Training of dental therapists started in Victoria in the 1970s. Gough Whitlam’s Government had started a Commonwealth-funded School Dental Program and, in Victoria, the Department of Health started training therapists in the mid- to late-1970s.

In 1992 when Jeff Kennett[75] came to power, there was a move to have these types of training activities out-sourced. The principle at the time was that the Department of Health was about steering, not doing the rowing.

A review was set up into the training of dental professionals, other than dentists, chaired by Hon. Robert Doyle.[76] It looked at training dental therapists, whether Victoria should start training dental hygienists and also the scope of practice and role of dental technicians and prosthetists. The outcomes included that Victoria should continue training dental therapists, that dental hygiene training should commence, and a decision was made that the training of prosthetists or advanced dental technicians should cease for a five year period and the need for further training should be re-assessed at that stage.[77]

The Department tendered out the training of dental therapy and there were a number of tenders, including one from the University of Melbourne School of Dentistry. And the School won that tender. I understand that some resources were moved from the training of dentists to this new training course. There was a two year training course, which started in 1996 or 1997, with a common first year for dental therapists or hygienists and then a streaming so that people could end up as a dental therapist or hygienist. And there have been some changes since. It’s now a three year degree.

Gerry Dalitz: I thought that the school dental nurse situation and all those sort of things happened in the days when caries were massive in children and dentists literally didn’t have the time or inclination to deal with the problem. That’s when fluoridation started up and the whole scene changed somewhat as we discussed before. Then there was a discrepancy in the need for some of these trainees.

John Rogers: I think it was in the 1960s that the average number of permanent teeth affected by decay in Victorian 12 year-olds was around ten. That decreased until the early 1990s, when about one tooth was affected by decay. There seems to have been a slight increase over the last 10 years, but it’s now less than two affected on average. So it’s a massive change from around ten to less than two permanent teeth on average in 12 year-olds.

There are still distribution issues such that a significant proportion of children, usually from disadvantaged backgrounds, have higher numbers of caries. But in general there has been an incredible improvement in oral health, which is partly due to water fluoridation and also to the fluoridation of toothpaste and improvements in oral hygiene. There may also be an effect from diet.

Peter Reade: I take it those comments don’t apply to our indigenous population whose oral health continues to worsen.

Henry Atkinson: Tony Storey and I started movements to get New-Zealand style dental nurses, as they were called then, onto the Dental Hospital staff and into the School Dental Service. We didn’t meet with any success.

We brought the idea up again at the Ministerial Advisory Committee between 1964 and 1968. The Committee was in favour, to the extent that they gave us permission to try to get a few onto the hospital staff. But the [Australian Dental] Association was opposed to this move and it was put back for a while.

Our idea was that they would come in eventually and the students would have to work with them. If we had them in the Hospital and in the School, the students would get used to them, as well as doing a lot of good as the caries rate among school children was very high at that time.

John Rasmussen: At the Hospital, I find the relationship between the ancillaries and dentists is quite good. I don’t mind things when they’re run as part of a team but it worries me to think of different dental therapists on each street corner making their own special offering. But as members of a team, I think it can work well. And I think economics tends to make that happen. I think very highly about the hygienists in the Hospital, in particular.

Henry Atkinson: We’ll fall out again, John, because I’ll go further than that.

Owen Crombie: As students, we were urged to study public health measures other than fluoride and the example of school dental nurses on the New Zealand model often came up. People would say that because of them, people in New Zealand had fewer missing teeth but many more fillings. You do see New Zealanders even now who have fillings in the most unlikely places, but they do have teeth to put them in.

It would have been the mid-1980s when the School Dental Service[78] started to use school dental nurses fairly extensively. But the nurses ended up with a difficulty as to what they did next because dentists weren’t seeing the large numbers of dental caries and the terrific number of deciduous teeth needing to be taken out. The job they were specifically hired to do wasn’t there. Instead we were seeing more of a need for diagnosing interceptive orthodontics or a need for being more gung-ho with long-term prevention which research has demonstrated can benefit the population. But school dental nurses and school dental therapists weren’t geared to do those things.

Some ended up getting jobs in private dental practices, along with other auxiliaries, and sought wages slightly more than a graduate dentist. Dentists were then under financial pressure to prescribe treatments that these auxiliaries could perform, whether they were needed or not. On the one hand, you could make sound arguments that auxiliaries are a wonderful thing, on the other you could argue that it’s yet another pressure to extract money from the public.

Ann Westmore: Let’s break now for lunch and re-convene in three-quarters of an hour. BREAK

Witness to the History of Australian Medicine