DHB Dental Care for HNC: Investigator

We were told at the last Auckland meeting that head and neckers were eligible for one episode of care by specialist dentists after treatment. In Auckland there is a service that spans ADHB and CMDHB called Oral Health with clinics at Greenlane, Middlemore and elsewhere. Aucklanders, as I have said before, have complained, lobbied and complained some more about the lack of long term surveillance of their radiation-affected teeth. 

What about the rest of the country? So far I have found that some other DHBs offer more. I'm writing here about dental care, not prosthodontic care. More on that later. 

My information comes mainly from fellow patients. I have information from two DHB dental departments: Canterbury and Nelson Marlborough.

If we start from the south, we have little information so far, apart from the fact that you can get a $300 pre-treatment dental check up at the Otago Dental School and that in Invercargill you have to ask to be seen after treatment and then will be checked six monthly. More information will no doubt be available soon.

Canterbury seems to set the best example with three to six monthly checks after treatment with products supplied and a two to three year duration of this surveillance. 

It looks as if West Coast gives two years free surveillance and offers co-paid care after that. 

Nelson Marlborough offers post rad follow up for up to five years. 

No news from Wellington and Palmerston North, a long wait in Bay of Plenty and nothing so far from Waikato.

A recent patient from one New Zealand DHB was told she would get free dental care for the rest of her life.

Auckland we know about and Northland, where we have many members: is, well, very promising. Generally patients are checked at the hospital every 3 to 6 months and root fillings are also provided while Auckland does not provide these. Not all Whangarei patients have been referred to this service. Maybe it is up to the discretion of the clinician treating the patient?

Why does it matter?

  • Expert care: hospital dentists see special needs patients all the time so have become skilled at treating difficult mouths. Two of us had troublesome dental pain that was actually caused by inflammation due to food stuck along the gum line. In both cases it took a specialist dentist to figure it out and recommend the vigorous use of inter-dental brushes. 
  • Cost: you need a lot more care after radiotherapy and many of us just can't afford this. One patient said it cost $400 every time she went to her dentist and fillings often fell out. Her root filling by a private endodontist cost $1500. 
  • Risk: if teeth aren't cared for, isn't the risk of osteoradionecrosis worse? If all teeth are lost the patient can be more socially isolated. Quality of life declines. 
  • Education: specialist dentists and hospital dental departments are uniquely qualified to teach us how to prevent rampant post-rad dental caries. 
  • Natural justice: Dental care availability according to where you live in New Zealand seems to go against every rule of natural justice. We ALL pay the same taxes.

We hope that the recent review of Northland/Auckland head and neck cancer services will lead to Auckland getting more funds to help us. After all, Auckland has to deal with tricky cases from around the country as well as their own people. 

Next year's work on the national Head and Neck Cancer Standards might expose this inequity in the system.

DHBs spend many thousands fixing us up during treatment; it's counterproductive not to keep us as healthy and functional as possible afterwards. Geography and post-codes shouldn't give some citizens advantages over others. 

Maureen Jansen, editor of HNCSN, amateur investigator of head and neck cancer issues. Always willing to be questioned and challenged.

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