Can you afford to go to the dentist?

Viv got a $1200 quote from her dentist to treat periodontal disease. “I work full time and have a mortgage and pay rates, insurance, petrol, food … I simply can’t afford to pay for dental treatment on top,” she said.

With the rising cost of a trip to the dentist, many of us put it off until there’s a problem.

Dr Assil Russell runs the dental charity Revive a Smile and sees people who can’t afford treatment turn up when the pain becomes unbearable.

“People who are living pay cheque to pay cheque, and don’t have any disposable income, end up leaving their oral health for years and the problem becomes worse as time goes on,” she said.

In desperation, some reach for the pliers. “We see a lot of DIY dentistry,” Dr Russell said.

Poor dental health doesn’t just come with a financial cost. If you’re in pain, you can’t eat properly, or function at work. There’s also the stigma of having bad teeth, which can put people off seeing friends or even leaving the house.

“Socio-economic disease”

Dr Rob Beaglehole, sugary drinks spokesperson for the New Zealand Dental Association (NZDA), is blunt.

“Dental decay is a socio-economic disease,” he said.

“The lower down the socio-economic rung you go […] the less likely you are to go to the dentist or dental therapist.”

Health statistics back that up. Children living in poverty have higher rates of dental disease than the rest of the population.

Tooth decay is not only painful for children but can lead to speech impairments and delayed language development.

Problems that aren’t treated when you’re young can go on to haunt you when you’re an adult. There’s growing evidence linking poor dental health to serious medical conditions, such as heart disease and diabetes.

Waiting for care

Routine dental care is free for children and teenagers until they’re 18. However, long waiting times and staff shortages are leading to delays in care.

In Auckland, more than 170,000 children are waiting for a check-up. Another 1362 are waiting for specialist treatment while 637 need treatment under a general anaesthetic.

NZDA president Dr Katie Ayers said district health boards (DHBs) don’t have enough oral health therapists to staff services.

“This means thousands of children are overdue for their check-up appointments across the country.”

Covid-19 lockdowns and limited opening hours for dental services haven’t helped.

Dental disease has become the leading cause of hospital admission for children.

Dr Beaglehole said about 8000 children were treated at hospital last year, at an average cost of $4000 for each patient.

Staff shortages mean DHBs prioritise those in the most pain. Next in line are patients who have been waiting the longest – in some cases more than three years – followed by those at low-decile schools.

Dr Martin Lee, public health researcher and Canterbury District Health Board community dental service clinical director, said the “seamless” service envisaged when the current system was introduced in 2006 hasn’t been delivered.

While facilities are friendlier places for children and their families to visit, lack of staffing is a significant barrier to providing care, he said.

Families may not be aware their children are entitled to free care either.

“Not everyone realises it’s free, particularly for adolescents,” Dr Lee said.

Some teenagers don’t go to the dentist because their family isn’t in a regular habit of attending, often only going when they have problems.

“Persuading teenagers they need to go so they can avoid problems later”, is also an issue, Dr Lee said.

Funding shortfalls

Once you hit 18, the cost of seeing the dentist falls on you

If you can’t afford dental treatment, Work and Income New Zealand (WINZ) may help (provided the treatment is urgent or essential). The hardship grant for dental care is $300 a year, although can be increased in exceptional circumstances.

Last year, about 80,000 grants totalling $35m were paid out; $23m of this must be repaid.

However, the NZDA says funding falls well short of meeting needs. It estimates the cost of providing free routine dental care to low-income consumers at $187m to $450m a year.

In its 2020 election manifesto, Labour promised an extra $176m for dental care. This money was earmarked to increase emergency grants from $300 to $1000 and fund another 20 mobile dental clinics to improve access in remote areas.

However, the funding wasn’t included in the 2021 budget.

Speaking to media after the budget, Minister of Health Andrew Little said he was “determined” Labour will make good on the commitment. “We don't get to do everything in a single Budget. It remains a promise to be fulfilled by us but we're in government for three years,” he said.

NZDA president Dr Ayers is “still hoping” the increase in urgent grants will happen during this term.

A rise in grants is top of the NZDA’s wish list. It also wants free routine dental care extended to 18- to 24-year-olds who are on benefits and community dental services overhauled to make sure those most in need get treatment.

Changing the system

Some relief could come with the pending restructure of the health system.

In April, the government announced DHBs will be replaced by one Crown entity called Health New Zealand. It’s expected to be up and running by July 2022.

Dr Lee thinks it could result in “public and private sector dental systems working together … and be better integrated with other local primary health services”.

Simple interventions could deliver big improvements.

A pilot programme in South Canterbury provides one example. It’s a collaboration between South Canterbury District Health Board, local health agencies, Arowhenua Whānau Services, and two education centres.

Children at Arowhenua Māori School and bilingual early learning centre He Manu Hou are given free toothbrushes, fluoride toothpaste and supervised brushing with the aim of encouraging toothbrushing habits.

“We know that this programme works well to reduce cavities and the pilot programme has also shown us that it helps tamariki to remember to brush their teeth at home,” South Canterbury District Health Board’s dentist Aravind Parachuru said.

South Canterbury District Health Board director of Māori health Joseph Tyro said the plan is to roll it out to other schools in the region. The roll out has already begun with early childhood education centres.

Sugary drinks tax

The other big factor in dental decay is what we’re drinking.

Dr Beaglehole points the finger at the role sugary drinks play in poor dental health. The number one reason kids get holes in their teeth is due to sugary drinks, he said.

Sugary drinks are worse for teeth than sweet food because of the way they’re consumed. As you drink, the liquid washes over every tooth surface.

Public health groups – including Health Coalition Aotearoa, the New Zealand Medical Association and the NZDA – have been calling for a tax on these drinks.

A similar tax in the UK led to a 30g reduction in the amount of sugar consumed in households each week.

A drinks tax is yet to make it on to the agenda here.

A Ministry of Health spokesperson said it’s monitoring international research but “there are no immediate plans to introduce a tax on sugary foods and beverages in New Zealand”.

Funding FAQs

What dental care is free?

Standard dental care is free for children and teenagers until they’re 18. But if your offspring needs to see an orthodontist to get braces, you’ll need to pay for it. 

You can enrol your baby or toddler for dental services by calling the Ministry of Health service 0800 TALK TEETH (0800 825 583). Your child’s first visit should be between their first and second birthday.

Community Oral Health Services see primary school children. The services are run by district health boards and staffed by oral health therapists. They can treat gum disease and teach kids how to care for their teeth. More specialist care is done by dentists. From the age of 13 to 17 years old, dental care is provided by local dentists.

What support is available for adults?

If you can’t afford dental treatment, you may be able to get a hardship grant from WINZ. This grant is $300 a year and is means tested. For example, if you’re married (with or without children) your weekly income before tax must be less than $858.72 to qualify. 

If you don’t qualify for a grant, you can apply for an advance payment on your benefit.

What if I don’t qualify for WINZ funding?

The NZDA, in partnership with Southern Cross Health Trust, offers free treatment for low-income adults with high dental needs. You must have a community services card and be over 18.

In the past six years, 4679 adults have got treatment through the scheme.

If you miss out on an appointment, you could try dental charity Revive a Smile. It provided 3707 treatments over the past two years, in conjunction with Southern Cross Health Trust. You need to apply via its website. You may be offered free treatment or asked for some contribution towards care.

What if I need dental treatment because of an accident?

If your dental injury is the result of an accident or sports injury, ACC may pay for treatment.

How much does a visit to the dentist cost?

The median cost for a routine check-up (with an x-ray) is $98, according to the NZDA’s latest fee survey. Once you’re in the chair, the dentist may find work that needs doing that costs over and above the check-up fee.

Fluoridated water

It’s up to local councils whether fluoride is put in drinking water supplies. However, the Health (Fluoridation of Drinking Water) Amendment Bill could change that. The bill gives the Director General of Health the authority to direct a council to add or remove fluoride from the water. 

At present, about half the country is drinking fluoridated water. Moves to fluoridate water in some areas have met fierce opposition.

Associate Minister of Health Dr Ayesha Verrall said the bill will put fluoridation “outside of the political realm and in the hands of someone who is resourced and able to make that expert decision”.

The World Health Organization recommends water fluoridation as one of the most effective public health measure for the prevention of dental decay.