The Government needs to put its money where its mouth is when it comes to dental care, writes Emma Espiner

This week marked World Oral Health Day. Yes I know it was probably behind International Speak Like a Pirate Day in your consciousness but there’s a day for everything if you look carefully enough, and this one was championed across the socialmediaspheres by public health organisations around the world. 

I’m intrigued about the true impact of these global campaigns. Who are they for, really? A signal to funders that one is doing one’s bit for a government contract, a drop of information into the ocean of the internet? A genuine desire for something better, no doubt. But does it reach anyone who needs it?

If I sound cynical, it’s because I am. I’ve been looking at the state of our dental care in New Zealand or more importantly, who misses out, and I’m pissed off. Flash graphics on social media don’t have a chance of making a difference in our communities without real structural change in the way we do things. More on that later. 

There seems to be a lack of understanding of the seriousness of poor dental health, and the importance of prevention, both by individuals and a parliament which has yet to do anything meaningful to address the longstanding failure of our dental health system to cater for all New Zealanders. Dental healthcare is free until your 18th birthday – although cost alone doesn’t address access issues – but the Ministry of Health’s website highlights the bleakness of the picture for anyone older:

Think about that official advice for a second. Imagine you are one of tens of thousands of adults in New Zealand with zero disposable income. The agony of the toothache comes on and you’re on the phone and websites checking to see whether you can get a root canal for less than you paid for your car. The result is many poor New Zealanders have holes in their mouths because they couldn’t afford to keep their teeth. It’s a brutal reversal of the children’s story where the tooth fairy takes your tooth and leaves you money.

Indeed dental health is a marker of wealth. Mary Otto, author of the excellent Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America said that bad teeth ” … confer the stigma of economic and even moral failure. People are held personally accountable for the state of their teeth in ways that they are not held accountable for many other health conditions.”

And it’s true, isn’t it? Pick your favourite personal responsibility trope and apply it liberally – someone hasn’t taken enough ‘care’ of their teeth, they smoke, they drink too much soft drink, eat too many sugary foods, are generally careless with their health. This is why the World Oral Health Day slogans grate a little. 2014 was especially banal “Brush for a healthy mouth!” I guess the whole truth isn’t as snappy: “Revolt against the systemic inequities which have dealt you an unlucky hand and reduced your opportunities for physical, emotional and mental wellbeing!” 

Dr Scott Waghorn, the Lance O’Sullivan of dentistry, gets it. By ‘it’ I mean the fraught relationship many of us have with our dentists, and the inequities which exist. Take our toothache patient above, for example. The pain from the tooth mingles with the anxious anticipation of the drill and the fear of not being able to afford it. My own household is relatively comfortable financially and I get worried going to the dentist because I never know what it’s going to cost and what we’ll have to go without to pay for it. It’s very easy to understand how people of more limited means might defer a visit, hoping the problem will heal itself, rather than face the potential of an inconceivably large bill, and the embarrassment and frustration of not being able to pay. And then if it doesn’t go away the only option remaining is a trip to the nearest hospital, an emergency extraction on the cards without which you’d face the risk of a life-threatening infection. 

This is a particular problem for Māori, having the least access to health care of any population group in Aotearoa, which translates to having two times the rates of extractions of non-Māori. In an interview with The Hui in 2017 Dr Waghorn said that he wanted to create a “marae experience” at his practice. A Māori patient of his told me that the experience of a bilingual environment, combined with a dentist who has a genuine interest in the lives of his patients and his community, does feel like a marae. Dr Waghorn puts his money where his mouth is, financing a free clinic day every year and providing interest-free payment plans and innovative, affordable preventive treatment plans. A previous article by Teuila Fuatai here at Newsroom looked at Dr Lance O’Sullivan’s iMoko platform and the ground-breaking potential of the technology to enable early diagnosis of health issues, including dental infections, in early childhood centres and schools.  

The social impact of poor dental health goes well beyond the biomedical. In that respect, it’s like many public health issues which have root causes so entrenched and enormous that it’s difficult to see where you could make a difference. There’s a role for systemic change which will require a courageous champion from among our legislators: fluoridation, greater regulation of the poison at the heart of many of these problems (soft drinks), a good look at the bizarre separation of medical and dental care as if the mouth is somehow separate from all the body’s other health needs, and funding for truly responsive prevention measures which engage communities from the get go. My biggest frustration in public health is the people who ‘do’ public health to communities without asking them what their biggest concerns are first and working backwards from there. Personally, I think the potential for scary infections and unceasing pain from untreated toothache might be community’s biggest concern about their teeth, but they might be more concerned with the impact of a jagged grin on their employment prospects. We don’t know unless we ask.  

Affordable dental care was the late Jim Anderton’s ‘unfinished project’, one recently taken up by former Prime Minister Helen Clark. At a speech this week Helen Clark joked about her hefty workload, having recently returned to public life in New Zealand, and “the many interests I’m pursuing now I’ve got some free time on my hands.”

I’m relieved that this cause has a strong voice in our former Prime Minister, because there seems to be little appetite for structural change from the government benches, with the Minister of Health telling Stuff late last year that he agrees with Helen Clark in principle but the health budget has effectively already been spent. Frankly, that’s not good enough. Dental treatment in New Zealand is a national shame. 

There is an old aphorism that ‘health is the real wealth’. In New Zealand we treat good teeth as the bach, the boat and the BMW – a luxury that comes with the lifestyle.

The government needs to do much more. My message is: put your money where our mouths are.

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