A new report suggests the unaffordability of dental care is widening the gap between the haves and have-nots when it comes to our pearly whites
Once you turn 18, you're on your own when it comes to looking after your teeth.
Unlike other parts of the health system, the government doesn't subsidise dental care for adults, meaning a trip to the dentist can put a serious dent in people's pockets.
Earlier this month, the Association of Salaried Medical Specialists (ASMS) released a report that found 40 percent of New Zealanders can't afford dental care.
ASMS chief executive Sarah Dalton says dentists and family doctors are quite similar, in that their practices run as businesses.
"The difference is that GPs have a subsidy, a partial payment from the government for the services they provide. Dentists do not, so it's a fully privatised service," she says.
Dental Association president Erin Collins says dentistry is a medical treatment and all medical treatment is expensive.
"The big difference is that in New Zealand, we're very fortunate in that our medical care is heavily subsidised through the hospitals, so we're not really cognisant of the full costs of receiving medical care.
"Whereas dental care is a fully out-of-pocket expense and there's no government subsidy for adults, or support for dental practices, to help ameliorate the cost of dental care."
Collins says the reasons dental care isn't publicly subsidised date all the way back to the 1930s and 1940s, when countries like New Zealand were setting up universal health care systems.
After World War II, Collins says dentists never ended up around the table in those discussions.
"So we ended up with these two streams, where dental care seems to sit outside of medical care in New Zealand."
University of Otago professor of dental public health Jonathan Broadbent says tooth decay is turning into a disease for people who are less well-off.
"People who tend to be more well-off often miss out on the experience of tooth decay, they are able to access preventative dental care services, or they've got the knowledge required and the behaviours, access to toothbrushes and toothpaste to look after their teeth much better," he says.
"Toothbrush and toothpaste: you might think that they're pretty inexpensive items, it's not so for many people - that is an issue."
Broadbent is concerned about healthcare being turned into "an industry".
"I was concerned when reading the financial statement of a major dental corporation in New Zealand that described oral health as a market ripe for investment, because of the levels of disease out there.
"I don't think shareholders should be part of the healthcare equation, I think it risks turning dentistry into a pure and simple commercial industry rather than a profession."
Dalton says the commercial model isn't working in some parts of the country, for patients or service providers.
"If we're talking about dentistry, there are parts of the country now where no dental practice will set up because it's uneconomic.
"What does that mean for those people? It's a failed business model, it depends on having enough people with enough money for them to be able to make a living."
Finance minister Grant Robertson has previously indicated about $1 billion of extra funding a year would be needed to provide universal free dental care.
Collins says the Dental Association has been advocating for a number of years for people on low incomes to have better access to dental care.
"Realistically, we don't believe that universal health coverage for dental care is ever going to be possible out of the general taxation," he says.
"New Zealand is better targeting those people who are in a difficult situation, who are deprived or are vulnerable, and ensuring that they can get access to dental care."
Some people are able to access dental grants through Work and Income, and these grants were increased from $300 to $1000 in this year's budget.
But Dalton says more sweeping, systemic interventions are needed.
"Some of them are broader, about prevention ... reducing our reliance on sugar and sugary drinks. Making all our schools water-only would be a fantastic thing to do, and it would cost nothing.
"We don't routinely collect and report data on the state of dental health and access to dental care, so we should return to mapping that data and reporting on it.
"We need a dental workforce plan as part of the work that Te Whatu Ora is adopting. We need to build our oral health learning in the medical curriculum.
"We would like more salaried dentists to be directly employed ... and, of course, we think that - even if it has to be done incrementally - we need to extend subsidised access to care.
"At the moment it stops when you're 17, we think it should be pushed out, we think pregnant women should have access, and over time, we should push that on."
But Collins points out that there's no such thing as a free lunch: someone has to pay for it, whether it's the individual or the taxpayer. He says intensified focus on those least able to afford dental care should be the government's priority.
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