Comment

History of a gnawing Kiwi crisis

New Zealand is in the middle of a dental crisis, and it's not the first time. Peter McKenzie looks to the history of our Army's dental policy for answers.

Each year, Army Reservists are required to do at least 21 days of training. Convincing people to come along to those trainings is tough. As a result, reservist officers have to be adept in the tricks of marketing. Luckily for them, they have one big advantage: free dental care.

Because of the widespread dental crisis faced by New Zealanders, the Army’s provision of free dental care is featured prominently in recruiting pitches. Reservists wait all year for one of the big weeks-long exercises when they can sit down in the dental chairs at Waiouru. But free dental care is only effective as a recruiting tool because the services available to the public are so inaccessible.

The prohibitive cost of dental care - a check-up, a filling and a clean can cost up to $645 - has caused a precipitous drop in the number of New Zealanders regularly going to the dentist. The last National Oral Health Survey indicated that just 40 percent do so. That’s led to the stories we all know well; the 26-year old mum with chronic tooth pain who needs 13 teeth out and the impoverished Hamilton man who pulled his teeth out with pliers and ground down the shards with a power tool. Now one in three New Zealanders has untreated dental decay, with no hope of treatment.

The crisis is so severe that universal, publicly funded dental care has rocketed to the top of the progressive political agenda. The problem is that it is expensive. Bill O’Connor, the president of the New Zealand Dental Association, has disapprovingly noted that: “Universal dental care would likely cost more than the entire annual budget of large district health boards like Auckland and Waikato DHBs”. Murray Thomson, a professor of dental epidemiology at the University of Otago, estimates that New Zealanders spend $1.8 billion on dental care each year. Universal dental care would spur greater demand, and thus it could cost even more.

Of course, this is not the first time dental crisis has gnawed at New Zealanders.

When New Zealand entered World War I, young men flooded to recruitment stations. But despite the obvious need for manpower, thousands were turned away due to debilitating dental health. It was one of the greatest threats to the New Zealand war effort.

So in 1915 the New Zealand Dental Association stepped up. They offered to treat all the recruits they could. Even more importantly, they would do it for free, so long as the government covered the cost of the resources used. Thus the Army’s Dental Corps was born. Britain, Australia and other Commonwealth allies had nothing like it.

When New Zealand entered World War I, young men flooded to recruitment stations. But despite the obvious need for manpower, thousands were turned away due to debilitating dental health. It was one of the greatest threats to the New Zealand war effort.

The biggest modern obstacle to providing affordable and effective dental care is the cost of dental infrastructure. For example, a single dental chair can cost $70,000. The costly bite of infrastructure was something the Dental Corps also had to deal with in 1915. Dental surgeries had to be constructed and outfitted from scratch at military camps. Tools had to be sourced and bought. New dentists and orderlies had to be trained. All the while, there was a wave of dental issues demanding attention.

Take the 17th Reinforcements, who trained and sailed in 1916. The first Director of the Dental Corps, Lt. Col. Thomas Hunter, described how, “The 17th reinforcements numbered 1998 men, and the treatment given them by civilian dentists, and in camp by members of the Corps amounted to 6335 fillings, 5237 extractions, and 854 dentures; while 371 fillings 48 extractions and 32 dentures still remained to be done on board the transports.” Each reinforcement numbered approximately 2000 men. Hunter went on to note that, “the number of teeth requiring treatment varied from 3016 in one reinforcement to 13,517 in another.”

In spite of this overwhelming workload, the Dental Corps, both in New Zealand and in the often inhospitable conditions of Egypt, was so effective that no member of any unit had to be held back as dentally unfit when the New Zealand Expeditionary Force deployed to Gallipoli.

The Dental Corps was such a success that it became a permanent part of the New Zealand Army. It has treated soldiers and local populations in countless conflicts from World War II to Afghanistan. They do it because dental health impacts every aspect of a person’s performance, whether physical, mental or emotional.

Twenty years after the Dental Corps was formed, New Zealand laid the foundations for our modern welfare state by passing the Social Security Act of 1938 and establishing a universal healthcare system. It was a remarkable act of legislative innovation which few other countries could compete with. It was also incredibly expensive, then and now. The cost of providing universal, publicly funded healthcare in the 2017/2018 fiscal year was $16.78 billion.

We swallow that cost because we know how crucial accessible healthcare is. It would be unconscionable if a child with severe septicemia had to be turned away because their parents couldn’t cover the cost of treatment, or if an unaffordable bill was sprung on a builder with a complex compound fracture after an unforeseeable accident.

Yet despite the fact that there is no genuine dividing line between dental health and the other services our system provides, dental care was left out. It was an odd omission, especially given the obvious success of the Dental Corps.

Now, more than a century after we first recognised its importance, universal dental care is back on the political agenda. Will that age-old vision finally become a reality?