Blazing the trail of dental nursing

A group of dental nurses in 1993.

“THE oral hygiene of rural children was appalling back in those days,” recalled retired teacher W Wong, now in her 60s.

Kapit was her first posting and concerned about the poor dental health of her pupils, she decided to do something about it.

She felt sad seeing small children with blackened teeth and having toothaches all the time. Some didn’t even know how to brush their teeth properly.

Wong said when she looked at the facilities of urban schools, she couldn’t help feeling envious. Her alma mater – SJK Methodist, Sibu – was the first in Sarawak to have a dental clinic.

But a decade-long wait brought change to Kapit in the form of better healthcare from Christ Hospital, which later became the government hospital.

Wong remembers Kapit had dentists like Dr Liberto Sison (Christ Hospital) and later, Dr Bob Baru (government hospital).

Retired dental nurses meeting up with Wong.

She is happy that today, the Primary School Dental Programme is still being maintained.

“I really have a lot of respect for those pioneer dental nurses who served so admirably in the rural areas.

“There were really not enough of them – just a sprinkle in the vast interior of Sarawak. If only we had more dental nurses and rural clinics in those days, people would not have had to suffer so much from poor dental care.”

Sarawak is bigger than the whole of Peninsular Malaysia, with an area of almost 130,000 sq km.

A locally designed silver buckle of a dental nurse uniform.

It hasn’t been easy to implement the school dental programme for both urban and rural areas since it was started in the 60s.

Although the remote areas continued to pose a challenge to the Health Department, the dental nurses, officers and staff persevered in their efforts to bring better healthcare to the rural population.

Dental nurses provided incremental oral health care to primary school children with annual check-ups.

According to a Miri dental nurse, if primary school children had access to proper dental care, they would have very healthy teeth and gums by the time they attended first year of secondary school.

 

Pioneering dental nurses in the 60s working in a makeshift dental clinic at a school library.

Early overseas training

In the 1950s and 1960s, New Zealand was the main dental nursing training centre for young Sarawakian women, selected for this rather new occupation at the time.

Female candidates with a Senior Cambridge Certificate were sent to either the Dominion Training School for Dental Nurses in Wellington or the training school in Christchurch under Colombo Plan scholarships.

The training took two years and three months, including three months of field experience where the trainees served as New Zealand state dental nurses. Sixteen Malaysians graduated from these training schools between 1951 and 1968.

After Sarawak joined Malaysia in 1963, dental nursing candidates were sent to the Dental Nurses Training School in Singapore or Penang, which adopted the New Zealand curriculum.

In 1964 and 1965, four nurses were trained in Singapore and 11 in Penang. From 1966 onwards, all the trainees – between eight and 12 per batch – were sent to Penang for training annually.

Tooth-brushing drill at a kindergarten.

Retired dental nursing matron Veronica Wong told thesundaypost, “In 1969, 10 of us were sent to Penang for training. We became the best of friends and never forget to wish each other happy birthday. Among our group were Edwina Lau, Jenny Ling, Connie Chang, Betty Yeo, Angela Aw, Rokiah Ahmad, Nona Hilil, Paula Lim and Mary Sia.”

 

Job description

Wong said, initially, the job of a trained dental nurse was to provide routine dental care to primary pupils in school clinics, including oral check-ups, fillings restoration, extractions, scaling, and dental health education.

Teeth brushing was supervised before class and after recess. The nurses would demonstrate this with a huge set of artificial teeth and a huge toothbrush.

“The Primary 1 kids were amused when we used the big toothbrush to show them the correct brushing movements.

“It was a bit amusing but should be effective if the teachers followed up by ensuring the children brushed their teeth properly. Some teachers helped with the session but in some schools, dental nurses had to supervise,” she added.

 

Mobile squad

In 1978, the Mobile Dental Squad was introduced to increase coverage of oral health services to school children in remote or less accessible schools.

Since then, more children have been treated through this outreach approach than the school dental clinics. Nurses in charge of school clinics have from time to time to visit places without electricity and water supply.

The squad would bring with them a lot of equipment, including generators.

Lau explained, “In many schools, water supply was an issue. Some schools we visited had no piped water and had to depend on rain, river or well water. Quite often, we had to bring our water supply.

“A generator – even noisy – was necessary if the school was too remote to be connected to the main grid. The lighting would be poor, making hard for the dental nurses to work.”

There are many remote schools in Sarawak yet to be reached.

Recalling her early nursing days, Datin Doris Wong said, “Very often dental nurses and team members had to stay overnight at the schools because of bad roads or low rivers. Today, I hear it’s still the same for some of the remotest schools.”

Aw added, “Not many knew the hardships of dental nurses in those days. One of the greatest challenges was having to leave our babies or toddlers at home when we were on travelling duty to the ulu.

“It was usually for a week to minimise government budget. We were very worried if our young ones had a fever or diarrhoea. But thankfully, family members were around to keep an eye on things. It was part of our career – the occupational hazards involved in travelling to the remote areas.”

 

School dental health activities

In 1983, oral kindergarten and preschool health services were first introduced on an organised basis.

Initially, the emphasis was on oral health education which included, among others, tooth brushing drills. Later, dental nurses carried out systematic and comprehensive oral healthcare for children in kindergartens near school dental clinics or through outreach initiatives.

In 1991, the Implementation of Toddlers’ Initiative programme at Maternity and Child Health Clinic was introduced as an extension of the oral healthcare services for antenatal mothers.

Its main objective was to raise oral health awareness and instil sound oral health practices for toddlers and their parents.

Toddlers together with their parents or guardians were given oral health education talks by the nurses.

In 1995, a new initiative was introduced to promote oral health awareness and sound oral health practices for toddlers and preschoolers as well as among the childminders and their young charges at daycare centres and nurseries.

 

Dayang Mordeana, who has retired from the dental service, is now training young dental nurses to use high tech equipment.

Qualifications

Initially, the dental nursing course was regarded only as a certificate qualification. However, in 1996, the course was recognised as equivalent to a diploma.

In 1998, a six-month post-basic training in the relevant specialities was introduced at Dental Training School Malaysia, which got good feedback from students.

Reena Steven said when she was in Primary 1, she was terrified of going to the dental nurse’s room, adding that the sound of the dental drill frightened her.

Once when she was due for a dental check-up, she pretended to be sick and went home.

Then one day, when she was in Primary 5, she met a woman at her aunt’s church office who had two missing front teeth.

According to Reena, the woman looked “a total mess”. As her husband had abandoned her, a kind aunt brought her to see the dentist.

The next time, Reena saw the woman, she was wearing dentures, looking more cheerful, and had found a temporary job with the help of the church.

Reena said she was at the time old enough to understand the woman’s situation. So she went back to the school dental programme and started getting dental check-ups.

Today, she has a perfect set of teeth – thanks to the lesson from the woman with two missing front teeth and, of course, all the dental nurses.

Simon Ting from Kanowit said the dental nurses he knew were all very dedicated and did a marvellous job. He met several of them from the mobile clinic while working in Sibu and Mukah.

“Sarawakians, especially from lower income group, should be happy we have good school dental service,” he added.

Although great strides have been made at improving Sarawak’s oral healthcare, more remains to be done.

Regardless, no one should forget that the pioneer dental nurses have blazed the trail to a vastly improved rural dental health service in Sarawak.

Without their dedication and devotion to duty, we might not have been able to get to the root of the dental health problem, especially for children in far-flung schools.

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