Health Minister David Clark is considering official advice on what dental care is provided to adults.
There are growing calls for free dental care for needy Kiwis as district health boards struggle with long queues at pain clinics and people turning up to emergency departments.
The Herald asked Clark's office for documents related to publicly funded dental care, including any discussion about possible changes to what's provided.
The Official Information Act response reveals Clark received a report from officials just before Christmas, titled Adult Dental Care and Oral Health Issues. It was withheld in full as the report is under consideration.
There is speculation among health advocates that Labour could make expanded dental care a policy ahead of the 2020 general election. Former Dental Association spokesman Dr Rob Beaglehole joined Clark's office as an adviser last year.
Clark has repeatedly said there is "huge unmet need in dental care", but there won't be significant reforms this side of the election.
The Waitematā District Health Board (DHB) has confirmed support for a "comprehensive dental service for all New Zealanders", with staff there noting long queues at pain clinics and people turning up to the emergency department (ED).
The DHB's chief executive, Dr Dale Bramley, recently told a community and public health advisory committee that the Ministry of Health was "already considering how the dental service could be included in the public health service, and that the DHBs should support".
The ministry has denied it is doing such work, but says the issue may be looked at after a wide-ranging review of the health system. That work is chaired by Heather Simpson, a former chief of staff to ex-Labour Prime Minister Helen Clark. An interim report is due in August.
Any move to provide more subsidised or free dental care would carry a huge cost. At present about $198 million a year is spent on oral health services, with most covering universal services for children and teenagers. Adults must pay the full cost, and bills can run into thousands of dollars.
A ministry briefing to David Clark ahead of his meeting with the dental council last October outlined the work of oral health therapists, who can at present perform restorative dental work only on patients up to the age of 18.
The council was considering following Australia and Britain in allowing oral health therapists to treat adults, and the ministry told Clark it "recognises there are potential benefits of extending the scope of practice", including making dental work more affordable.
Clark acknowledged that advice, but said "any future changes would need to be carefully considered so that there are not unintended consequences".
He wouldn't comment on the report now under consideration.
Roughly a third of Kiwis have untreated tooth decay, the last comprehensive oral health survey in 2009 found. Almost half of adults had avoided routine dental treatment in the previous year, because of cost.
Dr Assil Russell, founder of Revive a Smile, which has helped 10,000 people and counting, will present a petition to Parliament in the coming months calling for a subsidy for dental care for people who need it and an increase in the age for free dental care to 20 years.
People who tried to fix their own teeth in so-called "DIY dentistry" are seen by Revive a Smile at least monthly, including Rotorua man Charles Llewell, who took a power drill to the shards of his wisdom tooth. Others leave behind roots or suffer infection.
Work and Income can give out grants of not more than $300 a year for emergency dental treatment.
The cost of dental work
• Examination only: $76
• Single tooth extraction: $229
• Each addition tooth taken: $138
• Root filling: $735
• One surface filling: $153
• Composite crown: $408
• Hygienist - half-hourly rate: $110
• Full upper and lower dentures: $2557
Source: The average fee charged by NZ Dental Association members, according to the association's 2018 fee survey.