oral health therapy programs in … new oral health professional: the oral health therapist...

ORAL HEALTH THERAPY PROGRAMS IN

AUSTRALIA AND NEW ZEALAND

EMERGENCE AND DEVELOPMENT

Edited by AKL Tsang

The University of Queensland School of Dentistry

This publication is supported by an educational grant from Colgate Oral Care

© The Authors

AcknowledgementsPublisher Robert T. WattsLayout design Dallas Girdler

© 2010 The Authors

All rights reserved. Published 2010.

This book is copyright. Apart from any fair dealing for the purposes of private study, research, criticism and classroom use, as permitted under the Copyright Act, no part may bereproduced by any process without written permission. Inquiries should be addressed to the publisher.

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ABOUT THE BOOK COVER

"Mitre Peak"

(Photographed by Chris Piper)

Mitre Peak is one of New Zealand's earliest tourist destinations in the Milford Sound,described by Rudyard Kipling as the "eighth wonder of the world". Mitre Peak rises1700m out of the water and has another 270m underwater.

"Jacaranda mimosifolia in Late October"

(Photographed by Patrick Tsang)

The photo was taken at The University of Queensland. The Jacaranda is locally knownas the "exam tree" because of its full bloom coinciding with final exams at the end ofeach year. The species is a native of South America but is also regarded as a "signaturetree" in Australia where it is most widespread in South East Queensland and NorthernNew South Wales.

"Oral Health in a Tea Cup" (back cover)

(Photographed by Gigi Au Yeung)

Other photographs taken by Annetta Tsang at The University of Queensland.Photographs of oral health learning activities, taken during clinical and preclinical ses-sions.

CONTENTS

List of Key Contributors vii

Acknowledgements ix

List of Abbreviations x

Foreword xv

Preface xvii

PRELUDE

CHAPTER 1 1

A History of Oral Health Practice (Dental Therapy & Dental Hygiene) inAustralia and New Zealand

CHAPTER 2 17

A New Oral Health Professional: The Oral Health Therapist

INTRODUCTION

CHAPTER 3 29

The Genesis of an Idea

BACHELOR DEGREE PROGRAMS

CHAPTER 4 37

The University of Queensland

CHAPTER 5 75

The University of Otago

CHAPTER 6 99

The University of Adelaide

CHAPTER 7 131

Griffith University

© The Authors v

CHAPTER 8 149

The University of Melbourne

CHAPTER 9 181

The University of Newcastle

CHAPTER 10 195

The University of Sydney

CHAPTER 11 213

Auckland University of Technology

CHAPTER 12 239

La Trobe University

CHAPTER 13 257

Charles Sturt University

OTHER MODELS AND OTHER PROGRAMS

CHAPTER 14 265

TAFE South Australia

CHAPTER 15 289

Curtin University

CHAPTER 16 291

The University of Queensland's Academic Upgrade and Australian DefenceForce Programs

EPILOGUE

CHAPTER 17 309

Looking to the Future: Directions and Innovations

CHAPTER 18 319

The Collaborative Initiative... The First of Many?

vi © The Authors

© The Authors vii

KEY CONTRIBUTORS

Susan CartwrightBDS, DipClinDent(Perio)Auckland University of TechnologyAuckland, New Zealand

Deborah CockrellBDS, FDSRCPS, PhDAssociate Professor Head, Oral HealthDeputy Head, Faculty of Health SciencesUniversity of NewcastleCentral Coast, New South Wales,Australia

Wendy CurrieDipDT, MHthScEdDeputy Director, Bachelor of Oral HealthFaculty of DentistryUniversity of SydneyNew South Wales, Australia

Mark GussyCert DT, Dip DH, MEd, PhDAssociate Professor of Oral HealthSchool of Dentistry and Oral HealthLa Trobe University Bendigo, Victoria, Australia

Rosemary KardosBSc, PGDipTerT, MNZIPFaculty of DentistryUniversity of OtagoDunedin, New Zealand

Lynette McAllan BDSc, MSc (Paediatric Dentistry)Foundation Program Coordinator, OralHealthSchool of DentistryThe University of QueenslandQueensland, Australia

Colleen McCarthyGradDipChildDev, DipAppSci(DentTher)Foundation Program Coordinator, OralHealthSchool of Dentistry and Oral HealthLa Trobe UniversityBendigo, Victoria, Australia

Alison MeldrumMDSProgram Convenor, Oral HealthFaculty of DentistryUniversity of OtagoDunedin, New Zealand

Jennifer MillerCert DT, Ass Dip Health Admin, BEdProgram Coordinator, Oral HealthSchool of DentistryThe University of AdelaideSouth Australia, Australia

Susan MoffatCert Dent Therp, BA, DPHFaculty of DentistryUniversity of OtagoDunedin, New Zealand

viii © The Authors

Carol NevinAssocDipDT(WAIT)Department of Dental Hygiene andTherapyCurtin University of TechnologyWestern Australia, Australia

Joseph RahebBDSc, GradDipEducation,PostGradDipPublicHealth, MPHDepartment of Dental Hygiene andTherapyCurtin University of TechnologyWestern Australia, Australia

Jane RossiDDH, BAdVocEd, DipManProgram Coordinator, Oral Health(Dental Hygiene)TAFE SA Centre for Dental StudiesGilles PlainsSouth Australia, Australia

Julie SaturDipApplSci(Dental Therapy),GradDipHealthEducation, MHSc(HealthPromotion), PhDAssociate ProfessorHead of Oral Health TherapyMelbourne Dental SchoolThe University of MelbourneVictoria, Australia

Gregory Seymour AMBDS, MDSc, PhD, FRCPath, FFOP(RCPA),FRACDS(Perio), FICD, FRSNZDeanFaculty of DentistryUniversity of OtagoDunedin, New Zealand

Leonie ShortRDT, DipClinHyp, BA, MHP, AFCHSE,MAICDProgram Convenor, Oral Health TherapySchool of Dentistry and Oral HealthGriffith UniversityGold Coast, Queensland, Australia

Jenny SmythBDS, FDSRCS, FRACDS, FICD,GradCertEdSchool of DentistryThe University of QueenslandQueensland, Australia

Helen Tane Cert Dent Therp, PG Cert TT, MPHClinical DirectorSchool of Dentistry and Health SciencesCharles Sturt UniversityWagga Wagga, New South Wales,Australia

Annetta Tsang BDSc(Hons), GCClinDent, GCEd(HE),MScMed (Pain Mgt), PhDProgram Coordinator, Oral HealthSchool of DentistryThe University of QueenslandQueensland , Australia

Laurence Walsh BDSc, PhD, DDSc, GCEd, FFOP(RPA),FICD, FADI, FPFAHead of SchoolSchool of DentistryThe University of QueenslandQueensland, Australia

© The Authors ix

ACKNOWLEDGEMENTS

We would like to express our gratitude to our colleagues, staff and stu-dents for their personal reflections, suggestions, comments and sup-

portive help. Their contributions substantially added to this monograph,rendering this piece of work distinctly more representational, more engag-ing, more interesting and more comprehensive.

Auckland University of TechnologyLinda ButtleDonna Kennedy

Charles Sturt UniversityBarbara TaylorCurtin University of TechnologyRuss Kendall

Griffith UniversityHedley ColemanMarc Tennant

La Trobe UniversityVirginia Dickson-SwiftTim GodberJanice RothackerJon Willis

TAFE South AustraliaSue AldenhovenJohn McIntyre

University of AdelaideMelissa DegenhardtJosh GalpinKostas KapellasNatalie OlssonLuke ReesLindsay RichardsAccreditation Documentation Team

University of MelbourneHanny CalacheMark GussyPam LeongMike MorganClive Wright

University of NewcastleJane TaylorJanet WallaceLinda Wallace

University of OtagoRenee NattrassPimwadee Intharasri

University of QueenslandJenny BishopPhil CampbellLibby DannFelicity DoughertyClaire EdwardsJoan JamesTina O'ShannessyKathryn PlonkaJohn RutarDeborah Taggart

University of SydneyJanice BarrJoanne CoombesPeter DennisonBronwyn JohnsonIven KlinebergEric NaveaAlan PattersonClare PhelanKatherine PriceBernadette PluschTanya SchinkewitschEli SchwarzMiriam ThomasBettine WebbHans Zoellner

x © The Authors

LIST OF ABBREVIATIONS

AAUT Australian Awards forUniversity Teaching

BDH Brisbane Dental Hospital

ACT Australia Capital Territory BDS Bachelor of Dental Surgery

Ac Up Academic Upgrade BDSc Bachelor of DentalSciences

ADA Australian DentalAssociation

BHealSc Bachelor of HealthSciences

ADC Australia Dental Council BHSc Bachelor of HealthSciences

ADF Australian Defence Force BOH Bachelor of Oral Health

ADH Adelaide Dental Hospital BOHSc Bachelor of Oral HealthScience

ADHA American DentalHygienists Association

BOralH Bachelor of Oral Health

ADOH Advanced Diploma in OralHealth

CALT Committee for theAdvancement of Learningand Teaching

ADTA Australian Dental TherapistAssociation

CFC Common First Year

AIHW Australian Institute ofHealth and Welfare

CIC Curriculum IntegrationCommittee

ALTC Australian Leaning andTeaching Council

CLPD Centre for Learning andProfessional Development

ANZ Australia and New Zealand CMOH Centre for Medicine andOral Health

AQF Australian QualificationsFramework

COAG Council of AustralianGovernments

ARCPOH Australian Research Centrefor Population Oral Health

COHS Centre for Oral HealthStrategy

ARDS Auckland Regional DentalService

CORAL Centre of OrofacialResearch and Learning

ASP Academic Studies Program CPP Career ProgressionProgram

AUT Auckland University ofTechnology

CRA Criterion ReferencedAssessment

BAppHSc Bachelor of Applied HealthScience

CRC Cooperative ResearchCentre

© The Authors xi

CSP Commonwealth SupportedPlaces

DT Dental Technologist

CSU Charles Sturt University DTHWA Dental Therapy andHygiene Association ofWestern Australia

DAPP Dental Assessment andPrioritisation Program

DTP Dental Therapy Practice

DBQ Dental Board ofQueensland

EP EvolvingProfessionalism/Professional

DCNZ Dental Council of NewZealand

FDI Federation DentaireInternationale

DDSc Doctorate in DentalScience

FLAS Flexible Learning andAccess Service

DDS Doctorate in DentalSurgery

FTE Full Time Equivalent

DH Dental Hygiene FYA First Year Advisor

DHAA Dental Hygienists'Association of Australia

GDP General Dental Practice

DHB District Health Board GIHE Griffith Institute for HigherEducation

DH&CS Department of Health andCommunity ServicesVictoria

GPA Grade Point Average

DHP Dental Hygiene Practice GU Griffith University

DHSV Dental Health ServicesVictoria

GUDSA Griffith University DentalStudents Association

DipDentTher Diploma in Dental Therapy GVH Goulburn Valley Health

DLP Dental Learning Packages HECS Higher EducationContributions Scheme

DOH School of Dentistry andOral Health

HEDC Higher EducationDevelopment Centre

DOHT Dental and Oral HealthTherapists

HPCA Act Health PractitionersCompetence Assurance Act

DOHTAQ Dental and Oral HealthTherapists Association ofQueensland

IBL Inquiry-Based Learning

DPERU Dental Practice andEducation Research Unit

ICTE Institute of Continuing andTESOL Education

DSc Dental Science IFDH International Federation ofDental Hygienists

DSRU Dental Statistics andResearch Unit

IPE Interprofessional Education

xii © The Authors

ITMOSS Integrated Team Model forOptimising StudentSuccess

PDR Planning, Developmentand Review

MCQ Multiple Choice Questions PGDipDentTher

Postgraduate Diploma inDental Therapy

MEQ Modified Essay Questions PIFS Pacific Island Family Study

MOU Memorandum ofUnderstanding

PG Postgraduate

MRI Medical Research Institute QH Queensland Health

NHMRC National Health andMedical Research Council

QLD Queensland

NSW New South Wales QTAC Queensland TertiaryAdmissions Centre

NT Northern Territory QUT Queensland University ofTechnology

NZ New Zealand RELT Resources for Education,Learning and Teaching

NZDA New Zealand DentalAssociation

RSD Research SkillDevelopment

NZDHA New Zealand DentalHygienists Association

SA South Australia

NZDTA New Zealand DentalTherapists Association

SADS South Australian DentalService

NZDJ New Zealand DentalJournal

SADTA South Australian DentalTherapists Association

OH Oral Health SAH South Australia Health

OHC Oral Health Centre SAP School AssessmentProgram

OHEU Oral Health Education Unit SAQT Short Answer QuestionTests

OHT Oral Health Therapy SDS School Dental Service/s

OP Overall Position SOKS Save Our Kids Smiles pro-gram

OSCA Objective StructuredClinical Assessment

SoTL Scholarship of Teachingand Learning

OSCE Objectively StructuredClinical Examination

SPICES Student Problem Integratedcommunity ElectiveSystematic model

PBL Problem Based Learning SSP Special Studies Program

PCYC Police Citizen Youth Club TAFE Technical and Adult FurtherEducation

© The Authors xiii

TAS Tasmania UG Undergraduate

TEDI Teaching and EducationDevelopment Institution

UQ The University ofQueensland

TF Teaching Focused US United States of America

UAI University AdmissionsIndex

VIC Victoria

UMAT Undergraduate Medicaland Health SciencesAdmission Test

WA Western Australia

UK United Kingdom WDHB Watemata District HealthBoard

FOREWORD

Colgate has great pleasure in supporting this publication which detailsthe evolution of Oral Health professionals across Australia and New

Zealand. Colgate has a long and proud history of supporting oral health pro-fessionals throughout their careers, with a particular emphasis on educa-tion. The contributors should be congratulated for putting together a time-ly, readable and entertaining record of the development of Oral HealthTherapy in Australia and New Zealand.

Dr Barbara Shearer MDS PhDScientific Affairs Manager, Colgate Oral Care

© The Authors xv

PREFACE

I t is my great pleasure to introduce this important publication which tellsthe story of the development of oral health professionals in the ANZ

region, with all its vision, victories, politics, personalities, strategies, strug-gles, and successes.

Other dental educators, public health workforce planners and colleaguesfrom across the globe can now share in this journey, reflect on the lessonslearned, and apply these to their situation. The advent of the oral healthprofessional has changed forever the shape of the dental team in the ANZregion, and similar approaches are now being adopted in other countries, asthey grapple with the demands of appropriate health care and a worldwhere greater emphasis is being placed on the maintenance of health acrossthe ages.

It is clear that the emergence of oral health professionals in recentdecades has been one of the greatest advances in dentistry. It would be dif-ficult to overstate its positive impact on clinical patient care, particularlybecause of the strong joint emphases on disease prevention and health pro-motion which have been the hallmark of all the programs across the ANZregion.

Each of the individuals who have contributed to this book have devotedsignificant parts of their life to educating oral health professionals, andpassing on the very best knowledge, skills and clinical techniques to theirstudents. I salute their passion and dedication to this important task. Thedental profession at whole owes them an enormous debt of gratitude fortheir selfless efforts. This book is but a part of their legacy to the widerhealth profession. Their students and graduates will continue to shape theprofession, and pass on the vision to the next generation.

Finally, it is a particular pleasure for me to also acknowledge and thankColgate Oral Care for their support of this publication. Colgate have been amajor supporter of the education of oral health professionals across theANZ region, becoming involved in the various programs through work-shops of various types as well as supporting key academic positions and apowerful agenda for research into oral health issues of importance. Theirpartnership with dental education has added significantly to the quality ofthe graduates.

Professor Laurence J WalshHead, School of Dentistry, The University of Queensland

© The Authors xvii

PRELUDE

CHAPTER 1

A History of Oral Health Practice (Dental Therapy & Dental Hygiene) in Australia and New Zealand

Julie Satur

Susan Moffat

S ince the earliest notions of state responsibility for welfare,governments have searched for ways to deliver health serv-

ices in affordable and equitable ways. The mouth however, hasbeen considered a separate entity from the rest of the body inconsiderations of health status and largely excluded from main-stream funding mechanisms (Willis, 1989; Gardner, 1995;Hancock, 1999; NACOH, 2004). Dental care in Australia andNew Zealand is delivered via market based systems with verylimited safety net provisions for disadvantaged people and astronger, but inconsistent commitment to child services.

At the beginning of the twentieth century in New Zealand andelsewhere in the western world, concerns about national effi-ciency and racial fitness meant that social policy becameincreasingly centred on the health and welfare of children. AsMcDonald (1978) stated,

“The adult contribution of citizens, the society’s social capital,related directly to the degree of care given in childhood.”

Rearing and nurturing healthy children would producehealthy adults and ensure continued success for the nations. Inaddition to the enacting of legislation to protect infants andchildren, a range of new health initiatives developed that weredirected specifically at children. This included the New ZealandSchool Dental Service in 1921 (Tennant, 1994; Dalley, 1998). It isworth noting that after the state dental hospitals, the SchoolDental Services have been the longest running public dentalservices in Australia and New Zealand.

The dental profession shared these concerns about children’shealth. Dentists firmly believed that poor oral health con-tributed to poor general health. As early as 1905, F.W. Thompson,

© The Authors 1

Oral Health Therapy Programs in Australia and New Zealand

a New Zealand dentist, presented a paper entitled, “The teeth of

our children” at the first conference of the then newly-formedNew Zealand Dental Association (NZDA). Thompson had den-tally examined children in Christchurch, none of whom had asound set of teeth. He estimated that ninety-eight percent ofNew Zealand children did not receive the care they needed fortheir teeth. Thompson argued for state action on the groundsthat sound teeth were the basis of good health (Thompson,1906). Thompson’s paper was well-received by dentists and wasprinted and distributed as a parliamentary paper (NZDepartment of Health Annual Report, 1905).

NZDA members continued to examine children’s teeth, large-ly at their own expense, in order to advise parents of treatmentrequirements. They also hoped to gain enough evidence to con-vince the Government that some form of state intervention wasneeded to establish dental care for children (Didsbury, 1907). In1912, the newly-established School Medical Service further con-firmed that the oral health status of New Zealand children waspoor, with the NZDA estimating that 90% of children examinedrequired dental treatment and that only 25% would be able toafford that treatment (NZDJ, 1912).

The appalling state of the nation’s teeth became increasinglyobvious during the First World War. A high percentage ofrecruits were rejected for service and many others requiredextensive treatment to be made dentally fit (NZDJ, 1915;Brooking, 1980). The state of the troops’ teeth led to the forma-tion of New Zealand’s Dental Corps. The success of the Corpsmeant that politicians became more sympathetic to the eventu-al establishment of a state dental service for children (Brooking,1980).

However, the War also meant that there was little money avail-able for dental treatment in children. Despite this, the need forstate funding for children’s dental treatment was still men-tioned frequently at NZDA meetings and conferences, with var-ious schemes being suggested to combat the problem. For, asthe President of the NZDA, A. M. Carter, rather melodramatical-ly stated in his presidential address of 1916,

“….the war of the nations will end, and in our hearts we knowVictory will be ours, but in the dental disease so rampant in ourschools we have a more insidious foe, and one that has been fartoo long underestimated, and that is steadily sapping the vitalityand lowering the stamina of our national life” (Carter, 1916).

In Australia, many states established rudimentary schemes in

2 © The Authors

Chapter 1

the years after the First World War arising out of concerns aboutthe poor state of child oral health. This fed discussions at a fed-eral level during the 1940s about a nationalised scheme to beincorporated into the proposed national health scheme of theChifley government (Robertson, 1989; Gardner, 1995). This pro-posal was overturned through a change of government.However concern persisted about the state of oral health in thecommunity. Poor resourcing, lucrative private practice and thesmall pool of dentists available, particularly during the SecondWorld War, meant that these School Dental Services were neverreally universally effective (Robertson, 1989; Sendziuck, 2007).

As a result, a committee of the National Health and MedicalResearch Council (NHMRC) was established to make recom-mendations to the Commonwealth Government in relation todealing with the problem of poor child oral health (NHMRC,1965). These recommendations resulted in the expansion ofexisting state funded School Dental Services into a federallyfunded program. The Whitlam government in 1972, establishedthe scheme based on the model operating in New Zealand, pro-viding special purpose grants to establish training schools fordental therapists and school dental service infrastructure.Federal funding continued until 1981-1982, when the Frasergovernment absorbed this funding back into general revenue,contracting federal government involvement. The responsibili-ty for developing public dental services again reverted to thestates although with continued commitment to school dentalservices and with adult services being provided through thedental hospitals and some community health services (Lewis,2000; NACOH, 2004).

THE DEVELOPMENT OF DENTAL THERAPY

The origin of dental therapy has been variously attributed toboth New Zealand and Great Britain in the early years of the20th century. The following section describes the early years ofdental therapy’s development in New Zealand and its progres-sion to Australia.

New Zealand

In 1913, the then President of the New Zealand DentalAssociation, Norman K Cox proposed a system of school dentalclinics operated by the state and staffed by dentists and “oralhygienists” to address the dental needs of children between theages of 6 and 14 years. Cox (1913) suggested that these statedentists or “oral hygienists”, be trained in a short course at the

© The Authors 3


Dental School. There was opposition to this proposal from den-tists within the NZDA and from H. P. Pickerill, Dean of theDental School, who believed training school dentists at a lowerstandard to treat children was not desirable (NZDA, 1913a).However, a committee was formed by the NZDA to look into theproposed scheme and a NZDA deputation eventually met withthe Ministers of Public Health and Education to discuss the pro-posal. While the ministers agreed that it was not enough mere-ly to inspect children’s teeth (as the School Medical Service wasdoing), they believed such a scheme would need careful consid-eration due to the costs involved (NZDA, 1913b). Unfortunately,there was little progress made on implementing the proposalbefore war broke out.

In 1917, Richmond Dunn a dentist from Wanganui, publisheda paper which emphasised the need for dental care for childrenand the effects of poor oral health on their general health. Hewas particularly concerned that the proposed school dental clin-ics would only provide treatment for dental caries. Dunnstressed the need for preventive care for children, includingpre-schoolers. He believed that New Zealand’s “PlunketNurses”1 were the only people doing “real service for the race”,as they were able to give advice and service that improved thehealth of children and produced “strong and useful men and

women for the future” (Dunn, 1917). Dunn proposed the prepa-ration of a Bill that would create a new profession of “dentalnurse”. The dental nurse would advise parents of their child’streatment needs, give oral health advice, examine teeth andcarry out simple operative procedures. Having dental nurseswould solve the problem of there being insufficient dentists inNew Zealand to staff a school service and dentists would berelieved of the “child-work” that many of them found so “trying

to the nerves” (Dunn, 1917).

Norman Cox, in turn, proposed that New Zealand be dividedinto areas staffed by dental officers and dental nurses, under aDirector of Dental Services. The NZDA once again establisheda committee to investigate further possibilities and meet withGovernment ministers (Cox, 1917). The NZDA also gained thesupport of many influential groups, including the Plunket soci-ety, British Medical Association, New Zealand EducationalInstitute, the University of Otago Council and the media. In

4 © The Authors

1 In 1907, the "Society for the Promotion of the Health of Women and Children" wasfound The Society set up clinics and employed nurses to monitor infant health andprovide advice to mothers. These nurses became known as "Plunket" nurses, namedafter the first patroness of the Society, Lady Victoria Plunket. Eventually the Societybecame known as the Royal New Zealand Plunket Society (Bryder, 2003).

Chapter 1

1918, a powerful deputation was favourably received and in1919, the first four school dentists were appointed to the fourmain centres of New Zealand to form the basis of the SchoolDental Service (NZDA, 1918; Brooking, 1980).

There was much controversy surrounding the scheme, includ-ing opposition from within the NZDA. However, in September1920, at a special meeting of the NZDA, delegates from thebranches voted 16 to 7 to support the adoption of the SchoolDental Nurse Scheme (NZDA, 1920; Brooking, 1980). Schooldental nurses were to provide diagnostic and restorative servic-es to children “…in a rigidly structured set of methods and pro-

cedures which spared her the anxiety of making choices...”

(Leslie 1971).

The controversy surrounding the establishment of thescheme continued for some time. Leslie (1971) reports thatorganised opposition was considerable on the grounds that theemployment of dental nurses posed:

“ …a menace to the public, (a) menace to the (dental) professionand an injustice to those seeking to enter the ranks of the (dental)profession by recognised avenues…”

Colonel (later Sir) Thomas Hunter was appointed Director ofthe newly-established Division of Dental Hygiene under theDepartment of Health and was largely credited with the suc-cessful establishment of New Zealand’s School Dental Service(Brooking, 1980). Under Hunter’s direction, and despite opposi-tion, the New Zealand School Dental Nurse was born, trainedinitially in a school in Wellington run by the Health Departmentwith the first cohort graduating in 1923. After the Second WorldWar, training schools were also established in Auckland (1952)and Christchurch (1956), providing by 1990, a workforce ofaround 900, and a 95% participation rate by New Zealand'sschool children (Hannah, 1998; Tane, 2002). School dental nurs-es, (known as dental therapists from 1991) in New Zealandworked in mobile units and clinics attached to schools, provid-ing diagnostic, preventive and treatment services and referringtreatment beyond their skills to local dentists. Supervision wasprovided at a ratio of around 1 dentist to 50 school dental nurs-es with the purpose of ensuring therapists did not work beyondtheir skills and updated their practices (Leslie, 1971).

In 1980, as a result of New Zealand’s declining child popula-tion and reduced treatment needs, a decision was made to closethe Auckland and Christchurch training schools. A review ofdental nurse training established that an average of 25 gradu-

© The Authors 5


ates per annum would be sufficient to staff the School DentalService. The Wellington School was retained, as it was centrallylocated, had the largest patient group and because there wereno dental clinics in central Wellington (NZ SDS Gazette, 1980).In 1991, training of dental nurses passed from the Departmentof Health to the Department of Education, with the trainingbeing conducted by Wellington Polytechnic from 1991 to 1999(Molloy, 1991) until a further review of dental therapy educationoccurred which recommended auspice by a University. The firststudents graduated from the University of Otago in 2000 with aDiploma in Dental Therapy. Eventually both the University ofOtago and the Auckland University of Technology establisheddegree programs for dental therapy, with both universities final-ly moving to dual-degree bachelor programs i.e. oral healththerapy (dental therapy and dental hygiene) – AUT in 2006 andOtago in 2007.

The Spread of Dental Therapy

New Zealand’s model of service delivery demonstrated consid-erable success and was the target of inquiry by many othercountries around the world. In Great Britain, during the FirstWorld War, a small number of “dental dressers” were used tocarry out examinations and treatment for children in parts ofEngland. Their role however, was eliminated by the DentistsAct of 1921 because of hostility to the role on the part of the den-tists. They were later re-introduced, on the strength of the NewZealand scheme, as dental nurses when the high dental needsof children were ‘rediscovered’ in the 1960s, carrying out simi-lar services but under the prescription of a dentist who carriedout the examination and care plan (Larkin, 1980: NuffieldFoundation, 1993). School Dental Services staffed primarilywith dental therapists were also established in other countriesincluding Canada, South Africa, the Netherlands (temporarily),Fiji, Hong Kong, Malaysia and the Pacific Islands. In 2000, 28countries around the world utilised dental therapists (FDI 2001)and in 2009, in 53 countries world-wide (McKinnon et al., 2007;Nash et al., 2008). In some of these countries, including NewZealand after 1988, dental therapists also provided their servic-es to adults.

Between 2003 and 2005, Alaska made a radical move for theUnited States by sending students to New Zealand’s Universityof Otago to undertake the Diploma in Dental Therapy program.Eleven students graduated from the course and returned to pro-vide services to rural and remote populations in Alaska. This

6 © The Authors

Chapter 1

move was vigorously but successfully, contested by theAmerican Dental Association through the courts. Alaska nowhas its own Dental Health Aide Therapist training program(DENTEX) which is a collaboration between the Alaska NativeTribal Health Consortium and the University of WashingtonSchool of Medicine Physician Assistant Training Program,MEDEX Northwest (DENTEX, 2010). Subsequent to this, sever-al other US states are now examining the potential for dentaltherapists to alleviate the unmet needs for child oral healthservices, with Minnesota becoming the second state to legalisepractice in 2009 (MDH & MBD, 2009).

Australia

As early as 1919, a Melbourne dentist advocated a state dentalservice which would primarily have educational and other pre-ventive functions. He drew on the concept of the British systemof “dental dressers” for a new Victorian oral hygienist whowould provide much of the care under the supervision of a den-tist (Robertson, 1989). In 1923, in order to make recommenda-tions to the Victorian Cabinet for the extension of dental treat-ment for children, the Acting Director of Education for the Stateof Victoria wrote to the Principal Dental Officer for NewZealand’s School Dental Service expressing interest in thescheme to train young women as dental assistants for work inschools. Clearly, concern for child oral health was significant,but the threat of the development of another layer of practition-er, when the dentists were “… fending off the demands of record-

ed men, twilighters and mechanics…” was too great for the den-tists (Robertson, 1989). Likewise, in NSW during the 1930s and1940s, similar proposals were made for the initiation of oralhygienist services for children and similar political activity pre-vented their initiation (Franki, 1997).

The need to improve the dental health of children remained ofgreat concern and a ‘fact-finding mission’ was established tolook into the New Zealand Scheme in 1946 (Robertson, 1989;Gardner, 1992). But it was not until the 1950s and 60s that theNHMRC’s Dental Health Committee made recommendationthat any instrumentality responsible for the dental care ofAustralian children “… should now give consideration to the

utilisation of dental auxiliary personnel in the form of the school

dental nurse...” (NHMRC, 1965). The NHMRC noted the successof such schemes in other countries and in particular, over 90%participation rate and social acceptance attached to the NewZealand Scheme and also, the reluctance of the dental profes-

© The Authors 7


sion to support the concept of operative dental auxiliaries inAustralia. It made recommendations that demanded systematicand regulated non-university training2, the complementary(rather than substitute) nature of dental auxiliary practice, theneed to define the range of skills they could practice and, theneed for direction and control of their services by registereddentists. It stressed the need for administration by a dentist ofsuch services and for each state to train sufficient auxiliaries fortheir own needs to engender allegiance in its staff and to reducethe demands for reciprocity and the risks of competitivesalaries and other ‘undesirable developments’. Courses of train-ing should be as short as possible in order to maintain the cost-effectiveness of the auxiliary while ensuring competence. Italso suggested that such school dental nurses should be femaleand have their employment restricted to the government serv-ice (NHMRC, 1965).

As a consequence, in 1964 NSW passed legislation amendingtheir Dentists Act but could not generate sufficient support forfunding to establish a training program (Franki, 1997).Tasmania and South Australia thus established the first dentaltherapy schools to train dental therapists for their state’s dentalprograms in 1966 and 1967 respectively (Dunning, 1972; Gussy,2001). These courses were established in purpose-specificSchools of Dental Therapy operated in most cases by statehealth departments. When the Whitlam government offeredconditional block grants to expand the School Dental Schemein 1973 to encourage the development of auxiliary-based schooldental programs, all of the other states took up the extra fund-ing, with New South Wales establishing schools at Westmeadand Shoalhaven 1974, Queensland (at Yeronga) also in 1974 andVictoria (Melbourne) in 1976 (Gussy, 2001; H. Field, personalcommunication, 2009). Western Australia, which began trainingdental therapists in 1971, was unique in using the tertiary sec-tor for training. Dental therapists trained in a world first pro-gram at the Western Australian Institute of Technology (laterCurtin University) could work in both the private sector underprescription and, like the other states, autonomously in theSchool Dental Services. Their School Dental Service howevercontinued to operate like the other states, with dental therapistsproviding examinations (radiography, diagnosis and treatmentplanning) and dental treatment including fillings, extraction ofdeciduous teeth, local anaesthesia, preventive services and

8 © The Authors

2 The NHMRC (1965) noted several times in its report that auxiliary personnel shouldbe trained in an appropriate government instrumentality- '…that this is not a matterfor the University Dental schools'.

Chapter 1

health promotion to school aged children under the off-site gen-eral supervision of a dentist.

Prior to the establishment of the Australian Dental TherapySchools, many young women were also sent to New Zealand toboth the Christchurch and Wellington schools to undertaketheir training as school dental nurses, returning to complete aperiod of bonded service as dental therapists in their home stateSchool Dental Services .

The first dental therapy association was formed in 1935, andwas known as the New Zealand Dental Nurses’ Institute. In1995, at its Annual General Meeting, members voted for a newstructure and a name change to that of the New Zealand DentalTherapists’ Association (NZDTA, 2010).

Australia’s first dental therapy associations were formed inWestern Australia and New South Wales in 1973 (DTHAWA,2007; Currie, 2010) and in 1987, the Australian Dental TherapistsAssociation was formed (ADTA, 2001). In 2003, the associationchanged its name and focus to reflect the changes in educationoccurring around the country to form the Australian Dental andOral Health Therapists Association; this was also reflected inthe state associations although the Dental Therapy andHygiene Association of Western Australian had set this newdirection some ten years earlier in 1996.

Qualification for practice as a dental hygienist or therapist atthat time required a 1500-2100 hour, tertiary course of educationover two years requiring university level entrance requirementsgenerally with pre-requisite studies in English and Biology. By1979 the Australian schools were graduating a combined total ofaround 280, all female students per year (CommonwealthDepartment of Health, 1979). The closure of the WestmeadCollege of Dental Therapy in NSW in 2004 saw the end of an eraof dental therapy training by state governments in Australiaand New Zealand, with the move to a university educated den-tal therapist with, in most cases a bachelor-level degree. This isin keeping with international developments in dental hygieneeducation where many countries now offer three and four yearprograms awarding bachelor degrees (Hovius & Blitz, 2001).

THE DEVELOPMENT OF DENTAL HYGIENE

In many cases, the dental hygienist role developed as exten-sions of dental nurses’ roles. Dental nurses had developed inthe late 19th century as an adjunct to a dentist in the more pro-fessional surgical settings. Their role had been to assist at the

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chairside, clean instruments and perform some post-operativeand cleaning services, under the direction of a dentist in a sim-ilar fashion to the medical nursing role. Although dentalhygiene developed in a number of places world-wide, mostnotably Scandinavia, their history in the US is documentedbest.

In 1910 in Ohio, the College of Dental Surgery began offeringa course for dental nurses, which was discontinued because ofopposition from the dentists of Ohio. The first dental hygienistswere formally trained in 1914 when Dr Alfred Fones developedthe concept of a preventive service using women trained in hiscarriage house in Connecticut, to deliver classroom talks, edu-cation for parents and prophylactic treatment for children inpublic schools. Over the next ten years, courses of training wereestablished in several states in the US and by 1931, sixteen edu-cation programs for hygienists, of one to two years durationwere in existence. In 1923, the first meeting of the AmericanDental Hygienists Association was held which led to the draft-ing of professional ethics in 1926 and a journal in 1927. By 1954,dental hygiene licensure was available in all 50 states and by2002 in at least 23 countries world-wide including Australia(Darby & Walsh, 1995; IFDH, 2002).

In the US until 2007, legislation allows for three types of den-tal auxiliaries: dental assistants or nurses, dental hygienists andexpanded function dental auxiliaries or hygienists. Each statedefines the roles and regulation of dental auxiliaries in differentways but in most states they operate under the on-site supervi-sion of a dentist. In 1968 in the US, only nine states allowed forexpanded functions (beyond preventive, educative and prophy-lactic treatments) by dental auxiliaries, but by 1973, 44 statesdid so (Liang & Ogur, 1987). These functions include subgingi-val scaling and root debridement, the administration of localanaesthesia and in some states nitrous oxide analgesia, fissuresealants and tooth bleaching.

In Washington state, Colorado and California in the US, someprovinces of Canada, the Netherlands, Denmark, Norway,Sweden and Switzerland dental hygienists are licensed to prac-tice independently of a dentist in their own practices and innon-dental practice settings such as hospitals and residentialcare facilities (ADHA, 1999; Johnson, 2001). Washington stateand some Canadian dental hygienists also restore cavitieswhich have been prepared by a dentist but this procedure maynot be carried out in their off-site practices (WSL, 1998; Clovis,2000). Direct access to hygienists’ services is advocated by theAmerican Dental Hygienists Association as a means for increas-

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Chapter 1

ing access to care and increasing dental hygienist careeroptions and the Association has supported research into thedevelopment of such an option (Kushman et al., 1996; ADHA,2009).

Australia and New Zealand

Debate about the development of the dental hygienist role inAustralia occurred several times between the 1920s and 1960sincluding a proposal by the federal Labour Government in 1943to introduce “oral hygienists” to deal with the problem of unmetdental need particularly among children. These hygienists weredescribed in terms that would later more closely fit the title ofdental therapist rather than the US model (Robertson, 1989;Gardner, 1992; Franki, 1997). South Australia was the first stateto introduce dental hygienists in 1971, when enabling legisla-tion was passed by the South Australian state government fol-lowing lobbying by a group of dentists who had worked withdental hygienists while undertaking postgraduate studies inthe United States of America and the United Kingdom(DHAA(SA), 2005). The first dental hygienists to work in SouthAustralia were trained overseas, mainly from the UK, US andCanada, some of whom were previously dental assistants fromAdelaide who had undertaken dental hygiene training in theUK before returning to work in Adelaide. In 1974, the first den-tal hygiene training program was established in an initiativebetween the Department of Further Education, the Universityof Adelaide, Department of Dentistry and the Adelaide DentalHospital, taking its first group of students into a 12 monthcourse in May 1975. The first dental hygienists association wasformed and incorporated in South Australia in 1977 and in 1985,the National Dental Hygienists Association of Australia wasformed, becoming a member of the International DentalHygienists’ Federation in June 1986 (DHAA(SA), 2005).

Like South Australia, the first dental hygienists to work inmost states were trained internationally and lobbied localDental Boards and state governments for the right to practice.Dental hygiene is a relatively new profession in Australia, firstlegislated for in South Australia in 1971 and Western Australiain 1973. Practice was more recently legalised in ACT andQueensland in 1987, Victoria in 1989, NSW in 1990 and theNorthern Territory in 1996 (DHAA, 2002). Dental hygienistswere not permitted to work in Tasmania until 2001 (DHAA,2002).

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The employment of dental hygienists in New Zealand is alsorelatively new having only been formally recognised in legisla-tion in 1988. Dental hygienists in New Zealand were firsttrained for the Armed Services in 1974 and have since emergedfrom a range of training models and backgrounds includingpreceptorship, dental therapy to hygiene transition programs,immigration by graduates of international dental hygiene pro-grams and today, established tertiary educational programs.The first training program for general practice began at OtagoPolytechnics in 1994, and in 2001 dental hygiene educationtransferred to the University of Otago (Satur, 2003; Coates et al.,2009). At first a Diploma program was offered; this was then fol-lowed by the implementation of a degree program in 2001. Since2006 (AUT) and 2007 (Otago) dental hygiene education is offeredas part of a dual qualification in dental therapy and dentalhygiene. The New Zealand Dental Hygienists’ Association wasformed in 1993 and has branches throughout New Zealand(NZDHA, 2010).

In both Australia and New Zealand, dental hygienists wereinitially licensed by or practised under exemption fromDentists Acts and worked under the on-site direction or super-vision of a dentist. South Australia was the first to allow dentalhygienists to provide prescribed care in nursing homes where anurse or medical practitioner is available without the on-sitepresence of a dentist (SADR, 1988). This practice is now morecommon. In particular, there is now wider acceptance of hygien-ists in diagnosing and preparing dental hygiene care plans inVictoria, New South Wales and South Australia.

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Chapter 1

REFERENCES

American Dental Hygienists Association (ADHA). (2009). ADHA Policy Manual.Adopted 2008. Updated 2009. Retrieved September 2009 fromhttp://www.adha.org/downloads/ADHA_Policies.pdf/

American Dental Hygienists Association (ADHA). (1999). ADHA Practice ActOverview Chart of Permitted Functions and Supervision Levels by State. Chicago:ADHA.

Australian Dental Therapist Association (ADTA). (2001) A Title for the Association.ADTA 2002 National Annual General Meeting Papers. Hobart: ADTA Inc. SouthAustralia.

Brooking, T. (1980). A History of Dentistry in New Zealand. Dunedin: NewZealand Dental Association Inc.

Bryder, L. (2003). A Voice for Mothers. The Plunket Society and Infant Welfare1907-2000. Auckland: Auckland University Press.

Carter, A. M. (1916). Presidential Address. Delivered at the 10th Annual Meetingof Members. Wellington, May 1916. New Zealand Dental Journal XII, 30(May), 3-7.

Clovis, J. B. (2000). Professionalism in Dental Hygiene: An investigation ofKnowledge of Oral Cancer and Public Policy. (PhD Thesis, Dalhousie University).Canada: Nova Scotia.

Coates, D., Kardos, T., Moffat, S., & Kardos, R. (2009). Educational perspectiveand progression – Dental therapists and dental hygienists for the New Zealandenvironment. Journal of Dental Education, 73, 1005-1012.

Commonwealth Department of Health. (1979). World Dental Therapy Schools.ACT: Canberra.

Cox, N. K. (1913). Presidential Address. Delivered at the 9th Annual Meeting ofthe New Zealand Dental Association. New Zealand Dental Journal IX, 19(July),33-37.

Cox, N. K. (1917). New Zealand Dental Association Twelfth Annual Conference.State Dentistry. New Zealand Dental Journal XII, 42(May), 276-281.

Currie, W. (2010). The struggle to Begin; Dental Therapy and Dental Hygiene inNSW. NSW: DOHTA.

Dalley, B. (1998). Family Matters. Child Welfare in Twentieth-Century NewZealand. Auckland: Auckland University Press in association with the HistoricalBranch, Department of Internal Affairs.

Darby, M. & Walsh, M. (1995), Dental Hygiene Theory and Practice. W.B.Saunders, USA.

(DHAA) Dental Hygienists Association Inc. (2002). Retrieved May 2009 fromhttp://www.dhaa.asn.au/index.html

Dental Hygienists' Association of Australia (S.A. Branch) Inc. (2005). The Historyof Dental Hygiene in South Australia, DHAA SAB, Adelaide. Retrieved June 2009from http://www.dhaa.asn.au/dhaa-sa/history.html

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Dental Therapy and Hygiene Association of Western Australia (DTHWA). (2003).Submission to the Review of the Dental Act. Perth: DTHWA.

Dental Therapy and Hygiene Association of Western Australia. (2007). History.Perth: DTHWA. Retrieved June 2009 from http://www.dthawa.com.au/history.asp

DENTEX. (2010). DENTEX Dental Health Aide Therapists. Mission Statement.Retrieved April 2010 from http://depts.washington.edu/dentexak/

Didsbury, W. H. 1907). Report on Examination of Wellington School Children’sTeeth. New Zealand Dental Journal, 2(3), 78-82.

Dunn, R. (1917). The prevention of dental disease and the adequacy of dentalservice. New Zealand Dental Journal XII, 42, 198-203.

Dunning, J. M. (1972). Deployment and control of dental auxiliaries in NewZealand and Australia. Journal of the American Dental Association, 85, 618-626.

Franki, G. (1997). A History of Dentistry in New South Wales 1945-1995. NSW:Dental Board of New South Wales & ADA(NSW Branch).

Gardner, H. (1992). (Ed.) Health Policy: Development, Implementation andEvaluation. Melbourne: Churchill Livingstone.

Gardner, H, (1995). (Ed.) The Politics of Health: The Australian Experience.Melbourne: Churchill-Livingstone.

Gussy, M. (2001, April). Background to the Accreditation of Training andEducation of Allied Oral Health Professionals. Paper prepared for the AustralianDental Council by the University of Melbourne (unpublished).

Hancock, L. (Ed.) (1999). Analysing Health Policy. St Leonards: Allen & Unwin.

Hannah, A. (1998). New Zealand Dentists, Dental Therapists and DentalHygienists: Workforce Analysis. New Zealand: Dental Council of New Zealand.

Hovius, M. & Blitz, P. (2001, August). Basic requirements for 2/3/4 year dentalhygiene programme. Report of the Workshop. Report presented at the IFDH 15thInternational Symposium of Dental Hygiene. Australia: Sydney.

International Federation of Dental Hygienists (IFDH). (2002). Membership.Retrieved October 2002 from http://www.ifdh.org/members.html/

Johnson, P. M. (2001). International profile of Dental hygiene 1987 to 1998: A 19nation comparative study. International Dental Journal, 51(4), 313-324.

Kushman, J. E., Perry, D. A. & Freed, J. R. (1996). Practice characteristics of dentalhygienists operating independently of dentist supervision. Journal of DentalHygiene, 70(5), 194-212.

Larkin, G. (1980). Professionalism, dentistry and public health. Social Science andMedicine, 14A, 223-229.

Leslie, G. H. (1971). More about dental auxiliaries. Australian Dental Journal,16(4), 201-209.

Lewis, J. M. (2000). From ‘Fightback to Biteback’: The rise and fall of a nationaldental program. Australian Journal of Public Administration, 59(1), 60-72.

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Liang, N. J. & Ogur, J. D.(1987). Restrictions on Dental Auxiliaries: An EconomicPolicy Analysis, Washington DC: Federal Trade Commission, Bureau ofEconomics.

McDonald, D. (1978). Children and Young Persons in New Zealand Society. In:P.G. Koopman-Boyden (Ed.) Families in New Zealand Society. Wellington:Methuen Publications.

McKinnon, M., Luke, G., Bresch, J., Moss, M. & Valachovic, R. W. (2007).Emerging allied dental workforce models: Considerations for academic dentalinstitutions. Journal of Dental Education, 71, 1476-1491.

Minnesota Department of Health & Minnesota Board of Dentistry (MDH &MBD) (2009) Oral Health Practitioner Recommendations: Report to the MinnesotaLegislature 2009. Minnesota: Department of Health and Minnesota Board ofDentistry.

Molloy, R. (1991). School for dental nurses. New Zealand School Dental ServiceGazette June, 6-7.

National Advisory Committee on Oral Health for Australian Health Ministers’Advisory Council (NACOH). (2004). Healthy mouths healthy lives. Australia’sNational Oral Health Plan 2004-2013. Australian Health Ministers’ AdvisoryCouncil. Adelaide: South Australian Department of Health.

Nash, D. A., Friedman, J. W., Kardos, T. B., Kardos, R. M., Schwarz, E., Satur, J.G., Berg, D. G., Nasruddin, J., Mumghamba, E. G., Davenport, E. S. & Nagel, R.(2008). Dental therapists: A global perspective. International Dental Journal 58,61-70.

National Health and Medical Research Council (NHMRC). (1965). DentalAuxiliary Personnel. Reprinted from the Report of the 60th Session of theNational Health and Medical Research Council. CGP, Canberra: CGP.

New Zealand Dental Association (NZDA). (1913a). 9th annual meeting of theNew Zealand Dental Association. Discussion on presidential address. NewZealand Dental Journal IX, 19.

New Zealand Dental Association (NZDA). (1913b). State dentistry. Deputation tothe ministers. New Zealand Dental Journal IX, 19, 38-47.

New Zealand Dental Association (NZDA). (1918). State bursaries for dental stu-dents. Deputation to ministers. New Zealand Dental Journal XIV, 50, 49-60.

New Zealand Dental Association (NZDA). (1920). Association intelligence. NewZealand Dental Journal XVI, 63, 140-142.

New Zealand Dental Hygienists Association (NZDHA). (2001). Interview with thePresident of the New Zealand DHA; Legislation and the roles and education ofNew Zealand dental hygienists.

New Zealand Dental Hygienists Association (NZDHA). (2010). Welcome toNZDHA. Retrieved April 2010 from http://www.nzdha.co/nz/Home/tabid/39/language/en-US/Default.aspx

New Zealand Dental Journal (NZDJ). (1912). Editorial – School dentistry. NewZealand Dental Journal VIII, 15, 84-85.

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New Zealand Dental Journal (NZDJ). (1915). Editorial – Dental examiners to theforces. New Zealand Dental Journal X, 28, 150-155.

New Zealand Dental Therapists’ Association (NZDTA). (2010). New ZealandDental Therapists’ Association – Information. Retrieved April 2010 fromhttp://www.nzdta.co.nz/information

New Zealand Department of Public Health. (1905). Annual Report: Health ofSchool Children. Appendices to the Journals of the House of Representatives. H-31.

New Zealand School Dental Service Gazette (NZ SDS). (1980). Editorial. SchoolDental Service Gazette, October, 33-35.

Nuffield Foundation. (1993). Education And Training Of Personnel Auxiliary ToDentistry. London: The Nuffield Foundation.

Roberston, J. (1989). Dentistry For The Masses? (Masters Thesis, University ofMelbourne). Australia: Victoria.

Satur, J. (2003). Australasian Dental Policy Reform and the use of DentalTherapists and Hygienists. (PhD Thesis), Deakin University). Australia: Victoria.

Sendziuck, P. (2007). The Historical context of Australia’s Oral Health. In G. D.Slade A. J. Spencer & K. F. Roberts-Thompson (Ed.) Australia’s DentalGenerations: the National Survey of Adult Oral Health 2004-2006. AIHW CatDEN 165. Canberra: Australian Institute of Health and Welfare.

South Australian Government (SADR). (1988). Dentist Regulations 1988:Regulations to the Dentists Act South Australia 1984. Parliament of SouthAustralia.

Tane, H. (2002, July). Bachelor of Health Science (Dental Therapy) at theUniversity of Otago. Paper presented at the Oral Health Therapy EducatorsMeeting, University of Melbourne.

Tennant, M. (1994). Children’s Health, the Nation’s Wealth. A History ofChildren’s Health Camps. Wellington: Bridget Williams Books & Historical Branchof Internal Affairs.

Thompson, F.W. (1906). The teeth of our children. New Zealand Dental Journal3, 11-20.

Washington State Legislature (WSL). (1998). Chapter 246-815 WAC - DentalHygienists; Dental Hygiene Practice Act, State of Washington, US. RetrievedNovember 2001 from http://search.leg.wa.gov/wslwas/WAC%20246/

Willis, E. (1989). Medical Dominance. St Leonards: Allen & Unwin.

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CHAPTER 2

A New Oral Health Professional – The Oral Health Therapist

Julie Satur

L ike many other types of health care, dentistry has severaloccupational streams that have developed in response to

changing technologies and demands for care. In Australia andNew Zealand, dental therapists, dental hygienists and dentalprosthetists deliver care in combination with dentists and den-tal specialists in a team environment. Dental technicians areresponsible for the manufacture of dental prostheses, e.g. den-tures, mouthguards, crowns, bridges and orthodontic appli-ances, under prescription of a dentist. Dental prosthetists aredental technicians with advanced training who may prescribe,manufacture and insert dentures and mouthguards independ-ently. Dental therapists and hygienists provide primary preven-tive and clinical care of dental caries and periodontal diseasesrespectively, as well as oral health promotion.

Advanced dental nurses and expanded function dental auxil-iaries were developed to complement the work of dentists byproviding, under delegation, various clinical tasks. Most com-mon were oral hygiene instructions and other preventiveadvice, radiography, cleaning and polishing of teeth (dental pro-phylaxis). These functions were soon extended into areas suchas periodontology, orthodontics or surgical assistance andrestorations depending on the practices in which they worked.Today their most common characterisations are as dentalhygienists and dental therapists, with both occupations havingexisted for around 90 years.

DENTAL THERAPISTS

Dental therapists operate in a primary care role, carrying outroutine dental care and health promotion, referring patients toa dentist for services which are beyond their scope of practice.Up until July 2000, dental therapists in most states of Australiaand in New Zealand were limited to public sector employmentwith School Dental Services providing care to children and

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18 © The Authors

adolescents3 in collaborative and referral relationships withdentists and with the chairside assistance of a dental nurse.Their skills include examination, diagnosis and treatment plan-ning, radiography/radiology, preparation of cavities and theirrestoration with amalgam and plastic filling materials, pulptherapies and extractions of deciduous teeth, clinical preventiveservices such as prophylaxis and scaling, fissure sealants andfluoride therapies, diet counselling and oral health educationand promotion. Scope of practice differs slightly between coun-tries and jurisdictions but may also include fabrication ofmouthguards, orthodontic procedures on the advice of a dentistor orthodontist, extraoral radiography, placement of stainlesssteel crowns, incisal edge restorations, pulp therapies in perma-nent teeth and permanent tooth extractions. Since 2000,employment limits on dental therapists practice have been pro-gressively relaxed in Australia and New Zealand (Satur, 2003;Nash et al., 2008).

In practice, a dentist will be available by telephone for consul-tation and, in Australia, generally attend a dental therapist’sclinic weekly or fortnightly for half a day to attend to referredpatients, mostly comprising orthodontic referrals, complexrestorations, endodontics and permanent extractions. In NewZealand, patients with additional needs have been referred toprivate dentists, hospital departments or the Dental School. Inboth countries there is now a trend toward providing SchoolDental Services from larger community clinics in a more fami-ly-focused approach. The overwhelming majority of dental carefor children in New Zealand and Australia since the 1920s and1970s respectively has been provided by dental therapists(Coates et al., 2009; Dooland, 1992).

In 2005, an Australian national data collection found thatthere were 1760 registered dental therapists in Australia ofwhich 1521 or 86.4% were practising. Their average age was 40.7years, only 2.5% were male and they worked on average, 25hours per week, with 56% working part-time. This study alsoshowed that in 2005, around 79% of therapists worked in theSchool Dental Service and 21% in private practice employment.Ratios of therapists to population were low with a national aver-age of 7.5 therapists /100,000 population. Rural and urban distri-

3 The ages of people treated by dental therapists have traditionally been limited to 0-18 years although in Victoria the upper limit is now accepted as 25 years (and with-out limits in orthodontic practices) and in Western Australia dental therapists in pri-vate settings have provided care for all ages under prescription from a dentist formany years. Today in New Zealand, Victoria and Northern Territory, dental therapistswith appropriate training may also provide care for adults.

Chapter 2

butions differed with 6.6 therapists/100,000 people in urbanareas, 8.8 in inner regional areas, 10.9 in outer regional areasand 8.1/100,000 people in remote areas (Tuesner and Spencer2008a). Workforce misdistributions are a significant issue forthe dental workforce in Australia; however the distribution ofdental therapists in rural and remote areas is reportedly morebalanced than any other dental practitioner groups.

In 2008, of the 682 dental therapists registered with the DentalCouncil of New Zealand (DCNZ), 648 were practising in NewZealand. The average age was 48.9 years and only 15 were male(1.4%). The majority of therapists worked in the public sector(with District Health Boards (DHB)), while approximately 6%worked in private practice. 69% of therapists worked full-timeand, on average, therapists worked a total of 33.9 hours perweek. Data on the distribution of dental therapists in NewZealand is collated by DHB but includes all therapists workingin those areas, whether in the public or private sector. There isa variation in the therapist to population by area. The Bay ofPlenty had the highest therapist to population ratio at 132 ther-apists / 100,000 population, and the greater Wellington area hadthe lowest at 36 therapists / 100,000 population. The NewZealand average was 55 therapists / 100,000 population. Of con-cern is the fact that the New Zealand dental therapy workforceis ageing, with over half of dental therapists aged 50 years ormore. Therapists are predominantly older, female and Pakeha(NZ European); however, numbers of therapists representingother ethnicities and numbers of younger therapists areincreasing (Broadbent, 2009).

DENTAL HYGIENISTS

Dental hygienists have also worked as part of the dental teamproviding preventive and periodontal treatment interventions,in a team setting with a dentist. Their scope of practice variesacross Australia and New Zealand. For example, dental hygien-ists in most regions are registered to take radiographs, performrisk assessments, polish and remove deposits from teeth, takeimpressions and carry out periodontal debridement and dress-ings for periodontal surgeries. However, not all areas allow theirdental hygienists to administer local anaesthesia and apply fis-sure sealants, examine, diagnose and plan care for theirpatients. Dental hygienists also work in orthodontic practicesproviding clinical services, checking, maintaining and remov-ing orthodontic appliances and maintaining oral hygiene. Theirrole is also preventive and includes dietary counselling, oral

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20 © The Authors

health education and promotion and the provision of fluoridetherapies. There are no limits on the age range or employmentsettings of dental hygienists but they predominantly work inprivate practices and may require the on-site presence of a den-tist.

In Australia in 2005, there were on average 4.3 hygienists per100,000 population and practice ratios ranged from 1.9/100,000in Tasmania to 8.8/ 100,000 in South Australia. The 2005 nation-al data collection found that the average age of hygienists was36.8 years and they worked an average of 31.6 hours per week.Around 95% worked in private practices and only 2.5% weremale (Tuesner & Spencer, 2008b). Of interest is the rise in num-bers of hygienists across Australia over the past few years. Thesurvey carried out in 1996 (Szuster & Spencer, 1997) found atotal of 227 practising hygienists, whereas data collected in 2005showed that the number had more than tripled to 1046, with anincrease of 66% since 2003 alone (Tuesner & Spencer, 2008b).Western Australia and South Australia have the highest ratios ofdental hygienists, reflecting a longer history of practice andtraining.

Analysis of the dental workforce data for New Zealand is morecomplicated. Three types of worker exist: these are dentalhygienists, dental auxiliary and orthodontic auxiliary4. In total,371 were registered and practising within the above categoriesin 2008; with dental hygienists comprising the largest group at250 in number. The average age of the dental hygienist groupwas 39.8 years and only 6 were male. The majority of dentalhygienists worked in private practice, with approximately 53%working full-time. Approximately a quarter of the group workedin more than one practice. On average, New Zealand dentalhygienists work less hours per week (23.8) than their Australiancounterparts (Broadbent, 2009). In 2007, the average dentalhygienist / 100,000 population ratio for New Zealand was 5.2 /100,000 with higher ratios reported in the main metropolitanareas of New Zealand (Broadbent, 2009).

EMERGENCE OF A NEW ORAL HEALTH PROFESSIONAL

It is clear that there is significant overlap in the range of skillsand approaches to care by dental therapists and dental hygien-ists. There have been proposals for the development of a‘hybrid’ dental auxiliary combining the skills of a dental thera-pist and dental hygienist for some time (Barmes, 1983; Wright,

4 For a more detailed description of these categories and their scopes of practice, seehttp://www.dcnz.org.nz/Documents/Scopes/ScopesofPractice_Hygienists.pdf

Chapter 2

1991; Nuffield Foundation, 1993; DH&CS, 1995; Wright, 1995). Aformal recommendation that the skills of dental therapists andhygienists be combined to develop the generalist “oral healththerapist” arose from the 1993 Nuffield Inquiry conducted inthe United Kingdom. This inquiry defined and described theoral health therapist as one who could adapt their generalistoral health training and education (a combination of hygieneand therapy) to provide services in areas of greatest need whereaccess to care is limited and levels of disease highest. Thisinquiry also proposed that these practitioners be able to addskills in a modular way to meet particular specialised needs andto work in all types of practice settings – including both publicand private sectors (Nuffield, 1993). Several Australian educa-tors and policy makers attended the presentation of the find-ings and they were subsequently influential in dental policydevelopment decisions in Australia around that time (DH&CS,1995; Wright, 1995).

However, in Western Australia, there have been dental thera-pists working in the private sector providing both dental thera-pist and dental hygienist services under the prescription of adentist since 1971: the year that the training of dental therapistbegan (Gussy, 2001; DTHAWA, 2007). Western Australia wasunique in graduating dental therapists who could provide serv-ices for children and who had also completed a component deal-ing with the management of gingival health in adults. As men-tioned earlier, WA dental therapists could work in both the pri-vate sector under prescription and autonomously in the SchoolDental Services. These distinctions in title have remained inplace in Western Australia with School Dental Therapists able toexamine, diagnose and treatment plan and provide services toschool children under employment in the School DentalService and Dental Therapists providing treatment servicesunder the prescription of a dentist to all age groups in privatepractices. Some dental therapists have also undertaken addi-tional training in periodontal procedures to enable them to pro-vide dental hygienist services in private practices (DTHWA,2003 & 2007; Prichard, 1994).

Moreover, the Gillies Plains College of TAFE in SouthAustralia has been offering a program since around 1980,enabling dental therapists to acquire dental hygiene skills. TheUniversities of Melbourne and Queensland both commencedadd-on programs in 1999 for 8 and 26 students respectively, bothof which ceased in 2004 (H. Calache, personal communication,2002; L. Short, personal communication, 1999). The Universityof Melbourne at the time also offered the only bridging program

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to enable dental hygienists to acquire dental therapy skills.

CONTEMPORARY ORAL HEALTH THERAPISTS

In 1996, the University of Melbourne became the firstUniversity Dental School in Australia to offer dental therapyand dental hygiene education at the Diploma level, and appoint-ing the first dental therapists and dental hygienists as academ-ic staff. The Diploma in Oral Health Therapy was unique at thetime in that it had a core first year in which dental therapistsand hygienists studied the same units in shared classes, withseparate streams in the second year to develop their professionspecific skills. This program was designed to establish the firststeps towards developing the Oral Health Therapist inAustralia.

In 1998, breaking new ground, the University of Queenslandin combination with Queensland University of Technology,offered the first Bachelor of Oral Health degree program inAustralia which qualified graduates for registration as both den-tal therapist and hygienist i.e. oral health therapists. In 2002,the University of Adelaide followed and in 2005 the Universityof Melbourne’s Bachelor of Oral Health program began. Thiswas followed by the University of Sydney in 2006. In parallelwas the establishment of three new dental schools in Australia;the first at Griffith University on the Gold Coast in Queenslandin 2004, at La Trobe University in Bendigo, rural Victoria in 2006and Charles Sturt University at their Wagga Wagga campus inrural NSW in 2008, all of whom offer undergraduate programsin both Oral Health (program for oral health therapists) andDentistry (program for dentists). In 2005 the University ofNewcastle began a Bachelor of Oral Health in Dental Hygiene,which is the only single outcome Bachelor program in Australia.In 2010, the University of Newcastle commenced the first post-graduate program in dental therapy for dental hygienists.Western Australia’s Curtin University continues to offerAssociate Degrees in Dental Therapy and in Dental Hygiene,whilst Torrens Valley TAFE in South Australia, now the oldesttraining setting, continues to offer an Advanced Diploma inOral Health (Dental Hygiene).

In New Zealand, formal training in dental hygiene com-menced in 1994 when Otago Polytechnic offered a 15-monthCertificate in Dental Hygiene which developed into a two-yearDiploma program in 1998 (Hannah, 1998; NZDHA, 2001). Dentalhygiene education moved to the University of Otago in 2001,with the School of Dentistry offering a two-year Diploma pro-

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Chapter 2

gram. The oldest and last remaining (Department of Healthadministered) dental therapy school in Wellington closed in1991 and training was transferred to the Wellington Polytechnic.In 1999, the University of Otago introduced dental therapy edu-cation, offering a Diploma in Dental Therapy from its School ofDentistry (TAGDT, 2001). 2002 saw the introduction of a three-year Bachelor of Health Sciences in Oral Health (DentalTherapy) program (University of Otago, 2002). The Diploma andDegree programs in therapy and hygiene ran concurrently, withthe final students graduating from these courses in 2007. In2002, the Auckland University of Technology (AUT) also estab-lished a Bachelor of Health Science in Oral Health (DentalTherapy) program. Both the Otago and AUT programs havesince evolved into Oral Health degree programs with graduatesqualified for registration as both dental therapists and dentalhygienists.

These developments are in keeping with international devel-opments in dental hygiene education where many countriesoffer three and four year programs awarding bachelor degrees(Hovius & Blitz, 2001). The United Kingdom, as a result of theNuffield Inquiry recommendations, has shifted the emphasis intraining to a Bachelors degree in Oral Health Therapy althoughmany institutions continue to offer single outcome programs.In the Netherlands a similar development has also occurred andin the US states of Alaska and Minnesota, dental therapy prac-tice has been legalised as both an addition to dental hygieneand as a stand-alone qualification (McKinnon et al., 2007; Nashet al., 2008; IOM, 2009; MDH & MBD, 2009).

In 2009, ten out of thirteen Australian and New Zealand pro-grams are educating oral health therapists with only theUniversity of Newcastle, Torrens Valley TAFE and CurtinUniversity in WA offering single skill outcome programs. CurtinUniversity has indicated its intention to offer a combinedBachelor of Oral Health program in 2012.

In line with developments in dentistry, contemporary oralhealth therapists (including dental therapists and dentalhygienists) are more broadly educated professionals than theirtightly regulated predecessors. Courses today require studentsto study across a wider range of areas, often integrated withdental students for various course components. They are edu-cated to synthesise and apply knowledge to complex problems,understand and apply technology in more complex ways and tohave well-developed research, communication and cultural sen-sitivity skills in keeping with the contemporary health profes-sional role. Courses encompass clinical practice, biological,

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health and social sciences, ethics and evidence-based practiceessential to contemporary health practice and are accredited bythe Australian and New Zealand Dental Councils. Today, quali-fication for practice in oral health therapy requires a bachelor-level tertiary course of education and training over three years,with applicants to most courses requiring university levelentrance and pre-requisite studies in English and Biology.

The oral health therapist’s key role is as a primary oral healthcare provider who has a capacity to promote oral health for indi-viduals and the community, diagnose and recognise oral condi-tions, plan and deliver clinical and preventive treatment, evalu-ate care and collaborate with other dental and general healthpractitioners to improve the oral health status of the communi-ty.

The following chapters will describe in more detail, the educa-tion of oral health therapists for the Australian and NewZealand environment.

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Chapter 2

REFERENCES

Barmes, D. E., (1983). Review of the South Australian School Dental Service. OralHealth Unit, World Health Organisation.

Broadbent, J. M. (2009). Dental Council of New Zealand 2007 WorkforceAnalysis. Dental Council of New Zealand, Wellington. Retrieved April 2010 fromhttp://www.dentalcouncil.org.nz/Documents/ Reports/WorkforceAnalysis2007.pdf

Coates, D., Kardos, T., Moffat, S., & Kardos, R. (2009). Educational perspectiveand progression – Dental therapists and dental hygienists for the New Zealandenvironment. Journal of Dental Education, 73, 1005-1012.

Dental Therapy and Hygiene Association of Western Australia (DTHAWA).(2003). Submission to the Review of the Dental Act. Perth: DTHWA.

Dental Therapy and Hygiene Association of Western Australia (DTHAWA).(2007). History. Perth: DTHWA. Retrieved June 2009 from http://www.dthawa.com.au/history.asp

Department of Health and Community Services (Victoria) (DH&CS). (1995).Dental Auxiliary Workforce Review: Report to the Minister For Health,Melbourne: DH&CS. 95/0029.

Dooland, M. (1992). Improving Dental Health In Australia , Background PaperNo.9. National Health Strategy, Department of Health Housing and CommunityServices. ACT: AGPS.

Gussy, M. (2001, April). Background to the Accreditation of Training andEducation of Allied Oral Health Professionals. Paper prepared for the AustralianDental Council by the University of Melbourne (unpublished).

Hannah, A. (1998). New Zealand Dentists, Dental Therapists and DentalHygienists: Workforce Analysis. New Zealand: Dental Council of New Zealand.

Hovius, M. & Blitz, P. (2001, August). Basic requirements for 2/3/4 year dentalhygiene programme. Report of the Workshop. Report presented at the IFDH 15thInternational Symposium of Dental Hygiene. Australia: Sydney.

McKinnon, M., Luke, G., Bresch, J., Moss, M. & & Valachovic, R. W. (2007).Emerging allied dental workforce models: Considerations for academic dentalinstitutions. Journal of Dental Education, 71, 1476-1491.

Minnesota Department of Health and Minnesota Board of Dentistry (MDH &MBD). (2009). Oral Health Practitioner Recommendations: Report to theMinnesota Legislature 2009. Minnesota: Department of Health and MinnesotaBoard of Dentistry.

Nash, D. A., Friedman, J. W., Kardos, T. B., Kardos, R. M., Schwarz, E., Satur, J.G., Berg, D. G., Nasruddin, J., Mumghamba, E. G., Davenport, E. S. & Nagel, R.(2008). Dental therapists: A global perspective. International Dental Journal 58,61-70.

New Zealand Dental Hygienists Association (NZDHA). (2001). Interview with thePresident of the New Zealand DHA; Legislation and the roles and education ofNew Zealand dental hygienists.

Nuffield Foundation. (1993). Education And Training Of Personnel Auxiliary ToDentistry. London: The Nuffield Foundation.

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Prichard, J. L. (1994). Review of dental therapy, including training and of numbersof dentists required to meet local requirement. Report to the Commissioner ofHealth. Australia: Government of Western Australia.

Satur, J. (2003). Australasian Dental Policy Reform and the use of DentalTherapists and Hygienists. (PhD Thesis), Deakin University. Australia: Victoria.

Szuster, F. & Spencer, A. J. (1997). Dental Hygienist Labourforce in Australia 1996.AIHW Dental Statistics and Research Series no.12. South Australia: TheUniversity of Adelaide.

Technical Advisory Group for Dental Therapy/ Ministry of Health (TAGDT).(2001). Future Organisation of Dental Therapy Practice. Discussion Document andReport to the Minister for Health.

Tuesner, D. & Spencer, A. J. (2008a). Dental Therapists Labourforce in Australia2005. AIHW Research Report no. 35. AIHW Cat DEN 174. Canberra: AIHWDental Statistics and Research Unit and Australian Research Centre for PopulationOral Health.

Tuesner, D. & Spencer, A. J. (2008b). Dental Hygienists Labourforce in Australia2005. AIHW Research Report no. 34. AIHW Cat DEN 173. . Canberra: AIHWDental Statistics and Research Unit and Australian Research Centre for PopulationOral Health.

United States Institute of Medicine and Board on Health Care Services (IOM).(2009). The U.S. Oral Health Workforce in the Coming Decade. WorkshopSummary. Washington DC: The National Academies Press.

Wright, F. A. C. (1991, December). Towards Oral Health For All Australians. Paperpresented to National Health Strategy Workshop on Improving Access to DentalServices for Disadvantaged People.

Wright, J. (1995). Final Report for Future Education and Training of School DentalTherapists in Queensland. The Wright Consultancy Report to Queensland Health.Queensland: The Wright Consultancy Qld Pty Ltd, 1995.

University Of Otago. (2002). School Of Dentistry. Retrieved August 2002 fromhttp://www.otago.ac.nz/subjects/

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INTRODUCTION

CHAPTER 3

The Genesis of an Idea

Gregory J Seymour

I t is indeed an honour to write an introduction for this mono-graph on the Oral Health programs as they have developed in

Australia and New Zealand over the past 15 years. The genesisof these programs and the thinking that led to their develop-ment goes back to the early 1990’s in Queensland. At that time,Queensland Health was responsible for the training of schooldental therapists in Queensland. This was done at the SchoolDental Therapists Training Centre (later known as the OralHealth Education Unit) at Yeronga, a Brisbane suburb, some-what removed from the School of Dentistry of the University ofQueensland, which was situated at Turbot Street in the city.School Dental Therapists had been introduced into Queenslandsome 20 years earlier and Queensland Health had come torealise that they were not a tertiary education provider and atthe same time, there was increasing pressure to formaliseSchool Dental Therapy training into a degree program.

Following preliminary discussions with the three Brisbanebased Universities; The University of Queensland (UQ),Queensland University of Technology (QUT) and GriffithUniversity, it was decided that Queensland Health would reviewthe future of School Dental Therapy education in Queensland.Joanne Wright of the “Wright Consultancy Group” was thenengaged to undertake this review. I was fortunate to have beenappointed Dean of the Faculty of Dentistry at the University ofQueensland, firstly on an interim basis in 1993 and then for firstof two five year terms in 1994. As such, I was identified as oneof the key “stakeholders” and was subsequently interviewed byJoanne.

In developing any new degree program it is important toexamine the need for that program, what its knowledge andresearch base is going to be, how this differs from what isalready being offered and how it will complement what isalready being offered. In this context, many of these issuesoverlapped with respect to a possible degree for school dentaltherapists. There is abundant evidence to show that restorative

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dentistry does little in preventing oral disease. It is the ambu-lance at the bottom of the cliff scenario, and while it is of greatbenefit to the individual suffering from oral disease, it doesnothing to stop or reduce disease. Indeed, there is evidence thatearly simple restorative dentistry leads to further more complexrestorative dentistry and ultimately even to tooth loss.Therefore producing a profession whose sole role is the provi-sion of more restorative dentistry had little to commend it.Equally, the ageing population and the implications of oralhealth care for the elderly had also to be recognised.

I am sure that most dental educators, as well as the majorityof the profession, would agree that the knowledge and researchbase that underpins dentistry lies in the biological and physicalsciences. In this context the major advances in these sciencesover the past two decades have been in the areas of molecularbiology and nanotechnology such that if dentistry is to takeadvantage of these, in many cases, quite incredible advances,dental education needs to develop curricula so that the practi-tioners of tomorrow will be well equipped to apply them to thebenefit of the community as well as individual patients. Asthese sciences take up an increasing time within dental curric-ula other components must decrease. As well, it is essential thatgraduating dentists must be technically and clinically compe-tent such that sadly it is the social sciences which suffer fromthis curriculum pressure. Hence, a new degree which has thesocial sciences as its knowledge and research base would notonly be different from dentistry but, importantly, would alsocomplement it. Such a degree would train students to identifythe social determinants of health, in particular oral health,whether this was in a population or a specific community (e.g.school or nursing home) and give them the skills to be able tostart to address these determinants in a socially and culturallyrelevant fashion. In so doing, disease prevention could be initi-ated at a fundamental level. If these skills were also combinedwith the ability to provide primary care in children and oralhygiene for the elderly, a multi-skilled professional whichwould complement dentistry in meeting the health needs of thecommunity, would be formed. Such a profession would paralleldentistry and not compete with it.

These were the concepts that I put to Joanne Wright and sub-sequently this became the model accepted by QueenslandHealth as well as all other stakeholders. The model involvedcombining school dental therapy and dental hygiene clinicaltraining together with health promotion and public health sothat the social sciences became the knowledge and research

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Chapter 3

base underpinning the new degree. The graduates would never-theless be able to register as a “School Dental Therapist” or“Dental Hygienist” or indeed both.

Having accepted the model, it was then necessary to developthe program, while at the same time Queensland Health recog-nised the career aspirations of the existing school dental thera-pists, which basically meant that two separate programs had tobe developed. The Universities were then asked for expressionsof interest and both the University of Queensland with its wellestablished and highly regarded dental school and QUT with itsSchool of Public Health expressed their interest. At the timeGriffith University indicated that they were not interested inbidding for the program. As a result, Queensland Health askedUQ and QUT to form a consortium to maximise the strengths ofboth institutions and to develop the new program jointly.

A curriculum development committee with representativesfrom UQ, QUT and Queensland Health was formed and I askedDr Tina Paxinos and Dr Jenny Smyth to represent UQ on thiscommittee. The committee was tasked with developing not onlythe new degree but also the academic upgrade program forexisting school dental therapists. This was indeed a dauntingtask as these programs not only had to be developed but also gothrough the very rigorous academic approval process of bothuniversities. At UQ, this involved being approved by theFaculty’s Undergraduate Curriculum Development Committee,the Faculty Executive Committee and ultimately by theAcademic Board of the University. Finally, after having beenthrough this process both programs had to be approved by theDental Board of Queensland so that graduates would be able tobe registered. Subsequently the Australian Dental Council(ADC) undertook the accreditation of these programs and withthe formation of the joint accreditation process with the DentalCouncil of New Zealand, the New Zealand based programs alsounderwent accreditation.

The joint program consisted of the clinical components forschool dental therapy and dental hygiene being carried out byUQ, at both the Dental School in Turbot Street and at the OralHealth Education Unit at Yeronga and also Holland Park, whilethe health promotion and public health components being car-ried out by QUT at its Kelvin Grove campus. These latter com-ponents comprised fully one-third of the program and formedthe knowledge and research base for the degree. TheFoundation Director of the joint program was Dr Lyn McAllanwhile the Director of the Academic Upgrade Program was DrJenny Smyth. The first graduates of this joint University of

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Queensland/QUT program were in 2000.

In New Zealand, Auckland University of Technology adoptedthe program in 2006 with the first cohort of graduates being in2008. The University of Otago introduced the combined pro-gram in 2007 incorporating defined subjects in Sociology andMa

_ori Culture. The first graduates of this program will be in

2009.

It is personally gratifying for me, to see the germ of my ideafor new type of oral health professional, which was planted inthe early 1990’s, now not only to have germinated and blos-somed but for it to become firmly rooted into the provision oforal health care across Australia and New Zealand. The gradu-ates of these programs are multi-skilled and it will be importantfor all these skills to be used so as to promote good oral healthfor all Australians and New Zealanders.

Figure 3.1 Greg Seymour

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Chapter 3

Reflections from the Pioneer and Foundation Director of UQ OralHealth

Dr Lynette McAllan

My involvement with the development and implementation of the Oral Health andAcademic Upgrade Programs was one of the most satisfying experiences in my pro-fessional life. I was pleased to be available to apply the years of experience and sat-isfaction I had in some of my major areas of interest - paediatric dentistry, the edu-cation of oral health care professionals in undergraduate programs in dental therapy,dental science, postgraduate specialty programs, and in research.

It was inevitable that some of the Curricula Committee's "best" ideas did not transpireas the Committee was faced with compromises imposed by practical logistics of thetime and the constraints of available resources. The Committee acknowledged thedisappointments experienced by some of the interest groups, and how generousthey were in their tolerance with the inevitable "hiccoughs" and discomforts thatsometimes arose during the implementation phase. I am pleased that over timesome of these shelved ideas and concepts have been able to be implemented.

My task as Chair of the Curricula Committee was made rewarding by the unfailingsupport, enthusiasm and synergy that all members of the Committee gave to theproject and that their good humour never failed them. The Committee acknowl-edged the significant challenges to the project from the start: the sensitivity of theproject and what it signified and demanded for therapists in the workforce locatedthroughout Queensland; the walk into the unknown where there was no pre-exist-ing model to generate initial ideas; the unique set of determinants we were dealingwith that would determine the effectiveness of any designs that we came up with,particularly as the programs had to align to ensure the standards of outcomes.Challenges for the Academic Upgrade program included widespread geographic andoften remote locations of the existing workforce; the range of education bases andprofessional experiences within that workforce; and the constraints of existing com-mitments in the candidates' personal lives.

Figure 3.2 Foundation Director of UQ Oral Health - Lynette McAllan

& Current BOralH Program Cordinator - Annetta Tsang

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What impressed me throughout the project was the widespread enthusiasm andwillingness to contribute and support the implementation of both programs - bothwithin the Dental School, allied professions and members of interest groups. Theirpositive responses with ideas and support facilitated our task.

My advocacy for necessity for continuing education for dental therapists in the work-force who did not undertake the Academic Upgrade was satisfied in 1996, when Iwas granted recurrent annual funding by Queensland Health to establish my con-cept for annual state-wide Continuing Education programs. My role was to establishand manage an annual program offering a range of continuing education coursesthat could be delivered state-wide, onsite in the districts for all staff in clinical oralhealth services. While not limited to this scope, the courses were designed to ensurethat existing dental therapists in the workforce who did not undertake the AcademicUpgrade Program could acquire a strong contemporary knowledge base to supporttheir clinical practice .These annual programs offered a selection of courses thatinvolved people experienced in contemporary issues, knowledge and research.

I am impressed and delighted by the ongoing developments in the Oral Health pro-gram with each academic year. The enthusiasm and commitment of all staff and sup-port groups remains. The graduates have established themselves as integral to pro-grams providing and promoting high quality oral health care that is responsive tocontemporary community needs at both the patient and community levels. Theacknowledgement of their work, the respect and satisfaction expressed by patients,the community and employers is a tribute to the graduates' skills and enthusiasm.

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BACHELOR DEGREE PROGRAMS