Episode Transcript
Speaker 1 00:00:02 Kia Ora, and welcome to The Whole Tooth Ao/NZ, the show that is made by oral health professionals for oral health professionals. We'll bring you the kaupapa of the oral health profession in Ao/NZ to investigate the whole tooth and nothing but the truth.
Speaker 1 00:00:18 I'm Becky Ahmadi, and with me today is Emeritus Professor Murray Thompson. In today's episode, we'll talk about oral health trends, what's going on with publicly funded dentistry, and perhaps the future of dental care and Ao/NZ . We'll discuss the ins and outs of oral health and epidemiology and offer listeners a chance to hear one of the best, editors, researchers, supervisor, and an absolute exceptional advocate for good health. Be sure to listen all the way through and hear the gems that Murray has to offer. The whole Tooth Ao/NZ is sponsored by the Clare Foundation. Clare is a progressive philanthropic foundation that wants more for our people and our planet. Through a proactive approach, Clare invests in ways that positively impact our environment, oral health, youth well being, and women, to create extraordinary change. Check out Clare's website, clare.nz for the mahi that they're doing and supporting oral health. Our guest today is Emeritus Professor Murray Thompson. They are a scientific journal editor and recently retired dental public health academic with a passion for writing, music, cooking, physical fitness, and playing bridge. They're going to share with us some reflections from over three decades of dental epidemiology and public health research, Teenaa koe Murray. Thanks so much for joining me today,
Speaker 0 (Becky) 00:01:49 Kia Ora Murray, and welcome to the Whole Tooth. And how are you today?
Speaker 2 (Murray) 00:01:54 Good, Becky. I'm very good thanks. I'm fine. Yeah. I'm very well. I'm, uh, enjoying retirement. I've been retired now for, uh, just over three and a half months, and I'm still working really hard. But, um, it's nice to be able to go and walk the dog or go to the gym or whatever on my terms instead of someone else's terms, you know, and the, the downside of that is they're not paying me anymore, but, you know,
Speaker 0 00:02:29 Oh, it's that work. It's now you're in that absolutely well being phase of your life where you're still doing the things you love. Um, yes. Without that income stream. Yeah. But I'm sure Murray, with your amazing contribution to the field of oral health across, um, time and space that, um, you know, you've still got so much to, to offer and give as you go forward. And as I've read through your biography, which in your intro people would've enjoyed listening to that, there is a lot that you know about. And, um, I'd love to just touch on a few of those today. But first we'll go into, um, you Murray, who are you and what, what, um, floats your boat? And also love to hear what brought you into oral health. What, um, kept you and looking at oral health across your life and work.
Speaker 2 00:03:22 Um, I'm a Huntly boy at heart. I grew up in, in Huntly and had a wonderful childhood. Um, we didn't have much, but boy, we had fun. Um, and we were tearaways and, you know, we got into all the usual trouble and had a great time doing it, you know, and I was lucky enough to have a, a gift for reading and writing and, you know, English and spelling. And so that enabled me to be put ahead a year at primary school. And, you know, it, it just set me off. Just made everything else so much easier. Um, and I was able to be a bit of a 'larrikin' in my teen years and, and still, you know, maintain the academic side. Although, had I behaved myself more, I might have done better or done things a lot sooner, if you like, <laugh>. But, you know, that's, that's life.
Speaker 2 00:04:23 I ended up going away to university in, uh, coming to Dunedin. Um, yeah, a couple of things to get away from, parental overview, um, and oversight, I should say. And, and to, you know, a lot of my, um, seventh form classmates, we, we had only nine of us in the, in the seventh form, and, and more than half of us came down to Otago. So, yeah, that was a lot of, a lot of fun. But I, yeah, I, I come from, on my father's side, a family of Scot's immigrants who came out to New Zealand in the late twenties who were back in Scotland were tillers of the land. <laugh>, you know, they were farm laborers and, and, um, they came out to, um, New Zealand and went into the mines. So out the, the west southwest of Huntley, um, uh, Glen Massey was where they settled.
Speaker 2 00:05:25 And, and, um, so my grandfather, my great-grandfather, my great uncle, my father all worked down the mine. My dad had to leave school after primary school to go down the mine and, and help support the family. But in, in the end, he managed to, through just sheer doggedness to get a, an electrical apprenticeship and got himself out of there. Um, and he was a very clever man, and he should have gone to university and been a, an engineer. You know, he would've been great for that, but, um, he didn't get the opportunity. So that, that sort of really made an impression on me and, and, um, made me appreciate my advantages, you know, and the fact that, that the sacrifices that my parents made and, um, and my, my grandfather, um, Regian, he was a member of the, the New Zealand, uh, card carrying member of the New Zealand Communist Party.
Speaker 2 00:06:26 So that sort of colored the family politics as well. So we've always, I've always had a, a bit of a left wing take on things, and, and if you're in a profession like dentistry and you are interested in public health and, and equity and inequalities, and you tend to drift into public health dentistry, and this, this is exactly what happened, but I, I, I came to university, I, I mucked around for three years and did a B S C in physiology and had a great time <laugh>, and I thought, I need to do something. So I, I applied for medicine, dentistry, pharmacy. I think that was it. Yeah. Um, and waited to see, but the day before my final exams for my B S C and Physiology, I happened to be out at St. Kilda with some friends, and my flatmates actually, we'd found a skateboard near our house.
Speaker 2 00:07:23 So we took it out there and we were mucking about on it, just having a break from our studies. And I fell off the thing and broke my thumb. So then I ended up not having to, not being able to finish my b s e in time for the medical school applications, the dental school applications, all the pharmacy school ones. But, so I had to go back and, and, um, I worked that summer in the, the Huntly Pub as a Barman, and that in itself is University of Life level experience. And, um, I had to swat for my specials at the same time. So I sat specials, I finished my degree, and then Don Donald Beck, who was the professor of dental public health at, um, Otago School of Dentistry, phoned me at my flat and offered me the last place in my dental school class.
Speaker 2 00:08:14 So I thought, oh, yeah, I'll, I'll go and do that. And it was the making of me because suddenly, instead of the previous three years of, you know, unstructured sort of, um, basically more sophisticated larrikinism than I got up to back in Huntly. Yeah. I had a structured day. I was busy all day, every day, and going around with the same bunch of people for the next four years. And, um, you know, it, it was the making of me. I think I, because I've been put up at primary school, I was always a little less mature than my classmates anyway. And I think I just needed to grow up, you know, so I did dentistry. I then, I waited for the Waikato Hospital job there, there was only one house surgeon job in those days. I waited for that to become available because I was a Waikato boy.
Speaker 2 00:09:10 And I didn't realize until too late that Mark Ewing, who was the year ahead of me at dental school, and he, he was the, the, the health surgeon there, he decided to stay on for another year. So they didn't actually advertise the job. By the time I realized that I, um, had missed out on all the hospital jobs. So I ended up working in Huntly for the, um, the mayor of the town who was a, um, a dentist and, uh, a wonderful man, a guy called Robin Wright. And I'd known him for years. His son is my age, and his, his daughter is five years younger than me. And, um, I ended up marrying the boss's daughter, basically. Um, <laugh>, I wonder where that was going. <laugh>. Yeah. Yeah. Oh, lovely. No, that was great. You know, and all, all of this happening because I fell off a skateboard.
Speaker 2 00:10:03 Um, yeah. And, um, so we, we ended up getting married, and then six weeks later we left town and went over to England. 'cause I've always intended to go and study in England. And of course, small town like Huntly, all the rumors were, oh, he's knocked her up. You know, they <laugh> they had to leave because it was a shotgun wedding and all that. Um, you know, as it turned out, we didn't have kids for another seven years 'cause we were having too much fun traveling, you know? Mm-hmm. But yeah, it, it, um, I then got into post-grad study and, and Leeds and, and came back to New Zealand and started, I, um, we did a lot of traveling, came back to New Zealand, then I phoned up the, the Department of Health and said, Hey, it's me. I'm back. Have you got any jobs? And they said, oh, come down to Wellington and we'll interview you.
Speaker 2 00:10:53 So this is, um, um, Michael Hollis and, um, Peter Hunter, um, names that, that some of your listeners might recognize mm-hmm. <affirmative>. And, um, they offered me, uh, the, um, senior dental officer position in Palmerston North. I said, yeah, sure. That looks good. Yeah, I'll take that. So then I met Kathy downstairs, and we went along to Whitcomb and Tombs in Lampton Key, got got down from the shelf at, uh, a book of maps and, and found out where exactly Palmerston North was. And, and <laugh> drove through it on the way back home to Huntley and thought, oh, yeah, not a bad place. Nice. And, you know, it was a sunny day in Palmy, and the wind wasn't blowing. So it, it's always fantastic when it's like that. Yeah. So, and we, we were there for seven years, and that was, that was great. Both our kids were born there.
Speaker 2 00:11:46 I got into Harriers um, you know, I, I joined the local Harrier Club and, and did pretty well. And, uh, yeah, it was a good little period of our life and, you know, I ended up as P D O and then there was that period when the health system was, was undergoing a heck of a lot of change. So it was 87 through to 94, and I think in that time I had nine different managers, um, two of whom I respected. So it's not a bad strike strike rate. Um, and it was yeah, a a really, really interesting time to be in the, in the publicly funded health system at that time, you know, as it turned out. Yeah. I think I was the last person to be supported by the Department of Health to do postgrad study. They sent me down to Dunedin, um, as an external student to do my M CommDentc and then the rest is history. Yeah. Mm-hmm. <affirmative>, that was great. Yeah.
Speaker 0 00:12:53 Well, Murray, I've known you for a long time, <laugh>, but I've never known that about you. I think I've known you, from about 2005 post, uh, you know, past that. And, um, it's actually really lovely. It feels like a bit of a full circle moment where I now I'm like, oh, Murray, that's a lovely story of how you got to, to, um, you know, where you are now. And, and as I was reading your contribution to the Dunedin multidisciplinary study, it's, I can see how when you told your story, you told your, like, your lineage. And, and it is, it's not just you on this journey. You've got forefathers and you've got family, and you've got your boss's daughter that you're married, you know, and it, and it just brings such a richness to your life story. And, um, I can see a, a bit more of how you do what you do now, um mm-hmm. You know, because I guess as a head of department, you're my, you were my head of department, maybe you've never sat and had a cup of tea with you and be like, so tell me your life story. Murray <laugh>,
Speaker 2 00:13:55 I was a very reluctant head of department. I, I had managed to avoid it for years and years. Mm-hmm. And then finally it was my turn and I said, do three years. Okay. So that turned into five years, you know? Yeah. I was very happy to hand it over to Jeff Tompkins when I, yeah. Yeah.
Speaker 0 00:14:12 Oh, well, I don't have any, I don't have any bad memories from that time. Murray <laugh>. So, and I remember that you were always easy to talk to. I'm very fair. And just, I know there was no, no complaints from me as an employee. Yes. We've talked a bit about, oh yes. Your hobbies. So you talked a bit about your harriers, your, and you're into your, your running. And, um, am I allowed to tell the story about your <laugh>? Yes. About running down London Street? This is one thing that I always think about if I'm ever, um, opening my car door, actually every time. That's a bit strange. But, um, one time in the, was it, was it mid-winter or was it early
Speaker 2 00:14:51 In the morning?
Speaker 0 00:14:52 Early in the morning, Murray used to run in Dunedin. I dunno, you have to be a hardy soul to do that. It's usually like negative something. And I think someone flipped open a car door as you're powering down London Street, and you collected the car door, collected you and really hurt you. And I remember that and thinking like, gosh, you're, you're, um, I can't remember the exact injuries, but it just made me think always look in that rear <laugh>, that wing mirror could be a murray there.
Speaker 2 00:15:18 I I didn't hit the flat part of the car door, I hit the actual edge. Oh. And so I hit a car door shaped bruise all the way down my body. Shouldn't I
Speaker 0 00:15:27 Hit it?
Speaker 2 00:15:28 And, and next thing I sort of realize I'm on the, on the ground. I'm swearing my head off. You should have heard the effing and blinding. And, and you know, the, the taxi driver had leaned over to open the door for a woman who worked at Wakari Hospital as a nurse. And he picked her up every morning. And, um, I'd seen her coming to the path and I was watching her, and she'd seen me, and we were watching each other, so she didn't step in front of me. And then he leans over and opens the door. It's funny, a couple of months later, I was in that guy's taxi and I said, uh, you don't recognize me. Do you <laugh>? And he said, no, I told him the story and he was appalled, but it didn't get me a free taxi drive.
Speaker 0 00:16:16 No. Good. Oh, well, at least it <laugh> managed to, um, he from that and carry on. But I still, yeah, it is a good public service announcement. Always check before you whip open your car doors. Yeah.
Speaker 2 00:16:27 Yeah.
Speaker 0 00:16:28 Um, so yeah, I'd love to talk about your Dunedin study actually. Um, given that it's, it's provided a lot of insight for that lifespan, oral health, and it's certainly something, um, that I still think about in my day-to-day practice when I see five, four, and five year olds with, um, multiple carious lesions that I think, oh, this isn't <laugh>, this isn't a good, you know, at least that there's gonna be some serious change in, um, and, and diet and oral health beliefs and practices and, um, you know, access to toothbrush and toothpaste. There's, it's not a happy future for their mouth. So yeah. Any insights into, um, you know, stories about that? And also I'd love to hear about, like, as a clinician practicing today, how can we help these preschoolers better?
Speaker 2 00:17:19 Yeah, yeah. Um, it's interesting, isn't it? The, you know, first, first of all, can I say, you know, having been involved with the Dunedin study for since 96 when we came back to Dunedin, um, it's been an, an immense privilege. Just such a, a cool study to, to work in and, and to have been given the opportunity to revive the oral health side of the study, um, by Phil Silva. I, I had no funding, you know, um, but Phil Silva believed in me and Richie Polton, who was his offsider at the time. Um, they, they believed and they supported me, and, and we managed to resurrect it and, and get it going. And now, you know, it's really the only study that's telling us what happens to people, um, through their twenties, thirties, forties, fifties, you know, we've had longitudinal studies of kids, we've had longitudinal studies of older people, but nothing in the middle.
Speaker 2 00:18:25 So we've known nothing about the natural history of oral disease and oral health, and, and you know, we, so we've, we've been able to make some pretty, um, if I say something myself, I mean, yeah, it's, it's above, beyond what anything I I've done personally, but just the contribution of the study to oral health knowledge has been immense because we've been able to demonstrate that the caries, the average caries rate is constant through life, you know? Um, and the continuity in caries experience from early childhood through to adulthood. Um, so that's continuity in, in opportunities and behaviors and exposures and diet and that sort of thing, and beliefs and values, et cetera. Um, and coming from a, you know, Scot's working class background, I'm acutely aware of the, you know, the, the, the sort of the, the continuity of, of, of hopelessness and despair that, that can, um, manifest.
Speaker 2 00:19:38 And, and as, as people go through life as well, I was really lucky to be able to, to be upwardly mobile, you know? And, and that in itself has meant that as I've gone through life, my health has been much, much better than somebody who wasn't upwardly mobile, you know, and having, you know, I I, I went to a Huntly College High school, a reunion back in 2003, 2004, and, you know, that was life course research illustrated, you know, just looking at people in my cohort and, and the ways in which we had diverged in terms of our pace of aging and, and the manifestation of the various non-communicable diseases, the ones that kill us, you know? Mm. NCDs (non-communicable diseases). Um, and of course, the oral conditions are just, you know, more NCDs. So as we go through life, we accumulate these, this, this NCD burden, and eventually we get to a point in midlife where some of that becomes diagnosable.
Speaker 2 00:20:49 So suddenly your blood pressure gets to a point where you're diagnosed with hypertension, so now you're on anti-hypertensives, et cetera, et cetera, you know? Um, and we we're observing this in the Dunedin study, you know, in, in real time. Um, we've characterized the pace of aging in our study members using 19 different biological markers. And there's a range of, so all of us are aging chronologically at the same rate mm-hmm. <affirmative>, you know, one year every year. Mm-hmm. <affirmative> every year. I'm a year older, you know, in March, I click over, you know. Um, but a range in biological aging, our study members goes from 0.4 biological years per chronological year. They're the really well aging people, you know, that people who, um, are gonna be a really, really fit and healthy older people. And then at the other end, we've got people who are aging at two and a half times the chronological, um mm-hmm.
Speaker 2 00:21:54 <affirmative>, you know, rate of aging. And if you compare, you know, we've, we've got composite faces of the 10 most, uh, uh, slowly aging, um, males and females, and the 10 fastest aging males and females, and the latter looked like the parents of the former, you know, it's, it's really, really striking. Um, and it just sort of underlines the fact that our health at any point in the life course is the sum of all the beneficial and adverse exposures that, that that hit us and, and, you know, that we are exposed to, for want of a better word. And it's the very subtle differences that, you know, if we look cross-sectionally at any point in time, there may not be that much difference between people doing this and not doing this. Mm-hmm. <affirmative> say, in terms of brushing twice a day mm-hmm. <affirmative> with a fluoro tooth base versus not brushing twice a day. Um, but take that over time and the way in which the benefit accrues over time. You look at those people longitudinally, they diverge as they go through life. Mm-hmm. Uh, and, um, yeah, this is, this is what we're seeing,
Speaker 0 00:23:06 You know? Yeah. Oh, certainly. Um, gives me a lot to think about when I'm seeing at the moment, 11 and 12 year olds in a low-decile school. And it, in my mind, I have all these ideas that you are speaking about thinking some of these children, and I say children still because they're still young, but yet I think they think they're adults, um, with their behaviors, their hobbies of vaping, et cetera. Um, that, you know, their future pathways may not, uh, allow them to have, uh, to enjoy good oral health, um, to be able to, if they're already losing permanent teeth by the time they're 12, um, you know, like the, what, what's the future for these one? It's not just about the oral health, it's their wellbeing, et cetera, et cetera. Their job opportunities in the future, if they're missing front teeth and or back teeth for that matter, or if they're in pain, um, yeah, it does. I do think about that a lot. As we may just go into shortly, what's going on with publicly funded dentistry in the sense that after it's finished the free service finishes, um, where to from there? And I think Dunedin study shows us that, you know, those late, was it early, early thirties or late in the late twenties that, um, teeth start to get removed again from decay and cohorts?
Speaker 2 00:24:30 Yeah. Yeah.
Speaker 0 00:24:32 Sorry. Yeah. That's, that's, um, disappointing <laugh>. And we've got a public health heart and you're like, so what can I do for these? What can I do for these people in this, in this point of time that I'm with them, this intersection and time that might, you know, only minuscule affect their future given that that's, that wider determinants of health, you've got absolutely no control over.
Speaker 2 00:24:56 Yeah. And, and really interesting paper we published four years ago now in community dentistry and oral epidemiology, looked at childhood cognitive function and adult oral health. And what that study showed clearly, you know, we, we, we had IQ data on our study members measured on several occasions between three and nine. And so we're able to characterize our, all of our study members, put them into categories, four ordinal categories of, you know, the least, sort of cognitively able to, the most cognitively able, and then to look at what are those different groups like on average, by the time they get to their late thirties. And we were blown away. There were gradients in everything, and they were really, really strong gradients and the least cognitive. What essentially what it, our interpretation of it is that, that the more cognitively able, the brighter you are as a kid, the greater the chance you are, you have of being selected into, or selecting yourself into a life course trajectory that is going to be good for you.
Speaker 2 00:26:19 You're going to get a tertiary education, get a good job, live in a good area, get a health promoting area if you like. You're not gonna be living in one of these food deserts where all there are is vape shops, liquor stores, and takeaways. You know, um, and the, the aforementioned subtle differences in these exposures compound over time so that by the time these people get to mid adulthood, um, they have, or midlife, I should say, there are big, big differences between them, you know, and, and so it's about, I mean, it just, I suppose if you're looking at social policy and, and economic policy, and if it, if it's, I, I always say there's, there's the Labor Party approach and the National Party approach, or the National Party approach to say, well, every man for himself, every woman for herself, you know, um, if you, if you can't make it tough, you know, um, whereas the Labor Party approach or the, the, the sort of the, the, the Democratic socialist side of things will say, well, we have to help people.
Speaker 2 00:27:31 We have to support them and make sure that they get the same opportunities. And also to help ameliorate the, the, the, the ill effects of their disadvantage. And, um, you know, if if you're going to be making social and economic policy based on people's individual capabilities and nothing else, then you're gonna have a lot of victims and you're gonna have a lot of inequalities. And we've seen this time and time again, and unfortunately, I think we are heading, uh, that way again, um, because we're a media machine in this country, which is complicit in trying to dislodge, uh, current government for one where we know we are going to get essentially a neoliberal right wing shit show <laugh>.
Speaker 0 00:28:23 But
Speaker 2 00:28:24 That's enough of politics from me. I'm a left wing public health dentist. You know, you expect that sort of thing from somebody like me, <laugh>. Yeah.
Speaker 0 00:28:33 No, there's, that's, there's no surprises there. I'm sure the listeners also have feelings about politics and, um, I guess oh, as a, as a person on the ground, how, how can we influence, um, I, I think these social policies and the, I mean, apart from annoying our local mps, or, um, exactly.
Speaker 2 00:28:51 I, I think that's probably, well, of course we have a, a very important role in trying to treat and, and, you know, ease the suffering of people in that unfortunate situation. But we also have witnesses and advocates, you know, and it's, you know, the, the media, the, the politicians, the policy makers, the decision makers are always pretty, um, amenable, I suppose, or influenced by, you know, reports from the front line, you know, where people are actually having to deal with the consequences of these things. Mm-hmm. <affirmative> the health consequences of these policies. So, you know,
Speaker 0 00:29:40 I think professions,
Speaker 2 00:29:41 Oral health professions, we need to be doing our bit and shouting from the rooftops about this things. Mm-hmm. Yeah.
Speaker 0 00:29:48 Yes. I, I definitely agree with the, um, you know, the squeaky wheel gets that CRC, but <laugh>, I wonder that there's, um, a feeling of, uh, if you work for a certain employer that potentially you can't speak or align yourself with anything, um, in an advocacy space or, and I mean, it's not something I can talk about at this point, but however, um, there are ways and means of advocating. Uh, but if it comes to what's actually happening within, um, any given regional community or health service or publicly funded space, um, I don't know that that's actually, um, well known <laugh>. It might be anecdotally known, but it's not publicly known. You know,
Speaker 2 00:30:36 I fully appreciate that people would feel that they can't jeopardize their employment, you know? Um, and they feel might feel subtle or not, not too subtle pressure to shut the heck up, you know? Um, this is where we academics have an advantage because only the education act, we actually are required to be a cri critic and conscience of society. So we, that's why you see academics speaking out a lot on this sort of thing, you know, and maybe we need to do more of it, and I'm in a especially good position of no longer being on the payroll, so I can say whatever I like, you know, <laugh>,
Speaker 0 00:31:14 Well, Murray, we might have to, we might have to have a chat offline about this because, um, yeah. There's only so many conversations you can have when you keep saying, this is what my peers are saying, or this is what we are seeing. Yeah. And, um, there's only so many doors that can close <laugh> before you can actually say, it's something we feel like this, this is actually going to be a, um, more than a national crisis. It's not just oral health. Um, but, you know, when we see that we're in such significant arrears, and this is going right into the, what's going on with publicly funded dentistry, Murray, it's what I want to know. Yeah. Um, like where's it going? I I, my colleagues and I would say, well, not just me specifically have said we are concerned that we're going down the plug hole. That's what they say. <laugh>,
Speaker 2 00:32:05 I think, um, not to put too fine a point on it to <inaudible> doesn't know what the hell it's doing with oral health and it, it hasn't got its act together in a lot of areas. And, and, but certainly in the oral health part of the, the system, I think it's even less, um, functional than, you know, it should be. And yeah. Um, we, they used to talk about the Cinderella services being mental and dental, you know, and, um, we are still a Cinderella service. We are still at the end of the queue. And, you know, which again makes it important that we, you know, make as much noise as possible given the opportunity. Not, not all the time. 'cause otherwise they just say, oh, you know,
Speaker 0 00:32:51 It's, it's them again,
Speaker 2 00:32:52 Background noise. It's just those people again, you know, so
Speaker 0 00:32:56 I know, but if, yeah, I don't know, you won't, probably won't live on Facebook looking at the, um, parent forums. I do because I'm on a few of them. <laugh> just 'cause I, you can get quite involved with the parent forums or like, uh, whether it's special needs or whether it's, um, just community groups. Um, you know, anecdotally there's an unprecedented amount of people looking for oral health advice and saying, my child has this, I can't get in anywhere. What do I do? Where do I go? Um, and you know, it's that kind of stuff. Maybe it's far more obvious now that it's written down in a social media setting. Um, however, I've worked 20 years I think now within this field, and I've been in and out of, um, different regions and I've, I don't think I've ever felt this uncertain about the wellbeing of children <laugh> at this stage in my career. <laugh>. Yeah. Yeah. And that makes me a little nervous for not only my role as a dental therapist in the community, um, whether that's losing its, um, strength. I'm not a hundred percent sure of that. Um, but maybe it is. And also that idea of caring for children and, um, adolescents within the community setting is, seems to be losing its grip as well. Um, so
Speaker 2 00:34:13 Are you familiar with the, um, kids cam work of Louise Signal and, Hmm,
Speaker 0 00:34:19 I saw some bits and pieces for the preschoolers is that, um, they,
Speaker 2 00:34:23 They, they hung cameras around the necks of a hundred and sixty nine hundred sixty eight nine year olds. Um, and they wore them for several days, and these cameras took photos every couple of minutes. Right. And then they analyzed the images of, of course they had a button they could press when they went to the loo, that sort of thing, you know?
Speaker 0 00:34:43 Oh, right. But <laugh>, when they went to the dairy, but,
Speaker 2 00:34:45 You know, they, they counted up the number of exposures these kids had to good food promotion and bad food promotions and, you know, clearly the, the good stuff was far outweighed by the bad, the bad, uh, ads. And, and, and the ads were at school. They were everywhere. These kids were exposed to so much, they're bombarded by basically all this stuff promoting, um, sugar high, high short, high sugar, high salt, high fat, um, foods and drinks. What something we call the neoliberal diet, you know, the, the, the crap that we feed poor people in, in western countries, you know, because it's plentiful and it's slowly killing people.
Speaker 0 00:35:35 Yeah. And creating <laugh>,
Speaker 2 00:35:37 Creating a <crosstalk>
Speaker 0 00:35:38 Co-created comorbidities,
Speaker 2 00:35:39 Serious, et cetera, and diabetes and Yeah.
Speaker 0 00:35:44 Yeah. And, uh, yeah, it's, it seems,
Speaker 2 00:35:47 And, and, and then our profession has the cheek to point at these people and say, just, it's your behavior, you know, <laugh>,
Speaker 0 00:35:55 No, well, we're just absolute ambulance way down. Like we've, I feel like we're way beyond the bottom of the cliff now. Um, and you know, we are meeting these people for these moments in time in the clinic, hearing a glimpse into their lives, which it just so happens we're a region that you're sitting in. Some of those stories are not, you know, these people are not people that are able to, um, they find it difficult to access wherever you are, but also the cost of good food at the moment, I'm finding that difficult to feed my children well, um, yeah. And make sure that we've got, uh, all our fruit and veggies and I can't imagine what it's like when you have, um, minimum wage and on a benefit. So yeah, that's a problem in itself. Money <laugh>. Yeah. Good food, good schooling, going to school regularly, um, employment, but yes, I digress. So what's going on with publicly funded dentistry? Who knows ?
Speaker 2 00:36:51 <laugh>, who knows? Yeah. Yeah.
Speaker 0 00:36:53 Yeah.
Speaker 2 00:36:54 I, I think it certainly as always needs a good overhaul and needs somebody to sit down and have a damn good look at it. Um, yeah.
Speaker 0 00:37:03 Yeah. Do you have any, do you have any advice to anyone that might be listening, if anyone might be listening might about, 'cause I wonder that, um, you know, and it's no slight on anyone who is particularly in leadership in this space at the moment, um, is there any reason why it's not visible or why it's not audible? Um, what's actually going on? I just would like to know, I'm interested in that given that, um, you know, I guess maybe in other fields that we are more communicative about what's happening, I guess in a national level on specific, I don't know, healthcare services.
Speaker 2 00:37:42 Yes. Yes. Yeah, I dunno, I don't know what the story is, what, what the answer is really. Um, we, we tend to get a, a bit of a flurry of excitement about a dental issue that then there's a sudden moral panic and, and, and people like me get bloody bugged by lots of journalists for a day and then it goes away again. And then, so that's oral health that, that wave's been surfed, it's gone, you know, um, we don't need to think about it anymore until the next crisis or the next moral panic about whatever, or whether it's somebody, you know, suggesting having the temerity to suggest that we fluoridated a water supply or something like that <laugh>,
Speaker 0 00:38:31 Or suggest that we take G s T off. What is it? It, um, uh, <inaudible>.
Speaker 2 00:38:37 Yeah.
Speaker 0 00:38:38 Um, yeah. So could I, could I also boldly suggest, given that, you know, the oral health, oral health status across the lifespan is cumulative and and consistent. Consistent, did you say, or start with c across the life span
Speaker 2 00:38:55 And Yeah, it accumulates at a pretty consistent rate.
Speaker 0 00:38:59 Yeah. And given that I haven't seen anyone in the last few weeks or months that don't, you know, that have, um, good oral health say no caries. And, um, and I know that my window is a small window, however, given that I talk to a lot of people, what they're up to are, are we going to see in the next sort of 20 years youth with really poor oral health, which is gonna contribute, you know, contribute to, or am I just dramatizing this? Um, I'm interested to know, you know, because it's, we're in arrears for, I don't know if even arrears is talked about anymore, but you know, there's, it's not it's way past, way past arrears. Now, <laugh>
Speaker 2 00:39:44 The,
Speaker 0 00:39:44 So yeah, if
Speaker 2 00:39:46 You look at things like the Ministry of Health, oral health data, you know, that's all the average, that's the average child in these particular communities. And it doesn't, doesn't really take into account the ? you know, so if if you look at it over time, you know, the DMFs come down and, you know, continue to drop and the percentage caries free is inched up, you know, but that hides a lot of inequalities and, um, you know, it hides the mal-distribution of the disease burden. And so I think, yes, you are right. We are going to see a lot of young people with, um, missing teeth and poor oral health. We're going to see, and as they move into adulthood and, and middle age, et cetera, they're gonna have very poor oral health. I, you know, we, we've, we've seen a, a decline in the prevalence of eism over many decades, you know, and it's now at, at the point where it's, it's, um, the, what we call the incidents of it, the, the percentage of new cases every year is, is actually quite low. But I think we are gonna see it climb again because for
Speaker 2 00:41:04 Some people, you know, the transition to edentulism is actually a positive thing because it marks the end of decades of suffering, you know?
Speaker 0 00:41:13 Yeah. And that's not always necessarily seen as the, um, you know, the be all and end all. It can actually be a, a clear up, clear up all that bacteria and, and illness. Yes. Oh, Murray, we could talk, I could talk for days about this situation, but I really appreciate you've given us some insight and hopefully the readers can feel that they've got a bit more of the readers, the listeners or have, um, some more ideas of sort of that background, um, of when they're seeing patient by patient that there's actually a lot more going on in the background as well for them and for, um, the communities. So my last question, Murray, is do you have a magic wand solution to improving oral health in Aotearoa New Zealand? If there's one thing you could do flick your magic wand, what would it be?
Speaker 2 00:42:05 Oh, I think smoking's taking care of itself, so I think the periodontal side is going to improve. Um, certainly caries continue, continues to be, uh, the number one cause of tooth loss, the number one cause of poor oral health related quality of life. Um, and if you look at the mechanics of the, you know, the precarious lesion, of course there's sugar is the number one culprit. Um, if I, if I could ban, um, the advertising of sugar sweetened beverages and, and sugar, you know, highly processed foods and, um, make things, make fresh stuff, make, make it far easier for people to cook their own food, look after themselves better, feed themselves better, you know, for example, we no longer teach cooking in schools apparently, you know, so people come, come out of the school system and a lot of 'em can't cook, so they have to go and buy highly processed, you know, ultra processed food and, and it's, it's not good for them, you know? Um, I, I would say the best thing my wife did to me, did for me, um, was many years ago when we first started hanging around together. She said, we don't have a sugar bowl at home, so you'll have to stop putting sugar in your tea and coffee. And it was a teachable moment for me because I was so keen to hang around with her that I go, you stopped
Speaker 0 00:43:45 Having no sugar <laugh> for love Murray <laugh>.
Speaker 2 00:43:48 And you know, I worked out, I'm not, it's probably saved me having 42 kilos of processed white sugar a year. And I haven't had a new carious lesion since the mid eighties. Um, you know, <laugh>
Speaker 0 00:44:03 Well done, Murray. It's a lot to
Speaker 2 00:44:04 Be sent for. I still eat my chocolate, but, you know, um,
Speaker 0 00:44:08 Got milk in it. <laugh>, <laugh>. Oh no,
Speaker 2 00:44:13 We could do that for everybody. Well, you know,
Speaker 0 00:44:16 Yeah, yeah. To look at the, the things you're ingesting and the, and and what they're doing for your overall wellbeing. It's, yeah, it's so easy to buy rubbish at the supermarket, <laugh>. It's just everywhere. Absolutely everywhere. And okay, so your magic wand is to sort out the supermarkets and everyone gets to learn how to cook properly. <laugh> Absolutely. And to, and to, to, um, yeah. Nutrition, being able to know what foods to nourish your body, not just fill them up. Yeah, yeah, yeah. Oh, I think that's all that we need to have time for. Murray, we nearly talked for a whole, I don't know, three quarters of an hour, so that's not too bad. That went quickly. Um, yeah, it was an absolute honor and privilege to spend time talking to you, Murray. You are, um, a role model and, uh, and a champion for oral health. Um, not just in New Zealand, but also across the world. So, um, yeah, we'll keep an eye on things and Murray, I'll tap on your shoulder. I need a bit of help with my advocacy and um, yeah, we look forward to seeing more of what you do and um, yeah, if the media give you a call, you just give 'em a rant for us and say that good oral health, we need it in New Zealand. <laugh>. Thanks Murray. Cheers, Becky
Speaker 1 00:45:43 Kia Ora, ngā mihi to the Clare Foundation who have sponsored this podcast and enabled us to be able to interview such dental greats as Emeritus Professor Murray Thompson. We thank him also for sharing his time and energy with us, and we know listeners are going to enjoy, um, the gems that he has left behind in this podcast for us as oral health professionals going forward to improve oral health in Aotearoa. So go well, my oral health professional colleagues and peers and friends from us at The Whole Tooth Aotearoa NZ, noho ora mai.
