Desperate Kiwis are queuing at hospital pain clinics because they can't afford the dentist - and health bosses are now backing free dental care.
Waitematā District Health Board wants a "comprehensive dental service for all New Zealanders", its chief executive confirmed to the Herald.
The position comes amidst growing concern among health workers about people who can't afford hefty dentists' bills and live in chronic pain as a result, with some resorting to gruesome "DIY dentistry".
The issue has been outlined in recently-published minutes from Auckland and Waitematā DHBs' community and public health advisory committee.
There are long queues at hospital pain clinics for temporary fillings or teeth extractions, the meeting noted, and people are turning up at emergency departments because of dental pain.
Members discussed whether the health boards should call on the Government to provide subsidised or free dentistry.
In response, Waitematā DHB chief executive, Dr Dale Bramley, told the meeting the Ministry of Health was "already considering how the dental service could be included in the public health service, and that the DHB boards should support".
A resolution was passed by the committee, recommending the DHBs "support a comprehensive dental care access for all New Zealanders as part of public health system".
Bramley told the Herald on Sunday Waitematā DHB "would support a comprehensive dental service for all New Zealanders and we will help to support the Ministry of Health in any deliberations they may have on this matter".
However, Grant Pollard, the ministry's group manager for population health, denied any current work on possible changes to publicly-funded dental care.
"Though this may be looked at again following the outcome of the health and disability sector review," Pollard added.
That wide-ranging review of the entire health system is chaired by Heather Simpson, a former chief of staff to Helen Clark. An interim report is due by the end of July.
Any move to provide more subsidised or free dental care would carry a huge cost. Currently, 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 the thousands of dollars.
Kiwis without enough money live in chronic pain that affects work, quality of life, and mental and wider health. Gum disease increases the risk of heart disease, and poor oral health increases the chances of bacterial infection in the bloodstream.
About one in three New Zealanders 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.
Health Minister David Clark said there was "huge unmet need in dental care" - but there wouldn't be significant reform this side of the 2020 general election.
"We have people struggling with third world health conditions as a result of bad dental hygiene and inability to access the care and treatment they need," Clark said in a statement.
"Longer term, I do have ambitions to make dental care more affordable and accessible. However, it's unlikely we'll get significant change over the line with that this term."
Hamilton dentist Dr Assil Russell launched a petition last year calling for a subsidy for dental care for at-need people and an increase in the age for free dental care to 20 years.
Russell's charity Revive a Smile has treated almost 10,000 patients free of charge, including those with bad infections, and broken and rotting teeth.
One patient suffered four years of terrible pain before ripping off the top of a wisdom tooth using pliers, and then using a knife to try remove infected tissue. Pain continued after his botched DIY effort, and only stopped after he was treated for free through Revive a Smile.
Currently, Government-funded dental work for adults is limited to emergency care for pain and infection relief, and Work and Income grants for those on a low income and who are in serious pain and need urgent treatment. Dental care is also given to a small number of hospital inpatients, and work needed after accidents is funded by ACC.
The NZ Dental Association wants more subsidised care for people on low incomes, but not universal access - saying such a step would likely cost more than the annual budget of large DHBs.
The association surveyed members last year and found the average cost for an examination only was $76, a single extraction was $229, and $203 for a two-surface filling. Thirty minutes with the hygienist averaged $110.
Recently former Prime Minister Helen Clark added her voice to the debate, tweeting Jacinda Ardern, Winston Peters and Social Development Minister Carmel Sepuloni: "Time for a major government initiative on the right to dental care. NZ makes hospital care free – why not a right to dental care?"
Mike Bryant, Work and Income regional commissioner, said if people need help with urgent dental treatment, a grant is generally available up to $300, which in most cases didn't need to be paid back.
In 2017, just under 40,000 special needs grants - which can cover other essential items like food and power - were given out, at an average of $277.
"People don't necessarily have to be on a benefit to qualify for this help. Depending on a person's circumstances we may be able to provide further assistance though they may have to pay this back."
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.