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The New Zealand Dental Public Health Report: Comments by New Zealand Authorities
The New Zealand dental public health report: comments by New Zealand authorities A study of dental public health services in New Zealand was published, in part, in the September, October and Novem ber 1950 issues of t h e j o u r n a l and later published in full in pamphlet form is the first complete report of the New Zealand dental health program ever presented by a dental observer from the United States. It was prepared by Allen O. Gruebbel, secretary of the Council on Dental Health, who spent three months in New Zealand early last year observing and discussing all aspects of the program with public health authorities and with the purveyors and recipients of the service. Although every effort was taken by the author of the study to present a factual, unbiased report, some exceptions have been taken by New Zealand authorities to a few of his observations. These excep tions, together with the author’s replies, follow.
favor legislative action which would per mit dental laboratory technicians to pro vide prosthetic services directly to the public. Members of the Labor Govern ment presented the argument that al though dental nurses are not fully trained dentists they are permitted to provide intraoral services for patients, and that dental mechanics were equally qualified to provide prosthetic services for pa tients.” Such a statement is contrary to fact and has not been stated to any represen tatives of this Association in any nego tiations it has had with any government of this country, nor was it stated to Dr. Gruebbel by any authorized officer of the N. Z. Dental Association. We repeat once again, the Labour Government gave no indication what soever that it was in sympathy with this idea. The next paragraph in Dr. Gruebbel’s article reads as follows: “A petition was filed with the Government by the dental laboratory technicians requesting ‘chairside status.’ During the time the petition was being considered by the Govern ment, the dental laboratory technicians published statements supporting their cause in the newspaper. The technicians’ petition was rejected by the Government now in office upon the recommendation of the New Zealand Dental Association. The matter is settled for the present, but it is the consensus of the dentists inter viewed that the proposal will be revived if and when Government officials show a favorable attitude toward it.”
A TTITU D E OF T H E LABOR G O V ER N M E N T Comment • I am directed by the Central Executive of my Association to draw your attention to an incorrect statement in the article contributed to t h e j o u r n a l o f T H E A M ERICA N D EN TA L A SS O C IA T IO N by Dr. A. Gruebbel, which appeared in the September 1950 issue. In this article Dr. Gruebbel states (page 279) : “. . . The Labor Govern ment expressed sympathy with this idea [direct service by laboratory technicians to the public] and indicated that it would 317
318 • THE J O U R N A L O F THE A M E R IC A N D E N T A L A S S O C IA T IO N
In regard to this, it should be known that two petitions to Parliament were put forward on separate occasions by organized groups of dental technicians asking for chairside status, and were re jected in that regard. This is a different picture from that painted by Dr. Grueb bel, and we are concerned at the effect of such a mis-statement. The cordial relations which have al ways existed between the American Den tal Association and the N. Z. Dental Association are valued greatly by my Executive and we feel sure that your Association would not wittingly allow anything to appear in print which may eventually cause difficulties to the N. Z. Dental Association. It would appear that Dr. Gruebbel ac cepted this statement from some dentist in this country who was not in possession of the correct facts, and by incorporating such a statement in what may be ac cepted by the profession in your country as an authoritative treatise, he has placed -my Association in a position which may embarrass any negotiations we may have at some future time with any Minister of Health or his departmental officers. While my Executive is not wishing to make any comment on other aspects of Dr. Gruebbel’s article, it feels that a cor rection should be published in t h e j o u r O F T H E A M ERICA N D EN TA L A SS O C IA
nal
as soon as possible,, and that (in all fairness) it should be given prominence equal to that of the article in question. We trust that your Association will agree to our suggestion, and look for ward to a continuance of the friendly relations which have existed between our two organizations in the past. T IO N
N. A. Clouston, B.D.S. Honorable Secretary New Zealand Dental Association Kelvin Chambers 16 The Terrace Wellington, C l, N. Z.
Reply • The statements in “A Study of Dental Public Health Services in New Zealand” to which the above letter refers, were reported as the result of interviews with persons prominent in the affairs of government and the New Zealand Dental Association. It appears that these persons were not in possession of all of the facts. There fore, the opportunity to clarify the unin tentional error is welcomed. Allen O. Gruebbel
SC O P E O F T H E SERVICE Comment
in T H E
• I have recently read a report
JO U R N A L O F T H E A M ERIC A N D E N TAL A SSO C IA TIO N (September, 1950) on a
study of dental public health services in New Zealand by Dr. Allen O. Gruebbel. As the journal in question has a wide distribution, I would appreciate the op portunity of correcting two statements which Dr. Gruebbel has attributed to me. He quotes me as saying (1) that the scope of the service of the school dental nurse “has gone far beyond what was originally proposed,” and stated I had organized the Service in the first instance on the basis that school dental nurses would treat primary teeth only; and (2) that ever since the Service had been pro vided free of charge I had “found that children and parents are appreciating the dental care provided by the State to a lesser and lesser degree.” As it is evident that Dr. Gruebbel mis understood what I wished to convey in my conversation with him, I want to make it clear that it was never my inten tion to limit the school dental nurses to the care of primary teeth only. When I became Chief Dental Officer in 1920 the Government was already committed to the treatment of school children, that is from six years of age upwards. Conse quently it would have been absurd for me to have considered any plan that
C O M M E N T S BY N E W Z E A L A N D A U T H O R IT IE S
limited treatment to the primary teeth alone. No doubt I discussed with Dr. Grueb bel my belief that dental care should be commenced at as early an age as possible, and emphasised my interest in the pre ventive aspect of the problem. It may be that Dr. Gruebbel interpreted this as meaning that I intended to confine the dental nurses attention to primary teeth, but this was definitely not so. In regard to the second point, I con sider that the question of whether or not a public dental service should be pro vided free of cost to the individual is primarily a political one. Personally I am of the opinion that there are advantages in making at least a nominal charge for such services in order to retain interest, and no doubt I expressed the view that the provison of a free service might well lead to a lessening of interest. I am sorry if I gave Dr. Gruebbel the impression that this had actually occurred. On the contrary I was pleased to learn from one of the members of the United Kingdom Government’s Mission, which was in New Zealand at the same time as Dr. Gruebbel (and for the same purpose) that he had questioned members of the public from all walks of life, selected at random in the main towns he visited, and that he had been greatly impressed by the interest in and appreciation of the dental service that their answers revealed. In any case, as it is more than twenty years since I retired from the Service, I would not have presumed to comment
V O L U M E 42, M A R C H 1951 • 319
on a matter of which I had no official knowledge. I cannot help thinking that Dr. Grueb bel has over-emphasised minor matters of this sort and that he has been over anxious to belittle the achievements of a Service which is doing so much for the health of the children of this country. Thom as A . H u n ter, K .B .E . Form erly director, Division o f Dental H ygiene N ew Zealand D epartm en t o f Health H eretaunga, N ew Zealand R eply • According to the official records of the New Zealand Dental Association, published in the January 1921 issue of the New Zealand Dental Journal, Mr. Hunter informed the Executive Council that student dental nurses “will undergo an intensive training in a science course, embracing chemistry, physics, biology, anatomy and physiology. . . . Their train ing will proceed finally to a knowledge of the filling of simple cavities and simple extractions of temporary teeth. . . . Their work will be limited almost entirely to the temporary teeth. . . .” It is somewhat surprising to read Sir Thomas Hunter’s remarks about “free” dental service. He was quite emphatic during the interview in describing the ill effects on the people of comprehensive social security benefits in general and free health care in particular. A llen O . G ruebbel
favor legislative action which would per mit dental laboratory technicians to pro vide prosthetic services directly to the public. Members of the Labor Govern ment presented the argument that al though dental nurses are not fully trained dentists they are permitted to provide intraoral services for patients, and that dental mechanics were equally qualified to provide prosthetic services for pa tients.” Such a statement is contrary to fact and has not been stated to any represen tatives of this Association in any nego tiations it has had with any government of this country, nor was it stated to Dr. Gruebbel by any authorized officer of the N. Z. Dental Association. We repeat once again, the Labour Government gave no indication what soever that it was in sympathy with this idea. The next paragraph in Dr. Gruebbel’s article reads as follows: “A petition was filed with the Government by the dental laboratory technicians requesting ‘chairside status.’ During the time the petition was being considered by the Govern ment, the dental laboratory technicians published statements supporting their cause in the newspaper. The technicians’ petition was rejected by the Government now in office upon the recommendation of the New Zealand Dental Association. The matter is settled for the present, but it is the consensus of the dentists inter viewed that the proposal will be revived if and when Government officials show a favorable attitude toward it.”
A TTITU D E OF T H E LABOR G O V ER N M E N T Comment • I am directed by the Central Executive of my Association to draw your attention to an incorrect statement in the article contributed to t h e j o u r n a l o f T H E A M ERICA N D EN TA L A SS O C IA T IO N by Dr. A. Gruebbel, which appeared in the September 1950 issue. In this article Dr. Gruebbel states (page 279) : “. . . The Labor Govern ment expressed sympathy with this idea [direct service by laboratory technicians to the public] and indicated that it would 317
318 • THE J O U R N A L O F THE A M E R IC A N D E N T A L A S S O C IA T IO N
In regard to this, it should be known that two petitions to Parliament were put forward on separate occasions by organized groups of dental technicians asking for chairside status, and were re jected in that regard. This is a different picture from that painted by Dr. Grueb bel, and we are concerned at the effect of such a mis-statement. The cordial relations which have al ways existed between the American Den tal Association and the N. Z. Dental Association are valued greatly by my Executive and we feel sure that your Association would not wittingly allow anything to appear in print which may eventually cause difficulties to the N. Z. Dental Association. It would appear that Dr. Gruebbel ac cepted this statement from some dentist in this country who was not in possession of the correct facts, and by incorporating such a statement in what may be ac cepted by the profession in your country as an authoritative treatise, he has placed -my Association in a position which may embarrass any negotiations we may have at some future time with any Minister of Health or his departmental officers. While my Executive is not wishing to make any comment on other aspects of Dr. Gruebbel’s article, it feels that a cor rection should be published in t h e j o u r O F T H E A M ERICA N D EN TA L A SS O C IA
nal
as soon as possible,, and that (in all fairness) it should be given prominence equal to that of the article in question. We trust that your Association will agree to our suggestion, and look for ward to a continuance of the friendly relations which have existed between our two organizations in the past. T IO N
N. A. Clouston, B.D.S. Honorable Secretary New Zealand Dental Association Kelvin Chambers 16 The Terrace Wellington, C l, N. Z.
Reply • The statements in “A Study of Dental Public Health Services in New Zealand” to which the above letter refers, were reported as the result of interviews with persons prominent in the affairs of government and the New Zealand Dental Association. It appears that these persons were not in possession of all of the facts. There fore, the opportunity to clarify the unin tentional error is welcomed. Allen O. Gruebbel
SC O P E O F T H E SERVICE Comment
in T H E
• I have recently read a report
JO U R N A L O F T H E A M ERIC A N D E N TAL A SSO C IA TIO N (September, 1950) on a
study of dental public health services in New Zealand by Dr. Allen O. Gruebbel. As the journal in question has a wide distribution, I would appreciate the op portunity of correcting two statements which Dr. Gruebbel has attributed to me. He quotes me as saying (1) that the scope of the service of the school dental nurse “has gone far beyond what was originally proposed,” and stated I had organized the Service in the first instance on the basis that school dental nurses would treat primary teeth only; and (2) that ever since the Service had been pro vided free of charge I had “found that children and parents are appreciating the dental care provided by the State to a lesser and lesser degree.” As it is evident that Dr. Gruebbel mis understood what I wished to convey in my conversation with him, I want to make it clear that it was never my inten tion to limit the school dental nurses to the care of primary teeth only. When I became Chief Dental Officer in 1920 the Government was already committed to the treatment of school children, that is from six years of age upwards. Conse quently it would have been absurd for me to have considered any plan that
C O M M E N T S BY N E W Z E A L A N D A U T H O R IT IE S
limited treatment to the primary teeth alone. No doubt I discussed with Dr. Grueb bel my belief that dental care should be commenced at as early an age as possible, and emphasised my interest in the pre ventive aspect of the problem. It may be that Dr. Gruebbel interpreted this as meaning that I intended to confine the dental nurses attention to primary teeth, but this was definitely not so. In regard to the second point, I con sider that the question of whether or not a public dental service should be pro vided free of cost to the individual is primarily a political one. Personally I am of the opinion that there are advantages in making at least a nominal charge for such services in order to retain interest, and no doubt I expressed the view that the provison of a free service might well lead to a lessening of interest. I am sorry if I gave Dr. Gruebbel the impression that this had actually occurred. On the contrary I was pleased to learn from one of the members of the United Kingdom Government’s Mission, which was in New Zealand at the same time as Dr. Gruebbel (and for the same purpose) that he had questioned members of the public from all walks of life, selected at random in the main towns he visited, and that he had been greatly impressed by the interest in and appreciation of the dental service that their answers revealed. In any case, as it is more than twenty years since I retired from the Service, I would not have presumed to comment
V O L U M E 42, M A R C H 1951 • 319
on a matter of which I had no official knowledge. I cannot help thinking that Dr. Grueb bel has over-emphasised minor matters of this sort and that he has been over anxious to belittle the achievements of a Service which is doing so much for the health of the children of this country. Thom as A . H u n ter, K .B .E . Form erly director, Division o f Dental H ygiene N ew Zealand D epartm en t o f Health H eretaunga, N ew Zealand R eply • According to the official records of the New Zealand Dental Association, published in the January 1921 issue of the New Zealand Dental Journal, Mr. Hunter informed the Executive Council that student dental nurses “will undergo an intensive training in a science course, embracing chemistry, physics, biology, anatomy and physiology. . . . Their train ing will proceed finally to a knowledge of the filling of simple cavities and simple extractions of temporary teeth. . . . Their work will be limited almost entirely to the temporary teeth. . . .” It is somewhat surprising to read Sir Thomas Hunter’s remarks about “free” dental service. He was quite emphatic during the interview in describing the ill effects on the people of comprehensive social security benefits in general and free health care in particular. A llen O . G ruebbel