Listen
Accessing good dental care is not easy for thousands of low income New Zealanders, and for one woman, it is an unaffordable dream, as she cannot take on more debt.
Work and Income is funding at least $20 million a year in dental work for low-income workers and beneficiaries. More than half of the grants are essentially loans.
Jill* - a beneficiary - has a mouth full of rotten, broken teeth, and a continually infected mouth.
She told Checkpoint's Lisa Owen her dental problems started in 2009, when her former partner assaulted her, knocking her front teeth out.
"When there is full infection in more than one area, I don't function, I can't function at all. I don't sleep... I have been hospitalised for overdosing on Panadol, because it's so bad.
"I can't drive, the light affects my eyes, I get headaches, the pain is that bad."
She said money is what keeps her from getting her teeth fixed.
Jill does not like to smile or open her mouth in front of strangers. Only her husband had seen and knows the true state of her mouth, until she allowed Checkpoint's cameraman to film her mouth and the plate she wears.
"I chew gum all the time because there's so much infection, what do you think comes with that? Bad breath, it never goes away, even when you scrub your teeth."
Jill says money keeps her from getting her teeth fixed. Photo: RNZ
Her plate has dentures attached, with gaps that fit around her remaining teeth. It is more than 12 years old, and Jill said the poor fit means it is digging into and cutting her gums.
"All of my teeth that are broken, they all just started off as holes, and then I just left it and they break, they chip away."
People have asked her if it is due to drug-taking.
"People talk behind my back, I am aware of it, I can't do anything about it, so I just try and stick to the few in my family or isolate myself."
She has no confidence, she told Checkpoint. "There isn't any. This is as much as I've got right now talking to you, letting this be known."
What help is offered?
Beneficiaries and low-income earners can get up $300 a year through the Ministry of Social Development (MSD) for urgent dental treatment. That money does not have to be paid back.
For more costly treatment help, people can apply for 'recoverable assistance' from MSD. It is basically a loan that has to be paid back, even if at a minimal amount.
Jill has already had nearly $3,000 of dental work through MSD in 2010 and 2011. She is still paying it back at 50 cents a week.
Currently her total debt to MSD for various assistance is about $28,000.
Taking on more debt is what stops her getting her teeth fixed.
"That and just being uncomfortable in general, asking Work and Income for help and not having the money myself."
In the 2017/2018 financial year, the Ministry of Social Development gave just over $26.6 million of grants and advances for dental work to low-income workers and beneficiaries.
Of that amount, just over $15.6 million was 'recoverable assistance' - loans that are required to be paid back.
For the two years prior the figures are similar.
In total over the years 2015 to 2018, MSD gave approximately $75.5 million on dental work for low-income people and beneficiaries. Nearly $43 million of that is required to be paid back.
'You can't just take time off work'
Jill told Checkpoint she cannot explain how it would make her feel to have her teeth fixed.
"Maybe I would be able to go to my son's school without him being embarrassed .
"It's humiliating. I've lived most of my life like this, all my adult life thus far.
"I want to go to work to support my family. How do you tell people the reason you don't go to work and you're anxious is because you have problems with your teeth?
"Easy fixes, but when you don't have the money, it's only a dream."
Jill said she is too ashamed to do everyday things like taking her son to school.
"When I talk face to face with other adults… He's a teenager, he doesn't want to be mocked for having the mum with those funny teeth.
She said her own anxiety and insecurity is a big part of what holds her back, but there is also the debilitating pain of toothache.
"It can often take me nearly a week, if not longer, to actually get rid of the pain.
"You can't just take time off work, and there's not a day when it's not sore. Just some days it's not as bad as others, and you can't tell your boss you can't come in to work today because you've still got your dental issues. They won't put up with that."
File picture. Photo: 123RF
What can be done?
Beneficiary advocates say dental care is basic human right and the government needs to heavily subsidise it or make free.
Social Development Minister Carmel Sepuloni declined to be interviewed on Checkpoint, but in a statement, said: "The rise in special needs grants year on year for dental care shows that people are accessing their full and legal entitlement under this government.
"In the same period the number of grants for dental work that don't have to be paid has also increased."
Ms Sepuloni said the Ministry of Health has longer-term ambitions to make dental care more affordable and accessible.
The government's own welfare expert advisory group recommend the government review and increase grant limits so they cover costs for the likes of emergency dental treatment.
Ricardo Menendez March from Auckland Action Against Poverty said New Zealand had an inadequate public health infrastructure that was not suited to address its growing oral health inequities.
"More New Zealanders are struggling to afford paying for dental care," he said.
He said the debt burden was "massive," and the numbers just kept going up.
"There were 70,000 people that required a grant in the period of one year, which is massive. And these are the people who actually manage to get to Work and Income. That are able to take time off.
"We know of many people who carry ill oral health and do not take time off work until it becomes an emergency.
"The prospect of carrying such a massive financial burden for the rest of your life is a barrier for people to even want to access this help.
"We need to address cost barriers... But also looking at the socio-economic determinants of health, such as access to healthy kai, adequate incomes and other things."
He said dental care should be a universal right.
"This is time the government steps up, puts a proper policy platform and subsidises oral health for adults as well.
"We can't ignore that things like even being able to travel to a dental clinic, taking time off work, are other barriers that lead to people not accessing dental care."
*Name has been changed