The State of the Nation's teeth 90 years on - How are we doing?

23 March 2010 Media Speech

At the New Zealand School and Community Oral Health Services Society Conference

Thank you for inviting me tonight. This is probably the only time I’ll get a chance to give a speech in a brewery.

Some of you may be aware I am part of a national campaign to increase the legal drinking age and get rid of alcohol advertising. The alcohol industry doesn’t like that idea much.

There’s even a radio ad at the moment which advertises the latest party pills, and it starts by saying ‘Don’t let Uncle Jim ruin the party’!

So we make a fine team. I’m taking away their drugs and alcohol, and you’re taking away their sweets, lollies and sugary drinks!

But I don’t want to sound too negative tonight. Especially as we all have a reputation as reasonably serious people. Dentists and dental therapists always seem to get a bad rap.

Up till the 1980s, Kiwi kids used to tell their parents, ‘We’re off to the murder house today.’
They meant they were off for a check up. A dental nurse and a bus would arrive outside the primary school to carry the kids off to the murder house.

The parents themselves were raised on films where the dentist was often evil and probably insane; or otherwise a bumbling fool played by one of the Three Stooges or Groucho Marx.

There is a serous side to tonight though. Each of you here knows that the lack of affordable dental health care is a very grave problem in New Zealand.

Fifty per cent of New Zealanders do not receive regular dental care. Some even end up in a hospital emergency department where they get their teeth removed. There are queues of people at hospitals across New Zealand from 5am in the morning, waiting for pain relief or extraction - just like a third world country.

It’s a shock that there isn’t more outrage about this. A high level of untreated decay is a classic sign of poverty. Perhaps if people knew you could die from dental decay there would be more political action. We’ll know more about who is or isn’t seeing the dentist later this year when the results of a nationwide survey of the nation’s teeth are released.

This is the first time in twenty years that we’ve done a survey like this. It’s long overdue.
There’s some good news though; the last Labour and Progressive government extended free dental care to all kids under 18 years.

Tonight I’d like to pay tribute to my colleague, the former Minister of Health - and former school dental nurse - Annette King. She extended the under 18’s scheme to cover kids who were not at school or enrolled at a dentist. Before that, these kids fell through the cracks and didn’t qualify for free dental care.

She restored the School Dental Service which was in danger of disappearing all together after the previous National government had closed all the training schools. The number of therapists had dropped from 1000 in 1990 to a mere 400 by 1999.

Annette also made dental therapists a stand alone profession for the first time. That meant you were recognised for your skills, and you could practice on adults. Which means that if we did have a government which wanted to roll out affordable care beyond 18 year olds, we would have the capacity to do it.

The new dedicated Community Oral Health Services are targeting teenagers in the community. So are the hundred mobile clinics being introduced across the country over the next three years to service schools.

I’m looking forward to visiting the first of the purpose built community centre’s in Gisborne in the coming weeks.

I know you have worked hard to roll out this new scheme. I’d like to thank all of you here (and those who are absent) for your huge efforts in making Annette King’s policy decision in parliament a reality.

Reconfiguring child and adolescent oral health services has not been easy. It’s involved Chief Dental Officers and their teams, and people like Dr Robin Whyman who is not here tonight, and Dr Tim Mackay who is.

It’s involved dental therapists, managers, clinicians and support staff across the country.
We made history when New Zealand was the first country in the world to establish the School Dental Service, 90 years ago.

You are making history again.

My advice from the Ministry of Health this week is that although it’s early days to evaluate the success of the new scheme, you will achieve your target of reaching 60% of all eligible adolescents across New Zealand in the first year or so. That’s great news and we’ll keep monitoring progress.

90 years ago
It’s an historic time; this year marks the 90th anniversary since the School Dental Service was set up. I have a direct link in my office to that day 90 years ago when the idea for the school service began.
One of my research staff, David Cuthbert, who has worked for many hours on our dental policy, is related to the man who played a pivotal role in setting up the School Dental Service.

His great uncle was a man called John Llewellyn Saunders - ‘Llew’ to his family. I’m sure it won’t surprise you to hear that I don’t like smoking. But in the case of Llew I have to admit that smoking saved his life - and helped create the School Dental Service.

Like many men of his generation he went off to war in 1914-15. He was full of dreams for a fully funded dental service in New Zealand, and determined to survive the war so he could come back and make it happen.

He ended up at Gallipoli and the Western Front, which didn’t bode well for his future or the future of our community dental health services. He got hit by a sniper and thought he had been seriously injured. But the bullet had hit the cigarette tin in his chest pocket. He came back to New Zealand more determined than ever to introduce a fully funded state dental service. His great nephew in my office tells me the family still has that dented cigarette tin.

Llew had been shocked by the appalling state of dental health revealed by the wartime inspection of army recruits. He had a sense of urgency, a determination to make a difference that wouldn’t be out of place today. But he’d be encouraged to see people like you working in schools and the community delivering a free and affordable service to young New Zealanders.

At the time that Llew and his colleagues were designing the first School Dental Service, there was of course a private system of dentistry which was going from strength to strength.

Llew was like the 'Indiana Jones' of dentistry; He had a brave, can-do attitude. He was doing god's work and getting shot at. Those of you here tonight have picked up the fight where Llew left off. He succeeded in getting the first School Dental Service up and running. He believed a service made up of trained women could provide a much needed dental service to New Zealand children. He helped to create a school of dentistry to improve the quality of care.

And after his war time experience, he was part of setting up the New Zealand Dental Corps which looked after the teeth of soldiers serving overseas. Now we have to pick up the baton.

90 years on, who’s not getting dental care?

In the last election I argued for the introduction of affordable dental care for all New Zealanders - adults included.

I have been encouraged by the support I’ve received, and I have no doubt that we can achieve Llew’s dream of a fully developed state system of some kind.

The New Zealand Dental Association has agreed to look at the research from my office. We have costed various models for a subsidised system.

The Progressive Party is developing practical policies, and we’re doing it in consultation with dentists, dental therapists and hygienists. I’ve had many letters and calls, in support of this campaign.

Grey Power branches across the country have been in touch; The New Zealand Dental Therapists’ Association, the Nurses Organisation and many other organisations and individuals have also shown their support. But there are considerable hurdles to overcome.

The most vulnerable people in our society are unfortunately still the under 18s.
As Health Minister in 2008, Labour’s David Cunliffe issued a list a ten health targets. 'Improving oral health' was the second target.

When Tony Ryall became Health Minister he issued 'a slimmed down set of health targets’ - from ten to six. Oral health was not one of them

I’m realistic about what it will take to introduce an affordable public dental system for everyone. It will have to be done in stages; in the same way we introduced affordable GP visits, starting with the youngest followed by the oldest.

It was right to focus on 0-18 year olds first. Now we have to identify all vulnerable groups and target them. Once these kids leave your care, they are at risk. From the age of 18 many of these young adults will probably never go to the dentist. Some of them don’t see the dentist again for ten to twenty years.

When they do finally turn up at the dentists, the problems can be so big it’s almost impossible and too costly to treat them. Cost is a significant barrier. That’s one of the first things we have to fix. But we also have to incentivise them to go to the dentist, and get them used to looking after their own teeth. That will involve an education program together with a public campaign which is long overdue.

Another vulnerable group is pregnant women. Not only are their teeth at risk during pregnancy, but as mothers they will set habits for dental care at home with their children.
That’s why affordable treatment for the adult population is so important.

I’ve never understood why pregnant women get free GP visits during their pregnancy, but not free visits to the dentist.

The problems start before kids get to see therapists like you. They start between the ages of 0-5. Many parents do not know that their children’s teeth are forming before they are born. Although the 0-5 age group is entitled to free dental care, some new mothers are not aware of this.

The dangers of sugary fruit juices, sweetened milk or fizzy drinks are not sufficiently spelt out to new parents. I’m encouraged to see that at least Plunket and other early child support services will be doing more in the future to include information on dental care and the dangers of sugary drinks.

This was an initiative set up by the New Zealand Dental Association, Plunket and Colgate.
The next big problem we have is New Zealanders in retirement.

It’s not fair, but it’s a fact of life, that as you get older, the care of your teeth and gums becomes a bigger problem. In my parent’s day, teeth were extracted and false teeth provided, often as a 21st birthday present!

The baby boomer generation will go into old age with their own teeth, often heavily filled and a number of them missing.

I heard of a couple of old friends the other day. One was in his 90s and close to death. The friend of the dying man, who’d recently, spent all his life’s savings on his teeth, asked his friend:
“Will you do me a favour? Will you tell me if they have free dental care in heaven?”
The dying man replies: “You’re my best friend. I’ll do this for you.”
And then he dies. Next day the friend hears a ghostly voice and realises it’s his old friend.
“I’ve got good news and bad news,” says the ghost. “The good news is that there’s free dental care for everyone in heaven.”
“The bad news is - you’re booked in on Wednesday.”

Most retired New Zealanders (75%) live on their superannuation income alone. People in retirement homes are particularly vulnerable. They often don’t get the treatment they need.
I’m pleased to hear that the Dentist’s Association is about to roll out training for rest home workers on how to better manage dental care in rest homes.

What are the options for affordable dental care?

I believe that affordable dental care for everyone is achievable. Just like I believed that we could have our own New Zealand owned bank - Kiwibank - when everyone told me it couldn’t be done.

Llew’s dream - 90 years ago - of affordable or free care for everyone is closer today than it first appears.

I would like to see dental care brought into New Zealand’s general health system. Our research tell us that it would cost less than $1 billion to finance basic dental care for the whole population. That includes the money we already spend on free visits for under 18 year olds. And it includes the cost of those who end up in emergency departments.
We could raise this money either through income tax, or through a small ACC type earner’s levy in return for a life time of free or affordable dental treatment.

We’ll actually save money by promoting prevention and helping new parents introduce good habits for their children. We would save money by putting fluoride in the water in more places across New Zealand. I know this continues to be controversial, and you have been discussing this at your conference.

The anti-fluoride lobby should let the facts get in the way of their prejudice. On average the addition of fluoride in drinking water reduces tooth decay in children by at least 30% and strengthens the teeth of adults.

We could be on the brink of achieving affordable dental care. It’s possible, it’s affordable and it’s a social tragedy that half our population doesn’t get the dental care they need.
What we don’t have at the moment is the political will to make it happen.

But when you look back at the milestones in dental care over the last 90 years, it hasn’t been politicians who have led the call for affordable care. It’s been people like you.

Llew had to personally lobby Peter Fraser, Minister of Health in the first Labour government to expand the School Dental Service to cover teenagers.

Without people like Llew however, there wouldn’t be any school or community dental service at all. Without people like you, an ex-dental nurse by the name of Annette King wouldn’t have been able to win the argument in parliament to extend free dental care to all under 18 year olds.

She wouldn’t have been able to bring back the training of dental therapists, central to Llew’s dream of free dental care for children.

The next milestone is up to you. You have to go out there and create the political will to make affordable care a reality for all New Zealanders. We must pool our knowledge and our efforts to make a final push.

That’s the only way we will realise Llew’s dream, 90 years ago, of an affordable, high quality dental care system within the reach of every New Zealander.

ENDS

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