THE state of people's teeth risks becoming an entrenched dividing line between the haves and the have-nots.

Can you afford to visit the dentist? Sadly, the evidence is likely there when you smile.

Oral health is getting worse. Public health advocates like dentist Rob Beaglehole point the finger at a high-sugar diet and especially sugary drinks - fizzy drinks, energy drinks and fruit juice (Milo? That's also a bad idea in a baby's bottle).

The stats show that 35,000 children under 12 had rotten teeth pulled out in 2015-16. More than 6600 kids had to go under a general anaesthetic - some of them are having all their baby teeth out, such is the level of decay.

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Countrywide, it cost $14.7 million to extract rotten teeth from kids' little mouths in the year to June 2016.

It's happening here. The latest annual report from the Whanganui District Health Board notes that "oral health remains poor for the DHB population, particularly for under five-year-olds who do not attend dental services regularly, which often results in children needing surgery to remove all of their teeth."

The tragedy is that tooth decay is completely preventable. Dr Beaglehole strongly argues for a tax on sugar-sweetened beverages, which the government keeps ruling out.

Children's dental treatment is government-funded until they are 18.

If they leave school before 18, they can get fully-funded treatment at a private dental practice contracted by the local DHB.

That's important and I'm pleased my taxes help provide such services.

(As an aside, I'm appalled by how National is framing the debate on tax during this election campaign. I'm okay with paying tax - tax is not an evil, it's the price of being part of a civilised, caring society. My concern is that tax revenue is spent where it does most good.)

But kids fall through the cracks. If they move around a lot between schools - as kids from poor families very often do, due to precarious housing - they can go years between check-ups.

Once they turn 18, people are on their own. If kids come from a family with a culture of regular dental check-ups, the teenagers will turn up to a dental practice, says Whanganui dentist Dr David Evans. If not, they may not show up for years, until pain drives them in. And typically at that point, while one tooth might be aching, there is gross decay in a number of teeth and that's going to mean an expensive bill.

One person I spoke with this week told me he felt lucky to be able to get a bank loan to pay to have his teeth extracted and dentures fitted. That's not an avenue available to those living in the worst poverty.

There's a $300 grant available from Work and Income for "essential" dental work - assessed by a dentist as urgent - but that won't go far. And you don't have to be on a benefit to apply but it is stringently means-tested, and forget same-day treatment - there are considerable hoops to jump through.

Further assistance may be available via a special needs grant, but it may need to be paid back.

If there's no money spare to put aside for emergencies, you probably can't afford to have your benefit docked to repay the loan either.

There is a dental unit at Whanganui Hospital, and there are six very specific categories of people eligible for treatment there. The sixth category is "vulnerable adults with high oral health needs (as capacity allows)". Adults on low incomes need a doctor's referral, there's a waiting list and treatment may not be entirely free.

Smile NZ Free Dental Day is happening - between September 2 and 13 - as I write.

Some 50 dentists in 27 dental practices are volunteering their time to treat an estimated 750 low-income patients around the country - but sadly, no appointments are available in Whanganui.

Some people with more resources are choosing to travel to Asian cities to have major dental work done at a fraction of the price of local treatment - like one Whanganui man last year who travelled to Vietnam to deal with a rotting tooth where the infection had progressed into the bone.

His story ended well, although the root canal and bridge required a three-week stay.

Dental associations issue dire warnings of the risks of overseas treatment.

Right now, if you can afford to pay for it, you can readily access dental treatment in Whanganui - in contrast to the difficulties that can be experienced getting in front of a GP. But for how much longer?

David Evans is 69 and still working full-time, 40 years after he arrived here fresh from dental school. There are a few young dentists in Whanganui but David doesn't expect them to stay. Once they have a couple of years' experience, they'll likely be off to jobs in bigger cities.

David can rattle off the names of Whanganui contemporaries who found no buyers for their dentist practice. When it was time to retire, they had to simply close the door.


*Rachel Rose is a local writer, gardener, fermenter and fomenter. More information and sources can be found at www.facebook.com/rachelrose.writer.