DHBs to consult on improving school dental service

DHBs to consult on improving school dental services

District Health Boards will be seeking feedback over the next few months on how New Zealand's school dental services should be provided in the future.

New Zealand's School Dental Service is facing a number of challenges, such as ageing dental equipment and a lack of fixed on-site clinics. Currently, only 45 percent of primary and intermediate schools have a fixed on-site clinic, and many of these are not designed for modern dentistry, says Dr Clive Wright, Chief Advisor, Oral Health.

Dr Wright says that during the last decade, children's oral health has plateaued with some areas actually starting to decline.

“The prevalence of tooth decay varies considerably from region to region. In some areas, such as those with low levels of fluoride in water supplies, lower socio-economic communities and remote rural areas, children are more severely affected by tooth decay.”

The Ministry of Health and DHBs are working together to improve oral health services for children and adolescents.

A key part of the work is to ensure that dental services are delivered from facilities that comply with all relevant regulations and guidelines. It is also important for dental services to be accessible to all children including preschoolers, Maori, Pacific peoples and those from low socio-economic families and that they are delivered in a cost-effective, flexible and efficient manner.

Over the few months, DHBs will be consulting their local communities and school Boards of Trustees on any proposed changes to the way school dental care is provided. At present not all school dental services are provided from on-site dental clinic facilities and it is likely that in the future this will continue to be a trend.

“Parents can be reassured, however, that access to dental care for their children will be maintained or enhanced, although in some cases this may be at a clinic, at another school or centre, or through a mobile dental van.”

Questions and Answers

How many pre-school, primary and intermediate-aged children are looked after by the school dental service (SDS)?

In 2004 the SDS is providing care for more than 500,000 children: preschoolers (from the age of 2½), primary and intermediate school children and adolescents older than 13 years who are not yet attending secondary school.

What services does the school dental service provide?

Dental therapists staff school dental services and are employed by DHBs to deliver basic preventive and restorative oral health care. Those children who require dental care beyond the scope of the SDS are referred to a dentist or, if they have extensive treatment needs, to hospital dental units for treatment under sedation or general anaesthetic. Under certain circumstances the SDS also provides care to adolescents.

School dental services have traditionally been delivered from fixed dental clinics located on school grounds. In 2001, however, there were only 1128 dental clinics in use on school sites. In other words, just 45 percent of primary and intermediate schools have a fixed on-site dental clinic. Increasingly, schools are providing access for mobile dental caravans to facilitate dental care for children.

Who is responsible for the School Dental Service?
DHBs are responsible for ensuring that all eligible children receive regular dental examinations regardless of whether they attend a school with or without an on-site clinic. Children from schools without an on-site clinic are either transported to another facility or may use a mobile clinic. Currently there are some 40 mobile dental units providing care to children and adolescents at kindergartens and schools throughout New Zealand.

Ever since the inception of the SDS in 1921, the funding for establishing, maintaining and running school dental clinics has been split between the health and education sectors. Responsibilities for the costs associated with running school dental clinics have been assigned to one of these two sectors, depending on the policy of the time. Currently school dental clinics are owned by the education sector; the right of the health sector to use the clinics is historical rather than contractual and incurs no rental or lease charges.

How well does the School Dental Service work?

In New Zealand, the SDS continues to be a successful and important public health measure for the support of all families with young children. A school-based service has been shown to be a highly effective way of giving children access to dental services and of screening the greatest number of school-aged children for oral health care.

It is estimated that more than 95 percent of children of primary school age are enrolled in the SDS. Furthermore, the Dunedin longitudinal cohort study, running since the early 1970s, has shown that inequalities in the experience of dental caries are reduced during school years as a result of the universal access to free dental care (National Advisory Committee on Health and Disability, 2003).

How good is the oral health of New Zealand children today?

According to the National Advisory Committee on Health and Disability (2003), in the 15 years to 1988, dental disease in New Zealand children aged 5 to 13 years fell from one of the highest levels in the developed world to a very low level. Caries rates in New Zealand children continued to decrease until the early 1990s.

This dramatic change is attributed largely to:
•an improvement in people’s social environment
•the introduction of preventive measures such as water fluoridation and fluoride toothpastes
•health promotion
•health education
•regular dental care through the school dental service.

From the early 1990s dental caries rates remained largely static until recently when they increased slightly. Despite this overall improvement, inequalities exist between different groups of children. Maori and Pacific children have relatively poor oral health compared with other children, as do children living in low socio-economic areas and rural areas.

What are the challenges facing school dental services?
Only 45 percent of primary and intermediate schools have a fixed on-site clinic; of these, many are not designed for modern dentistry, do not comply with health and safety standards, and are not in a location that allows easy access to the eligible population.

Challenges include:
•Ageing dental equipment that is in need of replacement
•The need to ensure service delivery models keep pace with new technology, health and safety requirements, population changes, workforce changes and, for much of the life of the School Dental Service, an overall dramatic improvement in oral health status.
•A decline, for the first time in many years, in the oral health status of specific groups of children
•Variation in the prevalence and severity of tooth decay. Both are more serious amongst Mäori, Pacific peoples, those from lower socioeconomic groups and those living in rural areas.
• A split in responsibilities for school dental services between the health and education sectors, with the result that neither has the flexibility nor the incentive to maximise the effectiveness of these services.

How do DHBs and the Ministry propose to solve the problems?

In the future, it is envisaged that oral health services for children of preschool, primary and intermediate school age will be:
•delivered in a seamless manner from birth through to adulthood
•delivered from facilities that comply with all relevant regulations and guidelines relating to health and safety, including infection control
•accessible for all children of preschool, primary and intermediate school age, including Mäori, Pacific peoples, those from families of low socioeconomic status and those living in rural areas
•delivered cost-effectively, flexibly and efficiently.

As a result of these changes to oral health services, child oral health outcomes will be improved and inequalities in health status will be addressed.

How will this be achieved?

Each District Health Board is currently assessing school dental facilities using a national stocktake tool, as well as assessing the oral health needs of its child population and reviewing how well the current service is meeting those needs. As part of this process, DHBs will be consulting within their communities over the next 2 – 3 months. The work will be completed at the end of 2004. Using this information, the government will retain a nationwide dental health system for children and adolescents. Within that nationwide framework, DHBs will develop local service delivery models that meet the needs of their specific child populations most effectively now and in the future.

The Ministries of Health and Education will also need to work together to develop agreed principles relating to the reconfiguration of School Dental Service facilities. Among the matters to be covered are ownership of facilities, and protocols for building dental clinics in new schools, support structures and systems for mobile dental services and a greater focus on dental health education and promotion.

Will this result in less school dental clinics?

There will be no lessening of access in dental health care provision, however, the review may result in greater use of mobile dental services, “superclinics” combining access for primary, intermediate and secondary school children and “co-located” clinics with PHOs, community or hospital clinics.

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