Dental Asia November/December 2023

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UNDER THE SPOTLIGHT Leading through an oral health crisis Flanked by rising costs and labour shortages, New Zealand is experiencing an oral health crisis that has been exacerbated by COVID-19 in recent years. Fresh off the polls from a general election where oral health formed major policies on which officials campaigned, Dr Amanda Johnston, president of the New Zealand Dental Association (NZDA), speaks to Dental Asia on the struggles and hopes for oral health in New Zealand. By James Yau Since assuming her new office at the NZDA on 31 Aug, president Dr Johnston found herself “surprised” by the uptick of national attention for oral health in the run up to the recently concluded general elections. “At that stage, we did not realise that oral health was going to make up such major parts of some of the party’s policies. We were just trying to bring oral health to the attention of some politicians,” Dr Johnston shared. In what is said to be an oral health crisis where nearly half of its population delay dental treatment for reasons such as cost, accessibility, or waiting times, Dr Johnston described the climate of the oral health in New Zealand as being “stretched”. “The cost-of-living crisis is affecting patients’ ability to seek and pay for treatment. Another is workforce shortages. At the moment, everybody is overworked and under-resourced, and the problem we have is our nearest neighbours, Australia, is looking a lot rosier than it is in New Zealand. It is a big incentive for staff to just quit and leave New Zealand. We really need to keep our experienced and well-trained workforce here.” Moreover, for the island nation in the South-western Pacific with over 5.2 million residents, the crisis was compounded by the COVID-19 pandemic, where residents in rural and provincial areas felt its impact more gravely compared to their counterparts in the cities. “I think again it is an international situation. In New Zealand it was exacerbated by our extended lockdowns meaning that we could not access as much of an international workforce as we often could. Also, practices were closed so there was a backlog of treatment. Two years on, we are sort of getting to the end of that, but the workforce was affected and there is an after-effect of COVID being felt around the world,” she added. Although the election trail is over, regardless of the results, Dr Johnston’s mind is still preoccupied with making a difference, to achieve a better outcome in addressing the oral health crisis regardless of political climates: “We are keen on driving change. To do so, you need to provide a solution to the 18 DENTAL ASIA NOVEMBER / DECEMBER 2023
UNDER THE SPOTLIGHT problem, plus you need the political will to make it happen.” AN ORAL HEALTH CRISIS In New Zealand, dental care is fully subsidised by the state for all children ages 0-18 through the Community Oral Health Service and through private practices utilising the Combined Dental Agreement (CDA). Funding becomes private after these ages except for some community sections such as special needs patients and hospital inpatients oral cancer treatments. The policy proffered by the NZDA in dealing with the crisis since before the pandemic and global inflationary pressures was to raise the age cutoff for state-subsidised dentistry to age 25. “Across the board, evidence shows a big drop off in accessing treatment after age 18. We find that people in the young adult age group are not accessing dental treatment, not having routine care, and is the highest proportion age group that requires acute hospital treatment for dental disease that could have been prevented,” Dr Johnston said. She felt that targeting this demographic would be effective as it would provide early diagnosis and treatment for preventable diseases. “Through your life, it is hard to change your oral health status. People who have poor oral health at age 20 are likely to have poor oral health at age 50 and at age 70 because dental diseases are cumulative. If you have made it to age 25 with a minimal amount of dentistry, you have had good preventative programmes established and a much better chance of maintaining good oral health through the rest of your life,” she added. In addition to increasing the coverage for dental care, being heard and seen in the parliament is just as important. “Our department has gotten smaller and smaller. Now we have one national clinical director of oral health who works three days a week, who is the oral health voice in the Ministry of Health in New Zealand,” Dr Johnston said. The system of district health boards was abolished about a year before as the preceding government initiated a “complete overhaul” of the health system by establishing a co-governance model with Health New Zealand and the Māori Health Authority. Dr Johnston described the current system for oral health as being “diluted” through the whole health system. “At the moment, the current system that they have reestablished has oral health split into public health, community service and surgical service. Within the Ministry of Health in the past 10-15 years, there has been a significant decrease in the voice of oral health,” Dr Johnston said. “We are really keen to try and get a bigger workforce at the national government level, and to have a better voice and better presence in the central government.” A recent success in NZDA advocacy was the increase in non-recoverable payment for patients on benefit from NZ$300 to $1,000 per year, under the Emergency Dental Needs Grant from the Ministry of Social Development. However, Dr Johnston stressed that a “significant uplift in funding” was first needed before more workload can be expected to be put on the dental table. She was referring to the strain put on the operation of dental practices by the CDA funding model, which many dentists view as a “community service”. “The CDA is basically a capitation system with a minimal fee-for-service added on, where the funding is about 50% of what our private patients pay. But because we want to keep patients in our practice and keep them healthy, most of us in our communities are treating patients and expect to barely cover the treatment cost. We need to have that system revised and the funding brought into line,” she said. MAKING A CHANGE In the NZDA’s fight to resolve the crisis, Dr Johnston noted that it requires a “combination” of drivers beyond legislation, including community partners and public mindsets, to implement preventative strategies that would alleviate pressure on the public oral health system. Dr Johnston believes funding is needed before practitioners can manage an increase in work capacity (Image: NZ Herald) “It is ideal if you can get good preventative strategies that help to prevent disease. The cost is limited for the government, so they are the winners if we can get less disease out there. It also has benefits throughout every age group, where they can be influenced and hopefully helped across the board. My personal view is DENTAL ASIA NOVEMBER / DECEMBER 2023 19
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Page 4 and 5: CONTENTS TRENDS 11 A growing region
Page 6 and 7: EDITOR’S NOTE Something in the Ai
Page 8 and 9: DENTAL UPDATES Straumann Group acqu
Page 10 and 11: DENTAL UPDATES Mirco Stiehle and Mi
Page 12 and 13: DENTAL UPDATES Chamlion partners wi
Page 14 and 15: TRENDS successful proof-of-concept
Page 16 and 17: UNDER THE SPOTLIGHT DGX A100 based
Page 18: Moreover, companies may not be will
Page 23 and 24: UNDER THE SPOTLIGHT A second artifi
Page 25 and 26: DENTAL PROFILE Furthermore, with th
Page 27 and 28: DENTAL PROFILE “Our main priority
Page 29 and 30: DENTAL PROFILE singular platform fo
Page 31 and 32: CLINICAL FEATURE Using a 3D-printer
Page 33 and 34: CLINICAL FEATURE Quadrant Dentistry
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Page 37 and 38: CLINICAL FEATURE inclines, both in
Page 39 and 40: CLINICAL FEATURE Statistics The Wil
Page 41 and 42: USER REPORT Taking the first step i
Page 43 and 44: USER REPORT The IOS price war: Adva
Page 45 and 46: USER REPORT Rubber dam isolation By
Page 47 and 48: BEHIND THE SCENES Communicating tow
Page 49 and 50: BEHIND THE SCENES Pressure or vacuu
Page 51 and 52: invis is a comprehensive approach t
Page 53 and 54: Dr Dagnelid (left) will be speaking
Page 55 and 56: IN DEPTH WITH In addition to the pa
Page 57 and 58: SCAN TO REGISTER THE LEADING DENTAL
Page 59 and 60: PRODUCT HIGHLIGHTS Pac-Dent introdu
Page 61 and 62: PRODUCT HIGHLIGHTS ASI Dental Speci
Page 63 and 64: DUAL CURING CORE & RESIN CEMENT 3 I
Page 65 and 66: EVENTS CALENDAR 2023 NOVEMBER 9 - 1
Page 67: INSIGHTS P A L M A D E M A L L O R

Dental Asia November/December 2023

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