Child and Adolescent Oral Health Project FAQs
Child and Adolescent Oral Health Project Frequently Asked Questions (FAQs)
Young child having his teeth examined by Dental Therapist.
FAQs Category
Current Services & Information
New Services & Staffing
Mobiles Clinics
Fixed Clinics
General Project Information
FAQs - Current Services & Information
Why are the changes to the school dental service being made?
The Ministry of Health has made oral health a priority area resulting in additional funds to implement a regional model of care that is appropriate to increase accessibility of oral health services for 0–18 year olds.
The majority of existing school dental clinics no longer meet current standards eg Infection prevention, do not allow therapists to work with colleagues for professional support or to have modern dentistry equipment and work flows in place.
The support and participation over many years for both facilities and service delivery by schools and their families is acknowledged and appreciated and will continue to be valued in the newly configured service.
What is the present set up for school oral health in MDHB region?
MidCentral Health has 39 single chair dental clinics across the MidCentral District Health Board region. The clinics are owned and maintained by the Ministry of Education. MidCentral Health also has three mobile dental clinics with one chair in each of them.
The Child and Adolescent Oral Health Service is available only through the school year (40 weeks per year), predominantly during school day hours.
How many fixed and mobile dental clinics are there now and how many schools jointly use those?
All preschool children travel to a fixed or mobile dental clinic for assessment and treatment.
How many students and preschoolers do they see?
MidCentral Health sees around 23,000 children between the age of 2½-13. They also see approximately 2,700 adolescents per year aged from 13-18 years.
What is the current utilisation of clinics?
The dental clinics are used an average of 37%, based on a 40 week year. This means that although a very small number of clinics at larger schools have a dental therapist in them for up to 2/3rds of the school year, the majority of the dental clinics are not used for over 35 weeks of the school year, although the building still has equipment in it and is not able to be used for any other purpose. The Ministry of Health requires dental chairs to have 80% utilisation.
It is expected there will be around 33,000 0-18 year olds, particularly those of pre-school age requiring dental services in 2011. This is an increase of about 25% on current levels. Of these 33,000 it is anticipated 30% will be high requirement clients, requiring up to six monthly recalls. Total appointments are anticipated to around 44,000 per annum.
What is the oral health status for our district?
Good oral health is measured by the number of children who are caries-free, and the number who have “decayed, missing or filled” teeth (DMFT). Children and adolescents within MidCentral DHB’s district enjoy good oral health:
Why is good oral health important?
Poor oral health in childhood can lead to poorer overall health in adult years due to reduced nutritional absorption and recurrent mouth infections. The importance of a healthy smile and breath in the social and employment aspects of life is also important.
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FAQs - New Services & Staffing
What is the cost of the new service?
$3.9 million to purchase the four new mobile clinics, build three clinics, and provide the equipment for the clinics where new equipment is required, for example digital x-ray machines. The additional operational costs are estimated to be $1.2 million per annum.
How many patients will each clinic handle in a week?
Each dental therapist will see approximately 55 children per week.
Who sets the recommended numbers of patients, therapists and clinics?
The Ministry of Health in conjunction with the NZ Dental Therapists Association provides guidelines for the number of patients a therapist is able to work with per year and from this the number of chairs required is worked out. Consideration of the oral health status in different areas is also used in this equation to ensure that where there are areas of high oral health need, there are enough therapists and chairs to accommodate this.
Will a service be provided at the school my child goes to?
90% of primary schools will be receiving a service onsite. Installation of sites is currently in progress.
What happens after hours or on days the mobile/fixed clinics aren’t open?
It is proposed that there is an open clinic in each region of MidCentral District Health Board for 50 weeks of the year. This means the likelihood of not having a clinic open near is significantly reduced compared to current arrangements. If your child has significant pain after hours requiring emergency dental care the 0800 Talk Teeth line is available to locate the nearest clinic.
Are there any new services school children will receive under the new proposal?
- Services will be available over school holiday periods. An appointment system will be adopted which will give parents/carers the opportunity to be present at the appointment in order for them to gain an understanding into any oral health concerns that may exist. Also consent for treatment can be gained during this visit meaning that a child should only require one visit if treatment is needed. This also gives the opportunity for families with more than one child to have appointments at the same time.
- If x-rays are required these are able to be taken and read at the same appointment which means in the majority of cases treatment can occur at the one appointment rather than having to come back for another.
- Greater publicity will be given about those up to the age of 18 years old who are still entitled to free dental care. Greater oral health promotion and education will occur.
- Closer working relationships with other health and social service providers will occur to ensure that families/whanau are receiving what they are entitled to.
How often will children be seen for dental checks/treatment? Is it more or less than now?
All children in the region from 0–18 are entitled to a free check every year, or more often if their teeth require it. There is no limit to the number of visits per year required for dental work in this age group. Earlier oral health checks will be completed by WellChild providers (GP’s, iwi providers, Maori health providers, Plunket) at routine WellChild appointments.
What if major dental work is required, will that be done at the new mobiles or dental units?
Any dental work that requires sedation will be undertaken in the MidCentral District Health Board dental unit at Palmerston North Hospital, or through a contracted private dentist where they are able to undertake this work, in order to maintain a clinically safe environment for the period of sedation. All other work is able to be done in the new facilities.
How will the units be staffed – will there be more or less therapists/dental assistants than before?
There is a small increase in clinical staff (dental therapists and assistants) in the reconfigured service. The major change is that dental therapists will no longer have to work by themselves due to having a colleague in the two chair clinics, as well as a dental assistant to work with in single and double chair clinics.
There are currently 18 Full Time Equivalent (FTE) dental therapists working in the district and 13 FTE dental therapist assistants. Oversight is provided by a part time Clinical Director. Under the new model, the number of assistants will remain at 13 and 21 FTE (based on 52 weeks per year, 40 hours per week) dental therapists will be required.
Will dental therapists see fewer patients, or will they see more by working more weeks of the year?
They will be seeing more, mainly in the pre-school age groups.
Will there be any better computer link ups with the dental service locally, or nationally?
Currently MidCentral Health Child and Adolescent Oral Health Service does not have a computer system. One of the improvements is the development of an information technology system allowing electronic access to a clinical record of treatment for the child and the ability to report in order for MidCentral Health to be able to monitor oral health status in the region. The system will be able to link with existing MidCentral Health systems. In order to link with national and other providers, consent of individual is required. Where this is identified as a need this will be discussed with the individual (if over 16) or their carers (if under 16).
Will dental therapists need to be trained with using the new computers and will they be getting any help with learning the new systems?
A training programme for using computers has commenced. Specific training for the oral health computer programme that is identified will also be provided before staff are expected to use it.
How will adolescents access the new services?
Services for approximately 20% of adolescents will still be available through MidCentral Health in particular locations throughout the district, and also through contracted dental providers. Information on how to access the service will be provided through a variety of ways that will be finalised following engagement with stakeholders.
Will dentists with existing adolescent contracts be losing those contracts or will they keep them?
MidCentral Health provides adolescent oral health services in areas where there are not enough other providers available (insufficient capacity). Currently, MidCentral Health provides free district-wide adolescent health care to 20% of this population group. The plan is based on maintaining this current level (approx 2,700 treatments a year). Private dentists with existing contracts will keep those contracts.
What about pre-school dental checks, will they also be done in the new mobiles/ fixed clinics?
Pre-school oral health checks are able to be undertaken in both mobile and fixed clinics.
Where will pain management be available from?
All sites that a service is provided from will be able to undertake pain relief, including for a longer period of the day and over school holidays in accordance with the site schedule that is to be developed through community engagement.
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FAQs - Mobile Clinics
How many mobiles will MDHB get, and how many does it already have? What size are the MDHB mobile clinics (length and dental chair number)?
- MidCentral Health has four single chair mobile dental clinics and three double chair mobile dental clinics. In addition to that two more mobile dental clinics will be purchased.
- The new mobile dental clinics with two dental chairs are 11.5 metres long.
- The new mobile dental clinics with one dental chair are 7.5 metres long.
- The new clinics are purpose built dental clinics.
What do you mean by dental “chairs”?
Dental chairs are a key component of the service. These are the highly technical chair which the client sits in while receiving oral health care. Currently, most dental clinics and mobile clinics are single chair sites, ie they have one dental “chair”. Under the new arrangements, the majority of clinics, including mobile clinics, will be two chair units.
Why are we getting some larger mobile clinics and some smaller mobile clinics?
In developing the approved configuration MidCentral Health recognised that there are some rural areas that do not have a large population. In this situation a two chair clinic would be there for a very short time which would not support children that may need to have a second appointment to complete treatment. Additionally it would not allow the community to talk with the therapists while they are there about any oral health questions.
There are also some rural roads and small schools that would have difficulty accommodating a large two chair mobile dental clinic.
Who will pay for parents to take their children to a new clinic (mobile) site?
Oral Health services for 0–18 year olds is free, with the exception of those between the ages of 0–12 who choose to go to a private dentist, or where orthodontic care is required. If travel is required the cost rests with the parent/carer of the child.
Will the new mobile clinics be easily moved around the region – are there any roads they can’t go on?
The larger mobiles are not designed to go on some rural roads, however MidCentral DHB will have six smaller mobile dental clinics that are able to service remote areas where access may be difficult.
Who will be able to use the mobile clinics in school holidays?
It is anticipated that the service will still be run over school holiday periods in the future, but may be at other sites where children will be, rather than at schools. Therefore the mobiles will be used by the service outside of term time.
Will the mobiles cater for disabled people eg wheelchair access, ramps, lifts? If not, what provisions have been made for their dental care?
Unfortunately due to the high cost of installing ramps and lifts in the mobile dental clinics, and following an opinion from the Health and Disability Commission, the decision to not install ramps and/or lifts in the mobile dental clinics was made at a national level. With fixed sites now planned for all areas Palmerston North; IFHC and school based; Dannevirke, Horowhenua and Feilding IFHC) access for disability/ pushchairs etc can be managed through these fixed sites.
What Schools are the Mobile Clinics going to?
A comprehensive schedule will be available to schools and communities at the beginning of Term 3 2010. The following is a tentative schedule to date of where the mobile dental clinics will be.
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FAQs - Fixed Clinics
What was wrong with the original business case proposal?
The original business case was developed three years ago and since that time further information has become available that MDHB have fully considered in relation to the configuration of services. This includes, but is not limited to; the feedback received during the engagement period with all stakeholders, the ongoing development of Integrated Family Health Centres, the development of MDHB Rural Strategy and the ongoing development of Primary Health Care in general. New opportunities have arisen in the past two to three years and the revised configuration has been strategically aligned to these. Overall chair numbers will remain as proposed in the business case, however proposed changes will see Palmerston North serviced by an increased number of mobile facilities and Tararua and Horowhenua serviced by both mobile facilities and a single chair fixed clinic in an Integrated Family Health Centre. One double chair mobile facility currently on order will be replaced with two single chair mobiles.
It is now clear that a combination of mobile and fixed clinics in our rural centres will provide better access opportunities and service delivery to these communities, while still ensuring Child Adolescent Oral Health Services can meet all MoH requirements.
What has changed in the intervening period between the agreement of the business case and now?
As above and:
Considerable modelling of potential configurations for both fixed and mobile sites across the MDHB region has been undertaken in 2010. This analysis has identified a more strategically improved configuration to deliver services, but does involve a change in both the fixed site arrangements and the remaining mobile facilities.
The potential of the IFHC’s was not fully realised at the time of the CAOH business case agreement, eg co-locating a fixed clinic in an IFHC. The locations of the IFHC’s were not finalised until 2010, at which time it was notified that there would be an IFHC at Dannevirke and Levin.
Why are there fixed clinics in Tararua and Horowhenua when it was identified they would be serviced only by mobile clinics?
As above and
The original business case was concerned that the low level of 0-18 population was unable to sustain a fixed clinic in either Dannevirke or Levin and meet the MoH requirement for 80% chair utilisation. It was also stated that the widespread geographical population of Tararua and Horowhenua was a negative factor and that these areas would be better serviced by mobile dental clinics. At the time of the Business Case having a mobile only service was considered to be the most suitable configuration, and while the dispersed nature of the population is still a significant factor the recent modelling has demonstrated that the service can meet the overall target for 80% chair utilisation as this is a measure across all chairs and not by geographical region. The fixed clinics located in Horowhenua and Dannevirke will also be well positioned to manage any future developments in increasing oral health service delivery.
Alongside the modelling community engagement was completed in 2009 which raised the concerns about not having fixed facilities in the rural areas as a base, and around access to the mobile dental clinics for people with impairment/ disability. As a result of this community feedback, along with the MDHB implementation of the Primary Care Strategy and development of MDHB Rural Health Strategy changes are proposed to the location of fixed sites, by substituting a fixed double clinic in Palmerston North with a fixed single chair clinic in both Levin and Dannevirke. This will provide a service hub and universal access to facilities in both Horowhenua and Tararua, providing a similar level of access to those planned for Palmerston North and Feilding.
What will the new fixed clinics cost: a) at Dannevirke, and b) Levin?
The analysis of the modelling undertaken in 2010 for service configuration for both fixed and mobile sites across the MDHB region has identified a more cost effective and strategically improved configuration to deliver services.
Costs in Levin are minimal as one room in HHC was already fitted for dental services and Dannevirke will be a new build (definitive costs are not yet available but a budget is in place). In Dannevirke a room will be accommodated during building of the IFHC similar to HHC in Horowhenua, so again, costs will be minimised. It is more cost effective to build a dental chair into a new build.
In Tararua, wouldn’t it have been cheaper to continue with the single-chair Huia Range School clinic, instead of going with an IFHC elsewhere in Dannevirke?
Cost is not the only consideration in the configuration although is of course a key factor. Another factor fully considered has been that the school based clinics are owned and maintained by the Ministry of Education and responsibility for maintenance sits with the school. In the reorientation of service DHB’s will now pay a peppercorn rental of $1 per annum for each school site (fixed or mobile), with all maintenance responsibilities transferring to the tenant (MDHB), once the Deeds of Lease are agreed to with the school.
All of the benefits listed such as improved access and alignment to MoH and MDHB strategies, better integration with primary health care, creating a hub for patients and staff, scheduling appointments alongside other health professionals (integration with general health frameworks) etc, can all be best achieved by co-locating in an IFHC.
What was the difference between retaining a school based clinic in Dannevirke and fitting out a new area in the Dannevirke IFHC?
By co-locating with an IFHC MDHB CAOH can meet the following MoH goals;
- Re-orienting child and adolescent oral health services.
- Reducing inequalities in oral health outcomes and access to oral health services.
- Promotion of oral health.
- Building linkages with Primary Health Care.
- Building the oral health workforce.
Placing a fixed dental chair in the IFHC creates opportunities to integrate the CAOH service into general health frameworks. This configuration supports those patients attending for a well child check to have their oral health check at the same time, and also offer the potential of greater access for adolescents who have left school. The co-location also offers a safe alternative in the school holiday periods, and will be more suitable for mothers with pushchairs/ prams and for those with impairment / disability also allowing appointments to be scheduled alongside other health providers in the IFHC.
Does the extra building of two single-chair clinics add to the overall cost of the project? If so, by how much?
No the project will be implemented within the allocated funding.
Does the reconfiguration put the project behind schedule?
The project has been running behind schedule to date however a comprehensive implementation plan is in place with revised key milestones. The most significant delay will be in changing one double mobile to two single mobiles moving the delivery date from late 2010 to mid 2012. This is because MDHB will move to the end of the manufacturers building schedule for mobiles. However, this change gives the service more flexibility in scheduling and increases the number of mobiles that can gain access to a higher number of schools (as some schools cannot manage a double mobile, only a single mobile). Although this delay will require careful planning with some fixed sites remaining open while all mobile and fixed chairs are built the configuration is taking a longer term view for a more improved configuration to take the service into the future.
How did you originally calculate how many fixed clinics, double chairs and single chair mobile clinics were needed in the business case?
The number of dental chairs required was identified by reviewing the eligible population and the number of appointments required per year to ensure that all children and adolescents are able to have a minimum of one appointment per year, and then adjusting for the average number of children that require more than one appointment per year.
By changing a double-chair mobile for two single chair units does this put the project behind schedule? By how much, and why?
As above.
Has there been any other extra costs or savings found in the project?
There have been both additional costs and savings but overall the project will be completed within allocated funding.
Integrated Family Health Centres (IFHCs) weren’t being considered in Tararua and Horowhenua when the original plans were developed for the business case, so how will the fixed clinics being part of IFHCs improve/enhance the project?
As above.
What treatments can be done in the mobile units and what treatments need to be done in the fixed clinics?
It is proposed that patients would be screened (undergo an assessment) on the mobile clinics, with the decision made by clinicians to either treat on the mobile if required, or follow up the patient by appointment in a fixed site.
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FAQs - General Project Information
When do you expect to have the first new mobile clinic, and the others?
The first new mobile (single chair) was delivered in December 2009 and the double chair mobiles arrived in January, February and November 2010. The remaining two single chair units arrive in mid 2013.
What happens to the existing school dental clinics eg equipment and actual buildings?
The current dental clinics are owned by the Ministry of Education therefore once they are vacated by MidCentral Health it will be up to the school, in conjunction with the Ministry of Education, to determine what happens with those buildings.
The equipment within the clinics is owned by MidCentral Health. Where the equipment is able to be re-used, it will be.
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How can I find out more information?
Updates, project documentation and progress is available from the MidCentral District Health Board website:
http://www.midcentraldhb.govt.nz/oral-health
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Last Updated 09/02/2011