‘IT’S A SCANDAL’ Why Kiwi kids’ teeth are rotting

Dentists despair when they are forced to pull out rotten baby teeth. Jane Phare reports on the state of Kiwi kids’ mouths and what parents and caregivers can do to help.

Every year, thousands of toddlers and young children go under general anaesthetic so a dentist can pull out their rotten teeth. Some are still babies, not even a year old.

The statistics are grim. Around the country, roughly half of all Kiwi kids will have a cavity by the age of 5. That percentage is higher in poor communities and Māori and Pasifika children.

Last year, more than 8600 children aged up to 17 had a general anaesthetic to have dental work done and teeth extracted, although that number includes children with special needs or behavioural difficulties. Many families go private, meaning hundreds more children are treated by paediatric dentists and oral surgeons under anaesthetic in private hospitals.

More than 3790 children and adolescents are on a public waiting list for hospital dental treatment and most of that work will be done under anaesthetic. Dentist and public health specialist Dr Rob Beaglehole calls the state of children’s teeth in 2022 “a scandal”.

“It’s crazy. It’s the number one reason kids get admitted to hospital in New Zealand.”

He’s spent 25 years pulling out tens of thousands of tiny, rotten baby teeth. “Brutal,” he says. “It’s carnage out there in terms of children’s oral health.”

Waiting lists soared after Covid-19 added an extra layer of stress on an already overburdened public dental service. Lockdowns and subsequent health restrictions meant dentists and dental services could not operate for prolonged periods. It means hundreds of Kiwi youngsters may not have had their teeth checked in more than two years at an age when soft baby teeth can deteriorate quickly.

The Auckland Regional Dental Service alone has 186,500 children up to the age of 12 (or Year 8) currently due for an appointment out of the 279,000 enrolled. Last year it cancelled 8600 appointments in the March/April level 4 lockdown, and another 12,000 in the August/ September lockdown. The service was reduced to giving pain relief only.

The service’s director Tim Wood says it will take more than a year to catch up with “the backlog”. That delay will inevitably mean hundreds more little teeth are in the process of rotting and cavities forming that parents and caregivers may not know about.

Parents whose children are in the public system are advised to be proactive to make sure their child is enrolled ready to be called for a check-up. New Zealand children are eligible for free dental care until the age of 18.

In theory, parents and caregivers should be contacted when children are about 6 months old, and looked after until Year 8. After that, teenagers can go to a private dentist enrolled under the Government scheme for free treatment. The Government has extended free dental treatment for another year for adolescents who turned 18 last year but were unable to access the service before their birthday.

But they may have to wait. The Auckland Regional Dental Service, and others throughout New Zealand, face a number of problems: a backlog because of lockdowns and health restrictions, a limited number of mobile dental vans and relocatable units, staff off work because they need to isolate because of Covid-19, and not enough staff to fill existing positions.

Hamilton paediatric dentist Katie Ayers is involved with five district health boards in the North Island and says in some regions children who need treatment will wait well over a year for an appointment.

“A substantial number of those children will have toothache, on and off, and antibiotics on and off.”

Some district health boards are considering outsourcing groups of children or schools to private dental practices in an effort to catch up. Ayers, the access-to-care spokesperson for the New Zealand Dental Association, says Covid-19 restrictions since 2020 have meant the community dental service has no choice but to prioritise children with the greatest need, mainly low-decile areas, Māori and Pasifika communities, and children who are very overdue for an appointment. “What that means is there are some high-decile schools [children] that haven’t been seen for a long time either.”

Ayers and other dentists around the country are seeing increasing numbers of parents bringing their children in for private dental treatment, rather than wait. Some health insurance companies will cover children’s dental work under anaesthetic.

Dr Katie Bach, a specialist paediatric dentist with Kidz-Teeth in Auckland’s Meadowbank, regularly operates on children who need a general anaesthetic to receive dental treatment. In very young children she’s seeing cavities caused by ondemand overnight feeding or by sucking on bottles in bed. She sees children from all over the Auckland region, and from as far north as Whangārei. Decay in baby teeth is across all sectors, she says.

“Unfortunately it’s really common in children in New Zealand, especially our younger children. It’s difficult to clean their teeth. We’ve got lots of toddlers and pre-schoolers who continually graze throughout the day. Things can happen fast in little mouths.” Bach recommends three meals and two snacks a day and brushing children’s teeth twice a day using a smear of fluoride toothpaste. Staff shortages are making the dental backlog worse. In the Auckland region, vacancies are between 30 and 40 at any one time out of the 350 staff. Wood says those staff shortages mean some dental chairs in the region remained empty in the service’s 42 fixed clinics and 40 relocatable dental units. The service has extended its operating hours, including Saturday opening, but that puts additional strain on staff.

More mobile clinics would certainly help to deal with the backlog, Wood says, but then he wouldn’t have enough staff to run them. The service tries to treat highrisk children twice a year, mediumrisk once a year and low-risk every 18 months. But he admits there are children who will not be seen for longer. One of the issues is getting informed consent from parents or caregivers. The service has a team of staff dedicated to trying to track down guardians, but Wood says families move around, and change their numbers and addresses regularly. Dental staff frequently extract teeth that could have been saved if treatment had started earlier, he says.

Kiwis are the third-highest consumers of sugar per capita in the OECD, and sweet drinks are the number one source of sugar in the New Zealand diet up to the age of 30. “Fruit juice will rip into your baby’s teeth and it encourages that sweet taste. It’s very acidic and it’s packed full of sugar even though it might be natural sugars. Your tooth doesn’t care whether it’s Coke or juice,” Beaglehole says. Up against 40 teaspoons of sugar in a 1.25-litre bottle of fizzy drink, he doesn’t think the dental service backlog will improve until the sugar tap is turned off. Artificially sweetened drinks like Diet Coke and Coke Zero are no better, he says, because they are so acidic and maintain a desire for sweetness. They won’t cause cavities but they will gradually dissolve the teeth.

Next on Beaglehole’s list of causes is poverty. “The lower down the socio-economic rung you go in terms of income, the worse off your oral health is. The gap between the haves and the have nots is shocking.”

Why isn’t the nation outraged, he wants to know? There is pain and suffering involved, and children can’t concentrate at school. If baby teeth are forcibly extracted it can cause the adult teeth to grow back crooked. Beaglehole has taken out tens of thousands of children’s teeth. “And every time I do I feel sad that I’ve possibly affected their future smiles.”

He wants the Government to step up and recognise the country’s high sugar consumption.

Check out breakfast cereals, he says, naming one popular brand that contains more sugar than ice cream. “It’s got four stars. It makes an absolute mockery of the health-star rating. And taxpayers are having to fix up the mess that they are causing.”

In Beaglehole’s sights is advertising and sponsorship promotion of sugary drinks, including sports drinks, that influence children and teenagers. Clamouring, too, is the Protect Kids from Junk Food Marketing group, a coalition of organisations including the Cancer Society, Health Coalition Aotearoa and the University of Auckland Medical and Health Sciences department, that wants the Government to introduce restrictions on advertisers and marketers, particularly those targeting children and teenagers during peak viewing times.

Beaglehole favours a sugar levy on the soft drinks industry drink industry, modelled off a UK levy introduced in 2018, a move that led to massive amounts of sugar reduction in soft drinks. For many years he’s wanted to see primary and secondary schools adopt a wateronly policy and stop selling fizzy drinks and fruit juice in tuck shops.

This month the Government made a move along those lines after Education Minister Chris Hipkins raised a proposal to ban sweet drinks in schools.

Fluoridated water, too, is in the Government’s sights after the passing of the Health (Fluoridation of Drinking water) Amendment Act which shifts the decision about fluoride in drinking water from local authorities to the director general of health. But it’s not likely to be a quick fix with many millions of dollars of fluoridation-related infrastructure still to be done in areas like Christchurch which have unfluoridated water.

The Ministry of Health has also been making gradual progress in enrolling children in the Community Oral Health Service, with data between 2007 and 2020 showing that enrolments of pre-school children doubled from 43 per cent to 93 per cent. The average number of decayed, missing and filled teeth per child at school in Year 8 (age 12-13) reduced by more than half, although improvements were not as good for Māori and Pasifika children.

Professor Jonathan Broadbent, of the University of Otago, is heartened by a Ministry of Health proposed initiative to distribute toothbrushes and fluoride toothpaste to children in schools, with a primary focus on lowincome communities, and Māori and Pasifika children.

But the prevention needs to start much younger than school age, he says. “Once the child is born the teeth haven’t come through yet but they [the teeth] are already developed.”