Report highlights failures of NZ's dental care system, calls for universal access

The slogan "Healthy mouths, healthy lives" represents the World Health Organisation's (WHO) global oral action plan for the Pacific.

The WHO says one in two Pacific children has dental caries in their baby teeth, marking the highest prevalence worldwide.

A report released on Tuesday by the Dental for All Coalition highlights the struggles with oral healthcare in New Zealand.

One key finding of the report titled, I Didn't Want to Smile', is that the current $1000 grants for urgent dental care are "not fit for purpose".

The report also reveals the limitations and inaccessibility of these grants, which affect individuals over 18, while basic care remains free for those under 18.

The report states the failures of the dental care system and the stigma faced by those unable to afford treatment.

Key findings suggest that many individuals seek healthcare through GPs or face financial stress due to high dental costs.

A 2022 poll indicated that 74 per cent of New Zealanders support making oral healthcare free, with various political parties proposing free dental care in the 2023 election.

Brooke Pao Stanley from Manaaki Rangatahi and Auckland Action Against Poverty has watched individuals struggling with dental costs in South Auckland and advocates for change.

“In my work at Auckland Action Against Poverty, I repeatedly hear about people unable to afford dental care. I believe the way forward is to treat dental health like we do general health and make oral healthcare free within our public healthcare system.”

The report advocates for universal, free dental care that is compatible with Te Tiriti o Waitangi. It emphasises that dental issues often escalate due to a lack of access to preventative care and calls for societal change to eliminate the shame and stigma associated with accessing dental care.

During the 2023 election, the Labour Party proposed free dental care for those under 30, the Green Party promised free public dental care for everyone, and Te Pāti Māori pledged free dental for individuals earning under $60,000.

Greens co-leader Marama Davidson says the ActionStation’s Oral Healthcare report paints a dire picture of unmet needs and inequality across Aotearoa, highlighting the urgency of providing free dental care for all New Zealanders.

Stevie-Nyx Ruki works on a patient at Cliff Dental in Castlecliff, Whanganui. Photo/LDR

"Quality dental care isn’t a luxury; it’s a human right. It’s time we treat it like one,” Davidson says.

"For decades, successive governments have chosen to exclude dental care from the public health system. This is a political choice, and different choices can be made. No one should have to suffer because they can’t afford to see a dentist. 

“Cost is the single biggest barrier in accessing quality dental care. That forces people to make impossible choices: skipping other essential healthcare, being unable to pay for food, power or rent to instead pay for basic care, or even resorting-harrowing details of which we can read in the report to dangerous DIY dental care or going without anaesthetic to save costs.

“The consequences of unaffordability and inaccessibility are dire. Chronic pain, long-term health issues, and this government might be interested to note lost productivity. The costs of not acting are higher than if we just fixed this problem once and for all.

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“For low-income New Zealanders, the MSD emergency dental grant is a mere $1000, and any cost beyond that must be repaid. It’s not even close to enough. No one should be in debt to the state full stop. And definitely not for basic healthcare. But, people are being forced into debt as high as $25,000."

The WHO highlights poor oral health as a significant issue in the Pacific, with over 800 million individuals (42 per cent of the population) suffering from dental caries, severe gum disease, tooth loss, or oral cancers.

WHO Regional Director for the Western Pacific, Dr Saia Piukala, says the prevalence of oral diseases has risen by 30 per cent in the past three decades, particularly affecting disadvantaged groups.

He says that while most oral diseases are preventable and treatable early on, high out-of-pocket costs for care make it unaffordable for many, and oral health is often excluded from national universal health coverage packages.

“Having good oral health enhances overall health and well-being in every phase of life," Piukala says. "By integrating oral health into primary health care, we can achieve cost efficiencies and bring down high rates of non-communicable diseases, paving the way for better overall health outcomes in the Western Pacific.”

A recent Pacific conference for Chief Dental Officers in Fiji adopted the Suva Declaration on Improving Oral Health in the region and established the Oral Health Pacific Islands Alliance (OPIA).

Since 2019, Vanuatu has been strengthening its oral health promotion activities through its health-promoting schools programme, known as the Gudfala Tut Skul programme. The initiative focuses on increasing access to affordable fluoride toothpaste and encouraging good nutrition by reducing the intake of sweets, biscuits, and sugary drinks.

"This helps to promote not only good oral health but also overall well-being. By educating them on proper toothbrushing and good nutrition, we can help ensure a healthier future for generations to come,” says Dr Jenny Stephens, Acting Director of Public Health.

Children in Tonga learn to brush their teeth as part of the Mali Mali programme. Photo/Tongan Ministry of Health

In Tonga, the South Pacific Medical Team (SPMT), a voluntary group of Japanese dentists, has been working with the country's Health and Education Ministries and the Japanese International Cooperation Agency (JICA) to improve children’s oral health through a programme called “Mali Mali” or “smile” in Tongan.

Every week, the SPMT visits schools across Tonga to assist teachers in teaching children how to brush their teeth and use fluoride-containing mouth rinses.

As a result, schoolchildren now brush their teeth every day at school after lunch, supervised by their teachers.