The poor state of dental health in New Zealand has been highlighted in a new report Tooth be told commissioned by the Association of Salaried Medical Specialists (ASMS) and supported by Auckland City Mission - Te Tāpui Atawhai.
The report found 40 percent of New Zealanders - and half of Māori and Pasifika people - can't afford dental care.
In 2020, New Zealand recorded the highest unmet need for adult dental care among 11 comparable countries, it found.
A quarter of a million New Zealanders every year have to have a tooth pulled out because their decay is so bad.
Some survey respondents reported pulling their own teeth with a wrench when a tooth caused severe pain.
Cost, lengthy wait times and lack of transport were all barriers to access.
The senior dentists union was calling for free universal dental care.
"Universal dental care is critical to the good health of everyone in Aotearoa with cost benefit analysis showing every dollar invested in dental care will return $1.60 to the country. Despite this, no government has developed or implemented a plan to provide it," ASMS chief executive Sarah Dalton said.
There has been a 30 percent rise in the number of people who need hospital level dental care - which happens when problems are left too long, it said.
The situation was so bad the country has stopped reporting some figures internationally, it said.
Auckland City Mission - Te Tāpui Atawhai missioner Manutaki Helen Robinson said when circumstances prevent someone from practising daily oral habits, or they can't afford dental care, it was easy to suffer poor dental health.
"We know access to good oral health care would make an enormously positive difference to the overall health of people we support and many others who suffer the indignity of poor oral health. It truly is a basic human right and we are committed to helping people access that right," Robinson said.