From wider health problems, self-medicating toothaches with alcohol or drugs or not wanting to smile — dental issues can have a huge impact in the lives of people experiencing homelessness. The Wellington social service DCM provides free emergency treatment to break down barriers and help some of our most vulnerable access dental care.
The dental chair is humming when 1News visits Downtown Community Ministry (DCM)'s dental clinic for people on the homeless continuum, or 'taumai' as DCM calls the people they work with (meaning 'to be settled').
Ngata Reihana broke off a piece of his front tooth while munching on some lollies, and he's come in to get it sorted before it deteriorates any further, knowing all too well how bad dental issues can become.
"It's horrible getting toothaches. I've lost a few teeth eh, most of the back ones are gone. Gotta take better care nowadays," says Reihana.
The clinic fixes broken teeth like Ngata's and provides other emergency treatment for pain relief such as sorting significant gum problems, teeth extractions and fillings for painful decay — and does so free of charge for around 100 taumai each year.
Confidence boost from a new smile
DCM manahautū/director Stephen Turnock says that most of the people they work with have missing or decayed teeth, and the feelings of shame around this can take a toll.
"Taumai are no different from you and I. Yes, they are seen as dysfunctional, problematic, with a high amount of addictions, mental health barriers. But they still thrive off self-confidence, of being able to look someone in the eye and smile.
"When someone is continually looking at the ground, and not wanting to smile or feeling whakamā, then that creates more barriers."
Hilory Randell's had a decaying tooth filled that had been causing migraines and trouble eating. She'd tried to ignore due to caring responsibilities and a precarious housing situation.
"I don't really like dentists, so it's taken me a while to come here and actually face my fears," Randell told 1News at the clinic.
"But it was getting to the part where, ok girl, suck it up — you've got to go."
Randell cares for someone chronically ill, and they found themselves homeless in the Wellington CBD after friends they were living with kicked them out, "out of the blue". They would have ended up sleeping rough, Randell says, if it hadn't been for her companion's illness, as she knew he wouldn't have been able to endure it.
The pair spent time in emergency housing, transitional housing, and are now finally in a more stable housing situation.
Randell says she wasn't taught how to brush her teeth as a child and didn't get her first toothbrush until she was around 12 — she had to ask her grandfather to buy her one. Years of neglect led to numerous teeth being pulled out, which she now regrets.
As well as her challenging circumstances, the cost of dental care was also an obstacle in the past, and Randell says that before coming to DCM she hadn't been to a dentist for at least 15 years.
“That cost would put food out there for the both of us. Or that cost would buy me some clothes that I needed.
"These people here are the first ones. They actually made me feel comfortable coming to see a dentist."
Sophie McKenna, one of the dentists who volunteers at the clinic, says they take a different approach at DCM compared to what taumai might have experienced in the past, when they may have been "belittled" by dentists frustrated by their ongoing lack of oral hygiene.
"I'll say, 'what's the most important thing that I can help you with today?' And they look astonished. They are normally told to lie back, open up, and then a health professional gives them a carefully worded lecture about what isn't being done, how disastrous things are."
"And that's not we’re here for. We're here to make them feel better."
Randell is thrilled with how things have gone so far at the DCM clinic, with her pain relieved and the decay no longer visible: "I've got a white tooth you know, and it doesn't have a silver filling, it's a white filling. I love it."
Opening the doors to accessibility
DCM works with people experiencing homelessness in Wellington, providing outreach services for rough sleepers, harm reduction programmes and health services, and programmes to get people into homes and to support them to make a sustainable shift out of chronic homelessness. The dental clinic was set up in 2016, in partnership with the Wellington Dental Association, after DCM recognised a gap in access to oral health care for taumai.
Turnock says cost is not the only barrier to taumai receiving dental care: "They're isolated from the community, they've been trespassed, they don't have access to resources such as even a telephone, there's a wide variety of reasons."
"But predominantly, because of where they sit on our social structure, that ladder to even get access to [dental care] has so many more rungs that we take for granted every day."
“When someone’s having to find shelter for the evening, accessing oral health care is not the highest priority.
The DCM clinic is unique in Aotearoa. Although there are a few other services, usually hospital-based, providing free emergency dental care for those in need, Turnock says no others have the benefit of being on-site alongside other social support services, where people experiencing homelessness know the staff and can be supported all the way into the chair.
"We have the right support structures to get people to appointments. But also manage their addictions and their mental health in a way that the treatment can be provided here at DCM. Because they have a relationship here [it] opens those doors to accessibility," Turnock says.
Auckland City Mission is in the process of developing a similar clinic but needs further funding to get it up and running.
Turnock notes that it can go both ways — taumai might come through the doors for free dentistry and leave with a whole lot more.
"Through the availability of the health services, including dentistry, we're able to establish a connection. Then we can start to have a conversation about housing, about addictions."
McKenna says that she and the other dentists "punch above our weight significantly" when they fix something and relieve pain that many of the taumai have been dealing with for months, due to a cascade of other positive impacts.
"Dental pain is all consuming… to take them out of pain allows the head to clear a little. Maybe the advice and support that the DCM key workers are offering them, maybe can be taken on board that little bit better."
"And then it becomes a cycle of everything on the mend for just getting that tooth fixed."
Mo Amso, chief executive of the NZ Dental Association (NZDA), says that the DCM dental service is a "wonderful initiative" that shows the importance of having a holistic approach to supporting vulnerable communities, something also needed to improve access for the disabled and elderly populations.
"What's becoming apparent is equitable access to dental care is no longer only about money to pay for the service, but also providing a social network and wraparound support to facilitate that access," Amso says.
DCM's clinic is staffed by volunteer dentists and relies on donations and grants to cover other costs such as wages for dental assistants, equipment and materials. Turnock estimates the cost is $800 per taumai per visit (including the dentist's time in kind).
Having clocked up around 1300 appointments so far, "effectively that is a saving to our community of approximately $1.3m", Turnock says.
Amso says that while the dentists volunteering their time is "incredibly humane and incredibly admirable", clinics like DCM's should be funded.
"Dental care should not have to be accessible through charity, that shouldn't be the model of care of vulnerable adults in New Zealand."
Increase in dental grant welcome but a 'drop in the ocean' for dental health
Amso says there are multiple causes behind Aotearoa's "silent epidemic of tooth decay and oral disease", including our high-sugar diet, lack of fluoridation in some parts of the country, workforce issues preventing kids and teens accessing universal dental care, and flaws in the system for oral health care for adults.
"We certainly have a lot of vulnerable groups of people, like low-income adults, elderly and medically complex patients whose pathway to funding is limited and their needs are not fully met by the system at the moment."
Beneficiaries and low-income New Zealanders had some relief recently, with the maximum grant available from the Ministry of Social Development (MSD) for 'immediate and essential' dental treatment increasing from $300 to $1000 last December.
Figures provided to 1News from MSD show the total number of non-recoverable dental grants claimed (43,479) from the six months from December 1, 2022, when the Government raised the cap, has nearly doubled compared to the six months from December 1, 2021 (23,025).
The amount paid out has jumped from $6.4m to $30.8m when comparing the same time periods.
There's been a small drop in 'recoverable' grants — the loans for dental work exceeding the cap, from 19,806 to 17,133, indicating a decrease in the numbers of people getting into debt for dental treatment.
Shannon Soughtton, group general manager income at MSD, says the figures show a "huge uptake in support for dental care", and that "people on low incomes who may not have been able to afford the dental procedures they needed, have been able to".
Amso says the NZDA advocated for many years to raise the Special Needs Grants cap, and that the increase, the first in 25 years, has "gone quite a long way so far already in alleviating unmet dental need".
However, they want to see the maximum income threshold for eligibility raised to be in-line with the recent increase in the minimum wage. Currently someone working a 40-hour week on the minimum wage earns $908 before tax, ruling them out of accessing the grant with its weekly income limit of $900.93 for a single person 18 years old or over.
NZDA would also like to see the grant extended to include dentures, and routine check-ups and basic cleaning to prevent further costly issues down the track.
McKenna is thrilled and relieved to see the increase in the cap, but says more is needed to address New Zealand's oral health crisis, and urgently.
"We've been just desperate for an increase. To have it go up to $1000 is outstanding. [But] it's a drop in the bucket for dental health."
McKenna encounters patients in her private practice who are unable to afford the dental care they need but whose income pushes them just over the threshold for the grant. She finds it frustrating that dental care is not funded under our public health system, like it is in other places such as the UK where the National Health Service covers much of it.
"It's the one aspect of health that’s left out. You can have any other part of you treated… the more time that goes by the more there's that disparity across the society where it's the haves and the have-nots."
“For the have-nots, dentistry is just something they can’t even contemplate.
Turnock says that although the increase in the grant is welcome first step to acknowledging the true cost of dental care, systematic change is needed.
"We're still very much the ambulance at the bottom of the cliff. It's just really the multiple long-term systemic barriers that the people we work with deal with… who should have ideally received the proper health care decades ago.
"It's the inequity of access that is the real issue here. And [when] that changes we can start moving from the bottom."
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