Auckland District Health Board says demand for public dental care is increasing, and it has had to make changes to stop patients lining up for hours outside its South Auckland emergency dental clinic.
The DHB has traditionally run a drop-in clinic at Middlemore Hospital but in 2016 introduced a phone booking system which is still in place due to increasing demand.
An Auckland welfare trust said while the emergency clinics exist, primary dental care remains too expensive - and many people are pulling their own teeth out to stop the pain.
Uliti Lolohea had a toothache for more than a year and couldn't stand it any longer.
But the Auckland man said he couldn't afford to pay for dental work, so he went to Middlemore Hospital's emergency clinic to get the tooth pulled for $40.
"I don't want to pull my tooth out but I had no choice," he said.
"That's why I came here."
He said this was the fourth tooth he would have removed at the emergency clinic because he could not afford the cost of going private.
He said for people like him, struggling to make ends meet, there was no other option.
"I have got four kids to look after and a wife, and I am the only one working," he said.
"I can't fork out $800 just for one tooth."
The tumuaki, or head, of the Huakina Development Trust in South Auckland, Maria Clarke, said she saw cases like Mr Lolohea's on a daily basis.
Ms Clarke said some people were in so much pain they tried to pull their own teeth out at home.
"We have had instances where people are pulling their own teeth out," she said.
"We have had a few problems where people have had to come in and see the doctors to have them stitched."
"They've just ripped the teeth out, more or less, because it has become so loose or so rotten that that is the only way they can do it," Ms Clarke said.
The trust provides support in health and well being, environment and education issues, but Ms Clarke said dental care was the biggest issue it faces.
She said the problem was starting to become intergenerational.
"It's not just the parents," she said.
"Once the children come of age and don't get free dental care, they're the same because they've seen their parents behave in the same manner."
"They can't afford to go to the dentist - they're just too expensive," she said.
"There are a couple of dentists in Pukekohe that let you pay off your dental care but even that is a problem for a lot of families."
In a statement, the Auckland District Health Board said it was struggling to meet the increasing demand for its emergency dental services and some patients were not being seen as quickly as they - or the DHB - would like.
It introduced the phone-booking system because people had been waiting for long periods outside the clinic - now they could turn up for a scheduled appointment instead.
But Mr Lolohea said the system only made it harder to get an appointment.
After a week of trying to book via the phone system, he finally landed a spot, but he had to go to the hospital clinic at 5am to ensure he would be seen early.
'Third world health conditions'
Dental Association president Dr Bill O'Connor said problems around the price and accessibility of dental care have long existed.
He said delaying treatments only lead to more issues in the long-term.
"It is pretty traumatic and it is really stressful," he said.
"These problems don't get better on their own.
"They need treatment as soon as they can get it so long wait times are really unacceptable," Dr O'Connor said.
He said the demand for emergency clinics, which was "enormous", was growing every year.
But he said DHBs would only be able to improve their systems if the government provided funding.
In a statement, Health Minister David Clark acknowledged people were dealing with what he said were "third world health conditions" as a result of bad oral health and inability to access treatment.
He said his long term goal was to make dental care more accessible and affordable for New Zealanders - but change was unlikely before the 2020 election.
Dr O'Connor said a publicly funded comprehensive dental service was needed, but the government needed to act fast to help those in dire need.
"The barrier at the moment is there is not the funding available to provide the basic care these people are needing," Dr O'Connor said.
"If you extend it to a fairly comprehensive-type scheme, it is going to be really costly."
Dr O'Connor said a government-funded comprehensive oral health scheme would be to everyone's benefit.