Newshub can reveal more than 100,000 children failed to show up for their free dental checkups - even though they don't cost a cent.
The second part of Newshub's 'Because it Matters' series on dental health delves into the crisis with Kiwi kids' teeth.
- How one woman's teeth illustrate New Zealand's dental crisis
- Dental Association shocked at absence of funding in 'Wellbeing Budget'
- Poll: Do you get a regular dental check up?
A stunning 118,518 children are currently behind in their dental check-ups, up from 98,000 in 2018. The system has lost 20,000 kids in one year, even though dental care is free for under-18s.
It's a real problem because 40,000 children had extractions due to rotten teeth and gum disease, and 7000 kids under 12 had to be put under general anaesthetic to have teeth pulled.
The Ministry of Health says a five-year-old's oral health predicts the state of their teeth at age 26, which is a worry when we're pulling kids' teeth all the time.
On a Saturday morning in Hamilton, an operating theatre was at full throttle as a four-year-old boy was put under general anaesthetic.
His name is Tiaki and he comes from a small town in the Waikato. He was there because of his rotten teeth.
"Just because of the quantity of work he needs done at his age, he's much better to be asleep," dentist Katie Ayers told Newshub.
"He's got a number of fillings that need to be done, he's going to need some teeth removed as well."
She does this kind of work all the time - this is the fourth child needing extractions today.
The rotten teeth mean Tiaki has trouble eating his food. He's been on the waiting list for this for several months. And yes, sugar is to blame - and it started early.
"He had a habit of taking a bottle to bed with formula in it, which does have a lot of sugar in it," Ayers says.
If plaque is not taken off kid's teeth, they'll start to decay. Bacteria live in the plaque and they feed off sugar to produce acids which eat through the hard parts of the tooth until they reach the pulp inside. That's when the child's tooth becomes sore and needs to be extracted.
Ayers says this can happen within months, hurting kids much younger than Tiaki.
"Sometimes we have babies as young as nine or 10 months needing surgery."
Despite dental care being free, 120,000 kids aren't even going to their basic check-ups.
"We are seeing more and more kids needing this kind of work," Ayers says. "It's heartbreaking to see this kind of level of need."
Tiaki ended up with seven teeth extracted, including his front ones, and four caps. Ayers said it had to be done.
"I know that I'm improving his oral health. Even though I'm taking his teeth out, I'm actually improving his oral health, I'm making his teeth functional, and tomorrow I know he'll be eating better than he was today.
"You can't get on top of it. It's not that we want to be treating all these kids."
Her real frustration is that virtually all of this is preventable. The system is overwhelmed by the amount of disease it needs to treat, which is making it hard to keep up with check-ups and preventative care.
Free dental care has serious access issues. It's complicated - kids aren't being taken to the care and the dental system is overwhelmed.
On Monday Newshub asked Minister of Health David Clark and Prime Minister Jacinda Ardern - who is also the Minister for Child Poverty Reduction - what they intend to do about the crisis.
The Prime Minister says she's asked Clark for a 'please explain' as to why so many children aren't getting the care they need.