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What’s It Like To Be is a regular online column in which New Zealanders from all walks of life share first-hand experiences. Ahead of World Oral Health Day on March 20, Paulette Crowley talks to Robin Whyman, director of dental policy at the New Zealand Dental Association and a dental specialist Te Whatu Ora Hawke’s Bay, about the state of our nation’s teeth.
“Back in the 1960s and 70s, a lot of New Zealanders would lose their teeth in their adult years, even as early as in their 20s and 30s.
People are sometimes surprised when I tell them that an awful lot of us have pretty good oral health. If you look at the big picture, oral health started to get a lot better around the 60s and 70s. That was largely on the back of the fact that we had better coverage with fluoridated water and started using fluoridated toothpastes.
We now have about half the population with access to fluoridated water. Those two things, combined with good self-care and a good diet, have made a big difference to a lot of people’s oral health.
There’s another side to things, though. We are now seeing older people – largely the Baby Boomer generation – had quite high levels of dental decay in their earlier years but kept their teeth and now have to look after teeth that have had a lifetime of dental care. We now understand dental decay is a disease that doesn’t just happen in your childhood and then stops, and gum disease is a progressive condition.
Access to dental care can be difficult and paying for that as an adult is largely an out-of-pocket cost for most people. New Zealand has a funded dental system until your 18th birthday, and there’s ACC cover for accidents after that time but that’s where the funded system stops for nearly everyone. People on low incomes can access some funded dental care, but they must be in a very difficult financial situation to be eligible for grants.
Fear is another reason people don’t like going to the dentist – we know from studies that it’s one of the biggest drivers of people not going for dental care. Dentists are very aware of this and will try hard to provide a range of techniques to reduce anxiousness.
Another thing stopping people from going to the dentist can be not being able to find one. We train about 50-60 dentists a year, about the same number we trained when we had a population of about 3 million, and we have been very reliant on overseas dentists coming into the country. We are also short of dental therapists and oral health therapists. Certainly, some provincial areas are experiencing a lack of dentists.
If I were to wave a magic wand, I would definitely make some changes to our dental system, which hasn’t changed much over the years. We have large groups of children and adolescents with very low levels of dental decay. Maybe that means we see them a bit less often, so we can focus more on people with higher needs. But our payment systems need to be more focused on the providers being funded and reimbursed to make that work.
Maintaining free access to dental care until the age of 18 is vital. Research tells us if you start well with your oral health, then you will generally do better over your lifetime than people who start poorly.
Everyone needs to focus more on prevention of gum disease and dental decay. If about 80% of all water supplies around the country were fluoridated, it would mean better oral health for everybody and less inequity.
We also have to look hard at our diet and sugar consumption. There’s been some improvement in diet over the years, but we also have access to more processed food and sugary drinks these days. When you see a young person with very, very high levels of tooth decay, it’s common that sugary drinks are the problem.
The Dental Association thinks that a sugar levy or tax would be good. Countries that have done this show lower sugar consumption, which also reduces levels of obesity.
If I could give people three pieces of advice to look after their dental health they would be:
- Reduce how much sugar you consume, and how often
- Brush your teeth every day with fluoridated toothpaste and clean between your teeth with floss or a dental brush
- See a dental professional for check-ups as often as you can.
Most people can be expected to keep their teeth for their entire lives, although that’s not the case for everybody. The main thing to remember is, if you’ve got some dental issues, get on top of them early.
As for the debate about which toothbrush to use, research tells us manual toothbrushes can be just as effective as electric toothbrushes. I don’t like the vibration of electric toothbrushes, so I use a manual toothbrush, with soft bristles.”
