Why are people avoiding the dentist?

Alice Soper hasn't been to the dentist since 2017. She knows she should go, but is scared of what she'll discover when she finally fronts for the long-awaited check-up.

"I'm prone to having cavities," says Soper. "I spent a lot of my childhood in the dentist chair. I didn't love it there."

Even for her, six years is a long time to wait between trips. She knows the more she puts it off, the worse any problems might get. But she's worried about the cost, so keeps delaying booking in.

She's not the only one doing this. According to a study by the Association of Salaried Medical Specialists, reported in June 2022, 42% of New Zealanders can't afford to go to the dentist. Those numbers rise to over 50% for Māori and Pasifika. And shockingly, more than 250,000 decayed teeth are removed in Aotearoa every year. One dentist quoted in the study called those statistics "a national shame".

Yet the figures quoted in that report were already several years old when it came out. Since Covid, as inflation and the cost of living continue to escalate, the price of almost everything has gone up, including dental care.

In fact, a Consumer NZ survey shows prices have escalated rapidly since the association’s report was released. Across 12 dentists, we found that quotes for a check-up, x-ray, clean and a small filling repair could cost up to nearly $1000 depending on the dentist and the size of the filling repair – a whopping 131% increase from what it was estimated to cost just three years ago.

The true costs of delay

A six-monthly check-up is easy to skip when you’re balancing a squeezed household budget. The results, though, are starting to show.

Some people leave their rotting teeth so long they require hospitalisation, thus receiving free treatment. That’s not a good approach when New Zealand has one of the worst rates of sugar consumption in the OECD.

Yet, given there’s close-to-zero public funding for adult oral health care, and how difficult it is to establish the price of dental work until after you’ve had it, the likelihood of changing people’s attitudes to visiting the dentist seems lower than ever.

So, people like Soper continue to put it off. The Wellington-based writer and rugby player admits her finances could probably stretch to the occasional visit, but the lack of transparency around costs is a deterrent.

"If I was doing this properly, it's the annual check-up, that's $50," she says. "The hygienist appointment is usually about $150. So now we're talking like $200, and that's just to keep yourself sweet per year."

It nags at her, though, and sometimes, when she’s playing rugby, the irony that she could get free dental care if her teeth were damaged during a game hits her.

"I could ... get my tooth knocked out on the rugby field and get ACC to help with that. But just walking around in the world? No, forget about it."

When she gets really worried, Soper scours the websites of local dentists. But she can never find quotes, or information about pricing structures, so doesn't bother calling to make an appointment.

"I'm sitting in this limbo space," she says. "I can push it away – just brush and floss and not think about it."

Establishing the cost upfront

According to the Ministry of Health, Soper is doing some things right. If you're worried about the cost of going to the dentist, the ministry’s advice is to ask around for quotes.

"There is no fixed fee or recommended fee structure for private dentists," it says in its oral health guidelines. "The Ministry recommends that you shop around and ask about the fees for the treatment you require."

But that takes time, and when Soper does ring around, she struggles to make sense of what she’s told.

"I would love a breakdown. When you look across everybody's dentist websites ... nobody will give you a real cost."

That, she says, is her biggest barrier to taking the plunge.

"Put your costs on the front door, have a menu, let me know how much things are. I understand you might start the work and go, “'Oh, shoot, this is a little bit more difficult”.' But I should have a breakdown of what that is because then I can budget accordingly."

The only available indication comes from a 2020 NZ Dental Association survey, reported in 2021, which found the national median for an examination and x-ray was $98, a 15-minute scaling (clean) was $80 and a composite filling $250. The association says the results from a similar survey conducted in October will be available shortly.

The struggle to find out costs

Consumer NZ wanted to put the ministry's official guidelines, and Soper’s experience, to the test.

Over several days, we contacted a dozen dental clinics around the country. We told them we hadn't been to the dentist for several years. We said we needed a check-up, an x-ray, a clean and a small filling repaired. We requested quotes. We asked, "How much, exactly, would that cost?"

Soper was right: few of the dentists we spoke to wanted to say. Only one – Wellington's Victoria Street Dental – had prices listed on its website. Among the others, only some agreed to give us a quote, via email.

Wellington's City Dentists’ response was typical for most of the dentists we contacted, and confirmed Soper's experience.

We would be best to book a check-up appointment – costing $80 – so the dentist could provide “a treatment plan and estimate of costs," the receptionist advised.

For those dentists that did provide quotes, prices varied by dizzying amounts. West Auckland Dentists were among the cheapest, quoting $45 for a consultation, an x-ray for $35 and a clean and polish for $120, with a filling repair on top of that.

Lumino, based in Hamilton, was the most expensive. Its services included a new patient examination (at a promotional price of $69), a panoramic x-ray ($106) and a clean ($234). To repair the cracked filling would cost between $240-580, taking the cost of that single visit to a potential $989.

That's more than double the national median price for those services reported by the NZ Dental Association in 2021.

For Soper, that's exactly the kind of situation she's worried about.

"I think there's a real arrogance when you are talking to people about this money," she says. "There's no conversation about payment plans. There isn't any sensitivity around the way that that is delivered. You turn up for a mystery amount in the chair. They tell you what that is. And that's the end of the conversation."

Campaigning to fix the issue

Ricardo Menéndez March would likely sympathise with Soper's attitude. The Green Party MP has been on the front lines of Aotearoa's desperate dental situation through his work with the activist group Auckland Action Against Poverty. There, he saw firsthand how bad the situation is.

"I'd see it every day," he says. "People would come in with tens of thousands of dollars’ worth of debt with Work and Income NZ for receiving treatment that would have been avoidable, if they'd had access to early intervention.”

Bad teeth can impact every facet of a person’s life, says Menéndez March.

"If you're living in pain, you're losing sleep, you're potentially not being able to perform at work. That … can affect your employment outcomes on top of the impact of having rotten teeth and then only being able to afford extractions. Unemployed people [don't] feel confident to apply for jobs when they have a mouth full of rotten teeth.”

Menéndez March says costs are so high they're affecting everyone – from people like Soper, who could potentially afford treatment, to those who simply can't go until it's a medical emergency.

Even he’s avoided going to the dentist in New Zealand, getting a check-up, clean and two fillings done when he was in Mexico last Christmas. It cost him about $NZ200, far less than if he’d had the work done here.

In October, Menéndez March and the Greens put their money where their mouth is, turning dental care into an election issue. The party announced plans to offer free dental care for all, funded through a proposed wealth tax. They promised to train more dentists, and to send mobile dental vans into rural communities.

“People spend their lives in agony. It is heartbreaking to think that the situation gets so bad for some that they are taking pliers to their own teeth in a desperate attempt to fix problems that have spiralled out of control," Green Party co-leader Marama Davidson said when launching the plan.

Labour later launched its own free dental plan, for those under 30. We couldn’t find any dental plan promises by National, or Act.

For Soper, and everyone else desperate for affordable oral health care, the politicising of dental costs is a step in the right direction. But it's just a single step.

Until there are subsidies in place, or the Green Party gets its way and makes dental care free for all, Soper will continue to put off going to the dentist.

"I'll turn up [if] it's an emergency," she says.

Otherwise, her plan stays the same: "Brush, floss, and hope."