Do New Zealand's Dental Therapists Improve Children's Dental Health More than the US System? The Numbers Say No

WASHINGTON, May 6, 2013 /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 www.ada.org. For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA's consumer website www.MouthHealthy.org.

SOURCE American Dental Association

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Vote numbers were changed, Kenyan court told

NAIROBI, Kenya (AP) — Vote totals for Kenya's president-elect mysteriously increased between the time the ballot numbers were announced at some remote polling centers and when they reached the national tallying center in the capital, a lawyer for a civil society group told the country's Supreme Court on Wednesday.

Kenya's six-justice Supreme Court heard arguments from a civil society group and from the legal team of Prime Minister Raila Odinga asserting that the court should invalidate the election commission's declaration that Uhuru Kenyatta won the country's March 4 presidential election with 50.07 percent of the vote.

Kethi D. Kilonzo, an attorney for the African Center For Governance, played a video for the Supreme Court that she said showed Kenyatta's vote totals increased between when some local polling stations publicly announced their counts and when those numbers reached the national tallying center.

One center, in Nyeri Country, said publicly that Kenyatta had won 53,252 votes, Kilonzo said. By the time the national election commission read the result, Kenyatta's total had increased to 55,726, she said. In addition to Kenyatta gaining votes, other candidates, including Odinga, lost votes, she said.

"This is an election offense, altering the result of an election," she said.

Kenyatta cleared the crucial 50 percent mark by only 8,400 votes out of more than 12 million ballots cast, making each vote of his highly valuable. Had he gotten below the 50 percent threshold, Kenyatta and Odinga would have faced one another in a run-off.

Kilonzo told the court it should invalidate all returns from Nyeri, an action that would drop Kenyatta below the 50 percent mark.

Kenya's March 4 election was marred by myriad technical failures, including the failure of an early returns system. Kilonzo said that if the early returns system had worked properly, there would have been no way for someone to alter the ballot returns without it being noticed.

"The electronic transmission of results was not for the benefit of the (election commission), it was for the benefit of the Kenyan people," said Kilonzo, who said the commission seemed to shrug off the failure of the system as a minor technical glitch.

Kenyans across the country have been glued to TV sets this week as broadcasting networks carried the Supreme Court case.

The last time Kenyans voted for president, in late 2007, allegations of rigging to benefit President Mwai Kibaki sent thousands of Odinga supporters into the streets. Violent ethnic clashes lasting two months killed more than 1,000 people. Odinga was eventually named prime minister in a coalition government.

Since then, Kenya has passed a new constitution and upgraded its judicial system, winning praise from international partners and much of the Kenyan public.

The Supreme Court is to decide by Saturday on the petitions by civil society groups and Odinga's legal team. No major violence has been reported surrounding this year's election, but the Supreme Court decision is another potential flashpoint that could spark violence, depending largely on whether Odinga accepts the court's decision, if it rules against him.

The court on Tuesday refused to accept an 800-page affidavit submitted by Odinga's lawyers and denied Odinga access to computer logs of the election commission. Similarly, Kilonzo's side has been denied access to the election commission's voter registrar.

Mugambi Kiai, a Harvard-educated lawyer who runs Kenya's Open Society Initiative, said he thinks the Supreme Court is displaying a mindset of an "old constitutional order" that may base a decision on procedure instead of evidence. He suspects its decisions will keep Kenyatta as president.

"If by their ruling they're seen or perceived to be siding with one party or seen to be favoring one side of the argument, the next 'loser' will not go to the Supreme Court," Kiai said. "This Supreme Court has to be very, very careful. This case, it's not about Railda Odinga and Uhuru Kenyatta. It's not. It's about whether in this kind of dispute the next time the 'losing party' will have faith and trust in the Supreme Court."

Kilonzo's group is trying to demonstrate not that Kenyatta didn't win but that constitutional and legal safeguards were so breached that the legitimacy of the election outcome is open to question.

George Oraro, Odinga's lawyer, told the court that variances in the number of registered voters by the electoral commission made it almost impossible to determine how many people voted.

Oraro said the Independent Electoral and Boundaries Commission announced that it had completed a list of persons registered to vote on February 18 as required by the law. However, the electoral commission continued to change the number of registered voters illegally after the deadline, he said.

Oraro said that the changes in the voter registrar could have affected the outcome of the elections taking into consideration Kenyatta surpassed 50 percent by only 8,400 votes.

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Associated Press reporter Tom Odula contributed to this report.

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