More than 690 children in the Lakes district had teeth extracted in 2022. Photo / NZME
More than 690 children in the Lakes district had teeth extracted in 2022. Photo / NZME
The number of young people getting teeth pulled in the Rotorua district has more than halved over the past five years, with the number dropping from about 1500 to just over 690.
But one paediatric dentist fears this reduction reflects an “access to care issue” as a result of the pandemic and healthcare staff shortages, rather than an improvement in children’s oral health.
Figures provided to the Rotorua Daily Post by Te Whatu Ora Lakes show 1151 young people aged 15 and under had teeth pulled in 2017, 78 of which were done in hospital and the rest at community dental clinics.
The following year this figure jumped to 1279, and then increased even further to 1378 in 2019.
Only 950 young people in the region had teeth pulled out in 2020, with just under 10 per cent of those done at hospitals. This number dropped to 915 in 2021.
Last year 692 young people in the region had teeth extracted. Of those, 134 were hospital-based and 558 were through community dental services.
Te Whatu Ora Lakes community oral health services manager Juan Restrepo told the Rotorua Daily Post he could not make “any reliable assumptions” on the data because the downtrend in extractions had been affected by the pandemic.
He said extractions were due to poor oral health and it should “probably be considered positive” the numbers had reduced significantly.
Extractions took place to “alleviate the oral health condition of the patient” with the goal being for children to avoid tooth disease, he said.
When possible extractions were avoided in young people because they could have a “long-term” impact on teeth spacing.
Restrepo said lack of fluoridated water, socio-economic deprivation, sugary drinks, poor diet and not being able to access toothbrushes and fluoridated toothpaste were just some of the issues affecting the oral health of children in the Lakes district.
He said Te Whatu Ora Lakes, formerly known as the Lakes District Health Board, introduced a fluoridation programme two years ago to help decrease decay rates. Fluoride was painted on children’s teeth, ideally about twice a year.
It was the first DHB in New Zealand to introduce this programme, and expected to see “ongoing improvements in oral health as a result”.
It also employed a new oral health educator fluent in te reo Māori who was working closely with kohanga, preschools, kura and schools to increase knowledge about oral health.
Restrepo said it was proven communities with fluoridated water had “far lower” incidences of tooth decay.
He said the fluoridation directive, when implemented, would help reduce the number of tooth extractions, fillings and “the costs of dentistry in adulthood that many people cannot afford”.
“Dental care is free for all New Zealanders up to 18 years, and we really encourage all parents of children and adolescents up to 18 to make sure that they have no oral health disease untreated when they are 18 - while treatment is still free.”
Paediatric dentist Katie Ayers. Photo / Supplied
Reacting to the figures, paediatric dentist Katie Ayers said she was concerned about the drop as she “did not have any evidence” children’s oral health had improved over those five years.
Ayers said the “significant decrease” of teeth extractions in the district made her think it was an “access to care issue” rather than an overall improvement in young people’s oral health.
Hospitals being “under pressure” and a shortage of nurses and anaesthetic technicians during the pandemic may have played a role in fewer young people receiving hospital-based dental treatment, she said.
“I suspect one of the reasons for this might be that post-Covid it’s been more difficult to get surgical lists to operate on non-acute problems in the hospital systems,” she said.
“We’re seeing in many areas of the country that routine surgery just isn’t proceeding at the normal capacity.”
And children were now presenting to community dental services with “much more advanced tooth decay” due to the backlog of patients as a result of lockdowns and the low numbers of oral health therapists.
“Waiting times for checkups have extended considerably for most areas of the country. And so that means an area of tooth decay that could have been picked up when it was quite early and easily able to be fixed now has progressed far enough that the tooth needs to be removed.”
She said the main reason for those in the 15 and under age range having teeth removed was because of tooth decay.
“That would normally be tooth decay that has progressed so far that the tooth is no longer able to be saved. So by removing that tooth, it prevents an ongoing source of infection for the child.”
Ayers, also a New Zealand Dental Association spokesperson, said some young people could have “quite significant dental abscesses” but go for long periods without parents realising because they did not complain of pain.
“Some children will be having a lot of pain and a lot of you know often recurrent courses of antibiotics and ongoing pain relief, whereas other children may have quite a significant infection that’s just draining into their mouth and no one is aware of a situation.”
Rotorua dentist Leroy Chan, who owns Ranolf Dental Surgery, said the data did not tell the “full story” of children’s teeth extractions had reduced over the past five years.
He supported Ayer’s viewpoint, saying the lower figures likely reflected the overall decrease in dental treatments throughout the pandemic.
“We’ve had quite a number of months where we weren’t able to do treatment with all the Covid rules. I would be questioning whether this is really a drop or a blip with Covid?”
Chan also said he understood the community dental service was struggling with staffing issues which could also have contributed to the drop in recent years.
“I have had quite a number of patients who are parents bringing their children to me saying they can’t access the community dental service. It’s a struggle for them in terms of them coping with the client base.”
In July last year, then-director-general of health Dr Ashley Bloomfield told councils to add fluoride to some or all of their water supplies under the Health Act.
Included in the directive are Rotorua Lakes Council, Tauranga City Council, Western Bay of Plenty Council and Kawerau District Council.
It was the first time this power had been used since the relevant legislation was amended in 2021 to ensure a national approach to fluoridating water.
