Unlike most other healthcare in New Zealand, dental care is not publicly funded, and the cost can deter people from getting treatment. While children and adolescents are entitled to free basic oral health services until they are 18, adults must pay privately for most dental services.
The Ministry of Health website says there is no recommended fee structure for private dentists so costs can vary depending on location, specialisations and what equipment is used.
Dental Association president Dr Katie Ayers says adults should be getting check-ups every six to 12 months depending on their needs, but many are not.
“Around 50 per cent of New Zealanders receive regular dental care. The remainder are sporadic attenders. “In an ideal world, everyone would have access to routine dental care. This would include regular check-ups and cleaning, basic fillings, and removal of teeth when required.”
Cost not the only deterrent
While cost is a big deterrent, it is not the only reason that people do not get regular check-ups, she says.
“Many New Zealanders report that they don’t attend check-ups as they don’t see the need to; others report that cost is a factor.
“We have found that even when the cost barrier is removed, low income adults do not necessarily attend the dentist.
“Other barriers to access may include work commitments, transport factors and childcare issues.”
University of Otago associate professor of dental public health Dr Jonathan Broadbent says many people are not getting optimal and timely dental care for two reasons: cost and neglect.
“One of the most difficult groups is the working poor. They are ineligible for funded/emergency care but would still struggle to pay dental bills.
“The second thing that gets in the way of optimal care is neglect; people put off going to the dentist until they get problems.”
Often oral health can be managed easily and problems can be fixed cheaply if picked up early.
Prolonged dental issues can cause pain, embarrassment, psychological upset and functional limitations as well as costing more, he says.
Oral health link to wellbeing
Dr Ayers says poor oral health has also been linked to some types of heart disease, low birth weight and can affect an individual’s ability to eat, sleep, work and socialise.
“Of course, the most important aspect in ensuring good dental health is prevention. Dental caries [tooth decay] is a preventable disease, yet it is also the most widespread.”
Key factors in reducing tooth decay include reducing the frequency of sugar consumption, good oral hygiene practices (including the use of fluoridated toothpaste), and community water fluoridation.
Dr Broadbent says that, in general, dental problems are linked to a person’s behaviour or lifestyle.
“What a person does or doesn’t do directly relates to oral health. Having tooth decay is directly related to diet and self-care.
“Smoking is the main cause of gum disease. Poor oral hygiene and sugar are the main causes of tooth decay.”
Optimal dental care starts with prevention but also includes stabilising problems and rehabilitating the mouth, he said.
What is oral health?
The World Health Organization defines oral health as “a state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing”.
What dental services are publicly funded?
The Ministry of Health website states there is a limited range of dental services funded for some adults:
People with disabilities or medical conditions such as mouth cancer may be referred to a hospital for their dental treatment by their usual dental practitioner or GP.
People on low incomes with Community Services Cards may be able to get emergency dental care, such as pain relief or extractions.
The latest New Zealand Health Survey results (2017/18) show that most people feel like they have good oral health but not all get regular check-ups:
80 per cent of adults reported their oral health to be ‘good, very good or excellent’.
94 per cent of parents rated their child’s oral health as ‘good, very good or excellent’.
Most children (83 per cent) visited a dental healthcare worker in the past year, up from 76 per cent in 2006/07.
Nearly half of adults (47 per cent) with natural teeth visited a dental healthcare worker in the past year, down from 52 per cent in 2006/07.