services provided by dental professionals continue to change as more New Zealanders retain their natural teeth. There is now a greater emphasis on prevention of tooth decay and gum disease, and tooth preservation and enhancement.
Orthodontics, such as the use of braces, cosmetic dentistry, dental implants (implanting false teeth into the jawbone), tooth whitening (tooth bleaching), and crowning teeth have become more popular.