Alarm at rotten state of children's teeth

The state of children's teeth when they start school is deteriorating, and increasing numbers are having them all pulled out under general anaesthetic.

In the latest Health Ministry national statistics, for 2004, the average 5-year-old had 2.1 decayed, missing or filled teeth.

This compares with two teeth like this the year before and 1.83 in 2002, continuing an eight-year deterioration.

The picture is even worse in low-income areas and among Pacific Islanders, Asians and Maori.

Sugary and acidy fizzy drinks, powdered cordials and fruit juice attract much of the blame from dentists, especially when these drinks are put in sipper bottles, prolonging the exposure of teeth to the risky liquids.

Dentists say water and plain milk should be the preferred drinks. Sweet foods and drinks should be quarantined to set times, not consumed constantly.

"One of the primary drivers of dental decay is diet and consumption of sugars, frequency of consumption being one of the determinants of how much decay occurs," said the ministry's chief adviser on oral health, Dr Robin Whyman.

Regular brushing with a fluoride toothpaste and drinking fluoridated water were also important factors, he said.

Auckland District Health Board children's dentist Dr Callum Durward said some children aged 5 or younger were having all their 20 primary teeth removed under general anaesthetic at the Green Lane Clinical Centre because they had so much decay.

"That happens a few times a year. The numbers are growing."

The waiting list for extractions and restorative work for 2-to-5-year-olds is also growing. Some wait for up to a year for treatment. General anaesthetic was used because so much work needed to be done in their mouths, but the anaesthetic and extensive dental treatment cost several thousand dollars per child.

Children who had all their primary teeth extracted were more likely to need their adult teeth straightened. They were also at increased risk of further decay unless they changed their dietary and teeth-cleaning habits.

Dr Durward said part of the problem was low enrolment in school dental services, whose dental therapists provided treatment and explained about a healthy diet and oral hygiene.

Children could be enrolled from the age of 1, but less than 40 per cent of eligible pre-schoolers were signed up nationally.

The Auckland Regional Dental Service had improved on this by working with primary health organisations to encourage enrolment at the time of infants' vaccination visits.

School dental services were under stress, he said, and many children could not be seen when they should, because of therapist shortages.

The school services are widely regarded to be in a crisis, after the number of therapists halved in two decades and many of the remainder are older than 40. Many clinics and their equipment are outdated and need to be replaced.

But Dr Durward said the number of first-year students at Auckland University of Technology had nearly doubled this year, to 38, with the introduction of a combined dental therapist/hygienist degree. Otago University would introduce its combined degree course next year.

The Government is expected to announce funding for at least part of a five-year, $100 million capital spending programme for the school service, with a likely move to more mobile clinics and some community clinics to treat children and adolescents.

Less than 60 per cent of adolescents currently make use of state-paid treatment by dentists.