New Zealand School Dental Service
By Helen McCaul
Thomas Anderson Hunter was born in Dunedin, New Zealand, on 10 February 1963, the son of Scottish parents. Educated at Otago Boys’ High School he chose dentistry as a career and, as was essential in those days, was apprenticed to a Dunedin dentist, Alfred Boot, one of Dunedin’s most successful dentists, becoming registered in 1881. He travelled as far as Invercargill and Lawrence, where he and Boot spent much time repairing the damage wrought by rough tooth-pullers. Hunter also worked with Boot and other progressive Dunedin dentists to help provide extra instruction for their younger colleagues and so raise the standards. But the situation remained hopeless, with the first attempt to establish a Dental Association in 1989-90 proving a failure. Standards of training and practise remained low and quackery was still commonplace into the new century.
It is a tribute to the industry that Hunter’s long years of private practice in Dunedin from 1881 until 1914 are still remembered as a conscientious and distinguished contribution to his profession. His concept of dentistry, however, was wider than the confines of his own surgery and it is in the broad vision of a health service to the community that he is chiefly remembered. He took an active part in the inauguration of the New Zealand Dental Association in 1905 and was elected its first president. This was an important advance in the status of his profession, but of even greater significance was his association in establishing the Otago University Dental School. Parliamentary legislation quickly followed and a university education became an essential qualification for the practise of dentistry. Hunter later endowed this school with £10,000 for research purposes. When the New Zealand Dental Corp was established in the First World War, Lieutenant-Colonel (later Colonel) Hunter was appointed as its first Director, for which service he was awarded the C.B.E.
The cause of progressive dentistry only advanced from 1903 when Hunter and other Dunedin dentists won the support of the Liberal member for Caversham, T.K.Sidey. They persuaded Sidey that standards could only be improved if dentists were trained to university level and entrance criteria into the profession were tightened. Sidey’s new Dentists Act was passed in 1904, the second New Zealand Dental Association was established in 1905 to oversee its implementation, and the Dental School was established at the University of Otago in 1907. It was based in Dunedin, reputedly because Hunter and others had persuaded Premier Richard Seddon that the city had the climate most suited to scholarly endeavour. Hunter helped see through these developments as second President of the NZDA. He also made clear his commitment to the new training institution by guaranteeing £1,000 to ensure that the Dental School was built.
Reform took time and Hunter and the NZDA still had a problem with unqualified dentists gaining entry to the profession. However, H.P. Pickerill, foundation Director of the Dental School, insisted that the highest standards be maintained, and with the backing of Hunter and the NZDA he ensured that New Zealand dentistry developed independently of the dominance of the medical profession or dental mechanics. Meanwhile, Hunter gained in remuneration and status; by 1903 he resided in the elite area of Heriot Row and in 1905 he was Vice President of the exclusive Dunedin Club.
When soldiers were recruited for the First World War, about 60 per cent of men had to be sent for dental repairs. Hunter, as Chairman of the Executive Council of the NZDA, proposed that a civilian corps be established to perform work, at cost. This scheme, under the guidance of Hunter and Pickerill, proved so useful that a full New Zealand Dental Corps was established in November 1915. Hunter was placed in charge of its operation and given the rank of Lieutenant-Colonel. He worked mainly from New Zealand but travelled to Britain in late 1916 to oversee the establishment of dental units on the western front. He insisted the Corps remain independent from the New Zealand Medical Corps. For his efforts he was later promoted to the rank of Colonel.
Hunter’s experiences in the Dental Corps persuaded him that something dramatic had to be done to improve the dental health of future generations. Once he was appointed to the post of Director of the new Division of Dental Hygiene within the revamped Department of Health, he proposed his solution of establishing a school dental service, which was to constitute his greatest contribution to the development of New Zealand dentistry.
Hunter was a close friend of child health reformer, Truby King, who had initiated the Plunket Nursing system. Greatly admiring the work of these nurses, he based his dental nursing proposal on this model. He argues that women were better suited than men to working with children, and added that such a scheme would be far cheaper than training more dentists. Pickerill and others expressed concern that stand of dental care and the development of the dental profession would be undermined, but Hunter won the day because the cheapness of the scheme appealed to politicians.
Colonel (Sir) Thomas A Hunter proposed the idea of a dental school program staffed by young women trained in preventive dentistry in 1921. In the same year a Dental School to train the dental nurses opened in Wellington.
With the election of the first Labour Government in 1935, the programme was rapidly expanded with new facilities in Wellington and additional schools being opened in Auckland and Wellington in the 1950’s. In the post-war baby boom new dental nurses could not be trained fast enough to tend to the growing student population until new hiring and the new schools were built.
The creation of a School Dental Service staffed by women appealed to politicians as a cheap way to keep spending down in a period when government resources were stretched. Given the appalling loss of young men in the carnage of World War One, the resulting labour shortage mean that dealing with the dental care crisis would very likely to have required increased training and employment of women in dentistry. Such employment also provided a better means of earning income for those who would marry late or never marry because of the lack of sufficient males surviving in their generation. Moreover, the chronic state of dental decay in the early 1900s clearly indicated that limited income prevented the general population from effectively purchasing private dental care. If dental care of children were to remain a private expense, they would have simply gone without.
This was no sadistic experiment in the compulsory torture of the young: parental permission was sought and widely given. By the mid-1970s, more than 60 per cent of pre-school children and 95 per cent of primary school children were voluntary registered (by their parents) with the School Dental Service, underscoring the high participation rate by the community.
The School Dental Nurse, in her “whites” and red cardigan and her clinic, also known as “the murder house” to generations of kids, quickly became a part of the school community, though children tread rather warily in when in the vicinity of the clinic lest they be summoned inside for one of their twice yearly check-ups.
Significant improvements in dental health were registered over time. For instance, in 1925 there were 78.6 teeth requiring extraction for every 100 teeth that were restored. By 1974 this figure was reduced to 2.5 extractions for every 100 restorations.
Hunter’s initiative helped keep women out of dentistry until the 1970s: its emphasis on women’s traditional role and the provision of a job between school and marriage proved to be popular. He was a man of his times in which gender roles were firmly drawn. Hunter promoted the service with enthusiasm and got it away to a good start. He was knighted in 1946 for his work as foundation Director and celebrated by donating £1,000 to the Dental School for research purposes.
Thus, many young adult New Zealanders today retain a full set of teeth, many with few fillings, in strong contrast to the first half of the twentieth century when many of the same age cohort had lost many or even all of their teeth by sometime in their twenties or thirties.
Thomas Anderson Hunter devoted a lifetime to the progressive improvement of dentistry in New Zealand, participating in the movement to improve the training and practice of dentists by establishing the first Dental School and university degree in Dunedin.
The military call-up graphically brought to public attention the poor physical health of New Zealand’s youth, at least of military age. Dental Health was no exception.
Thomas Hunter died at the age of 95 on 29 December 1958. His long career in dentistry had seen major advances in dental care and a shift from the apprentice system to full professionalism. His dental nursing scheme later influenced developments in more than 15 countries. Latter day opinion of his worth is divided and some believe that Hunter wanted to keep women out of the mainstream of the dental profession. However he can be credited with introducing a novel and distinctive experiment in public health care which became an integral part of the New Zealand childhood experience.
The New Zealand School Dental Service was a world-first, providing preventative dental care to primary and pre-school children from clinics located on school grounds. Rather than take the children to the dentist, the dentist was brought to the children
Colonel Sir Thomas Anderson Hunter was the man who made it all possible. Such is the price of succeeding by swimming against the stream and getting spectacular results.
Helen McCaul trained as a Dental Nurse in the 1970’s. She went on to work in New Zealand then for the South Australian School of Dental Therapy (Adelaide) - which was a school service was based on the NZ scheme. Further travel took her to Britain before returning to New Zealand.