Welcome to Season 2 of The Whole Tooth Ao/NZ. On the eve of 2024, Diane and Becky get together for a chat about oral health in Aotearoa.
Listen for the thoughts, opinions and health statistics that have been on the mind of the team at Rebecca Ahmadi & Associates.
What does 2024 look like in the field of publicly-funded dentistry? There are more questions than answers….
Grab a cuppa, a pen and paper and be encouraged by this episode.
Becky & Diane, The Whole Tooth Ao/NZ
Listen here:
Transcript
Goodbye 2023, Hello 2024!
[00:00:05] Speaker A ( BECKY): Kia Ora. And welcome to the Whole Tooth, Aotearoa NZ, a podcast for oral health professionals made by oral health professionals. Here we will share the kaupapa of the oral health profession at Aotearoa, where we will seek to speak the tooth, the whole tooth and nothing but the truth.
[00:00:23] Speaker B (BECKY): The Whole Tooth Aotearoa/ NZ is sponsored by the Clare Foundation. (www.clare.nz) Kia Ora oral health professionals, how you goin? Sit back and listen while where we summarize our 2023 experiences and put out some predictions for our 2024 forecasts for oral health in Aotearoa.
[00:00:44] Speaker A (BECKY): But anyway, Kia Ora Diane, how are you?
[00:00:47] Speaker C (DIANE): Becky and Kia Ora, everyone. It’s lovely to have you here,
Becky, and nice to catch up in person when we often seem to be catching up online.
So lovely to have you here and to be talking through 2023 and some learnings from 2023 that we can take forward into 2024 and make 2024 a better time for oral health and a better time for practice.
[00:01:16] Speaker A (BECKY): Yeah, that’s great. I think it’s timely since we’re rocketing towards the end of 2023 here on the eve of New Year’s Eve.What are some of our reflections of 2023 around oral health in New Zealand? I don’t know if we’ve had any great progress. Do you think things have been just a bit stagnant across the board after Covid, people are still just trying to get through the hordes of patients that need their care and attention.
[00:01:48] Speaker C (DIANE): I agree, and I feel that all the changes with Te Whatu Ora, it has not yet resulted in great changes for oral health services. So the focus has been on tamariki and children and getting through the backlog and also vacancy. The vacancy factor has been significant, I think, across New Zealand.
[00:02:19] Speaker A: So we’re still going into 2024 with some staffing issues, I guess, also retention and recruitment issues as well. Across the board in the community, oral health service and poor oral health isn’t going away. So we need some strategy to move into 2024. And certainly the conversations that Diane and I have over cups of tea, we’re very solutions based. We like to create solutions for the problems that we see. And we’ve been having some chats about what we think could succeed in 2024 to make some slow improvements towards good oral health for more people in Aotearoa.
[00:03:08] Speaker C: Yeah, I think in 2023, there was. The New Zealand Health survey was released mid 2023, and that covered a period of time from 2022 through to 2023. And key findings included oral health. And some of that was actually reasonably positive. Mind you, I guess that all of us, when we’re asked a question, often want to report that we’re doing the right thing rather than the wrong thing.
So how much actually is good?
[00:03:56] Speaker C: Yeah. So 77.5% of the respondents reported that their oral health was
good, very good or excellent? Yeah. Most parents and caregivers, being 92.1%, reported their
children’s oral health to be good, very good or excellent.
[00:04:18] Speaker A: Maybe they didn’t ask any of the kids that I saw, but yeah, I’d be interested. I mean, as much as data is, data and interpretation is just as it is. I wonder, as a parent, would you not want to say, my kids oral health is really poor and that’s my fault?
[00:04:35] Speaker C: Around 66% of children aged one to 14 years brushing teeth with fluoridated toothpaste at least twice a day.
[00:04:48] Speaker A: That’s self reporting. That’s so interesting.
[00:04:53] Speaker C: It is really interesting to see how people feel or think that they’re doing, but perhaps doesn’t mean that people know the right thing to do.
[00:05:02] Speaker A: Yeah, they know they should be brushing twice a day for two minutes and throwing a bit of floss in there and eating well and avoiding sugar laden acidic drinks. But in reality, what does that actually look like? If someone asked you, do you have good oral health? Yeah. Anyway, I don’t want to pick apart how they’ve reported that because I’m sure they’ve done it with robust methodology and manner, but I’m always interested in self reporting. Do people really want to report the reality of themselves? I don’t know.
[00:05:35] Speaker C: Nearly 60% of adults and children living in the most deprived neighborhoods brush their teeth twice a day with a fluoridated toothpaste, compared to nearly 80% of children and adults in the least deprived neighborhoods.
[00:05:53] Speaker A: Okay, so it’s interesting.
[00:05:56] Speaker C: Is this a picture that oral health therapists and dental therapists see out there?
[00:06:04] Speaker A: Could you just run through all those stats one more time? Like what are the each one key stats?
[00:06:10] Speaker C: Three out of four adults reported their oral health to be good, very good, or excellent? Most parents and caregivers, that’s 92.1%, reported their children’s oral health to be good, very good or excellent. 65.9% of children aged one to 14 brush their teeth with standard fluoride toothpaste. At least twice a day. And that in the most deprived neighborhoods, that goes down to 60%. Compared to the least deprived neighborhoods, that’s 80%. Nearly half of adults experienced unmet need for dental care due to the cost in the past twelve months. And that is actually something that’s higher since the last oral health survey that included oral health, unmet need for dental care was highest amongst the 25 to 34 year age group and the 35 to 44 age group and lowest and the oldest age groups.
[00:07:33] Speaker A: I think that’s an accurate, reasonably accurate picture of an overall what’s going on, especially with who’s going to have money as they’re trying to set up their lives as a young adult to pay for dentistry. And yeah, as time goes forward again.
[00:07:54] Speaker C (DIANE): It shows a place for dental therapists and oral health therapists with the adult scope. Possibly. So community clinics were set up with the view that they were there for a whole community, possibly, rather than just children.
[00:08:14] Speaker A (BECKY): Yes, certainly seeing the whole family would not only just benefit the children, it would benefit the whole family, because it does bother me somewhat. Not that I’m super interested in caring for adults, given that I love children far more, but seeing the mummas ou there, or the caregivers and they have such poor oral health and such bad breath, and you think, would you not benefit from a lovely clean or some ohi? Or that just might be my utopian dream. But if I’m trying to support the child’s improvement of oral health, if no other member of the family has good oral health or can get to a point of good oral health, what’s the point?
[00:09:01] Speaker C: It’s true.
[00:09:03] Speaker A: Yes. So, yes, that brings us, I think, to prevention. We’ve been discussing solutions for 2024. What do we think that will solve some of the greater problems would be prevention, education and promotion of good oral health within the community setting.
[00:09:21] Speaker C: Yes, and perhaps that’s a new role, Becky. So perhaps the whole preventionist role needs to be led and facilitated in some sort of way to get that happening consistently across the region for high deprivation areas, low desile schools, areas of need and people in need.
[00:09:50] Speaker A: I’d love to hear how the oral health promoters are going across the board. I know they meet once a year, so we might try and catch up with them in 2024 and see what’s going on for them in their regions. And are they able to, as individuals do, the oral health promotion, education and prevention that’s needed for the communities? So that could be something we could touch on later in there. But the evidence shows prevention is going to be the key to success. And it’s something that seems to have dropped off the wagon.
[00:10:29] Speaker C: Yeah, and understandably so, because I think when you’re met with the mountain of need, you’ve got to focus on the mountain of need and you have to get through and the children out of pain.
[00:10:44] Speaker A: Yeah. And that luxurious prevention aspect really has to be. There has to be a champion within the service that’s going to step out and say, I know this is going to take time and energy and it will take time before we see results, but we have to put prevention back into our routine care and within the planning time, energy, that it can’t just be dropped off or left out because what’s the result? More need more resources, more time down the end, you got to put in a bit more to get a bit more at the end you’ve got to.
[00:11:26] Speaker C: Put in resources because I think that the resource we’re most short of is people on the ground to do things. So there needs to be a new model that incorporates some new things. That would be one new area that I’d be thinking of.
[00:11:44] Speaker A: Yeah. Certainly applying fluoride is something that’s beneficial. I know there’s different schools of thought on what regional fluoride programs do, but it’s the best thing we’ve got in New Zealand at this point in time for anything alternative to chairside care. Who could do that role? We’ve been talking about also our plunket lift the lip team as well. And how are they going out there? If there’s anyone that could talk to us about that, we might have to go and tap shoulders with. Tap a shoulder to Plunket and have a chat to them about how’s that lift the lip program going and what are they finding in their experience? The Well Child / Tamariki Ora nurses, sorry, called them the wrong thing.
[00:12:31] Speaker B: Yeah.
[00:12:31] Speaker A: How are they going with that and are we integrated with them in a community service setting?
[00:12:38] Speaker C: Great idea. I also am thinking about graduates coming through and the support that’s in place in all the different regions around educators and just the need for mentors, coaches, everything else that really gets people integrated into and feeling confident and competent in practice.
[00:13:05] Speaker A(BECKY): Definitely, because in our study group we talk about lots of different things in the world, but mostly oral health and I think some of the biggest issues that we have with graduates exiting the university setting and coming in to a community oral health service setting or a private clinical setting is there’s a massive gap between education and industry, through no fault of anyone, not blaming anyone here, but the obvious thing is, these graduates are coming out with high levels of knowledge, a skill set that needs development, care and compassionate, empathetic coaching, that it’s such a shock to come from a university setting into what I would say is not an exaggeration, the chaos of the community or health service where clinicians are just inundated with work. And as a new graduate that can be extremely. That’s either going to be a great challenge or it’s going to be a daunting prospect. And we’re losing our new grads quite quickly out of public dental care.
[00:14:22] Speaker C: Do you feel it’s better in private practice?
[00:14:24] Speaker A: Not that I’ve heard. This is anecdotal, by the way, listeners, not from the
people that I’ve talked to in private. You’re also. This is very generalist statement. Depending on who your team is and who’s within your practice depends on whether you get to use all of your skill set, some of your skill set, and whether you’re supported. You’re handheld for a period of time or whether you’re dropped in it and say good luck, off you go.
Certainly we hope that people are as mentoring and coaching ideals are that they’re handheld
until they can walk on their own and that they’re given enough space to grow and not be left to fly on their own, because that can be a very dangerous place to be when you’re a new graduate in a clinical setting where everyone’s too busy to care for you. But I know there’s some great
mentoring programs out there, some great clinical coaches out there. It would just be wonderful
if all new graduates had access to that quality and high level of mentoring and coaching across the board to bring them into that level that is needed to provide care appropriately to.
[00:15:44] Speaker C: In your opinion, Becky, does that need to be on site or could that be remote?
[00:15:50] Speaker A: I think there definitely needs to be a period of time. For some on site. There’s nothing better than having a clinician sit with you. There’s a lot of emotions, a lot of adjustment and assimilation to get yourself into a clinical setting. You might not necessarily need the mentor very close to you because that’s someone that you’re going to chat to and run ideas past. But that idea of a clinical coach, they need to be in your pocket for a period of time. You need to be with them, breathe with them, hear their highs, lows and whatever, and coach them over that, over whatever deemed period of time, few weeks, months, whatever that this person needs. Because everyone’s needs are different when they come into this clinical space to be able to get them to their optimum place for individual practice.
[00:16:44] Speaker C: Great. And for Rebecca Ahmadi and Associates, what does 2024 bring?
[00:16:52] Speaker A: I hope it brings something. I still love doing the podcasts, obviously, because you hear my voice all the time on them, and you’re very good at them, too. I love a good banter, but I think for Diane and I have sat with Rebecca Amadi and associates for a couple of years now, where we feel more assured of the direction we want to go in. We’ve refined our thoughts and ideas about what exactly we could offer the oral health community in New Zealand, and that’s certainly around our skill set of that clinical coaching and mentoring. We both have years of expertise in supporting oral health professionals to grow and to flourish. Also our love of education and empowering others to learn. Both of us are avid learners and we read widely. We think deeply, and we care about education and quality within the oral health profession. And so that’s something we’d love to support the oral health profession, to grow, to see things differently, to look to the future and think within your own regions. What could I do, or we do as an individual or as a cohort to grow our oral health profession in our community. Like, the limitations that we’ve placed on ourselves as oral health professionals is sometimes you don’t know about your limitations, but it’s painful. Please, just think, as an oral health professional, you can be anything, do anything, grow anything that you want, because we are the ones that need to improve oral health in Aotearoa. No one else is going to do it for us. So that’s my call to action. Is that, yeah, you got to get moving, people. It’s 2024.
[00:18:42] Speaker C: That’s great. So, Rebecca Ahmadi and Associates, how can we support that?
[00:18:49] Speaker A: How can we help others? But we could do that through meeting with you, talking with you. We could do that through facilitation of courses, events online, or face to face. There’s many modes of being able to share information. The great thing about being online isthat we can create online packages or we can come to you to sort things out. Because of course, in a clinical job, you would sometimes see people you want to have hands on support and care. And of course, we have friends in many places to support us with their desire to share knowledge widely and have it really accessible so that everyone has the chance to look at best practice and to understand, get really in depth with those DCNZ policies and requirements, because they will lead you towards greater professional satisfaction and safety within your practice.
[00:20:03] Speaker C: Yeah, I think that’s fantastic. And some work around the side has been the ACC or progression for dental therapists and oral health therapists to become registered oral health professionals for ACC. Hopefully that will come to fruition in 2024.
[00:20:23] Speaker A: That is an absolute no brainer. Thank you to the New Zealand Oral Health Association. And I think, OHCAN, might be doing a bit of mahi around that. Certainly our study group have talked about it for a period of time, that it’s a no brainer. You’re in your clinic, you’ve got a toddler that’s whacked their front tooth on the. Whatever, the kitchen bench, and then you’re telling them that they have to then take their toddler and their baby to their local dentist, which they don’t have, and find an appointment, get a park, get another time. All those things where you could just sign that off there when there’s no other indications. Trauma, just like every other aspect of clinical dentistry, it has a set parameter of information and boundaries within our scope of what we can identify, what we can diagnose. And I think that our clinical skill and knowledge around trauma is sufficient to manage the general issues of the child population we see. And of course, if the trauma is outside of our scope of practice and outside of our level of care that we can provide, then off they go. They need specialist care at a dentist or the emergency department. And if we’re trying to create a community or health service that’s for equity and for equality of the people that come to see us, we need to provide services that they need and ACC, registration and dentistry is one of them. So, yes, thank you, ACC. When you finally add dental and oral health therapists to your register, we will welcome that and celebrate it in 2024. Fingers crossed?
Fingers crossed, yes. So, as you can see, I’m quite passionate about these things.
We touched on the model of care. Should we touch on that a bit more as an overview of service provision? It’s going, it’s working. People are being seen if they’re in need.
[00:22:30] Speaker C: Yes, I think some areas possibly better than other areas. So are we a national service?
[00:22:41] Speaker A: I don’t know.
[00:22:43] Speaker C: Do we actually reach all people in some sort of way? And does the contract that we provide care to, is the contract actually correct.
[00:22:55] Speaker A: Or does the contract actually meet what the community or the patient needs? Is that what you mean? Are we under a contract that’s not allowing us to provide the care that’s warranted?
[00:23:08] Speaker C: Have we had some surveys recently to understand what the patient perspective is? It’s interesting. I was talking to some people about manage my health app and asked if they could access the children’s medical records, which is quite a process, I understand, to get your children added into manage your health. So where is a visibility for parents of oral health, and where’s the visibility of when you were last seen by a dental therapist or oral health therapist? How do you understand that when you’re a parent? How do you understand what you’re entitled to? So, yeah, people say they know to brush your teeth twice a day, which is great. It means some stuff that was done in the past is actually, like stuck. And what was done was obviously done well because people have those messages embedded, be that via television, via somebody telling them that, but they have got that message. But what do they know about oral health care and when you need to access it, when you last accessed it, and particularly around children when you’re next due?
[00:24:31] Speaker A: Yes. Government says you’re allowed a yearly checkup. You’re entitled to a yearly checkup. Yet, how many children under 18 have had their yearly checkup in the last five years?
[00:24:46] Speaker C: And I also understand in the contracts that if you have an electronic information system, that you can spread that out to 18 months.
[00:24:58] Speaker A: Okay. But it shouldn’t be 18 months because it states on both of those websites that your child under 18 is entitled to a free dental checkout. So 18 months isn’t yearly. And who do we see getting those yearly checks? What’s the word? It’s not the people. There’s not enough information out there. Who’s getting seen? Who’s not getting seen.
[00:25:33] Speaker C: And if you’re a parent. Yeah.
[00:25:35] Speaker A: How do you know that you get a yearly free checkup.
[00:25:37] Speaker C: Yeah. How do you know when you were last seen? How do you find that out? Without knowing the oral health service, you haven’t got easy access to information.
[00:25:49] Speaker A: Yeah. And certainly the not personalized. Not at all. And you actually actively seek that information. You might think, haven’t seen my child hasn’t been seen for a couple of years. You have to go and try and get hold of somebody at 800 talk teeth. And I know there are people doing hard work behind the scenes there, but the volume of calls that they’re getting, I’m sure are difficult to manage that.
[00:26:14] Speaker C: Volume, capacity to cope with it at times through it. And I’d come back, how does that influence equity that you haven’t got that information?
[00:26:26] Speaker A: Yeah. It really penalizes the people who have low health literacy, have experiencing poverty, experiencing other issues within life, any disabilities? Certainly, yeah. All our vulnerable populations miss out because all our mobile upwardly, financially capable, et cetera, et cetera. Those populations are snagging those spots. That’s not equity.
[00:26:56] Speaker C: They know where to go to lock.
[00:26:58] Speaker A: They know where to go to look, they know how to sort of use information. Yeah. And that really irks my social justice string. That’s not how we want a community or health service to operate. It’s meant to be there for the community and for the patients that we see. I know we say everyone, but we should aim to be catering for the vulnerable. Yeah. So, model of care. So what are we doing? First of all, we don’t know exactly what’s going on out there. That would be lovely for someone who wants to do any research on in the community oral health service, who’s being seen, when are they being seen and what exactly is going on? Overall?
[00:27:50] Speaker C: I think following some patient journeys, some personas. Really good. So we start off with somebody who’s been born, when did they first access services and what happened to them over the course of life would give a really interesting perspective on oral health.
[00:28:12] Speaker A: Could we do that retrospectively? Probably could collect it off titanium. But that gives us quite a one dimensional or two dimensional maybe picture of a person. Or is that a project that you’d start from now and that you go through, collect a birth cohort? I wonder if the multidisciplinary studies collected that in Dunedin?
[00:28:35] Speaker C: Certainly got information around information, isn’t it? So it includes your contact with the orthodontist, for example, or other services, not just publicly funded dental services.
[00:28:51] Speaker A: I would like to hear some stories because the Facebook mums groups that I frequent, there’s been certainly some heartbreaking conversations around people trying to get care, specifically dental care, for their children. And some of the experiences that they’ve had have been negative, but they’ve not been able to return to that space. They’ve just chosen not to go, therefore missed appointments. I know you might say it’s that patient, that parents responsibility to get that child to the clinic, but it’s part of our responsibility as well, to maintain follow up. Yeah, a bit shared responsibility, but I think the community is not supported enough to access the care they need and the clinicians aren’t supported in a way that allows them to do all the things they need to do in their role.
[00:29:43] Speaker C: Yeah. I’m also thinking for model of care, the mobiles now, in the main, are getting older and possibly. Have we got enough of them? Are they configured right? If you’re building new mobiles for the future, what would those future mobiles and future clinics look like? I imagine they wouldn’t look like the clinics of today. Yeah.
[00:30:07] Speaker A: And I’m not sure exactly what all the models are in each region, but we have some that have screening prevention vans, we have some that have treatment vans. It’d be interesting to see how that’s all going and what the review of.
[00:30:26] Speaker C: The whole model review is well needed.
[00:30:29] Speaker A: Do I need to start a Phd?
[00:30:33] Speaker C: Inspiring me to study a masters on what the whole model looks like and evaluate, because there has been some technology changes in the patch over that time. So we seem to again be being locked into old technology in many respects. I’m thinking of. [00:31:02] Speaker A: Yeah, give us an example of what’s the technology?
[00:31:05] Speaker C: Cloud based software systems. I’m thinking of AI for x rays, x ray reading. I’m thinking of intraoral cameras.
[00:31:18] Speaker A: And that certainly gives a bigger picture. And also when you’re referring or when you’re trying to consult with other peers or your community dentist, for example, you’ve got intraoral pictures to back up your digital x rays and et cetera, et cetera. So you get a greater picture and greater provision of care for each patient.
[00:31:40] Speaker C: I’m thinking about security in clinics. I’m thinking silver fluoride or silver diamond fluoride, whichever one’s chosen and how that’s put into practice. I’m thinking some services are possibly still using amalgam and how that fits.
[00:32:05] Speaker A: Yeah, there’s certainly some questions that need some answering and maybe in 2024 we go ask some questions and see what’s going on out there.
[00:32:16] Speaker C: I think we need greater communications.
[00:32:19] Speaker A: Yeah, definitely. There’s nothing wrong with sharing a bit of information, people, especially when it’s all for the greater good. And we’re here to improve oral health. And we propose at this podcast, the whole tooth are nothing but the truth. So yeah, we’re looking for these answers and looking for it is time to look at the model of care and say, is it meeting the needs of our population? You may have picked up. We don’t think it is, but how do we know that?
[00:32:49] Speaker C: Yeah, how do we know that? It possibly is in certain areas? It possibly is exactly what people are expecting of the service, but there may be other areas that it may not be. So how do we do that? Is there opportunities with the new minister of health to look at things? I know he likes data. Is there opportunities to look at things slightly differently around the model of care and Māori& Pacific providers, what space do they fit in as well into this arena of oral health?
[00:33:36] Speaker A: Dentists as well, public private mixes is always a discussion to be had.
When one area can’t provide care for everything, how can we work with greater integration into collaboration and greater understanding of each other? Of what is a dental therapist?
How amazing are they? Yes. And what can an oral health therapist bring to create success in your practice?
[00:34:10] Speaker C: Innovation out of University of Otago. So any studies on new materials, new ways of doing things, what’s happening in that space would be great to know. Same for the defence force. So are they still doing their clinics in various areas? So that would be interesting to know. And of course, the NZDA and I see that more and more oral health is becoming more integrated. We’re looking at oral health across the lifespan, If we look at a Persona, then we’re looking across a life course, potentially, so that obviously has contact with public health via private practice dentists, where care is funded under a service agreement. So we need to be working with dentists and with the whole patch to think our way forward.
[00:35:15] Speaker A: Yes, this time of siloed healthcare provision and segmented health care
provision doesn’t do any group any justice, really.
[00:35:26] Speaker C: The model of care needs to reflect the whole that everybody brings their value.
[00:35:34] Speaker A: So, yeah, the model of care, we think it’s time for a rethink, a review of i
and a refresh. And who doesn’t love a bit of change? 2024 has to be the year, year of opportunities. Friends, don’t be afraid of a little change, because how bad, worse can things get?Sorry, That is a terrible thing to say. Yeah, but looking at change as an opportunity for growth, never be afraid that change is going to bring worse things towards you. Of course there’ll be things you don’t like, but we are amazing adapters and change might bring that thing that you need to really get going to improve oral health in your community. You might be happy just as you are. So, yeah, we’re all good with that.
[00:36:25] Speaker C: So I think it’s thinking through what, 2024, what the opportunities are out there and which ones you’d like to grasp for yourself. And if there’s things there that you would support or not support, then that’s all good. And Rebecca Ahmadi and Associates is perfect to hear those things and to support you on this journey.
[00:36:52] Speaker A: Yes, we’re a platform for sharing the stories, the kaupapa of the oral
health profession in Aotearoa, because we care about what’s going on, as we affectionately call it, the ‘coal face’, because that’s where the real mahi is done. And, yeah, we want to share those stories so you can listen and hear what your peers are up to and not feel isolated or alone in your clinical practice or in your region that you’re in.
So, yeah, I think that’s it from us. So happy New Year to you all.
[00:37:32] Speaker C: Happy New Year.
[00:37:36] SPONSOR: The Whole Tooth Aotearoa/NZ is sponsored by the Claire Foundation. The Claire foundation is a progressive philanthropic organisation that wants more for our people and our planet. They’re proactively acting in ways to positively influence our environment, oral health, youth, well being and women to create extraordinary change. You can find them at W.W.W.Clare.nz . That’s Clare; C-L-A-R-E.
From us at The Whole Tooth Ao/NZ. KA KITE ANO!
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bout, you know, decisions that are being made.
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