Getting to the root of national decay

Experts say New Zealanders are having increasing problems maintaining good dental health, ROSALEEN MacBRAYNE reports.

Reports of hundreds of children waiting to have rotting teeth removed under general anaesthetic are raising questions about New Zealand's dental health.

These include whether more water supplies should be fluoridated and the lack of basic dental health habits in some families.

The problem is common in places such as Northland, a poor, non-fluoridated area.

But the New Zealand Dental Association says dental decay is not just a problem in lower socio-economic areas. Executive director Dr Robin Whyman says the affluent, too, have been seduced by skilful marketing of snack foods and so-called health energy drinks.

And it is not only young people who suffer from caries. There are increasing problems maintaining the dental health of the elderly who have kept their own teeth and can no longer get to, or afford, a dentist.

Concerns involving adults in recent months have varied from possible links between gum disease and heart disease and research suggesting pregnant women with infections around their teeth are more likely to give birth to premature babies.

Dr Whyman says annual surveys of children are done through the school dental service. But the last national survey of adult oral health was 14 years ago, in 1988.

Operations to extract teeth and fix other serious problems can be effective. But dentists say such expensive work does not fix such important basic problems involving lifestyle and family awareness of dental hygiene - including diet and regular cleaning of teeth.

The issue of using fluoride to prevent tooth decay polarises people, especially when water supply authorities revisit the debate.

Only about 57 per cent of New Zealanders are on fluoridated water supplies. The figure has barely fluctuated for years. But that hides the fact that though some councils - like Ashburton this month - may vote to discontinue fluoride, others may decide to introduce it. Christchurch is the only main city which does not have fluoridated water.

Tauranga's water will remain fluoride-free, despite warnings last week from the Bay of Plenty medical officer of health, Phil Shoemack, of a sharp decline in children's dental health.

Since fluoride was removed from the Tauranga district's water in 1992, the number of children being referred to Tauranga Hospital for dental surgery has risen from about 10 a year to around 200, with as many again on a waiting list of up to six months.

Dr Shoemack says the increased workload is not just due to the lack of fluoride, but the problem is greater in areas where there is no fluoridation.

He and an Otumoetai dentist, Graeme Lynam, have lobbied the Tauranga District Council to rule again on the contentious issue, saying it is the local body's responsibility to have a rational, scientific look at the question.

The Tauranga District Council's policy committee quashed Dr Shoemack's proposal that it establish a tribunal to hear evidence.

Governments have shied away from making fluoridation mandatory, even when health ministers have been pushing its merits.

"We would like to see it made compulsory, but the realities are that it won't be," says Dr Whyman.

He says if fluoridation is to remain a community decision, then it should be made by district health boards, rather than by councils, as it is a health issue and the boards pick up the significant extra costs of dealing with the consequences.

Dr Whyman says fluoridating municipal supplies is a cost-effective and sensible measure to help prevent dental decay.

Though those against the "mass medication" of public water supplies argue that anyone who wants fluoride can take it in tablets and toothpaste, health professionals say that approach is not as effective.

Tablets or paste may be a highly concentrated periodic "quick fix," but water is more consistent, and keeps a lower level of fluoride bathing around the teeth.

nzherald.co.nz/health