Should New Zealanders avoid dental health care due to cost?

In New Zealand, a trip to the dentist is a significant expense for many and one that is put off for as long as possible.

The risk for dental problems is determined in early childhood and can be intergenerational. Those born into disadvantaged families go on to have greater rates of tooth decay as adults. Tooth decay is the main reason why children older than 1 year require pre-arranged hospital treatment. After respiratory conditions, dental treatments have often been the second-biggest cause of hospital admissions. Children receive free basic oral health services until their 18th birthday, yet most adults can only access dental services through the private system.
 
In 2021, more than 8,600 children aged 1-17 had general anaesthetic for dental work. Many families go private, meaning hundreds more children are treated by paediatric dentists and oral surgeons under anaesthetic in private hospitals.
 
In 2020/21, 39% of adults aged 15 years and over avoided going to a dental health care worker in the previous 12 months because of cost. Only 34% of people living in the most deprived communities visited dental care in the previous 12 months, compared with 56% in the least deprived areas.

The financial support for low-income families who need to visit the dentist has not been increased for more than two decades. A 2019 report by the New Zealand Dental Association showed that, if the government provided NZ$900 worth of subsidies each year for the people most in need, it would break even in terms of return benefits. Even at a cost of $590 per person per year, the Government would get a $1.60 return on each dollar spent.
 
Historically, oral health professionals have had a bio-medical focus on oral disease prevention, with health education often focusing on personal responsibility for health, and the need to maintain a healthy lifestyle that promotes good health and wellbeing. This perspective however, overlooks the underlying complexities of a person’s life, the reasons why they cannot make the changes that seem on the surface (to those of privilege) to be the easy, sensible and responsible choices: eat less sugar, brush twice a day and attend dental checks.

New Zealand needs to increase our spend on preventive dental care to save on the high costs of dental interventions. Currently, population-level prevention represents a very small component of the public dental health care budget.

Short-term changes would mean things like emergency dental grants, while long-term fixes include getting compulsory teeth brushing in schools. In the medium-term, more could be gone to get more dentists in hospitals. Additional strategies would include: health promotion initiatives, water fluoridation, nutrition labels on food and health promotion in schools.