By Frank Film
Why are children as young as two having all their teeth taken out? Frank Film gets to the roots of our national crisis in dental health.
Clearance. The word brings to mind everything-must-go sales. Or clear-felling land. But in the world of dentistry "clearance" has a very different meaning.
"Dental clearances means taking out all the teeth in a mouth," says a specialist paediatric dentist for the Canterbury District Health Board, Dr Arunkumar Natarajan.
"Two-year-olds have 20 teeth - I've taken 20 teeth out of two-year-olds."
In 2019 more than 40 percent of five-year-olds in New Zealand had tooth decay. Ministry of Health data shows the number of zero-to-14-year-olds requiring general anaesthetic for rotten teeth removal increased from 4500 to 7500 between 2001 and 2016.
One hundred years since the school dental service was established in New Zealand in 1921, our children's teeth are falling through the gaps.
For more than eight decades dental nurses managed an often-dreaded regime of dental checks and drills, cotton wool angels and amalgam, usually from small wooden buildings or allocated rooms on the school grounds.
In 2006, the school dental service was changed to a community dental service. Dental care is still free for children under 18 and pupils still get their annual check-ups at school through mobile clinics.
But those requiring treatment now go to community hubs; those needing 'special care' are referred to hospital.
While the proportion of children aged five-to-12 without tooth decay has gradually improved every year, the number of hospital referrals goes up, Natarajan says.
"In the last year 1300 kids were referred to us. Of these, 80 percent would be put to sleep. We have done full dental clearances on two to five-year-olds."
Sugar the main bugbear
Frequency of food intake is an important factor. Every time our teeth come into contact with food, he says, there will be an acid attack on the teeth.
"But if you look at the main problem, it is sugar. Sugar is the culprit."
He points to the supermarket aisles dedicated exclusively to sugary drinks.
"That wasn't the case decades ago."
Now it is public enemy number one for young children with dental decay.
"When sweet foods go into the mouth, bacteria feed on them and produce acid," says CDHB public health dentist Dr Tule Fanakava Misa. "This acid causes the holes in the teeth."
Oral health is worse for the 20-30 percent of New Zealand children experiencing child poverty - after all, at the local dairy a bottle of fizzy drink is often cheaper than a bottle of water.
Māori and Pasifika kids are disproportionately represented in the higher end of poor dental statistics.
Ministry of Health statistics from 2019 show that, while nearly 59 percent of five-year-olds overall have no caries, this figure drops to 41 percent of Māori children and 34 percent of Pasifika children. Of the 18 percent of Canterbury's children experiencing severe tooth decay by the age of five, 26 percent are Māori and 40 percent are Pasifika.
"The inequality gap is still huge," Dr Misa says.
Three defence strategies
Dr Natarajan takes Frank Film through the three main defence strategies.
- Sugar tax - under the UK soft drinks industry levy, drinks with more than 5 grams of sugar per 100ml are taxed on a two-tier rate. Research published this year by the British Medical Journal shows since the levy was applied in 2018, the amount of sugar purchased in drinks has decreased by almost 10 percent - equivalent to three fewer teaspoons per person per week. "So we know that works," Dr Natarajan says.
- Better labelling - even if parents and childminders do have time to squint at the ingredients list, the information can be confusing. "A 600ml can of fizzy drink has 16 teaspoonsful of sugar," Dr Natarajan says. "But we don't say that clearly."
- Fluoridation - For children and adolescents, "the lifetime reduction in the incidence of tooth decay is around 40 percent. If you fluoridate the water, it will save about $1400 million over 20 years," he says.
"These are all the solutions I can see, because we need to prevent decay before they get to the point where they need to be put to sleep and have their 20 teeth taken out."
Some schools are initiating their own solutions. Every day after lunch pupils at Arowhenua Māori School in Temuka, South Canterbury, brush their teeth as part of an oral health programme first trialled in Scotland. The toothbrushing and positive health messages, says Joseph Tyro, director of Māori health at the South Canterbury District Health Board (SCDHB), are now spreading throughout the local community.
"In Scotland they noted a 70 percent decrease in tooth decay," says Dr Aravind Parachuru, specialist paediatric dentist at the SCDHB.
"So we thought, why can't we get some improvement in South Canterbury? Why can't we have our children smile in a better way?"