The huge hole in the provision of dental care in the existing publicly funded system means adults largely miss out.
Some tens of millions of dollars are paid out annually by the government in dental grants for adult dental care for those on low incomes and with limited assets.
Grants of up to $1000 a year do not have to be paid back, but above this amount they may have to be.
Anyone who has been to a dentist recently will understand how little treatment $1000 might cover, particularly if there have been years of poor or non-existent oral care.
There are also concerns about whether the $1000 grants can be too difficult to access.
In an ongoing cost-of-living crisis, it is understandable many people will choose to not grin and instead bear the continuing pain of dental problems because they see no alternative.
Some dentists are generously offering some services free of charge to some adult patients, but they know they are merely scratching the surface of the need.
There is no doubt bringing some public dentistry services available to all — basic dentistry, not procedures with a purely cosmetic benefit — would be expensive.
However, the question remains whether not doing anything comprehensive in this area is a false economy.
Or put another way, have we got to a point where the cost of not addressing our national dental crisis is outweighed by the value of introducing universal care?
That is certainly the argument the Dental for All coalition, made up of community organisations, campaigners, unions and oral health professionals, is promoting.
It will also not be simple to introduce the sort of community level care considered necessary, both from a workforce and facility perspective.
Not all dentists support the idea of publicly funded care for adults and, even among those who do, there will be differing views about the level of care and how it should be arranged.
They can also highlight, without looking too hard, the shortcomings in the existing publicly funded services for those under 18.
But these problems cannot be an excuse for endless procrastination about adult care. At some point this is a bullet which will have to be bitten (hopefully without fracturing any more teeth) when it is estimated about 40% of adults cannot afford the care they need.
Anyone who is paying attention also knows there is a need for comprehensive oral health policies which could include measures such as making all schools water only, holding the line on fluoridation of water, doing something meaningful to ensure everyone has better access to cheap healthy nutritious food, clamping down on junk food advertising and the number of fast food outlets and joining other countries which have taxed sugary drinks.
The Dental for All coalition, which had its beginnings in 2022, was gathering steam last year with a roadshow around the country getting support for their adult care campaign, hearing repetitive miserable stories about people living in constant pain, resorting to extracting their cavity-laden teeth with pliers, or ending up in hospital emergency departments with serious infections.
Although at the last election, Labour, Te Pāti Māori, New Zealand First and the Green Party all had policies which would have extended some adult access to care, only the Green Party has reiterated its promise so far. That would support free annual dental check-ups and basic dental care for all adults, funded from extra taxes such as a wealth tax.
We would be surprised if either major party promises anything near that, even without a wealth tax, but some progress in this area is overdue.
