Ideasroom

Time for a state boost for dental care?

Has the time come for greater state support of dental care for particular groups in NZ society? Murray Thomson and Jonathan Broadbent from the University of Otago's school of dentistry take a look

The face and mouth are a vital part of well-being and how others see us. Basic human functions like eating, drinking, speaking and smiling can be readily affected by dental problems. Tooth decay is the most common chronic disease in the world, and anyone with teeth is at risk of it.

Tooth decay continues through life, with about one newly affected tooth surface per year in the average person. Early detection of tooth decay is essential for keeping your teeth, which is why regular dental care is so important. It is possible to stay dentally healthy without regular care, but when problems occur, the sooner they are dealt with the better.

We know that well over half of adult New Zealanders are not able to go for routine check-ups because they cannot afford dental care. You might like to ask your local candidates whether they are comfortable with that.

While New Zealand’s system of dental care for children and adolescents has been both praised and imitated overseas, poor oral health among disadvantaged New Zealand adults remains a pressing problem. Our national surveys show that there are considerable inequalities in adult oral health: 25-44-year-olds living in the most deprived neighbourhoods have four times as many untreated decayed teeth as those living in the least deprived areas. Considerably more Māori than Pākehā suffer disruption to their day-to-day lives caused by poor oral health.

We now know that, once young people are no longer eligible for state-funded routine dental care, inequalities in oral health steadily widen as they pass through adulthood. Let’s take the gradual loss of teeth as an example. The percentage with tooth loss among people in their mid-20s who have grown up in a deprived household (and who remain deprived as adults) is more than twice that of people who are better off. That’s shocking enough, but consider that the difference is over three times by the time those people are in their late 30s.

By the time they reach old age, those differences will be much greater. Poor oral health also continues down generations: parents with poor oral health are much more likely to have children who also suffer from it. You might like to ask your local candidates whether they are comfortable with oral health inequalities such as these.

Has the time come for greater state support of dental care for particular groups in New Zealand society? There is overwhelming support for it from the public: in our most recent national oral health survey (undertaken in 2009), 80 percent of adults felt that there are some groups who should be entitled to lower-cost dental care. Low-income adults (supported by 67 percent) and older people (56 percent) featured prominently among those nominated groups.

Recent work by the NZ Dental Association shows that even dentists support greater state involvement, as long as it does not interfere with most adults paying privately for their dental care. And then we have the unfair situation whereby a health emergency can be promptly dealt with at no cost to the patient, yet a dental emergency is not. You might like to ask your local candidates about their stance on basic dental care for low-income New Zealanders.

It’s not all bad where adult oral health is concerned, of course. For example, ongoing reductions in tobacco smoking rates have meant that rates of periodontal (gum) disease are steadily falling (although more can be done). We have the Health (Fluoridation of Drinking Water) Amendment Bill awaiting its second reading in Parliament: its primary purpose is to enable District Health Boards (rather than local councils) to make decisions on whether to adjust the fluoride content of water supplies in order to help prevent tooth decay. You might like to ask your local candidates why it is currently stalled, and what they are going to do about it.

New Zealanders used to be famous for their “false teeth faces”, but the bad old days of wholesale extractions and full dentures in young adulthood are well behind us. In a way, fixing that problem has meant that we are now victims of our own success: New Zealand now has unprecedented numbers of rest home residents with at least some of their own teeth remaining, but as yet no organised or effective system for maintaining their oral health.

We know that tooth decay rates in rest homes are far higher than they should be, and that almost half of us will eventually end up in aged care. But that’s a whole other article… in the meantime, you might like to ask your local candidates about their views on supporting effective and affordable preventive programmes in the aged care sector.

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