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Talking Teeth

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With a taxi driver’s knowledge of the streets, a small white car and a dentist’s kit packed in a portable suitcase, Tule Misa is determined to improve the oral health of Christchurch’s Pacific communities.

Tule Misa

Tule Misa is the face of Pacific dentistry in Christchurch. In her role as a community dentist with the Canterbury DHB, she visits local schools to treat children and actively supports more than 60 dental therapists who work in them. Her particular focus is to help kids with poor oral health, including Pacific kids, who urgently require dental care.

Local statistics show disturbing inequalities between the oral health of Pacific young people and other ethnicities, says Tule. Not only are rates of tooth decay, missing teeth, fillings and periodontal disease worse among Pacific young people, but they are also far less likely to access the services which are available and free for those under 18.

“Pacific kids have one of the lowest attendance rates for using school dental services. In Christchurch in 2002, the school and community dental services data showed five-year-old Pacific children had the lowest attendance compared to other groups.

“The situation is really bad. Pacific people are one of the most vulnerable groups in our community in terms of oral health diseases.”

Tule puts this down to the following – lack of awareness about the available services, lack of understanding of dental diseases and how to prevent them and, more tellingly, different cultural priorities.

“The Pacific approach to going to the dentist is not preventative. Pacific people only go to the dentist when they are in pain or there’s a serious problem. Going for a check up is not something they would normally do.

“I’ve worked in Fiji, Tonga and here in New Zealand and that is how Pacific people think – they’ll only turn up when they’re in pain. Probably only 1 in 100 will come just for a check-up. Their awareness of the importance of oral health is very poor.”

For those over 18, cost is another barrier. While it may cost only $100 a year for an individual to have regular checks to maintain good oral health, the economic considerations are different for large Pacific families, says Tule.

“Pacific people are very family oriented. It’s not just about one person; people have to think about their whole family going and $100 won’t cover all those people.”

Changing this situation is obviously a huge challenge, but Tule Misa is enthusiastic, visiting numerous school dental clinics each year and linking in with local Pacific communities and churches.

“My role is to talk teeth and spread the message that oral health should be a priority for Pacific people. Getting the information out there is vital.”

Here too, however, it is a case of the messenger being as important as the message. Tule grew up in Tonga, trained in Fiji where she gained her Bachelor of Dental Surgery and a Post Graduate Diploma in General Dental Practice from Otago University and settled in Christchurch 2003. Tule enjoys combining church talks with oral health messages, given that most Pacific people are church-goers. She believes this is another effective avenue where oral health messages can be disseminated.

“I work dental health messages into any sermon I may deliver at church. I’m always talking teeth,” laughs Tule. “If you can reach Pacific people at a church meeting it will be more effective than just sending them a pamphlet.”

This raises the wider issue of the need for cultural connection in public health promotion.

I see a lot of Pacific children with dental decay and some of them have just migrated from the islands. The change of diet when they come to New Zealand is tremendously influencing their dental health. They are drinking more sugary and fizzy drinks and parents aren’t realising that such behaviour is damaging to the children’s teeth.

“It’s important that Pacific people work with Pacific people because our sensitivities can be very different. If you just tell Pacific people to stop doing something, it won’t work. The message won’t get through. Oral health promotion can’t just be a lecture if you want to change behaviour. Pacific people have to be aware of the problems and the causes. Dental decay is not caused by one thing only, it has so many contributing factors such as diet, bacteria, teeth and time. We can modify our diet to prevent dental decay by limiting the type of food that is bad for the teeth. We can disturb the bacteria in the mouth by brushing twice daily so they will not attach to the teeth and do the damage. We can also use fluoride toothpaste to help strengthen the tooth structure from the process of dental decay. Water fluoridation is proved to be effective and efficient for the population’s dental decay prevention.”

Tule says many more Pacific people are needed in the field of dentistry. “In New Zealand there are very few Pacific people in the workforce of dentistry. We need to encourage more Pacific students to consider dentistry and oral health as their career path.”

The Ministry of Health’s Oral Health Strategy rightly focuses on prevention, says Tule.

“Prevention is still the priority because dental decay and periodontal disease are preventable. People aren’t born with them. Prevention should be the first priority for Pacific people. They have to become responsible for their own oral health. If they come up with their own solutions it will be more effective than anything else. This is starting to emerge. We’re looking at initiatives like getting churches to fund toothbrushes.”

Fluoridation of the local water supply could also make a big difference to the oral health of children, but the topic is a contentious issue locally and the region still doesn’t have fluoridated water.

“Recent studies by Lee and Dennison comparing children from areas with water fluoridation like Wellington and areas that don’t such as Christchurch show an enormous drop in tooth decay in areas with fluoridation. It’s a big local issue we need to work on because it will be a very good thing for Pacific people to get water fluoridation happening.”

The impact of diet and nutrition on oral health is another key area for attention.

“I see a lot of Pacific children with dental decay and some of them have just migrated from the islands. The change of diet when they come to New Zealand is tremendously influencing their dental health. They are drinking more sugary and fizzy drinks and parents aren’t realising that such behaviour is damaging to the children’s teeth.”

Since nutrition is also a key factor in the fight against diabetes and obesity, Tule says it makes sense to link key messages about all three areas.

“If people are talking to Pacific patients about diabetes, it’d be great if we could also get some oral health messages in there too.”

Oral health hasn’t attracted the same publicity as health issues such as diabetes and obesity but it is equally vital for the wellbeing of Pacific people, says Tule.

“Oral health affects everything. If you don’t have good teeth you can’t eat properly. People with tooth pain can’t concentrate on work or study. The way that we speak is formed by our teeth. In young people, milk teeth are an important guide for our permanent teeth. If they’re extracted early it will cause problems. Oral health is a huge and important issue for Pacific people.

“At the moment dental health is one of the least important priorities for Pacific communities. Pacific people will give money to community-based functions but not to their oral health needs. We need to change those priorities. I like the Ministry of Health’s vision of good oral health for all for life. My vision is good oral health for all New Zealanders including Pacific people for life. I don’t see this happening in the next ten years, but if we can get our messages about prevention across to the young people we’re looking after now, in 30 years’ time their oral health will be as good as any other group. That’s what I love about being a clinician. You’re making a difference.”

Pacific Oral Health

The last New Zealand Health Survey noted that Pacific people are less likely than average to visit the dentist. In 2002–2003, only 21 percent of Pacific people saw a dentist – half the national rate.
Children of Maori or Pacific ethnicity, or those who are from low-income backgrounds, or who live in rural or non-fluoridated areas, all have poorer oral health relative to other groups.
The average number of missing or filled teeth is higher for Pacific children at Year 8 and school entry than the total New Zealand average.
The relative disparity between Pacific and total New Zealand children persists despite fluoridation.

In 2006 the Government launched a ten-year plan for improving oral health – Good Oral Health for All, for Life: The Strategic Vision for Oral Health in New Zealand. It includes seven areas for action in oral health services:

re-orientation of child and adolescent oral health care to community-based services. $100 million will be spent over the next five years establishing an appropriate infrastructure for community-based services
reduction of inequalities (especially for Maori, Pacific and rural New Zealanders) in oral health outcomes and access to oral health services
greater focus on oral health promotion
building of better linkages with primary care services
development of the oral health workforce
development of oral health policy
greater research, monitoring and evaluation.

The Strategy supports the development of Maori and Pacific oral health providers and workforce so services are appropriate and appealing for these groups.

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