Filling the big hole in Wairoa's dental service

While none of us much like having our teeth drilled, Wairoa is a town in desperate need of a dentist, as a recent initiative proved. Reporter Matthew Rosenberg has looked into why finding a dentist for Wairoa is - like pulling teeth.

Halfway down a back street in Wairoa sits a nondescript building with graffiti on its brick facade - it was previously occupied by the town's only local dentist, who closed up shop almost two years ago.

When the practice doors swung shut, it left a register of patients facing a long commute to either Gisborne in the north or Napier in the south.

But for many of Wairoa's 4500 residents that hasn't been feasible, as evidenced by a recent week-long dental initiative, Tō Waha, that ran out of the local school two weeks ago.

The need was high. On the first day alone, 77 extractions were performed and 43 fillings put in.

"Yeah, we used to be full," said Dental Health Wairoa co-owner Samarth Khanna, speaking from Auckland and reflecting on the more-than-2000 patients his surgery has on its books.

"That practice used to be booked out at least a month or two in advance."

Samarth owns Dental Health Wairoa along with his father Sanjay and brother Samar. It's a business he sometimes wishes he'd never bought.

Purchased just before New Zealand's first lockdown in March 2020, they were operational for only a few weeks before their plans were halted. When lockdown finished so did their dentist, who decided to return to Auckland.

With the previous owner gone - a dentist who worked two days a week - the Khanna family found themselves in a difficult situation that didn't get any better as they struggled to recruit.

Brother Samar stayed on in his capacity as a clinical technician, but was restricted to doing only dentures. He, too, eventually decided it was time to leave Wairoa.

"To be honest, it really has (been disappointing)," he said. "If we'd known the lockdown was happening, we wouldn't have bought the practice, at least not before that.

"If we were dentists, we would definitely love to work there because there are patients. There are people there who need the dental care. We can't provide it."

The search for a dentist continues, but Samar laments that the business can't access locums from overseas because of Covid-19 - something that would be a temporary fix, but helpful nonetheless.

"After the lockdown there's just nobody that really wants to work there," Samarth said.

NZ Dental Association access to care spokeswoman Dr Katie Ayers acknowledges there isn't a quick fix to the situation, but holds out hope things can improve.

That said, dentists are a finite resource. Every year 65 to 70 graduate in New Zealand, but similar numbers that used to come in from overseas are no longer turning up on our shores.

Part of the reason is a change in the registration process, which means overseas dentists are now required to sit exams when they come to New Zealand, she said.

Would a dentist want to move to a small town?

Ayers said attracting dentists to the backblocks is a difficult task anywhere because most dentists want to work full time.

In Wairoa, the issue wouldn't be so much if the work was available, but how sustainable it would be.

"I can imagine in a town like Wairoa where there is such an immense need, yet so few of the patients can afford what they need . . . that would be just soul destroying.

"You'd be wanting to do lots and lots of charity work and you can't sustain a practice that way."

Other factors are at play preventing dentists from taking up the call to work in small towns.

While group settings lend themselves to better working conditions and peer support networks, the flipside is a feeling of being professionally isolated in smaller centres, Ayers said.

"We find that dentists that work on their own at their own surgery are at higher risk of things going wrong than dentists who work in a group setting, where you can share costs, discuss cases over a coffee, and you know you've got much better peer support that way."

How to fill the gaps?

Ayers said the ideal model is to find local youth who are interested in the career, train them, and hope they go back to the same area they came from.

But for now, the only real solution she can think of for Wairoa is creating a role for a salaried dentist supported by the district health board and government to meet the needs of those who need the help most.

She also believes the government needs to front up on its pre-election promise of increasing funding available to people through the Ministry of Social Development from $300 a client to $1000.

"When I graduated as a dentist 26 years ago, beneficiaries could access $300 of dental care," Ayers said. "And 26 years later, beneficiaries can access $300 of dental care. You can imagine how much the cost of performing dentistry has increased over the decades.

"If you went to a practice in Wairoa and had $1000 to spend, you could get quite a lot of dentistry done."

While that will not solve the issue of making treatment more accessible to low income earners, it will be a start, she said.

"It's up to the government to help out. That charity project was fantastic, and there's little projects like that going on all over the country where dentists are donating hours, and often they're paying their staff and paying for the materials.

"But in reality, the needs are so great. It's just a drop in the ocean."

Throughout the week-long Tō Waha initiative in Wairoa, volunteers from around the country treated 307 people.

Working up to 13 hours a day, the team managed to exceed the 250 patients originally booked by also working their way through a waiting list of 57.

More than 300 teeth were pulled and 277 fillings given over the week, preventing further extractions.

Samarth Khanna's brother Samar left the practice to study dentistry in Australia, and hasn't ruled out coming back to the small town.

"Hopefully four years later he comes back and he can actually work and start seeing the patients if we hold the practice for this long," Samarth said.

While it's some light at the end of a long tunnel, one question remains - can Wairoa wait that long?

Local Democracy Reporting is Public Interest Journalism funded through NZ On Air