Addressing barriers to dental care: a Tūranga Health and Trinity Koha Dental initiative

Aotearoa New Zealand has high levels of unmet need for dental care.^1,2 Half of adults only visit a dentist when they have a problem rather than attending for checkups or regular preventive care.³ There are also considerable inequities in oral health by socio-economic position⁴ and by ethnicity.^5,6 The Dunedin Multidisciplinary Health and Development Study shows that people who grew up with low socio-economic position are less likely to routinely visit dentists⁷ and that long-term regular attendance impacts oral health and oral health quality of life.⁸

The Levesque model of access to healthcare⁹ identifies several aspects of healthcare that affect access. These are approachability; acceptability; availability and accommodation; affordability; and appropriateness. In Aotearoa, affordability appears to be the most important barrier to dental care. Although dental care is publicly provided with no user charges for those under 18, care for adults is provided primarily by private dentists on a fee-for-service basis.² There is some public funding of dentistry in hospitals, and private dentists provide some publicly funded services through Work and Income New Zealand (WINZ), Accident Compensation Corporation (ACC) and the Combined Dental Agreement (CDA) for children and adolescents.² WINZ, for example, may provide up to NZ$1,000 per year for “immediate and essential” dental treatment (not preventive care), for people on benefits or low incomes. Further assistance may be provided, but this may be “recoverable”, i.e., become a debt to WINZ.¹⁰ In Canterbury, the Canterbury Charity Hospital provides free care to a limited number of low-income patients, and this has been shown to improve oral health–related quality of life.¹¹

In a systematic review, Schwendicke et al. found that almost all studies internationally reported that people with lower socio-economic position had higher risk of caries.¹² In Aotearoa, Māori are more likely to have poor oral health and less likely to be able to afford to see a dentist, and they are more likely to have their daily lives impacted by their oral health.⁵ In the 2024/25 New Zealand Health Survey, Māori were less likely to rate their oral health as “good”, “very good” or “excellent” than non-Māori, as were people living in areas of high deprivation (compared with those in areas with lower levels of deprivation). Similarly, Māori and those living in areas of high deprivation were more likely to report that cost prevented them from getting dental care.³

The Tūranga Health/Trinity Koha Dental Clinic initiative

Tūranga Health is an iwi-based healthcare provider based in Gisborne. It has a long history of innovative service delivery.¹³ In 2024 and again in 2025, a charity dental provider, Trinity Koha Dental Clinic (TKDC), visited the rohe (region) and provided free dental care for people with high unmet need for dental care. TKDC has provided this service elsewhere, but in this initiative Tūranga Health also added wrap-around services.

TKDC is part of Youth With A Mission (YWAM) Ships Aotearoa,¹⁴ whose mission is to provide free medical and dental care to people in isolated areas of the Pacific, including Aotearoa. Between 2021 and 2024, they provided 7,687 dental services to 3,445 patients in Aotearoa.

Over a week in 2024 and a fortnight in 2025, TKDC offered free dental services in collaboration with Tūranga Health. In 2024, the target population was young mothers. In 2025, individuals living with long-term conditions, disabilities and/or mental health challenges were intentionally included. These populations were prioritised due to the regional demographic profile, where such conditions disproportionately affect Māori. Dental services included dental checkups, treatments, cleaning and hygiene education. Local and other dental professionals volunteered their time. One dental caravan, a dental trailer and a mobile dental chair were used so that services could be offered in three settings, including rural and urban.

In addition to affordability, Tūranga Health and TKDC attempted to address other barriers, such as accessibility and acceptability of services. Approachability was enhanced by Tūranga Health staff contacting eligible patients and encouraging them to take part in the service. Accessibility was addressed by Tūranga Health staff organising the appointments, creating waitlists in case people did not attend and by transporting people to and from appointments. Acceptability was ensured by staff greeting and checking in patients, and providing manaaki (care, for both patients and staff). Availability and accommodation were addressed by providing childcare.

In 2025, Tūranga Health’s approach to winter preparedness included access to dental services (provided by TKDC and local dental staff), immunisations (childhood/influenza vaccinations), car seats (to reduce childhood injury), firewood, home insulation and raised-bed gardens.

The aim of this paper is to describe and evaluate this intervention, the services delivered, feedback from participants about whether and how the service met their needs, and which aspects of it addressed access barriers.

Methods

We used data routinely collected by Tūranga Health to describe the service. In addition, Tūranga Health routinely collects patient feedback for service monitoring and quality improvement.

Patient feedback for the service was gathered through one-on-one kōrero (conversation) with 18 patients using the service. These patients were interviewed during the 2024 and 2025 dental programmes and represented the three priority cohorts: young mothers, people living with long-term conditions and people living with mental health issues and disabilities. Sampling was largely based on convenience, people who were available and willing to talk, but we also attempted to include a range of demographic groups. Fourteen men and three women were interviewed.

Interviews were semi-structured: a set of questions was used as a guide for discussion, rather than a structured questionnaire. This asked about patients’ previous experiences with dentists and other healthcare, what they hoped to gain from the services, and what they got, how they felt now, as well as their experiences on the day. Interviews were audio recorded. We carried out a basic deductive thematic analysis. The parts of the interviews answering the questions were transcribed, and we organised and summarised responses in a Word document.

Ethical approval for this study was granted by the University of Otago Human Ethics Committee (H25/0454) as a retrospective evaluation of routinely collected data.

Results

Table 1 describes the number of people seen, dental treatments, vaccinations and car seats provided. In 2024, 207 treatments were provided to 40 patients, and in 2025, 605 treatments were provided to 178 patients. Patients were all adults, and some attended as couples or whānau groups.

View Table 1–2.

Most teeth that were provided restorative care were severely decayed/damaged (yet restorable) anterior teeth. Scaling was provided for people who were evaluated as having periodontitis. Most tooth extractions were routine “simple” extractions, but nearly 10% of teeth extracted in 2025 were surgical extractions (surgical extractions are those that may involve lifting a tissue flap, removing bone, tooth sectioning or sutures).

In 2024, one dentist worked each day. Table 2 shows the number of patients and procedures for each day in the 2025 programme. In 2025, multiple mobile clinics ran concurrently. In the second week there was a dental caravan with a dentist, a mobile dental chair with another dentist, and a dentist or dental therapist working in a dental bus provided by Health New Zealand – Te Whatu Ora. Tūranga Health provided lunch and dinner for staff. Each day was scheduled for 8 hours, but this was often extended if patients needed additional work beyond the scheduled appointment time.

In 2025, patients were largely Māori (81%) with the remainder evenly split between Pacific and other ethnicities. Sixty-three percent were female. Few were under 20 years old (2%) or over 80 (1%), but otherwise there was a roughly even spread, with 38% in their 20s or 30s, 29% in their 40s or 50s and 31% in their 60s or 70s.

Although appointments were scheduled for 1 hour, some patients needed to stay longer, and 13 patients returned for a second appointment.

The qualitative data showed that participants reported the cost of dental care, the lack of childcare, travel time, money for travelling and needing to take time off work as barriers to dental care. For example, one patient explained, “I went 2 years ago and ended up getting two teeth pulled out and it cost ... 860 bucks. So, that was my week’s wages and a loan off somebody plus it was just ... taking food out of my kid’s mouth.” Previous poor experiences with dentists were also reported as discouraging people from seeking dental care.

Several participants reported that their teeth had been causing considerable pain and affecting their daily lives. One patient explained, “For my last job I was losing so much hours at work because of my teeth and just going to work in pain and having to get sent home.” The high level of need was demonstrated by one participant who said that they received eight extractions in the 2024 programme and hoped to get another seven extractions in the 2025 programme. Also, another reported having received numerous prescriptions over 2 years to treat recurring infection but not being able to have the tooth extracted.

The dental services were praised by participants because they reduced travel time and transport was provided: “It did make a difference for me in my current situation, so my car is a bit broken at the moment ... to actually come out and pick me and my whānau up. Yeah, that made a big difference.” Other advantages included childcare being provided and large families being welcome, assistance with filling out forms, the service being more welcoming and friendly and being delivered by a trusted provider.

As well as providing treatments, the service included dental hygiene education. Participants said they were encouraged to look after their teeth, learnt skills and felt empowered to share their knowledge with their extended family.

Discussion

This novel service offered in 2024 and expanded in 2025, treated a total of 218 patients. The high number of procedures provided indicate a very high level of unmet need, and the number of extractions performed demonstrate that patients had not been able to access timely care. Patients described a range of barriers to mainstream dental care which the service overcame. For example, it was provided free of charge, and transport and childcare were provided.

This dental service also helped to improve vaccination rates by encouraging and removing barriers to vaccination in an area with low vaccination rates. Early childhood vaccination rates in the Tairāwhiti region for Q4 2024/2025 were the fourth lowest in the nation at 74.5%.¹⁵ Providing wrap-around support, including dentistry, could serve as a gateway to better overall health practices, such as vaccinations.

Other research has established that lack of affordability is a barrier to accessing dental services, particularly for Māori.¹⁶ Due to lower average incomes, Māori and Pacific peoples need to spend a higher proportion of their weekly income to receive the same dental treatment as Pākehā New Zealanders. Other innovative interventions for providing dental care to those with high needs have been documented.^1,17 For example, Broughton et al. found that providing comprehensive dental care led to a marked improvement in quality of life, including psychiatric symptoms, in a sample of tāngata whaiora (people with mental health problems).¹

Importantly, this initiative addressed a range of barriers to dental care (in addition to affordability), making the service acceptable, welcoming and accommodating. As they did during the COVID-19 pandemic, Tūranga Health tried to ensure that patients received a “great experience”, with food and coffee as an expression of manaaki.¹³ The success of the programme depended on the trust patients already had in Tūranga Health. This was particularly important in reaching patients with high dental need and previous traumatic experiences with dental professionals. Tūranga Health’s existing community connections also meant they were able to secure locations in rural community hubs to expand the programme in 2025. Tūranga Health and TKDC worked with local dental professionals to ensure that they were involved in and supported the initiative.

Limitations: because we asked participants about how they felt and what they had gained immediately after treatment, they were not yet able to describe any longer-term impacts of the service.

Conclusion

Tūranga Health’s dental programmes demonstrate that making dental services accessible involves more than just eliminating cost barriers. Dental services also need to be acceptable and available to people with high needs. In this innovative initiative, childcare, transport and assistance to people who struggle to complete forms were provided. The service provides immediate care to some of those who are unable to access existing services. To scale and sustain this model of care would require substantial investment. The ongoing neglect of oral health among socio-economically disadvantaged populations perpetuates preventable morbidity and avoidable suffering. Addressing these inequities should be considered a public health priority and warrants co-ordinated policy and funding responses.