2. Issues in
Oral Health
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2.1 State of Oral Health
The New Zealand Dental Association position is:
That oral health is an integral part of general health and a basic human right.
That oral health and dental care must be considered as an integral part of
Health Policy making
Oral health encompasses a range of diseases and conditions. Those with the greatest public impact include tooth decay (dental caries), chalky teeth (molar hypomineralisation), gum disease (periodontal disease), oral cancer, oro-facial and dental trauma, and congenital malformations such as cleft lip and palate.
In the 2009 New Zealand Oral Health Survey, 90% of New Zealand adults had some or all their natural teeth, but one in three had untreated tooth decay, one in three had early signs of gum disease and 15% had moderate or severe gum disease. The D3Group estimates that 19% of children have molar hypomineralisation, which can be a contributory cause to tooth decay and early tooth loss. Further analysis of data in the New Zealand Oral Health Survey found 40% of the adults reported a history of dental trauma and, in 2023, over 35,000 people registered new claims for dental and facial injuries with ACC. In 2022, the New Zealand Cancer registry recorded 631 people with cancer of the lip, oral cavity and pharynx. All of these oral conditions have chronic and cumulative effects, and people affected require ongoing oral health care throughout life.
Many oral conditions are theoretically preventable, but they are also complex multifactorial conditions with socio-economic, environmental and biological determinants. Oral conditions have risk factors in common with other chronic conditions, such as diabetes, heart disease and respiratory diseases. Oral health is integral to general health, and oral health needs to be included within health policy decisions for people of all ages, ethnicities and abilities.
2.2 Tooth Decay and Inequity
The New Zealand Dental Association position is that it supports
That health equity is the right of all New Zealanders and this includes oral health.
There are considerable fiscal, economic and social costs in not addressing oral health inequities.
Oral health inequities are unfair and unjust.
That poor oral health is a well established contributor to reduced quality of life.
That dental decay is the leading cause of oral disease, its effects are responsible for significant health loss and costs.
That improving oral health equity requires giving every child the best start in life, including preventive dental care and appropriate treatment services to maintain their oral health.
Tooth decay is the most common chronic disease among New Zealanders of all ages and is responsible for significant health impact and costs. It is a largely, but not entirely, preventable disease that can have a substantial impact on personal appearance, self-esteem, social interaction, employment, the ability to speak and chew, and on general health. Untreated decay can lead to pain, dental abscesses and serious infections.
Although tooth decay is largely preventable, we do not all start out with the same early years of life, we live in differing social environments, and we have different levels of access to care. Early childhood oral health is measured as children decay-free and the severity of dental decay at age 5. Early childhood oral disease has remained largely unchanged, with persistent inequities throughout a period of more than 15 years, from 2005 and 2022.
Figure 1: Precentage of 5-year-olds with caries-free teeth by ethnicityImprovements have occurred in both the severity of dental decay and the proportion of children decay-free at Year 8 (age 12-13 years) over the same period. However, inequities have persisted.
These differences are creating very different levels of oral health within our population with disproportionate impacts on the health and well-being of whānau, Māori, Pacific people, people with disabilities and people with low incomes, across the age spectrum.
Dental decay is a chronic and cumulative disease. The Dunedin Multidisciplinary Health and Development Study has demonstrated that people with the least favourable dental health at age 45 years had higher decay scores at age 5 years, lacked exposure to community water fluoridation in the first 5 years of life, had lower childhood IQ and lower childhood socio-economic status, and parental ratings of their own or their child’s health were poor.
The impact will grow with time in groups most at risk. Healthy diets, fluorides and dental care mean that most adults in New Zealand now retain most of their teeth into later adulthood. While this can be a positive outcome, dental decay continues through adolescence and into adulthood. In older adulthood, other health conditions complicate dental health. Untreated dental decay and periodontal disease can cause serious complications, including severe pain and infection.
In 2023/2024, an estimated 321,000 (7.4%) New Zealand adults had one or more teeth removed due to decay, abscess, infection or gum disease. Approximately 31,000 (3.3%) children had one or more teeth removed over the same period. Pacific children were twice as likely to have had a tooth removed compared to non-Māori and non-Pacific children. Additionally, children living with the greatest levels of deprivation were over 3 times more likely to have a tooth removed than those experiencing the least socio-economic deprivation.
Dental care is one of the most common reasons for children’s admission to hospitals, and for young children, dental disease is a leading cause of potentially avoidable hospitalisations. Admission rates to public hospitals for dental care have reached unsustainable rates, with approximately 8,000 children every year undergoing a general anaesthetic to have one or more teeth removed due to tooth decay. Ongoing research in New Zealand continues to show high rates of acute admissions to public hospitals for dental infections for people in their 20s and early 30s.
In 2024, The Frank Group assessed that the current settings for adults with poor oral health in New Zealand were creating substantial, economic, fiscal and social costs in sick days, lost productivity costs of funded dental and medical care, and low quality of life.
Achieving equity in health recognises that different people with different levels of advantage require different approaches and resources to achieve the same outcome. Equitable health outcomes are influenced by factors much broader than the health system, including the dental care system. Nevertheless, equitable oral health care is necessary for the success of any quality health system. It is key to improving better oral health outcomes for Māori, for Pacific peoples and for people with the least socio-economic advantage.