Dental system costing NZ $2.5b a year in lost productivity, $103m in sick days - report

New Zealand's dental system is costing billions of dollars a year in lost productivity and social impacts, a report has found.

The report is another call-to-arms to make free dental care universal, with campaigners saying that the cost of not acting is exceeding what it would cost to bring dental into the public healthcare system.

But the government is so far staying cautious.

Going to the dentist costs on average $353 per visit. It is estimated 40 percent of New Zealanders cannot afford dental care.

Hugh Trengrove, an Auckland public health dentist, said the impacts that dental problems had on productivity were clear for anyone who had experienced them.

"It impacts your ability to sleep, to eat, to function daily, and it will certainly have an impact on your productivity.

"If you've got a toothache, even if it's a transient background toothache, it will impact your ability to work, and also impacts your social interactions and your ability to engage with people. And if you're in a work environment, there's certainly productivity effects with that."

Dental for All, a group of health professionals, unions, and anti-poverty campaigners calling for dental to be brought into the public health system, has commissioned a report into the social, economic, and fiscal costs of New Zealand's current dental settings.

Using the Treasury's cost benefit analysis tool CBAx and existing New Zealand and overseas studies, consultancy firm FrankAdvice found the current system was costing New Zealand $2.5b a year in lost productivity, and $3.1b in lost life satisfaction or quality of life.

It also estimated $103m was spent on sick days.

The obstacle for universal dental has always been the cost, which could be up to $2b.

ActionStation and Dental for All campaigner Max Harris said the question had always been how much it would cost the government to do something, when it should be how much it was costing to not do something.

"We know it's creating shame, it's creating stigma, it's meaning people can't participate in society, they can't smile. But what this report also brings out is we're losing a lot in the economy by keeping dental out of the public health system.

"What this is really driving at is people not going to job interviews, poor oral health having an impact on the workforce, and I think that's really important as we consider rebuilding the economy."

The report did not consider the costs or benefits for people who could afford private dental care, and found some impacts that did not have an estimated dollar value.

Many of the values were also based on data from before 2022, and so could not factor in the impacts of the increased eligibility for dental grants expanded by the previous government.

Therefore, Harris said, the estimates were conservative.

"Leaving dental out of the public health system could cost even more than the numbers that have been produced in this report, but because we've tried to be responsible in those estimates, we've ended up with the numbers where we are now," he said.

"I should add, there were also some other outcomes we couldn't provide costings for. So this is really a minimal estimate of how much it's costing our society to not bring dental into the public health system."

Dental care is currently free for under-18s. People on low incomes or a benefit can apply for grants for immediate or essential treatment, but not for periodic cleaning or check-ups.

Trengrove, who is also a Dental for All member, said there had been increased demand for urgent and emergency care, which was largely restricted to extractions.

He said in an ideal world, nobody would need dental care.

"If we had effective public health measures in place, and an effective and functioning system that improves access education, and preventative services, then tooth decay could be a thing of the past. And we chose not to do that as a nation, we chose not to invest in oral health for adults, and there's real costs to that."

Expanding free dental care is an issue that comes every election cycle.

In 2023, the Green Party campaigned on universal free dental, paid for by a wealth tax.

Te Pāti Māori proposed free dental for families earning under $60,000, while Labour ran on making it free for under 30-year-olds, with a view of expanding it incrementally.

Labour's health spokesperson Dr Ayesha Verrall said it was still party policy to expand access.

"There's no logical reason why free healthcare stops at your teeth," she said.

But given workforce and other infrastructure would need to be built up, Verrall said introducing it incrementally was the only feasible way.

"Setting up people well for life with good dental care in early adulthood is a really important start that will keep them well throughout their lifetimes. But to build up to universal free dental, I'm pretty confident that'll go beyond a single political term."

Harris believed the will for political change had never been stronger.

"Really, this is just about fixing a gap, correcting an anomaly, and we think it could be brought in universally. Some politicians will want to be more cautious, but we would urge those politicians to act quickly, because as this report shows, inaction is costing us."

Prime Minister Christopher Luxon told RNZ the health system as a whole needed to get up to scratch first, with the focus for now on its five health targets, before looking at dental care.

"I appreciate there are real issues and concerns around dental. But for right now, our system, which we've put record amounts of money into, you know, this is a system where we've put $17 billion extra into over the next three years, but we need the system to be improved."

But Trengrove said the problem could no longer be ignored.

"I think the tide is turning. I think people are concerned about it. When you consider the government is not funding dentistry, it's actually pushing the cost of dentistry onto the individual, and often the most vulnerable," he said.

"If you stand back and look at it like that, then I don't think the politicians have any choice. I think that they do need to stand up and address this."

Trengrove acknowledged the public health system as it stood would not be able to provide universal access. He instead proposed an integrated model which was publicly funded, but engaged private practices to provide the services.

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