The word brings to mind everything-must-go sales. Or clear-felling land.
But in the world of dentistry “clearance” has a very different meaning.
“Dental clearances means taking out all the teeth in a mouth,” Canterbury District Health Board (CDHB) specialist paediatric dentist Dr Arunkumar Natarajan says.
“Two-year-olds have 20 teeth – I’ve taken 20 teeth out of 2-year-olds.”
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In 2019, more than 40 per cent of 5-year-olds in New Zealand had tooth decay. Ministry of Health data shows between 2001 and 2016, the number of 0 to 14-year-olds requiring general anaesthetic for rotten teeth removal increased from 4500 to 7500.
One hundred years since the school dental service was established in this country in 1921, our children’s teeth are falling through the gaps.
For more than eight decades, dental nurses managed an often-dreaded regime of dental checks and drills, cotton wool angels and amalgam, usually from small wooden buildings or allocated rooms on the school grounds.
In 2006, the school dental service was changed to a community dental service.
Dental care is still free for children under 18 and pupils still get their annual check ups at school through mobile clinics.
But those requiring treatment now go to community hubs; those needing ‘special care’ are referred to hospital.
It is here the tooth fairy is facing bankruptcy.
While the proportion of 5 to 12-year-olds without tooth decay has gradually improved, every year, the number of hospital referrals goes up, Natarajan says.
“In the last year 1300 kids were referred to us. Of these, 80 per cent would be put to sleep. We have done full dental clearances on 2 to 5-year-olds.”
Frequency of food intake is an important factor. Every time our teeth come into contact with food, he says, there is going to be acid attack on the teeth.
“But if you look at the main problem, it is sugar. Sugar is the culprit.”
He points to the supermarket aisles dedicated exclusively to sugary drinks.
“That wasn’t the case decades ago.”
Now it is public enemy number one for young children with dental decay.
“When sweet foods go into the mouth, bacteria feed on them and produce acid,” CDHB public health dentist Dr Tule Fanakava Misa says.
“This acid causes the holes in the teeth.”
Oral health is worse for the 20 to 30 per cent of New Zealand children experiencing child poverty – afterall, at the local dairy a bottle of fizzy drink is often cheaper than a bottle of water.
And Māori and Pasifika kids are disproportionately represented in the higher end of poor dental statistics.
Ministry of Health statistics from 2019 show that, while nearly 59 per cent of 5-year-olds overall have no caries, this figure drops to 41 per cent of Māori children and 34 per cent of Pasifika children. Of the 18 per cent of Canterbury’s children experiencing severe tooth decay by the age of 5, 26 per cent are Māori and 40 per cent are Pasifika.
“The inequality gap is still huge,” Misa says.
Natarajan says there are three main defence strategies.
One is a sugar tax – under the UK soft drinks industry levy, drinks with more than 5 grams sugar per 100ml are taxed on a two-tier rate.
Research published this year by the British Medical Journal shows since the levy was applied in 2018, the amount of sugar purchased in drinks has decreased by almost 10 per cent – equivalent to three fewer teaspoons per person per week.
“So we know that works,” Natarajan says.
The second defence is better labelling – even if parents and childminders do have time to squint at the ingredients list, the information can be confusing.
“A 600ml can of fizzy drink has 16 teaspoons full of sugar, but we don’t say that clearly.”
And the third is fluoridation.
For children and adolescents, “the lifetime reduction in the incidence of tooth decay is around 40 per cent,” Natarajan says.
“If you fluoridate the water, it will save about $1400 million over 20 years.”
“These are all the solutions I can see, because we need to prevent decay before they get to the point where they need to be put to sleep and have their 20 teeth taken out.”
Some schools are initiating their own solutions. Every day after lunch pupils at Arowhenua Māori School in Temuka, South Canterbury, brush their teeth as part of an oral health programme first trialled in Scotland.
Joseph Tyro, director of Māori health at the South Canterbury District Health Board (SCDHB), says the toothbrushing and positive health messages are now spreading throughout the local community.
SCDHB specialist paediatric dentist Dr Aravind Parachuru says a 70 per cent decrease in tooth decay was noted in Scotland.
“So we thought, why can’t we get some improvement in South Canterbury? Why can’t we have our children smile in a better way?”
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