DENTAL BENEFIT

Evening Post, Volume CXXV, Issue 100, 30 April 1938, Page 15

DENTAL BENEFIT

SUGGESTED SCHEME

LIMITED SCOPE AT

FIRST

EDUCATION NEEDED

In approaching the subject of dental benefits under a scheme of national health insurance, the ,main considerations ware the scope of the service to he given, the means by •which it was to be given, and how such a service could be limited to the funds available, Mr. J. L. Saunders, 8.D.5., Director of tlie Dental Division of the Department f/f Health, stated when giving evidence before . the' Parliamentary Select Committee on State Superannuation and National Health yesterday afternoon. Mr. Saunders quoted the experience of his Department in school dental treatment and recommended treatment at the outset for all under 20 years' of age. He also advocated dental education and some check on the consumption of foodstuffs harmful to the teeth.

"It is obvious that to be effective, dental benefits must include all forms of dental treatment that are necessary to eliminate septio- conditions from the mouth, and to give reasonable powers of mastication," Mr. Saunders said. "This, in fact, should be a fundamental principle. It is a principle that applies now to the Government's dental service for school children, and ibe same should apply in a general Scheme, with the inclusion, of course, Of the additional forms of treatment that are appropriate to adults." LIMITED SCHEME. In suggesting a limited scheme that would give a complete service to those treated, Mr. Saunders referred to the way the . school dental clinics had proved the value of complete systematic treatment. "The success of this policy, carried out for the past 16 years, is strikingly demonstrated by the steady reduction, year by year, in the number of teeth that have had to be extracted as unsaveable," he said. "When the School Dental Service was first established, for every 100 teeth saved by suitable treatment, 114 had to,be extracted as unsaveable. As a result of the carrying out of the policy indicated, the proportion of teeth extracted as unsaveable has dropped steadily < each year, until last year only 14.6.'teeth were, extracted for every 100 saved."

Mr. Saunders suggested it would be better to continue the school treatment; until the. patients were able- to earn the basic wage than to treat adults and leave a gap (between the periods of treatment. ■ • "In the present state of our knowledge, decay of the teeth, if not entirely preventable, is. certainly, capable of very great reduction, if certain elementary principles of. diet and cleanliness are observed," Mr. Saunders stated later. "It is not necessary to go beyond our own shores to find proof of this, , In the. New Zealand, School Dental Service it is a. matter, -of common knowledge, based on experience, that children who are inmates- of- orphanages and similar institutions are much less susceptible to dental decay than: are other. children.; In the light pf pjeseht-day! knowledge, this can be ascribed to their relatively simpler diet and to the more regular routine of their lives, as compared with the majority of New Zealand children.

"Dr. R. E. T. Hewat, D.D.S. (N.Z.), carrje.d out an investigation on this subject, and in his published results he states definitely that the percentage of decayed teetb in school children was found to be higher, than in orphanage children.

"Therefore, if the maximum benefit ia to be obtained from the.money ex^ pended on a national scheme, a cam-< paign oi dental health education should be an essential part of ; such, a scheme.. By means of broadcasting, Press propaganda, moving picture?, and .other forms pi publicity, the public: should be shdwn how dental disease in the aggregate could be .substantially reduced; to the advantage of the general health of individuals, and to the relief of the dental benefit funds." , ;

For the same reason, he added, some control should be exercised over the consumption of deleterious foodstuffs by children at school and over the sale of such commodities by the shops in the vicinity of schools.

SUMMARY OP RECOMMENDATIONS,

Mr. Saunder§ symrnarised his. recom-. mendations under the following eight headings:— ; . ' . :

1. Dental benefits to include a^ll necessary forms of dental treatment within certain specified limits, and to be conditional on the individual pro* senting for regular re-examination and treatment, at stated intervals, yearly or half-yearly.

2. Dental benefits to be provided mainly through private dental practitioners, but travelling dental surgeons, who would be full-time Government officers, would be necessary for sparsely-populated areas where there are no resident dentists, and for more advanced treatment iof school children.

3. The basis of remuneration of private dental practitioners to be determined after discussion with the profesElon.

4, Limitation of service according to the funds available at the commencement to be in the direction of provide ing a, complete service for fewer persons, with re-examination at regular periods, rather than merely sporadic treatment for a larger number, which would be very costly, and would confer no lasting benefit. An age-limit of twenty was suggested tentatively, to commence with. Thus, with school dental clinics serving all primary schools, every person would have the opportunity of being kept dentally fit by means of regular re-examination and treatment at stated intervals, from preschool age to the age of twenty.

"This age-limit of twenty is merely a suggestion, and is made without any knowledge of the probable cost," he said. "If, on investigation, the latter is found to be excessive, a lower age could be fixed and the contributory system outlined in paragraph 3 of this summary, introduced at any stage-that might be decided upon."

5. The dentist to submit to a regional dental officer for approval a detailed report on the teeth of every patient who presents for treatment under, the scheme, together with details of the proposed treatment, and the amount of subsidy claimed. " No subsidy to be payable for any treatment undertaken without approval, except that some provision should be made to meet cases where emergency treatment was required. Regional dental officers to have the right to inspect dentists' official records, and to examine patients who had undergone treatment in order to ensure that a satisfactory standard was maintained.

6. The provision of artificial dentures to be omitted from a national scheme, in the meantime, except for persons of advanced years,. or <in cases where it could be shown that the removal of tfce natural teeth was necessary in

the interests of the patient's general health.

7. Patients outside the scheme unable to afford private dental treatment to have it provided under Hospital Board arrangements.

8. (a) A campaign of dental health education to be an integral part of a national scheme, and the consumption by schoolchildren of foodstuffs deleterious to the teeth to be controlled, (b) Inquiry by a competent investigator into the causes of dental disease, with special reference to its prevalence in New Zealand. "NATURAL AND LOGICAL." "A national scheme developed as outlined as an extension of the Government's existing service for school children would be a natural and logical development," Mr. Saunders said. "It would be based on the principle of prevention of major, dental defects in children, adolesfcents, and young adults, which is of the utmost importance, bearing in mind the fact that susceptibility to dental decay is greatest during these periods, and lessens with increasing age. Thus such a scheme would show, in improved dental and general health, the best return for the money expended. It would be educational! in itself, and, in addition, instruction in the principles of dental health should be an integral part of the scheme."

Mr. Saunders also presented a supplementary statement on the extension of the school dental service to secondary school children. Some 90,000 children fj:om 1600 schools were now under the care of the School Dental Service, he said, and the service was being expanded to make it available to all primary school' children in the next three years. The extension of the treatment to the Sixth Standard would make a further 48,000 children eligible for treatment.

■ "Coming to the question of dental treatment for the pupils of secondary and technical schools," he said, "the problem here is complicated by the fact that the.pupils do not remain for any definite time, as they do at the primary, schools. It is understood, for instance, that a considerable ■ proportion remain for only one year. The. treatment required at this stage would be essentially work for dental surgeons, not dental nurses. Here again, the dental surgeons could be either departmental officers or private practitioners; The number of pupils in secondary and technical schools is as follows, according to the 1937 annual report of the Education Department:— District high schools (secondary department), 4749; technical schools, 9163; high schools and colleges, 17,883; private secondary schools, 4982; total, 36,777. SUPPLY OF DENTISTS. "It is considered unlikely that sufficient dentists would be forthcoming to staff a full-time service for such a number, and it would therefore be necessary to have recourse to the services of private practitioners. This brings u$ to the type of service envisaged in my original statement on dental benefits —a private practitioner service controlled by a central authority, supervised locally by regional dental officers, and with remuneration in accordance with, arrangements made between the dental profession and the Government. The service would continue upwards from the present primary school dental service, and its uppermost limit could be determined according to the. funds available.

"There would be no serious administrative or professional difficulties in extending'the ;..*scope of the school dental service 'upwards in' this way, provided the co-operation of the dental profession was forthcoming. If all the 48,000 pupils in Standards V and VI of all primary schools (including forms.l and II of intermediate schools) accepted'treatment, it is estimated that 95 additional school dental nurses would be required, over and above the 455 estimated to be required to treat all pupils up to Standard IV, making a total of 550. In addition, a small staff of dental surgeons would be necessary to deal with the more cony plex cases, especially among the older children. The number required could be ascertained only by making a survey of Standards V and VI, but it could be put down tentatively at 20 to 25. These estimates are made on the assumption that 100 per cent, of the pupils accepted treatment. At present only approximately 70 per cent, of eligible children accept. • "Before any estimate of the cost of providing dental treatment' for secondary and technical schools could be attempted,' it would be necessary to make a survey in order to ascertain how much treatment would be re^ quired; that is, if it were decided to initiate treatment for all the pupils of these schools as from any given date. ilf on the other hand, it were decided to proceed gradually, following the pupils through from the primary schools/the cost at the outset would Ibe very much less, and several years would elapse before it reached its maximum-" .