Almost 50 per cent of Kiwi adults don't go to a dentist. What's going on?
December 12, 2017 at 8:49 AM
Almost 30,000 children had teeth removed in the year to December 2016. The same year, 6600 kids were hospitalised with rotten teeth.
While those figures are shocking, almost of the adult population doesn't even go to get dental check-ups due to the cost.
Former prime minister Helen Clark is pushing for free dental care for adults, too. In a recent social media post, Clark wrote: "I am increasingly concerned about the deterioration in New Zealanders' dental health.
"We read shocking stories about the state of children's teeth, but there are also many adults who cannot afford regular dental hygiene appointments and basic treatment who end up with serious problems."
HOW DOES OUR DENTAL CARE SYSTEM FOR ADULTS WORK?
National Clinical Director for oral health, Riana Clarke, said basic dental care for children and adolescents up to their 18th birthday was fully funded by the Government.
Emergency dental care for relief of pain and treatment of infection for low income adults was funded through district health boards and was usually subject to patient co-payments.
"Dental treatment required due to accidents is funded by the Accident Compensation Corporation. Work and Income New Zealand provides special needs grants or loans for urgent dental treatment for low-income adults," she said.
New Zealand Dental Association chief executive Dr David Crum said: "In terms of where dental care is delivered for adults in New Zealand, it's a high-quality service model that is delivered through private practice by dentists and beyond that, there's very little other service provision.
"Some of the district health boards - well most - will run to some varying degree relief of pain or emergency treatment so it's limited in terms of low-income adults to those two aspects.
"In its entirety, it's private practice delivery, really.
"The evidence in terms of outcomes is that there has been a dramatic improvement in the last 20 years. In terms of dental health - and in fact in some ages groups - we have seen a lifetime decay experience halve."
Dental services in New Zealand hospitals: The number of publicly funded procedures by gender and age group to the year ended June 2014. FIGURE NZ
Crum said there was still a large sector of New Zealand that only attended a dentist in private practice when they saw a need.
"They don't attend for routine check-ups. They use their dentist like doctors when something's not right or it hurts."
"So perhaps 40 per cent of the population haven't seen a dentist in the last year or two years."
"You're getting a large group of people who are seeing a dentist when they have got problems rather than doing the recall and check-up, and amongst that group there are a significant number [for whom] the cost is a barrier."
Head of Preventative and Restorative Dentistry at the University of Otago, Associate Professor Jonathan Broadbent, echoed that.
He said emergency dental care funding for adults was "the ambulance at the bottom off the cliff".
New Zealand hospitalisations for dental cavities: The number of publicly funded patients discharged by district health board of residence to the year ended June 2014. FIGURE NZ
Because of that system [of funding] for emergencies only, it results in people delaying care until [any issues] become so serious they can get it addressed."
Summing up, Crum said system worked well, but there was a sector of New Zealand who were not attending and for whom the cost barrier was significant.
HOW EFFECTIVE IS IT?
The 2009 Oral Health Survey found dental decay was the most prevalent chronic - and irreversible - disease in the country.
One in three adults had untreated coronal decay and one in ten had root decay. A quarter had experienced trauma to one or more of their upper six front teeth.
"There was clear evidence of need for dental care among adults, with nearly half of feeling they currently needed dental treatment. In the past year, nearly half of all adults had avoided dental care due to cost and one in four adults had gone without recommended routine dental treatment due to cost," a summary of the survey said.
Over half (55.3 per cent) of all adults reported feeling they did not see a dental professional often enough, with the highest prevalence among 18–34-year-olds (about 70 per cent). One in two adults (45.9 per cent) felt they currently needed dental treatment.
About 44.1 per of adults had avoided dental care due to cost in the last year, and 25.3 per cent had gone without recommended routine dental treatment in the past year due to cost.
However, the oral health of New Zealanders had improved over time, the survey said.
"The prevalence of total tooth loss has decreased dramatically among New Zealand adults since 1976, and adults are retaining more of their natural teeth into older age."
Further, the survey said: "Trends show that a far smaller proportion of people were missing one or more teeth due to pathology in 2009 than in 1988, with prevalences almost halving among 20 - 24-year-olds and 35 - 44-year-olds.
"There has been a dramatic decrease in the prevalence of edentulism (toothlessness), with particularly large reductions among 35 - 44-year-olds (12.8 to 1.7 per cent) and 65 - 74-year-olds (61.6 to 29.6 per cent).
HOW MUCH WOULD FREE DENTAL CARE FOR ADULTS COST?
"If you wanted to make dentistry free for everybody, that's $800 million to a billion a year," Crum said.
The Ministry of Health hadn't costed providing universal dental care, it said.
In comparison, the MOH said dental care for 18 and unders cost about $144m per year, excluding GST.
Emergency dental care for low-income adults with Community Services Cards cost $8.5m and hospital dental services, $46m, excluding GST.
Broadbent said if free dental care were to suddenly be provided for adults, there would be a capacity issue.
There simply wouldn't be enough dentists to do all of the work.
Crum said making it free wouldn't necessarily increase attendance.
"When we talk about making it free, it is free for children and adolescents and yet, in that adolescent group, one third don't attend.
"A lot of it is a mix of priority and cost and personal attitude towards health."
Clarke, when asked what stood in the way of providing free dental care to adults, said: "The current focus for publicly funded oral health treatment is on the oral health of children and adolescents.
"Evidence indicates that oral health status at age five predicts oral health status at age 26. Facilitating and supporting good oral health from an early age helps set people up for life and thereby reduces the likelihood of needing costly dental care in later years."
Health Minster David Clark said free dental care for families in need was "the direction we need to head in". However, budget constraints would limit that.
At a senior doctors' and dentists' conference last week, the health minister was asked if he would consider an affordable, accessible primary care dental service for vulnerable and low-income adults.
Clark said he "fundamentally" agreed, but funds were limited.
More affordable access to dental care would mean changes to the workforce as well, he said.
He also wanted more advice about working towards that goal.
A DIFFERENT WAY TO FUND
Broadbent said he was in favour of taxing unhealthy products to help pay for dental care.
"If our dental care became free for everybody there would be a capacity issue. There would not be enough dentists to provide cover," he said.
"If you are making an argument that we should publicly fund dental care then it makes sense to tax the unhealthy behaviour that contributes to risk for dental issues."
That included smoking - which caused gum disease - and sugar - which caused tooth decay.
Broadbent also suggested extending the care provided to adolescents to people in their early 20s and people on low incomes.
Rates of dental decay were high among people in their 20s and cost was listed as a factor preventing low income earners from visiting a dentist, Broadbent said.
Clark's comments in her Facebook post were similar to Broadbent's.
"One way ahead would be to build on what is available to beneficiaries and to extend that to adults in families receiving Working for Families payments," she wrote.
Broadbent pointed out that most dental care was a form of surgery. That was why it was expensive.
WHAT SHOULD WE BE FIXING HERE?
Crum said regardless of other issues, better access to dental care was a priority for the association.
"But at the moment, that's still taking the perspective of fixing things that are broken rather than preventing disease in the first place.
"Our main priorities have been, for some time, community water fluoridation and the reduction of sugar. We can give better accesss to care for everybody but it the disease is not prevented in the first place we're wasting our time and huge sums of money.
"Our next priority is to think about and look forward to what is available for treating the elderly. We've got a growing population who are entering their old age with their teeth heavily filled, needing constant maintenance and repair.
"So that my generation, that's what we are facing in huges numbers, where as my childrens generation, when they come through, will have very little dental work that needs to be maintained because there is a large proportion of kids that don't have any fillings.
"So it's preventive, the elderly, and access for low income adults.
"To be fair, I think we're getting some real traction on the water fluoridation and sugar."
LET'S NOT FORGET A LOT OF THIS IS PREVENTABLE
Crum said "I think, in these sort of debates, we forget that this [dental decay and gum disease] is almost completely preventable... with a bit of self responsibility.
"We are talking about high costs and people can't afford dentistry but what it takes is a toothbrush, fluoride toothpaste and minimising sugar. That sort of gets lost in the discussion.
"Then where do you prioritise it with the rest of the health spend when you have things like cancer ... that are perhaps not as preventable.
"I don't think this is heading down the track of free care for everybody. I think where it needs to go is really targeted and consistent subsidy for low-income adults and it can only be delivered in private practice, because that's where the workforce is. It's also the only vehicle of delivery where there is a dentist in every community."
"If every community had water fluoridation we'd see a reduction of 40 per cent of dental decay. Think of the money that would save, rather than trying to provide free care to fix the problem."
Fluoridation would cost about 80 cents per person per year, he said.
Clark said in her Facebook post the issue was broader than treatment.
"Prevention must encompass looking at the damage done by excessive sugar consumption and the Government acting to curb that, as is happening in other countries."
- Leith Huffadine, Stuff