GUARDING YOUNG TEETH

Dominion, Volume 29, Issue 196, 16 May 1936, Page 19

GUARDING YOUNG TEETH

The

By

N.C.L.C.

[.“Devay of the teeth is not a mere chance unfortunate disability of the day. It is the most urgent and gravest Of all diseases of our time, a more serious national scourge than cancer or consumption, and is the main cause of unfitness and disease in general.”— Sir Truby King.] IF New Zealanders have not recognised the truth of this startling statement, New Zealand Governments of the last seventeen years

have, and to-day the country has a State dental service for primary schoolchildren which is the equal of any similar service in the world. In one respect it is unique. Dental nurses, and not dentists perform all operations, which for the last five years have exceeded 500,000 annually. Each year more than 80,000 children are being given treatment at 252 clinics by 182 nurses, and each year all these figures

are increasing. The service is controlled from Wellington, where the Director of Dental Hygiene, Mr. J. L. Saunders, D. 5.0., 8.D.5., who works under the Department of Health, is stationed. At Wellington, too, "all the

nurses are trained, taking a two years’ 4 course before they are sent to all parts of New Zealand to take charge of clinics.

Prevention is the keynote of the service’s objects; regularity of attention is the basis of its methods. The aim is to reduce the tremendous amount of dental disease in New Zealand and to build up the health of the people by seeing that the children are dentally healthy and by instructing them in the principles of dental hygiene. The task is immense, but it can be made much lighter if parents give the service

their enthusiastic co-operatiou when their children are of the ages treated by the clinics and if they send them to practising dentists regularly after they can no longer be given attention by the service. Otherwise much of the immediate and ultimate value of the treatment will be lost.

At present any child attending a primary school may be enrolled for treatment from the time he starts school until he has passed out of the fourth standard, provided, of course, that the school he attends has a clinic associated ■with it. Much as the authorities would like to extend this service to include all the primary schools in the Dominion, and also children of preschool age, so far the scope of the service has had to be controlled by the amount of money available. Actually some thousands of children under five years of age are receiving treatment. The value of this service certainly cannot be measured by the very modest charges that are made. In Wellington parents pay a registration fee of 2/6 a year for each child; elsewhere the maximum charge is 5/-. For this small fee the children are examined regularly every six months after the initial treatment, and the parents can be assured that the attention given is of the very best. The State does not foist half-trained nurses upon the children. No nurse is sent out to a clinic until she has passed a final examination conducted by a dental surgeon, who has no association with the service, and by the superintendent of the- training school. Enough opposition had to be overcome when the system of dental nurses was introduced for the State to make sure that the members of the service conform to a very high standard. No difficulty has ever been experienced in maintaining this standard. Dental nursing is, becoming increasingly popular with girls who have no chance of going to the university. Hundreds of applications are received each year for admission to the training school, and as many as 350 applications have been received for twenty-five vacancies. No applicant is accepted, however, unless she has had a sound preliminary education, and has an attractive personality and a good physique. The minimum educational requirement is the entrance examination of the University of New Zealand, and every applicant is personally interviewed and has to pass a strict medical examination. Special attention is paid to qualities of selfreliance and leadership. Good natural

teeth are one of the qualifications a girl must have. The lowest age accepted is 18, but most of the nurses are between 20 and 25 when they are at the training school. The Training School. The Government established the school soon after the Great War. For

years members of the dental profession and other interested persons had been advocating such a system, and it is probable, too, that the decision to organise the service was influenced by the large number of permanent or temporary rejections, through dental defects, among men wanting to go to the

Front. Colonel T. A. Hunter, who had been in charge of the army dental service during the war, was chosen to organise and direct the new service. His decision to train girls evoked a storm of criticism, but after much discussion and the rejection of alternative schemes, Colonel Hunter’s proposal was officially approved by the New Zealand Dental Association as the one best calculated to solve the problem. Since then the association has taken a very live interest in the development of the service.

In 1920 the Wellington Clinic and Training School for Dental Nurses, which fulfils a double function, was opened in the old War Records building in Whitmore Street. It is still in the same building, though part of Whitmore Street has disappeared. As the service has expanded, however, more room has had to be taken, and now the clinic and training school occupies most of the ground floor and has an “annexe” in- the eastern wing. In the first year 35 girls were accepted as probationers; to-day there are 105 students and dental nurses at the school and 264 in the whole service. Of those at the school 51 were appointed this year. The student dental nurses are trained by a staff of dental surgeon instructors, under the superintendence of Mr. A. D. Brice, and the control of the matron, Miss E. M. Haines, who has been with the service since it was started. In their first year of training the girls wear a neat pale blue uniform and in the second year they graduate to the

regular uniform, white, with, when necessary, a red cardigan. When they have completed their training and have passed the final examination they may wear the coveted medallion of the service. Ou appointment, student dental nurses are required to enter into an agreement, under bond, to serve in the department for a minimum period of five years. They may not leave the service and begin practice for themselves ; nor may they work for a registered medical practitioner.

Study of the theoretical side of child dentistry occupies the greater part of the first year, gradually increasing attention being given to the practical side. The second year is devoted almost entirely to the treatment of patients, under the supervision of dental surgeons. The syllabus of training is arranged to give the student a general knowledge of the structure and functions of the body before going on to a more intimate study of the dental and oral tissues in health and disease. In their first year they are given a good grounding in such fundamental subjects as anatomy, physiology, histology, and pathology, leading on to the special dental knowledge required in these and the more purely technical subjects, such as dental surgery. They also take a course of metal work, combined with dental anatomy, for developing manual dexterity. The training is progressive. beginning with lectures and study and proceeding to practical work. In their second year the dental nurses do (he actual treatment. They are charged with making clean ami healthy mouths. They do this by saving the teeth wherever possible by means of

fillings, by extractions, when necessary under local anaesthesia, and by silvei nitrate treatment, cleaning, and so on Other' subjects taken in the seconc year are organisation and administra tion, dealing with the work of conduct ing school dental clinics, and a ' short course on the preparation of addresses

The department considers dental health education to be one of the most important duties of the dental nurse, and she must be able to instruct parents as as well as children in the elements of preventive dentistry. In addition to class examinations, there are two qualifying tests, one at the end of the first six months and the other at the end of the second year.

At the training school the internal organisation has been designed to develop responsibility, a sense of discipline, and a “service atmosphere.” The “team spirit” has been cultivated and has won comment from prominent visitors from other countries. Inside the Clinic. Though the Wellington centre is the training school for the Dominion, the clinical side of its work will attract most attention from the casual visitor. The parent who takes her child there for treatment does not see the students in the “annexe” learning the methods of dentistry on mechanical dummies: nor does she go into the lecture room. She does, however, see the waitingroom, with its instructional lantern slides being shown on a screen in the corner, its posters advocating constant care to the teeth and diet, friezes ol happy children, the books and papers for the waiting children, and the neatly-dressed and pleasant-faced

nurses. Sometimes she also sees the clinic. Here, at present, there are 25 chairs, each of which is kept constantly busy, each dental nurse attending to about six children every day of the week. The clinic has had as many as 10 chairs in it. The large room is white-painted and is very clean and cheerful. On the walls are posters similar to those in the waiting-room, and more decorative friezes.

For (hose used to the fearful anticipation of a visit to the dentist, the most remarkable feature of the clinic will be the complete preoccupation of the children in the waiting-room with their book’s aud the absolute quiet that

■, reigns inside. Apparently the ehili’ dren enjoy a visit to the clinic. They i. go into it eagerly and endure the treat--1 ment without a murmur. Sometimes ' a child who is visiting the clinic for ' the first time whimpers a little, but the *• others seem to be happily affected by the presence in the room of other children. The dental nurses certainly seem to have the ability, natural pei* Imps in women, of managing young children. Even a cursory visit to the clinic proves that the confidence of the children in the nurses is complete. A difference between the Wellington clinic and the others in the country Is that whereas elsewhere attendance is a part of school routine, when the school is linked up with a clinic, and after the parent has consented to enrolment. in Wellington it is voluntary.

If the efficiency of the service can be measured by one instance, it is by reference to the ratio of extractions to fillings. In preventive dentistry extractions may be said to represent failure if they have to be made to teeth which were under the care of the service before decay started. In this respect the New Zealand School Dental Service compares very favourably with similar services in other countries. For instance, statistics show that in one overseas country, for every 100 teeth tilled, 254 are extracted; in New Zealand, for every 100 teeth filled, .17 are extracted. The ideal set by the service

is: “Treatment should be conservative in character—by filling rather than by extraction.” Out in the Field. When they have completed their training the nurses are sent out into the field to take charge of clinics. These

are to be found from Whangarei to Stewart Island, from the East Cape to the Fox Glacier. Of the 252 centres, 111 are main centres and 108 are subbases. In each of the four main provincial districts there is a district superintendent. At all the centres dental treatment, is given. New districts are opened up as trained staffs become available, and fresh avenues of extending the service are being constantly investigated. Two years ago. for instance, an experimental mobile dental clinic was established by the Wanganui Mobile Dental Clinic Committee and is being operated a unit of the service. The clinic serves a group of 20 country schools, its chief advantages being its convenience and the saving of time that is effected by carrying out the treatment at the schools themselves instead of having the children sent to a central clinic. But the cost of such a clinic, as the department’s experience some years ago—when an ambulance that had been used in the Great War was commissioned—proved, is much greater than that of the stationary clinic. In the present case the cost is being met by the Wanganui committee.

Once in charge of a clinic serving a group of schools, the dental nurse is responsible for making dentally fit, and keeping so, the children of the specified schools constituting her “group.” Sometimes, in sparsely-populated districts, a nurse may have two or more clinics, at each one of which she treats the children of a definite number of schools. She has to organise her work and her visits so that she re-examines every child on her registers twice each year, giving them whatever further treatment is necessary. Regular sixmonthly revision .forms the basis of the organisation. Where her register allows her to do so. a nurse accepts children who are too young for school. To the parents she gives advice so the children can bo kept under dental observation or, if necessary, given preventive treatment. Advice is also

given on the diet and dietetic habits necessary to. ensure the physiological cleanliness of the mouth.

When fully developed a “dental group” consists of about 500 children — the number one nurse can control conveniently. If 500 patients cannot be concentrated at one centre, subbases are established at suitable places in order to build up the number to the required total. At the end of each month the dental nurse submits a report on the work of her clinic to the director of the service. Details

of the treatment given are included, and an account is made of all her activities to further dental health educa-

tion. The clinics themselves are built to standard plans, based on the needs of the different districts. The Cost of the Service.

At present the service reaches about half of the children eligible for treatment—B4,ooo out of a total of about 169,000 up to and including Standard IV of all primary schools —and provides for 1590 schools out of 2988. The cost is not far from £50,000 a year.

To assist the department in the local administration of clinics, dental clinic committees have been organised. Each committee has to raise about £6O a year for a one-officer clinic, £3O of this being paid to the department to cover the cost of drugs and materials used, and an approximately equal amount being used locally for cleaning, lighting, heating and other charges of a general nature. Committees are empowered to charge parents a maximum of 5/a child each year, with the provision that no child is to be debarred from treatment because of the genuine inability of the parents to meet the charge. This fee is not for the treatment, but for the materials.

Generally speaking, the dental clinic committees are very well organised and have little difficulty in raising the money which it is their responsibility to find. In a few districts the committees have had difficulty in finding the money because of the economic

position of the parents. In some other cases, however, the parents do not seem to give the committees the support they and the service deserve. Without the committees the clinics and their requirements would not be kept prominently before the public. Headmasters and teachers also do much valuable work. The local dental clinic committees are now finding about £lO,OOO a year toward the cost of the service; the Government is providing from £40,000 to £45,000.

The usual capital cost is from £275 to £3OO. exclusive of the site, which iu most cases is available on Education Department property. Before 1931 a Government subsidy of £2 for £1 was granted for the erection of a clinic, but since that year of depression there has been no subsidy and the whole capital cost is found locally. Some Facts.

Since the service was started 15 years ago,> more than 5,000,000 operations have been performed by the dental nurses. In 1931, the year covered by the last annual report of tbe Department of Health, 163,555 permanent teeth were filled and 236,005 fillings were made to “first” teeth. Tbe number of extractions of permanent teeth was 1,992, and that of “first” teeth 68,215. Other operations numbered 157,111, making a total for the year of 626,878. At the Wellington clinic attendances were 29,565; fillings 15,139; extractions 1700; and other operations 19,046. Since the clinic was opened attendances have been, to March 31. 1935, 399,325; fillings, 265,522; extractions, 66,107; and other operations, 213,775. In addition to this activity, tbe service has paid close attention to the necessity for educating the children and their parents in the need for preserving the teeth and preventing dental disease. In 1933 talks and addresses by officers of the service numbered 286; in the following year they increased to 425. Chair-side talks, surprise dental inspections, and the distribution of leaflets were carried out as matters of routine procedure. In that year some 90,000 educational leaflets were issued to clinics for distribution to patients, in the hope that they would be taken home to the parents and read. “The work of a School Dental Service,” states the annual report for the year ended March 31, 1935, “would show surprising results if only it were fully supported in the homes.” Results of the Work.

As for the results of the work being done by the service, if the majority of people in New Zealand, have not recognised them, authorities from overseas have. “New Zealand,” said Dr. James Kerr, whose name is known to all who arc interested in child welfare, “has afforded a pattern dental service for years.” The system was held up in the House of Commons by Sir Percy Harris as worthy of attention by the British health authorities. It has been used at Harvard University as the basis for preventive dentistry lectures. Australia, Norway, Honolulu are other countries which have taken intelligent and inquiring notice of New Zealand’s service, which, it has been stated abroad, leads the world iu school dentistry.

The service is still in the process of development. In recent'years the depression has been responsible for the Government placing some restrictions upon the acceptance of applicants for training. But -this year the school has more student dental nurses than it has ever had before and the Minister of Health, Hon. P. Fraser, is taking a keen interest in the service and has announced his intention of giving some information- about his policy to tbe House. Officers of the service look forward to the time when treatment will be available to every child in every primary school in the Dominion and to those younger children who have not yet started school but for whom regular treatment must result in even better results than the seryice is at present achieving. There is no limit to what can be done for the public by the dental nurses if the money is forthcoming and if parents give the service the support its past results prove it merits.

“There is still great need,” said Sir George Newman, Chief Medical Officer of the Board of Education of England and Wales, in 1934, “of a wider appreciation among mothers and children, and indeed among the whole population, of the value of the eare of the teeth in- childhood, adolescence, and adult life. The loss of teeth is in itself a serious disadvantage, particularly in youth, and also subsequently, but the process of decay which produces such loss entails an exceptional extension and degree of infection, local or general. Septic conditions in various parts of the -body are in this way engendered, and are liable to lead to personal ill-health, and even to disease and mortality. The burden of disease and death due directly and indirectly to dental defect cannot be measured or estimated, but it. is certainly one of the most prevalent of the causes of physical deterioration and incapacity. Dental disease is perhaps the most common of all physical defects among children.”

“Ut Prosim”—“That I may do good” •—is the motto which the dental nurses have chosen and school medical officers, teachers, and visiting dental authorities have found that this ideal is being realised to the full, while thousands of parents have cause to be thankful to the vision of those who were responsible for the organisation of the service and to those who have maintained and developed it. It remains now for the authorities to extend the service as they are able to, so that the greatest benefit can accrue not only to the children but also to tbe whole nation. Year by year the service is reaching more and more of the country’s scattered primary school population; one of these days its embrace will be complete.