5. Workforce
5.1 Dentist and Dental Specialist Education and Competencies
The New Zealand Dental Association position is:
That a general dentist requires undergraduate education and training in a university programme accredited by the Dental Council of New Zealand, or to have been assessed and approved by the Dental Council of New Zealand to have an equivalent level of education and training to a
New Zealand trained dentist.That a dental specialist requires a postgraduate programme of education and training accredited by the Dental Council of New Zealand, or to have been assessed and approved by the Dental Council of New Zealand to have an equivalent level of education and training to a New Zealand trained dental specialist.
Undergraduate dental education involves the teaching of future dentists to prevent, diagnose and treat oral diseases and meet the dental needs and demands of the individual patients and the public.
Graduating dentists should be able to carry out the full scope of practice of dentistry as defined by the Dental Council of New Zealand using modern, appropriate, effective and currently accepted methods of treatment. Dentists require interpersonal communication skills to work successfully with patients, members of the dental team, wider health system teams and colleagues. These skills are fundamental for dental practice in New Zealand.
Dental education should include the development of cultural awareness and cultural safety appropriate to practise in New Zealand.
It is important for undergraduate dental education to take into consideration the broadening role of dentists in line with the broadening definition of oral health and quality of life. Dentists require a strong understanding of the relationship between oral health and general health and the role of dentists in intra- and inter-professional collaboration in the delivery of oral health services.
Dental specialists have undertaken a further period of education and training of at least three years in scopes of practice established in the Health Practitioners Competence Assurance Act. Dental specialists have a higher level of training and experience in their specialist scope of practice than general dentists or other oral health practitioners.
5.2 Dental Workforce Demographics, Demand and Supply
The New Zealand Dental Association position is:
That an increase to the number of New Zealand government-funded dental student positions is required:
to improve the representation of Māori and Pacific peoples in the dentist and dental specialist workforces.
to improve the regional distribution of the dentist and dental specialist workforce.
to address the estimated increases in workforce requirements and low baseline levels of access to dentists.
to address the plateau in overseas qualified dentists registering in New Zealand; and
to address a substantial reliance upon overseas trained dental specialists.
That dentists and dental specialists are the practitioners that encompass the practice of dentistry, and that in addition to clinical dentistry their practice can include clinical leadership, teaching, research and management.
That the development of inter-disciplinary workforce teams, including oral health therapy and clinical dental technology, and integration of oral health into primary care teams can strengthen access to oral health care.
The New Zealand Dental Association is aware that a complex range of issues influence the number of dentists in New Zealand, and their distribution within the country.
There is substantial regional variation in the number of dentists as a ratio to the population. The number of dentists has increased steadily over the past 25 years, overseas trained dentists as a proportion of the dentist workforce have doubled but plateaued at approximately one-third of the workforce since 2010. While a greater number of Māori and Pacific peoples will be required for the dentist workforce to match their proportions in the New Zealand population, it is notable that many of the dentists educated in New Zealand have remained in New Zealand to practice over the past decade.
Dental therapy and dental hygiene training programmes have changed to a Bachelor of Oral Health and the number of dental therapists is declining with retirements. In contrast, the numbers of oral health therapists are growing, and they hold a wider scope of practice that includes dental therapy and dental hygiene. There are further changes to the scope of practice of oral health therapists developing, with newer graduates able to provide a limited amount of adult dental care.
While on overall assessment the number of dentists per 100,000 population has grown, the growth does not take sufficiently accommodate for an increasingly dentate older population with higher oral health needs, or that baseline levels of access to dental care in New Zealand are comparatively low.
5.2.1 Active Dentist and Dental Specialist Numbers
During the period 2012 to 2024 the New Zealand population grew from 4.4 million to 5.1 million. The population 15 years and older, who primarily receive dental services with dentists, increased from 3.5 million to 4.4 million. The dentist population increased from 2,127 to 2,724.
Despite the increasing number of dentists, the ratio of dentists to the New Zealand population declined 4.9% during this 12-year period. Further analysis suggests that dentists were working 18.9% more hours each week. The pattern of a declining ratio of dentists to the population, and a greater average number of hours worked each week, suggests a dentist workforce under increasing demand to address the oral health needs of the population.
Beneath these headline figures are greater challenges in the dental workforce available to the population.
5.2.2 Regional Variation
There is substantial regional variability in dentist to population ratios. In 2024, central Auckland and the Southern region (both former DHB regions) accounted for over 1 million people, 20% of the population and 18% of the dentists. Both regions had more than 50 FTE/100,000 population greater than 15 years of age. Auckland is the largest city and the Southern region influenced by the dentist workforce of the University of Otago Faculty of Dentistry.
The challenge of headline figures and regional variability is illustrated by the Southern region though. In 2022 Dunedin had 120 FTE dentists per 100,000 people greater than 15 years of age while Invercargill had 58 and Gore 15. Dunedin City has a large proportion of dental specialists which is consistent with them being a large component of the teaching staff of the University of Otago School of Dentistry.
In 2012, 60% of the former DHB areas of the country had a dentist ratio of 45 FTE to 100,000 population over 15 years of age, or lower. By 2024, this has increased to 85% of the former DHB areas. At dentist to population ratios of this level other international jurisdictions (eg Ireland) have described dentist workforce difficulties, including lack of access to care and inability to recruit and retain a dentist workforce.
Research by the New Zealand Dental Association in 2022 found that 38% of urban and suburban dentists, and 61% of dentists in rural locations, reported their workload as greater than they would like. A greater proportion of rural practitioners experienced poor mental health than those in other localities.
5.2.3 Low Baseline Utilisation of Dental Care
Modelling by the Ministry of Health of dentist workforce demand has estimated that a workforce growth of 11.3% will be needed in the period 2020 to 2029.
However, that growth is based on the 2020 assumption that only 1.7 million people will use dental services. Put another way and based on a 2020 population of 5.1 million people, 4.2 million of who are aged over 15 years, this assumes service access by only 33.7% of the total population and 41.6% of the population aged 15 years and over.
The 2022/23 New Zealand Health Survey estimated that 1.95M people aged 15 years and over (49% of that population) visited a dental health care worker in the past 12 months. A number of these visits would have been to oral health practitioners other than a dentist, such as a dental hygienist or clinical dental technician. On that basis, workforce modelling estimates of around 42% of the population with access to a dentist in the past 12 months appear to be reasonable.
As described in section 4.3, these levels of utilisation of dental services are associated with poor access for people in the highest category of deprivation, and with delays in access to care.
5.2.4 Demography of the New Zealand Dentist Workforce
The New Zealand dentist workforce is significantly under-representative of Māori and Pacific peoples at 4.4% and 1.8% respectively in 2024.
Over the last 10 years, overseas-qualified dentists have comprised approximately one third of the dentist and dental specialist register. In the period prior to 2010, there was a steady increase in the proportion of overseas-qualified dentists from approximately 5-10% in the mid-1990s.
Dental specialists with an overseas qualification comprise a slightly greater proportion of the number of dental specialists registered, at 44.5%, while it is 31.4% for general dentists. The primary countries of origin for qualifications of overseas trained specialists are the UK, Australia and the USA.
Unlike the 20-year period of steadily increasing numbers of overseas qualified dentists, the situation now appears to have plateaued. For the foreseeable future, maintaining and enhancing the New Zealand dentist workforce appears to be increasingly reliant upon the supply and retention of dentists from New Zealand training.
There is a single source of New Zealand-trained general dentists: the University of Otago Faculty of Dentistry programme. The government provided funding for 54 New Zealand students per annum from the mid-1980s until an increase to 60 funded positions per annum in the graduating class of 2018.
Historically, New Zealand lost graduates overseas, especially to the UK and Australia, resulting in approximately two-thirds of the Otago class remaining in New Zealand 10 years after graduation. However, overseas employment opportunities for dentists with a New Zealand qualification diminished from the 1990s, particularly due to EU employment restrictions.
Graduating numbers from the University of Otago remaining in New Zealand have generally been high since 2015, as a result of small numbers of internationally funded students over the New Zealand government-funded cap continuing to reside and work in New Zealand.
5.2.5 Changing Dental and Oral Health Therapist Numbers
A new scope of practice known as Oral Health Therapy was introduced by the Dental Council in 2017. In 2012, there were 804 dental therapists and 593 dental hygienists and orthodontic auxiliaries (1,397 practitioners). By 2022 the total workforce of oral health therapists, dental therapists and dental hygienists/orthodontic auxiliaries had increased to 1,752 practitioners (753 OT, 593 DT and 406 DH/OA). However, the scopes of practice for these workforces make it complex to assess their impact on New Zealanders' ability to access dental services.
Dental therapists largely had a scope of practice in dental care for people aged under 15 years (a very small number had an adult scope of practice). Dental hygienists had a scope of practice in preventive and periodontal care for children and adults, but mostly for adults. Oral health therapists have a combination of these scopes.
An adult scope of practice for oral health therapists has been introduced by the Dental Council, but to date access to training has been limited and almost all oral health therapists have a limitation on their scope of practice excluding dental care for adults other than the traditional preventive and periodontal services. This is changing, but it is unknown how much additional care will be made available to the population by the extended scope of practice.
Meanwhile, the numbers of dental therapists are declining, creating access issues for children who have traditionally been provided most of their dental care by dental therapists. Health New Zealand | Te Whatu Ora and Te Aka Whai Ora | Māori Health Authority acknowledged this issue in their Health Workforce Plan 2023/24. They indicated then that the public dental system is 220 (20%) short of oral health therapists currently and would need an additional 10% of trainees on top of the current pipeline by 2032.
5.2.6 Public Sector Oral Health Workforce Plans
Neither the 2023/24 Health Workforce Plan nor the 2024 Health Workforce Plan of Health New Zealand | Te Whatu Ora comprehensively considered the dental workforce needs of the country. The plans are limited to considering the publicly funded sector needs of Health New Zealand | Te Whatu Ora.
As discussed, the 2023/24 Health Workforce Plan estimated that Health New Zealand | Te Whatu Ora had a projected shortage of 220 dental or oral health therapists. The 2024 Health Workforce Plan indicates a plan to secure 100 additional places in undergraduate education for a range of allied health professions that include oral health therapy. It also states,
“Acute shortages in dental workforces (oral, dental and maxillofacial surgeons and dentists; and oral health therapists) … produce specific challenges for patients requiring those care pathways….”.
The 2024 plan commits to creating “6 advanced dental training roles”.
5.3 Wellness in the Dentist Workforce
The New Zealand Dental Association position is:
That it aims to support dentists across the profession by focusing on four key recommendations made from its research with Revolutionaries of Wellbeing.
Strategy and governance: the Association has a focus on setting up the systems and structures to influence wellbeing at a system level.
Relationships: the Association is working closely with other key stakeholders to advocate for a greater focus on wellbeing in dentistry.
Communications and resources: the Association aims to provide dentists and dental practices the tools to better lead wellbeing themselves, and is encouraging greater storytelling of the realities of dentistry.
Member support: the Association is strengthening access to wellbeing supports, collegiality and social wellbeing through NZDA networks.
Dentistry is a demanding profession which challenges practitioners physically, mentally, intellectually and emotionally. Dentists across the world struggle with the various demands of the role, and dentists in New Zealand are no different.
In 2022, the New Zealand Dental Association engaged Revolutionaries of Wellbeing (ROW) to help it better understand wellbeing across the dental profession. ROW undertook a qualitative and quantitative research project with 517 dentists surveyed and 4 focus groups with dental students, practice owners, contractors and public sector practitioners across practice settings. The report provides a strong understanding of the drivers of wellbeing within the dentistry profession, including the psychology of the ‘average’ dentist, a greater understanding of what ‘good’ looks like and the qualities and competencies of a thriving dentist.
The ROW research found that the profession is challenged across a range of psychosocial risks, from patient interactions, staff relationships, the complaints process, the fear of making mistakes, and isolation. Dentists were struggling across a number of fronts. Notably, the pursuit of ‘perfection’ has led to dentists being unwilling or unable to speak openly about their mistakes or their struggles.
The New Zealand Dental Association has established the Well Aware Together programme to support dentists, and to be a world leader in wellbeing in dentistry.