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Do New Zealand's Dental Therapists Improve Children's Dental Health More than the U.S. System?

Posted on Wednesday, October 9, 2013


WASHINGTON/PRNewswire-USNewswire/ -- In discussions of workforce issues and the media, New Zealand is frequently hailed as proof that dental therapists are the key to improving the oral health of underserved populations in the US.  The latest example is a brief published by the Pew Children's Dental Campaign, "Dental Therapists in New Zealand:  What the Evidence Shows." But that report contains a significant error, one that undermines Pew's overall premise. As it turns out, New Zealand and the United States have identical levels of untreated tooth decay in school age children. 

"Dental Therapists in New Zealand:  What the Evidence Shows" purports to demonstrate that the use of therapists in that country has resulted in dramatically better oral health outcomes among children than in children in the US: "Among 5- to 11-year olds, the treatment disparity is the most dramatic. In New Zealand, 3 percent of children in this age range have untreated tooth decay, compared with 20 percent of U.S. kids."  The brief's authors derived the statistic of 20 percent untreated decay among U.S. children from a 2012 report by the U.S. Centers for Disease Control and Prevention.  Their error—unfortunately glaring—was in assuming that the 20 percent figure represented permanent teeth only (originally reported by the CDC in May 2012; corrected in June), when in fact the CDC reports the statistic is for both primary and permanent teeth. 

While New Zealand's rate of 3 percent may be accurate for permanent teeth, the report referenced by Pew (2009 New Zealand Oral Health Survey) notes that 17 percent of baby teeth in New Zealand's 5- to 11 year-olds have untreated decay.  That adds up to a total of 20 percent. We have confirmed our reading of the data with the CDC. 

Why does this matter?  Because the Pew Children's Dental Campaign uses its erroneous calculations to buttress its arguments that New Zealand's use of dental therapists is responsible for better oral health among New Zealand children than those in the US.  When the numbers are corrected, those arguments fall apart.

"Ultimately, a 20 percent rate of untreated decay in children is unacceptable in any country," said ADA President Dr. Robert A. Faiella . "We are committed to changing this, as we know Pew is.  Unfortunately, debates about dental midlevel providers have threatened to drown out discussions of how to extend known, proven solutions to greater numbers of Americans who lack access to dental care, many of them suffering with untreated disease.  That's why the ADA remains committed to pursuing proven, actionable measures to deliver care now to those in need, prevent disease from occurring and recurring, and provide the knowledge that empowers families to become good stewards of their own oral health."

About the American Dental Association

The not-for-profit ADA is the nation's largest dental association, representing 157,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA's consumer website

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