From Innovative to Outdated? New Zealand's School Dental Service 1921-1989

Concern about children’s oral health, and its overall effects on general health and national efficiency, had been an issue for at least two decades prior to the founding of the School Dental Service (SDS) in 1921. Prominent members of the New Zealand Dental Association (NZDA) first proposed the form the Service would eventually take. It was to be staffed by specially-trained dental nurses who would work in clinics built on school grounds. Much of the original success of the SDS can be attributed to the vision of its founder, Sir Thomas Hunter, and the ongoing drive of its subsequent Directors. Credit, however, must also go to the dental nurses themselves, who played a major role in establishing the Service, particularly in its first decade. These ‘pioneer dental nurses’ quickly gained the support of the public, with every school determined to have its own dental clinic and dental nurse. Supported by successive Governments and New Zealand’s welfare state policies, the SDS went from strength-to-strength over the next few decades, with its goal being to provide ‘full coverage’ to all primary school children and the majority of preschoolers, a resolve tested by the advent of the post-war ‘baby boom’. Despite pressing local needs, the SDS was able to offer international assistance, primarily through the Colombo Plan, to other countries wishing to establish their own school dental services. At its Golden Jubilee in 1971, the SDS was lauded for its success in developing an innovative programme. Two oral health surveys, however, would reveal that New Zealand children had heavily-filled teeth and that many adults lost their teeth at an early age despite the fact that New Zealand had commenced water fluoridation in the 1950s. Inequalities in oral health were now evident between groups of New Zealand children. During the 1970s and 1980s, the Service faced cuts in spending, reduced student intakes, and difficulties in procuring equipment. This, combined with the slow introduction of new treatment techniques, led to dissatisfaction within the workforce. What had once been viewed as a new and exciting career for women was now restricted in terms of job satisfaction and career progression. Major health reforms were introduced in the late 1980s and, by 1989, the Government created 14 Area Health Boards, each responsible for providing health (including dental) services to their respective regions. This signalled the end of an era for the SDS, for what had once been a single highly-centralised national service had now become a decentralised, regionalised dental service system