Over the years, Reece has had nine molars extracted from his mouth because it is cheaper than getting them fixed. When he opens his mouth, nearly every tooth on the bottom row up to his canines are gone.
The 41-year-old, who didn’t want to include his last name in this story, said he didn’t look after his teeth when he was young and now is unable to afford getting them fixed properly.
Losing his teeth has become his biggest worry, he said.
In New Zealand, routine dental care is free for under 18-year-olds. There is also some emergency dental care available through the public healthcare system and a means-tested Work & Income grant is available for dental costs under $1000.
However, the cost of dental care for most adults means nearly half (42%) can not afford to go. That number increases to 54% for Māori and 51% for Pasifika, according to a 2022 report by the Association of Salaried Medical Specialists (ASMS).
This is because dental care is excluded from the public health system so the average dental appointment bill is $353 — about half of an adult minimum-wage earner’s weekly income.
A single dental implant, like Reece would need, can cost between $5000 and $8000, with a full setup for upper or lower teeth costing between $18,000 and $30,000.
“It’s scary. I honestly don’t know what I am going to do,” he said.
“There is just no support for it when you get older and no one has that kind of money to do something about it.”
Cost of NZ’s dental care system
A new report commissioned by Dental for All, a group of health professionals, unions and campaigners calling for universal dental care, looked into the social, economic, and fiscal costs of New Zealand’s current dental care model.
The report uses New Zealand and international studies and on dental care across and along with Treasury cost-benefit analysis to make estimates.
The estimates found a lack of access to dental care could contribute to up to $103 million in sick days and $2.5 billion in loss of work productivity.
“We know our current approach to dental care is failing communities. But what this report shows is how our current approach doesn’t make economic sense either,” ActionStation campaigner Max Harris said.
“When people are affected by oral health this can lead downstream to health problems like loss of sleep, diet and sometimes disabilities which is an increased cost. Also not feeling good in your physical health can contribute to worse mental health and less social interaction or productivity at work.
“We shouldn’t have to put a number figure on these things…but what it does say is if you add up all of those different interactions this actually costs society significantly.”
Harris said the estimates are conservative and the costs of the current system could be “even higher” as the report could only use data that was publicly available before 2022.
The report also does not factor in the impacts on increased dental grants for low income earners or people who can afford private dental care.
Minister of Health Dr Shane Reti told Re: News, in an emailed statement, it is important to ensure primary and community health services (including oral health services) are “responsive to need” and pointed to the current funding available for under 18 year olds and low income earners.
“I will continue to receive advice on how we can further improve oral health services across New Zealand,” he said.
‘I took out a loan to get my wisdom teeth out’
When Hope saw a dentist when she was 17 she was told she needed a root canal but she said this work was delayed until she was 18 years old and so she could no longer afford to get it done without the government funding available for under 18-year-olds.
“I just dealt with it because I couldn’t afford it,” she said.
“When I was living as a student, I was living off living costs and so it was either I get my teeth checked and work out a payment plan or I eat that week.”
By the time she was 21, she spent about a year taking Panadol and putting Anti-flamme on her cheek every other day where her teeth hurt to try and cope with the pain.
“My teeth hurt so much all the time and I couldn’t deal with the pain anymore. So, when I was 22, I took out a loan to get the root canal and get my wisdom teeth removed.”
The procedure cost Hope around $2500, which took her four years to pay off.
Hope said if there had been government funding for dental care for over 18-year-olds, she would have had the procedure earlier and could have avoided the chronic pain.
Liberty McIntyre-Reet, 22, has also had to put off getting dental care because she cannot afford it.
When Liberty went to the dentist for the first time since leaving high school last year, she was told she needed seven fillings at a cost of around $2000.
“I just burst into tears in the waiting room. I just wasn’t prepared for it at all. This was last year and I haven’t been back since,” she said.
Current state of dental care
Because of the cost associated with the dentist, many New Zealanders avoid going regularly which has led to a 30% rise in the number of people who need hospital-level emergency dental care. A quarter of a million New Zealanders need a tooth extracted every year due to severe tooth decay.
The Dental Care for All report highlights how specialist and emergency dental care through the public health system costs an average of $4.7m a year.
Harris said the reason dental care largely sits outside of the public health system is “not due to good policy or a medical reason”.
“When the public health system was set up, dentists lobbied to keep oral health out of the public healthcare system, and so we cut teeth out of our understanding of health as a whole. And so really, this is just about correcting an anomaly,” he said.
Sarah Dalton, the executive director of the Association of Salaried Medical Specialists, said there is “no doubt” making the hefty investment into universal dental care would end up saving the country money in the long term.
But the true cost of universal dental care — where dental care is government-funded for everyone — is unclear. A 2018 Ministry of Health report put the cost of fully-free dentistry at $658m, however, more recent estimates by Association of Salaried Medical Specialists put it at over $1 billion.
“We supposedly have the social contract in New Zealand, that health care will be free for people who need it. But dentistry, GP, physio, podiatry, hearing, and optometry are all privatised so these services have a for-profit model.
“But then hospital care is free — now I am not saying we change this but any preventative health care people can access in the community that doesn’t involve being in a hospital is way cheaper for the state and way, way better for the person.”
What’s in the way of universal dental care?
Dr Robin Whyman from the New Zealand Dental Association doesn’t believe universal dental care is realistic for New Zealand with the current workforce restrictions facing the sector.
Data from 2019, published by the NZ Dental Council, shows New Zealand’s workforce is among the lowest in the OECD.
“The practical reality of doing that is a very big jump from where we are today,” he said.
Whyman points to how there is still only one dentist training course in the country at the University of Otago which trains 60 dentists per year — a number which hasn’t changed in 40 years.
“If you look at the dentist numbers around the country there is a very big difference in the availability of dentist numbers across the country. And it particularly affects provincial and regional New Zealand the most. So we very much believe that you’d have to address the workforce issue first.”
Whyman said universal dental coverage should instead be extended to people in their mid-20s and more funding should be available for specific groups and parts of the country that have higher levels of dental disease.
Whyman also said there needs to be a bigger focus on prevention activities such as increasing water fluoridation across the country, and looking at a sugar tax on products like sugary drinks and toothpaste and brushes being more affordable.
“We know that people who have high levels of dental disease, or even moderate, have knock on effects in terms of health issues and suffer because they are unable to access dental care, which is what this report and many others shows,” Whyman said.
“But we need to think what is the priority here with the workforce that we have and so targeting those high risk people first is the most realistic solution.”
