A Northland principal is sounding the alarm over the dental hygiene of children in his region.
Hora Hora Primary School is just off the main street in Whangārei.
School principal Pat Newman said tooth decay was a serious issue in his school - and it came down to cost.
"If you haven't got a lot of money, then every now and again you want to reward your kids," he said.
"When soft drinks are cheaper than water and junk food is cheaper than good food, that's what happens."
University of Otago research found that by the age of five, 60 percent of Māori and 70 percent of Pasifika children have already experienced some form of tooth decay.
The paper's author, Dr Dorothy Boyd, said unhealthy foods were pushed on kids. "You'll find often that the marketing of unhealthy foods is directed at children," she said. "For example, the breakfast cereals with the most sugar often have cartoon characters on them."
Rebecca Ahmadi, a dental therapist who used to work in schools, said even the most well-meaning parents struggle against marketing.
"They're like 'where are the chips? Where are the sticky muesli bars?' So we're competing against supermarkets that are providing all of this food that creates opportunities for dental decay," she said.
If parents could not prevent tooth decay, it fell to dentists to pick up the pieces, but dental therapist Helen Tane said the system struggled to meet demand.
"We struggled with the shortage of our workforce to get to all of the children," she said. "What would happen is the higher socio-economic areas, where the parents could advocate on behalf of their children, would request for them to be seen more regularly."
Consequently, children in low-decile areas received less attention.
Auckland dentist Vikki Nelson said that as children's teeth got worse, treatment became more invasive.
"I'm taking teeth out of kids again, that just shouldn't happen," she said. "They're not compliant in the dental chair, because they're in pain and they're scared, so we have to get them into the hospitals to get anaesthetic, and the waiting lists are nine to twelve months."
Dr Rebecca Ahmadi said the government's funding did not go far enough.
"As the money went from the top to the bottom, there was very little left to provide the preventive care that the children desperately needed," she said. "We ended up just providing the essential care, which is ambulance at the bottom of a cliff stuff."
But principal Pat Newman wanted to see more responsibility be taken by the community.
"When does it come down to society having a role in this?" he said. "When does it come down to whānau saying 'hey you shouldn't be giving your kid that Coke,' where does the responsibility of whānau and community come in?
"We put out lots of [advice] about healthy eating, but quite often no notice is taken of it. And as a result, the dental hygiene of children in Te Tai Tokerau is in my opinion third world quality."
Dr Boyd said change had to happen. "Now is an opportunity for radical change," she said. "However, this cannot be left to oral health services. As a society, it is time for us to demand that our children are enabled to be healthy."
She recommended a limit on junk-food marketing aimed at children and for healthy foods to be made affordable for low-income families.