Dental care in Nelson

First dentists in Nelson

JW Tatton. (Copy Collection, Nelson Provincial Museum, C2643). Source NZETC.
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One hundred and fifty years ago the first dentists arrived in Nelson by ship from England. These dentists were often jack of all trades: pharmacists, doctors, and blacksmiths, as well as tooth pullers.

Before 1880 a dentist mostly needed a strong wrist, as their main activity was to extract teeth. No local anaesthetics were available, and the only drill available was not effective. Little repair work was carried out by the early dentists, but they did also make expensive sets of false teeth, from ivory and gold, extracted human teeth or porcelain. Dentists practising at this time included the very successful John William Tatton and Herbert Pearson Rawson. Tatton, who practiced from 1858 was also a doctor and chemist, and famous for his connection with the Dun Mountain company and the plaster casts of the Maugatapu murderers' heads.   Rawson practised in 1880 and went on to become the first president of the New Zealand Dental Association in 1905.

Looking along Hardy Street, Nelson. Showing (on right), Newman Brothers Crown Livery Stables; G F Dodds - dentist;The Wilkins and Field Hardware Company - ironmongers, 1911(?). 'Sir George Grey Special Collections, Auckland Libraries, 35-R858
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Mãori dental care

Caries and periodontal disease affected the earliest Mãori inhabitants of Nelson. Around 1500 AD, changes in diet led to their teeth, especially the back teeth, being worn down at an early age. European observers, such as Captain Cook, frequently misjudged the age of Mãoris, as their toothless state made them appear to be much older than was really the case. When the European settlers arrived, Mãori diet changed again. Softer European foods and also sugar, tobacco and alcohol, coupled with a less active and healthy lifestyle, affected the natural health and also the teeth of Mãori. Apart from the chewing of fern roots, which had a natural cleansing effect on the teeth, little is known of early Mãori attempts at oral health measures.

The Mãori did, however, make good use of herbal remedies, using the extracts of bark, leaves and roots of native plants. The kawakawa, or Mãori pepper tree, was used to relieve toothache, as was the matipo or mapau, using a liquid made by boiling the leaves. To ease pain, a decoction of manuka or kanuka leaves was used and similar use was made of the inner bark of the Pukatea, which was steeped in hot water and placed over the painful area. The boiled leaves of the Koromiko hebe were used for a mouthwash and gargle.

Kawakawa. Source Wikimedia
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Dentists registered from 1880

Registration for dentists and chemists was required under the first Dentists Act which was passed in 1880.  At this time there were about 50 dentists practising in New Zealand. By the year 1901 there were 282 registered. In the next four years to 1905, when the New Zealand Dental Association was founded, there were 464 registered dentists. Dentistry became a more esteemed, and profitable profession. The Dental Bill of 1904 set standards to protect the public.

unknown, “Dental operating theatre.,” ourheritage.ac.nz | OUR Heritage, accessed July 10, 2015, http://otago.ourheritage.ac.nz/items/show/5948.[1920's second Otago Dental School
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After 1880, major technological innovations revolutionised dentistry throughout the western world. The introduction of the engine-operated foot pedal enabled dentists to drill teeth and fill them on a large scale, and surpassed the old hand held drill. A new adjustable dentist’s chair became available, increasing the range of operations a dentist could perform. Cheaper and improved filling materials, such as gutta percha and various amalgams were introduced, however gold continued to be used. Vulcanite rubber became available as a base for false teeth. Coal gas, which was used for heat and energy, enabled a greater range of metallurgical work using gold and other metals, for the construction of complex bridgework, and nitrous oxide became available for pain relief, allowing an increase in operating possibilities.

Gradually the profession developed, with the formation of the apprenticeship system, the establishment of the dental school and the dental degree, and the setting up of the New Zealand Dental Association.

New Zealand introduced the Bachelor of Dental Surgery in 1907. Prior to that, dentists trained overseas, usually in North America, Ireland or England. A Dental School opened in Dunedin in 1908 and control of dental education came under one centralised body, the University of New Zealand.

Improvement of general dental care

The inspection and repair of the teeth of New Zealand Defence Force volunteers in 1914 highlighted the nation’s poor dental health. The New Zealand Dental Corps (NZDC) was formed in 1915 to provide dental treatment in camps to members of the Defence Force. Their other duties included using dental records to identify disfigured war dead.

The involvement of dentists and dental mechanics in active war service enhanced the prestige of dentistry and demonstrated the value of public dental-health programmes.

The leader of the NZDC, Colonel Thomas Hunter, returned from war in 1918 determined to move the focus of dentistry from extraction to restoration and prevention of decay. As director of the new division of dental hygiene in the Department of Health, he successfully advocated for the establishment of the School of Dental Service in 1921 to treat primary school children.

In  the 1920s the Department of Health began an advertising campaign to encourage healthy eating and personal dental care, utilising posters, exhibitions at agricultural shows, health weeks and lectures. The campaigns continued into the 1960s, increasingly using radio, film and television.

The passing of the Social Security Act 1938 led to general improvements in access to health care, including dental-health care. From 1937 milk was provided free in schools, to supply calcium for teeth as well as improve children’s nutrition generally.

By 1947 dental care was provided free to students up to standard six (year eight), and a government-subsidised scheme staged by new dental graduates was established to treat the teeth of adolescents up to the age of 19. This was later lowered to 16.

The School Dental Service

The School Dental Service commenced in 1921 in response to the large amount of dental decay in New Zealand children’s teeth. It was a world first and staffed entirely by female dental nurses and free to all primary aged schoolchildren.

New Zealand. Department of Health. New Zealand Department of Health :Preventive filling. The protective filling; why the School Dental Service fills certain second teeth soon after they erupt through the gum. R E Owen, Government Printer, Wellington, New Zealand. 25,000/10/50 -9980 [1950]. Ref: Eph-A-DENTAL-1950-01. Alexander Turnbull Library, Wellington, New Zealand. http://natlib.govt.nz/records/30120566
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The first intake was of 35 women, who started their training in a building that later became the Prime Minister's house. Twenty five clinics were built across New Zealand and staffed by the 23 graduates of the first training intake. The first clinic opened in July 1923, proving to be popular and efficient. Dental nurses with transportable equipment serviced remote areas. Further training schools were established in the 1950s.

Changes in the 1960s

By the 1960s the average intake was 270 students per year across three dental nurse training schools in Wellington, Christchurch and Auckland.  When Jennifer Lucas, from Nelson, trained to be a dental nurse in the Wellington Dental school in Willis St in 1962, it had become a popular career choice for women.

Jennifer did a two year training followed by a third year out working in clinics but under supervision.  Her job was to examine and clean teeth, do fillings and tooth extractions, apply fluoride treatment to teeth and provide health education.

In 1966 nurses averaged 300 fillings per month compared with 40 per month these days. Jennifer did a range of fillings. “Copper amalgam was used for primary teeth, silver amalgam for secondary teeth and a white filling (silicate) for front teeth.   Copper was heated until beads of mercury came up and then the mixture was mixed with a mortar and pestle and excess mercury squeezed out through gauze. No gloves were worn and there was a real danger of mercury poisoning.”  Zinc oxide powder and Eugenol (oil of cloves) was another filling mixture, but it set very slowly. Children from 2½ to 12 years at primary and intermediate schools were treated by the dental nurse and secondary school pupils were treated by a dentist.

At the clinic visitors were greeted by the distinctive aroma of methylated spirits, dettol and other cleaning fluids. The walls were covered with Department of Health posters encouraging cleaning teeth and healthy diet. The nurse wore a white starched uniform and veil, white seamed stockings and bright red cardigan. Uniforms and laundry service was provided as part of the job.

Jennifer said “We did everything in the clinic ourselves. Along with providing treatment we did a lot of paperwork, such as setting up appointments and writing reports. Although we didn’t take X-rays we were required to use this information. On the creative side we made many gauze bumble bees for “good children”  to take away as a momento of their visit.”

Extensive coverage by Nelson dental nurses

Marguerite Hill. (2010) Examples of butterflies and bees made out of cotton swabs, paper bibs and dental floss, which decorated School Dental clinics or were given to children to take home visiting the dental nurse for the first time were allowed to take one home.[Source Te Ara]
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The Nelson area extended to Kaikoura and Haast and originally employed 68 dental nurses, or dental therapists as they were later called. Nurses were sent to outlying areas such as the French Pass with transportable equipment to set up a temporary clinic. Jennifer found herself working at Nelson Central School which had a very wide catchment to serve including Hira, Tasman Street and Clifton Terrace schools.  These pupils could be seen in the dental clinic but French Pass children required the setting up a temporary clinic.  In 1964, 1965 and 1967 Jennifer set off on the bus to French Pass with a huge tin trunk containing anaesthetics, a primus to boil water on, a tin steriliser, a spit bowl, dental instruments and other paraphernalia required. The treadle drill broke down to fit in a wooden suitcase, and the folding wooden dental chair fitted into a canvas haversack. Where the dental nurse would visit, who she would see and where she would stay was organised by the School Dental Service.

Jennifer recalls ”I got off the bus at French Pass and set up the clinic in the back of the Post office for approximately seven days. Children came in from Durville Island in a launch to be seen.  I stayed in the local guesthouse. The next stop was Okoha.  I stayed with the Redwoods family here who were very friendly and hospitable. I was transported here from French Pass by the Connollys launch, and remember the hair-raising row ashore in a rowboat that made several trips to bring myself and the equipment ashore. As Okoha school was fairly basic, and was set in the middle of a paddock, I set up my gear and worked on the lawn outside the Redwoods house.  Some of the children’s teeth were excellent partly due to their limited access to fizzy drinks and sugary food.”

“Next stop was the Manaroa School where I was hosted by the Harvey families and I set up my equipment at their homes, boiling the steriliser on the stove.  Next I went overland to Waitaria Bay School and that first year no water was laid on, presenting a number of challenges.  I stayed with the Nott and Godsiff families. Next stop was Portage then over the hill to catch the Mail Boat back to Picton, then the bus back to Nelson.”

Dental health improves

In later years the service to French Pass was discontinued citing risks of cross infection, and children had to travel further to get dental care. The improvement in children’s teeth after the introduction of the school dental service was marked.  In 1925 there were 78.6 teeth requiring extraction for every 100 teeth restored; by 1974 this figure was reduced to two extractions to 100 restorations. Today many retain their teeth through adulthood whereas it was common in the first half of the twentieth century to lose your teeth by your twenties or thirties. 1940s Health posters urged youth to guard their natural teeth for they are the best.  Whilst filling teeth was an important duty of a dental nurse, they were dedicated to dental education to prevent cavities and tooth loss in the first place. Sugary drinks, however, remain a problem. Fluoridation of water is still a contentious issue despite lessened tooth decay in areas that switched to fluoridated water. Flouride toothpaste is recommended in the fight against tooth decay, and mouth guards in sports.

Trained nurses often gave up their careers when they married and Jennifer also had a break when she had children.  Returning to work fulltime in 1983 she was required to retrain, as the use of high speed drills had been introduced, as well as a number of other changes. Improving dental health had resulted in nurses seeing children once yearly rather than twice yearly, so each nurse doubled her number of patients. Jennifer worked at a number of clinics serving many schools including Central, Nelson and Broadgreen Intermediates, Clifton Terrace, Auckland Point, Enner Glynn, and Lower Moutere.

In the 1990s the School Dental Service (SDS) changed from a national service, run by the Ministry of Health, to a more fragmented service under different governing and funding bodies.  The SDS was rejuvenated and renamed Community, and subsequently Child, Oral health Service, after evidence of worsening decay in pre-schoolers teeth and poor dental health in some areas of the community. It provides treatment and advice for children from birth to age eighteen. 

2015

Jennifer Lucas, of Nelson,  was interviewed by Debbie-Daniell-Smith in 2015 (updated 2024)

Sources used in this story

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