Approximately 1500 rotten teeth were pulled from the mouths of Bay children last year.
Experts say poverty, a lack of dental therapists and poor parenting are to blame for the high number of extractions.
They say more preventative education is needed and Tauranga's water needs to be fluoridated to combat the fact 50 per cent of five-year-olds are starting school with fillings or decay.
Figures released to the Bay of Plenty Times under the Official Information Act from the Bay of Plenty District Health Board show about 1500 teeth were extracted in 2017 from 1200 children aged 0 to 13 due to decay. Data revealed 300 had to be done under general anaesthetic and tooth decay was one of the most common reasons for children's admissions to its hospitals.
Quality and Patient Safety manager Debbie Brown said tackling the range of factors that contributed to high rates of decay was complex.
''As parents, it is our role to look after our kids' teeth right from the moment the first baby tooth appears.
''We know the conditions that kids are born into for example socio-demographic status, income, education, knowledge, political environment has an impact on their health and well-being. Not all families and whanau have the same opportunities.''
There was an apparent social gradient (equity gap) evident in oral health, ''with the heaviest burden of poor oral health on our Māori and Pacific children, and those children who also experience the most deprivation in our region'', Brown said.
NZ Dental and Oral Health Therapists Association chairperson Arish Naresh said the dental therapists were struggling to cope with demand.
More resources were needed to focus on prevention and integrate with other health and social services, he said.
Some parts of the country were operating evening and weekend clinics to increase access he said.
''Like every other non-communicable disease, 80 per cent of it was in 20 per cent of the population.
''The children having high levels of decay are more likely to come from low-income families and experience other health issues such as rheumatic fever due to poor housing, diabetes and obesity due to poor nutrition.''
NZ Dental Association president Bill NZDA President Dr Bill O'Connor said children relied on their parents to make healthy choices.
''They don't choose what their parents let them eat and drink, and they don't choose if their parents bring them along for treatment.''
Some children were falling through the cracks, and there was a severe shortage of oral health therapists, he said.
''Some definitely come into the system at age 13 with lots of work needing to be done.
"They seemed to have slipped through the system or have not had the treatment needed.
''But having said that, the vast majority of kids are very well treated by the system. Those at the bottom of the stats are the really difficult ones.''
Nationally 36,000 teeth were extracted from children last year, he said.
''They have already got the holes in their teeth, so our concern is why are they not being seen this year to get those cavities treated and filled rather than being seen next year when its too late and they have to get them extracted.''
The association was a strong advocate for community water fluoridation ''which reduces decay by up to 40 per cent'', he said.
On December 7, 1992 fluoride injections into the Tauranga water supply stopped following a referendum which divided the city.
O'Connor said it was also pushing the government to make schools ban all sugary drinks and lollies.
Ngai Te Rangi chief executive Paroa Stanley said it was easy to point the finger at vulnerable, low-income families but a lot of decisions that could make a difference ''were out of the hands of the person in the street''.
Fluoridation and a tax on sugary drinks were crucial issues, he said.
Stanley agreed parents had a big a role to play, but for some Māori families, it was about access, affordability and a cultural change.
''Horrific'' was how he described the state of some kids teeth aged 16 and over who had left school and attended Ngai Te Rangi's free after-hours, youth mobile doctor's clinic - which had been operating for more than 10 years.
''Once they stop going to school they stop all these other services and very few of them are engaged with dental services, so they have grown into parents with the same attitudes.''
In the future, Stanley hoped Ngai Te Rangi could operate a free mobile dental clinic to help address the issue.
A Ministry of Health spokeswoman said the Community Oral Health Service provided by DHBs throughout New Zealand was provided with $116 million additional capital funding to build new fixed and mobile dental facilities in the 2006 Budget.
Another $32m was allocated per year to focus on family/whānau involvement, health education for self-care and early intervention.
There had been significant improvements in child oral health for all population groups since the reinvestment programme, she said.
The percentage of five-year-old children in Bay of Plenty who are caries-free had increased from 44 per cent in 2007 to 51 per cent in 2016, while the average decayed, missing or filled teeth per school Year 8 child in Bay of Plenty has reduced from 2.44 to 1.39.
BY THE NUMBERS
* The BOPDHB currently employs 22 Dental and Oral health therapists in the Tauranga area.
* It also employs/contracts two dentists for Tauranga/Whakatāne hospitals.
* A number of local dentists are contracted by BOPDHB to provide basic dental care for children.
* The local kaupapa Maori dental service employs four dental therapists and one dentist.