Real stories from real dentists and their patients

– Dr Manu-Aroha Walker

An Invercargill dentist focussing on kaupapa Māori-based oral health care says poor Government-funding for adolescents’ dental services means hundreds of rangatahi with serious and preventable dental health conditions can’t get treatment. 

 Manu-Aroha Walker was speaking at the launch at Parliament on August 21 of the NZ Dental Association’s Roadmap Towards Better Oral Health For New Zealand.

 The Roadmap was launched by the Chair of the Health Select Committee, Sam Uffindell MP, on behalf of Health Minister, Hon Simeon Brown. 

 Manu-Aroha says 300 Invercargill Year 9 rangatahi could not enrol with a dentist at the start of 2025. 

 The problem stems from the fact the Government-funded Oral Health Service Agreement (OHSA), that supports free dental care for Year 9 to 17 years, is under-resourced and under-manned: contracted fees don’t cover the real cost of care, so providers can’t sustain clinics, and workforce shortages compound the bottleneck 

 “This problem is just getting worse,” she says. 

 “In New Zealand, dental care is publicly funded up to the 18th birthday, based on the evidence that strong oral health habits early in life have a long-term impact. But that doesn’t help much if you can’t even access a dentist in the first place. 

 “Dentists who operate under that scheme are losing money.  They can’t keep delivering services under those circumstances – it’s unsustainable – so something’s got to give.” 

 Manu-Aroha says the public sector provides just 15 percent of dental services in Aotearoa, with the vast majority delivered through private providers. 

 “Our system is fragmented. If we can work together more effectively, the entire community will benefit. What we need is a united front, supported by adequate resources and clear communication.” 

 But research shows that around 45 percent of New Zealanders can’t afford private dental care, and only 36 percent of people in the group with lowest incomes saw a dentist in the last 12 months she says. 

 As a result, many are forced to live with untreated oral health issues—problems that can impact their overall health and ultimately place additional strain on the wider health system. 

 “I’d like to see targeted investment to community oral-health hubs serving high-need communities, with an early-intervention focus that stops minor issues becoming serious and costly. 

 “I’d also like to see more emphasis on prevention as highlighted in the Roadmap. There are things we can do as a sector, working with Government, to tackle the oral health problem we face as a country, but we can’t do them without political support.” 

– Dr Sophie McKenna

Inside a dental system failing both patients and providers, and why dentists say it’s time for change. 

 Dr Sophie McKenna sees what many New Zealanders don’t: people at the farthest margins of society, whose lives (and teeth) are breaking down and the system is not set up to respond. 

 At the DCM Dental Service in Wellington, where Dr McKenna leads the volunteer clinic, patients are often without a toothbrush, a bank account, or a permanent place to sleep. 

 Many are navigating homelessness, mental distress, and addiction. Without a fixed address, some can’t even access the most basic social supports. 

 “These are people living below the line we think is the bottom,” Dr McKenna says. “And oral health is the least of their worries, until it becomes the worst.” 

 Dental emergencies are common. 

The hospital dental department cannot readily see patients with dental pain unless they meet certain criteria (medically compromised etc) and Emergency Departments only have capacity to treat dental pain with a medical viewpoint, sending the patient to find a private dentist. 

 Dr McKenna recalls a patient who during Covid ended up in intensive care after antibiotics failed to stop a raging infection and their dental complaint didn’t reach a certain threshold, until suddenly it was a medical emergency. 

 “There were necessary rules, but people like this fell through the cracks,” she says. 

 “We forget that dental infections can become life threatening. Research these days proves that heart heath, gut health, inflammatory issues, and many other aspects of general health are directly and negatively affected by poor oral health. 

People suffering very poor dental health are not just those experiencing homelessness. 

In the private practice she works in, in Porirua’s middle-income suburb of Whitby, Dr McKenna is extracting more teeth than ever before.  

 “Lots of people jump from one dental crisis to the next. They can’t afford (or don’t appreciate the value of) checkups or fillings, so by the time they come in, it’s too late to save the tooth. By then, even if they had all the money in the world, it couldn’t be saved.  

“I’m making more partial and full dentures every year and we thought this old-school model (pull teeth then get a plate) was dying off as oral health knowledge and availability improved. What’s most devastating is that we’re seeing it in 30, 40, 50-year-olds, not the elderly as we might expect.” 

That cycle is familiar to thousands of New Zealanders: wait until it hurts, pull it out, avoid the dentist for another few years – and repeat. 

Cost is the main barrier, but Dr McKenna says fear, stigma, and a lack of understanding keep people away too. 

“It’s generational. A lot of people haven’t grown up seeing the dentist regularly, and now they feel priced out of the system despite dentists these days charging far less proportionally to costs and incomes, than was charged in the 70’s and 80’s.” 

The system itself is fundamentally broken, she says. 

With dentistry operating entirely on a user-pays model, many Kiwis are priced out of basic dental care.  Fees vary between cities and clinics, as is reasonable for a business model, but this is health care. 

“There’s no way to have transparency, there’s no consistency, and no safety net. It’s basic health care, but it’s viewed as a luxury.” 

Dr McKenna, like many dentists, supports the idea of a universal baseline: for example, every New Zealander should have access to at least one annual check-up and one filling, perhaps means-tested. 

“It wouldn’t fix everything. But it would give people a reason to show up early, before things fall apart.” 

What won’t work, she warns, are poorly thought through initiatives. 

“A proposal to extend free dental care to young adults won’t succeed to address the core issue if there are not enough dentists; if we don’t fund it properly; if we don’t address care in the child and adolescent years; and if we don’t work on prevention initiatives like sugar consumption. 

“We’re already providing adolescent care at a loss and are not allowed to add a surcharge, unlike funding for GPs, funding for ACC etc. Dentists signed the Health NZ contract because fundamentally we want to support teens and have them on the right track.  

“If we can set them up to be educated by us about the importance of oral health, receiving all the preventative and protective treatment options we have in our toolbox, then we massively improve their chances of staying orally healthy. 

“I’m not sure that politicians understand that the moderately funded teenage contract is funded correctly for teens that arrive already in good dental health, but not at all well for lower income areas where I often see teens who have not had a check since primary school but are now 16 and have lots of decay. 

“To add 12 more years of the population to this, with many of these people in poor dental health needing a huge amount of work to get them dentally fit …we actually cannot afford to sign that contract, both the workload and the funding would undo us.” 

She admits it’s complicated with a huge amount of dental work needed to get the population dentally healthy. But then dental wellbeing could be maintainable, and the population vastly improved medically because of it. 

What’s needed now is leadership and a 10–20-year roadmap that’s grounded in reality, she says. One that recognises dentistry as essential healthcare and a human right, funds it sensibly and puts patients, not politics, first. 

 “Because right now, we’re pulling too many teeth. And it’s heartbreaking.”