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 an 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 2 ½ - 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?
A period of engagement is being undertaken throughout the 4th term of 2009 with schools, iwi, Pasifika peoples, and communities to identify the best locations for services to be provided from, and the options for how often and for how long a clinic may be at a particular site. In any locality agreement will be reached on the most appropriate site for a clinic, given all the factors that need to be considered.
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 2 – 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 25.5 Full Time Equivalent (FTE) dental therapists working in the district, based on a working 35.7 hour week over 40 weeks of the year, together with 7.2 FTE dental therapist assistants. Oversight is provided by a part time Clinical Director. Under the new model, the number of assistants will be increased to 13, and 21 FTE (based on 52 weeks per year, 40 hours per week) dental therapists will be required. Although the FTE shows a reduction in dental therapist FTE, it is an overall increase due to the changed definition of an FTE.
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 three single chair mobile dental clinics. In addition to that five more mobile dental clinics will be purchased.
- Four of the new mobile dental clinics will have two dental chairs and are 11.5 metres long.
- One of the new mobile dental clinics will have one dental chair and is 7.5 metres long.
- The new clinics are purpose built dental clinics as opposed to the current mobile units which are modified caravans.
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 four (three existing and one new) 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, 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?
MidCentral Health is exploring local solutions to enable people with disabilities to enter the mobile facilities. The internal spaces inside the mobile dental clinics are able to accommodate people with disabilities.
What Schools are the Mobile Clinics going to?
The following is a tentative schedule to date of where the mobile dental clinics will be.
Single Unit
Somerset School (Mid March - Approx. end of term)
Waitohu School (Term 2 - Onwards)
Double Unit
Foxton Primary School (End of March for approx. 2 weeks)
Coley St School (April for approx. 4 weeks)
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FAQs - Fixed Clinics
Under the new proposal how many fixed dental clinics will there be in the MDHB region, and where will they be sited?
In the new configuration there will be three fixed two chair dental clinics located in Palmerston North. The specific sites for this are currently being explored through a period of engagement with stakeholders.
In addition to this, it is proposed that there will be fixed chairs (two in Palmerston North, and one in Feilding) co-located with other health and social service agencies. This relies on the outcome of work that is in progress by MidCentral DHB to potentially co locate some primary care services with MidCentral Health Services in both Palmerston North and Feilding.
What factors are taken into account when the sites are chosen?
The sites will be chosen in line with the Ministry of Health’s priorities:
- Improved access to Maori, Pacific peoples, and those of a low socio-economic status.
Other considerations are the security of the site for children and staff, access to toilets, parking, proximity to public transport, agreement from the site owner, ability to physically accommodate the clinics, long term school plans and population in the area. There is a national guideline that has been developed for site selection that will be followed.
What are co-located dental clinics?
In addition to the three double-chair clinics which will be owned by MidCentral DHB and sited at schools in areas of high need, the DHB would like to have a single chair clinic and a double chair clinic established as part of a large primary health practice. Large primary care health practices are being established throughout the district and include a range of health practitioners, such as GP services, pharmacists, radiologists and laboratory services. They provide a one-stop-shop health service and MidCentral DHB would like dental clinics to be a part of two such practices.
Could either Horowhenua or Tararua sustain a fixed dental clinic?
The populations of these regions are unable to sustain a fixed dental clinic.
If not, why not? What would happen if we put one fixed clinic in say Tararua (or allowed the existing relatively new clinic at Huia Range School clinic in Dannevirke to remain open)?
In order for a single fixed chair to be able to continue operating there needs to be a population of 1300 patients, and 2600 patients for a two chair clinic. If a single chair fixed clinic was located in either Horowhenua or Tararua it would mean that half to two thirds of the children living in those areas (ie Tararua being from Eketahuna to the east coast up to Herbertville, across to Norsewood and down to the Woodville end of the Manawatu Gorge, and Horowhenua being from Foxton to the west coast down to Te Horo and across to the ranges) would have to travel to that one clinic for assessment and treatment in order to keep it operating.
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FAQs - General Project Information
How will the service engage with local communities – schools, BOTs, MPs, district councils, iwi and any other stakeholders?
Engagement forums occurred in 2007 in the development phase of the business case, and a further round of engagement around the sites for the clinics is occurring July – October 2009. A series of forums and workshops, along with meeting with individuals who request this is occurring.
When do you expect to have the first new mobile clinic, and the others?
The first new mobile (single chair) is to be delivered in December 2009, with the first two double chair mobiles arriving in January and February 2010. The remaining two mobile dental clinics (two chair) are anticipated to arrive in approximately August 2010.
When do you hope to decide on the sites for the new fixed dental clinics?
It is proposed that sites for mobile and fixed dental clinics will be able to be confirmed late November 2009.
When do you hope to have the fixed dental clinics finished?
MidCentral Health anticipates the fixed dental clinics to be completed and operational by August 2010.
When will the new service start?
The public will see the first changes in February 2010, however the full changes will not be completed until approximately December 2010 due to required transitional changes.
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 01/03/2010