Oral Health in NC: Equity, Access, & Action
Foundation for Health Leadership & Innovation
Building leadership, shaping practice, affecting policy, and driving innovation through collaborative partnerships.
Oral health is often viewed as a specialty service, siloed from other types of health care. Yet, the mouth is undeniably part of the body, and oral health profoundly impacts overall health and quality of life in both obvious and subtle ways. To build a healthier North Carolina, we must elevate the importance of oral health and invest in integrated care so everyone—regardless of who they are or where they live—can thrive.
"We must reimagine how we engage with oral health in the broader health care landscape and implement the necessary strategies to get us there. We must fundamentally alter how we think about and integrate oral health into medical practice, urging policymakers, health care professionals, and the public to recognize that inadequate oral health can no longer be ignored." — Dr. Steve Cline, Vice President of NCOHC
In this newsletter, we will explore the state of oral health in North Carolina and identify opportunities for action to improve access and equity.
Shaping the Future of Oral Health in NC
Earlier this month, our NC Oral Health Collaborative (NCOHC) team published the 2024 Portrait of Oral Health, an annual report that examines data, research, gaps, and provider perspectives to paint a clear picture of the oral health landscape in our state. The team also partnered with the NC Medical Journal (NCMJ) to release an oral health-focused edition of their November quarterly issue.
In it, NCOHC Vice President Dr. Steve Cline poses critical questions: "How did we let the mouth get separated from the rest of the body? And more importantly, how do we put oral health back into overall health?"
With these two new publications, along with the NC Institute of Medicine's release of the?Oral Health Transformation Task Force recommendations and?Medicaid expansion,?we have crucial momentum. Drawing on this, we can move towards a future where we integrate all types of care to support whole-person and community health.
The State of Oral Health in NC
The 2024 Portrait of Oral Health was compiled by the NCOHC and FHLI communications teams in collaboration with University of North Carolina Gillings School of Global Public Health students Hannah Kim, Emily Liu, Jacob Thayil, and Mary Yin. Here are some key findings from the report:??
In addition to revealing key details about North Carolinians' oral health, the report also exposes research gaps, such as racial diversity of dental hygienists and tooth decay among adults.
"Effective oral health-related policymaking and program implementation rely on comprehensive, accurate, and timely data." — Patrick Roberson, DDS, Ruma Simhan, DDS, MPH, Osaremhen Ikhile, DrPH, MPH, BDS, Oral Health Data Gaps and Needs in North Carolina, NC Medical Journal, Vol. 85, Issue 6, 2024
We need equitable research practices to advance oral health access and equity. We All Count's Data Equity Framework provides a systematic process with seven stages to raise awareness and support equitable decision-making in data collection.
Progress in Oral Health Policy & Practice
In many ways, this has been an incredible year for health access and equity thanks to Medicaid expansion, which made health insurance, including dental insurance, available to hundreds of thousands of North Carolinians—many for the first time. To ensure everyone can access the care they need, we must push for systemic changes that increase the number of oral health providers in rural and underserved areas. This includes incentivizing private practice dentists to serve more patients with Medicaid insurance.
Today, 45% of practicing dentists in NC accept Medicaid, and just 28% provide meaningful care, meaning they make annual Medicaid claims of $10,000 or more. In comparison, approximately 86% of practicing physicians in the state accept patients with Medicaid insurance. The reason most often given by dentists who do not serve a meaningful number of patients with Medicaid is low reimbursement rates, which remain nearly the same as in 2008.
"The time for complacency in oral health is over. We stand at a critical juncture where we must embrace bold, innovative strategies to tackle this silent epidemic. Oral health is not a niche concern; it is a core component of overall health that directly impacts chronic disease management, quality of life, and health care costs. By integrating oral health into every facet of health care—education, practice, policy, and community engagement—we can create a healthier society that treats the mouth as if it is as vital as any other organ."?— NCOHC Vice President Dr. Steve Cline
In addition to highlighting much-needed policy changes, the 2024 Portrait of Oral Health reviews the ongoing impact of the COVID-19 pandemic, which exposed new and existing public health challenges. It also led to an expansion of teledentistry and a wider adoption of preventive, non-surgical approaches to managing tooth decay like Silver Diamine Fluoride.
Interventions like these remain even more vital in the wake of Hurricane Helene in Western North Carolina. Teledentistry and mobile clinics will continue to play critical roles in making oral health more accessible. However, as the region transitions to long-term recovery efforts, many rural communities continue to face additional barriers due to unreliable Internet and road closures caused by infrastructure damage.
Collaboration with the NC Medical Journal
Featuring diverse perspectives on oral health policy, integration, disparities, and more, the NC Medical Journal oral health issue encourages broad dialogue among policymakers, providers, and the public. Along with a spotlight on Wake Smiles dental clinic and conversations with dental health leader Frank Courts, DDS, PhD, and Eastern Carolina University School of Dental Medicine Dean Greg Chadwick, the journal covers:
The issue also highlights the importance of cultural attunement and addressing social drivers of health (SDOH), emphasizing how integrating this approach can transform care delivery and improve outcomes. According to the NC Department of Health and Human Services, up to 80% of a person's health is determined by social and environmental factors. Culture intersects with all these SDOH, and culturally attuned care is a person-centered approach founded on this understanding.
"Being a culturally attuned health care provider means getting to know your patients beyond their body, their teeth, and beyond what you think they may feel or believe about their health." — Jamie Burgess-Flowers, MSW, LCSW, Kelsey Yokovich, MSW, Cultural Attunement: A Critical Social Driver of Oral Health, NC Medical Journal, Vol. 85, Issue 6, 2024??
In contrast to culturally competent care, culturally attuned care is individualized and requires a commitment to openness, humility, and a continual learning process. Integrating cultural attunement into dental student recruitment, pre-doctoral dental education accreditation standards, and widely adopted clinical practices can improve the standard of oral health care for patients. Explore the issue to learn more.
Opportunities for Action on Oral Health
FHLI focuses on community-based solutions that build toward systems-level changes. In oral health, we are leveraging years of community-based efforts across the state and advocating for targeted policy changes to modernize the dental safety net. In the 2024 Portrait of Oral Health, NCOHC outlines its 2025 policy priorities:
Successful advocacy cannot be done in a vacuum. NCOHC will continue bringing together coalitions from various backgrounds to collaborate and identify the best solutions to the problems too many North Carolinians continue to face. Here are some ways to engage:???
We also hope you will join us for our annual Legislative Breakfast early next year!?In partnership with fellow FHLI programs, the NC Rural Health Association, and the Center of Excellence for Integrated Care, NCOHC will co-host the breakfast in Raleigh on February 18. Stay tuned for more details. We look forward to seeing you there!