New Zealand's accident compensation scheme is one of the things that most surprises people about dental care here - both residents who did not realise it applied to teeth, and visitors who did not realise it applied to them.
It is also widely misunderstood. Every week someone rings us confident that ACC will cover something it will not, or assumes it will not cover something it will. This is the practical version: what qualifies, what does not, and how it works at the appointment.
The one-line rule
ACC covers dental injury caused by an accident. It does not cover dental problems caused by decay, gum disease or ordinary wear and tear.
Almost every question about ACC and teeth comes back to that distinction. A fall, a knock playing sport, a bike or ski crash, a car accident, an elbow in a rugby game - those are accidents. A tooth that has been weakened by decay for two years and finally gives way is not, even though the moment it breaks can feel very sudden.
What ACC will usually cover
If the damage came from an accident, these are the things ACC will normally contribute towards:
- Chipped, cracked or broken teeth
- Teeth knocked out, or knocked loose
- Damage to existing fillings, crowns, bridges or dentures, where an accident caused it
- Injury to the jaw, gums, lips or the soft tissues of the mouth
What ACC will not cover
This is the part that catches people out. Decay, gum disease and wear are not accidents, however suddenly the result shows up. Neither, in most cases, is a tooth that chips or cracks while you are eating - biting down on something hard is treated as ordinary use of your teeth rather than an accident, and that single distinction decides more claims than anything else.
A tooth that was already heavily filled or cracked, and then breaks under normal chewing, is usually in the same category. ACC may look at whether the injury was really caused by the event or by the state the tooth was already in.
None of this means the tooth cannot be fixed. It means the cost sits with you rather than ACC, and we will tell you which it is before we start.
Visitors are covered too
ACC covers accidental injury that happens in New Zealand, regardless of where you live. That includes tourists, working holidaymakers and seasonal staff. Queenstown being what it is, a good share of the accident cases we see belong to people a long way from their own dentist.
If you came off a bike at the park or caught an edge on the Remarkables, come in. We can talk you through whether your situation qualifies, and deal with the tooth either way.
ACC contributes - it rarely pays everything
This is the second thing to understand. ACC pays a set contribution towards each item of treatment, and dental fees are often higher than that contribution. The difference is a surcharge that you pay.
How big the surcharge is depends on what is needed. A small chip repaired with composite may have very little left over. An implant to replace a lost tooth will have more. Either way, we work out the figure before treatment starts and tell you, so there are no surprises on the way out.
How the claim is lodged
You do not need to do anything before you come in. We are a registered ACC provider, and we complete the claim form as part of the appointment. All we need from you is an honest account of how the injury happened and roughly when.
Two things help. Come in soon after the accident rather than weeks later - the link between the event and the injury is clearer, and the tooth is easier to save. And if the injury happened somewhere with a record of it, such as a ski patrol or a sports club, that detail is worth mentioning.
What to do straight after a dental accident
For a knocked-out adult tooth, hold it by the crown, keep it in milk, and ring us immediately - the first hour matters more than anything after it. For a chip or a crack, save the pieces in milk and get seen within a day or two. Either way, ring 03 441 8248 and tell us it was an accident. We are at 12 Lake Esplanade in central Queenstown, with free off-street parking.
General information, not a diagnosis. Written and reviewed by Dr Adrian Paul, BDS (Otago), principal dentist at Lakeside Dental Practice, Queenstown. If something is worrying you, see a dentist.
