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Our New Year’s Resolution: Great Oral Health in 2020

At NCOHC and the Foundation for Health Leadership & Innovation (FHLI), we are reflecting on 2019 and planning for 2020. Here are our highlights from last year and our plans for the year ahead.

What NCOHC Accomplished in 2019

In 2019 we supported communities across North Carolina, helping local leaders build relationships and collaborate with provider networks, educators, and more, to positively impact oral health outcomes.

We increased NCOHC’s educational impact, piloting an oral health practicum experience with Campbell University public health students and leading roundtable sessions at the UNC Gillings School of Global Public Health. Director Dr. Zachary Brian spoke at more than 40 workshops and presentations across North Carolina and around the country.

On the policy front, NCOHC worked hard to develop a fruitful partnership with the North Carolina Dental Society (NCDS). Together, we sponsored a regulatory rule change that will allow dental hygienists to practice to the full extent of their licensure, a change that will expand access to affordable health care for those who need it most.

Stay tuned, as the rule change is expected to be approved by the Rules Review Commission later this month!

Finally, with help from the oral health and policy advisers who make up our Collaborative Acceleration Team (CAT), NCOHC developed a Strategic Plan, setting ambitious goals to guide our work for the next five years.

be sure to check out our full Year in Review in NCOHC’s December Newsletter.

What We’ll Do in 2020

With guidance from our Strategic Plan, NCOHC will hit the ground running in the new year. We expect to see the regulatory rule change that we co-sponsored with NCDS signed into effect in the next few weeks, and we will continue to positively impact the oral health of North Carolinians through state-level advocacy.

We will continue to work with communities across the state to help local leaders increase access to oral health care. We will provide resources to these leaders, oral health care providers, and to the general public, and we will leverage our newly expanded capacity to increase NCOHC’s organizational effectiveness

stay tuned to our developing Resource Center—part of our newly redesigned website—for the latest oral health news and information for providers, policymakers, and the public.

All our work will impact NCOHC’s overall goal of advancing systemic change in oral health care. Our aim is to promote a value-based approach, recognize social determinants of health and barriers to equitable oral health care, and promote solutions to create an equitable landscape for all North Carolinians.

These are Our Oral Health Care Resolutions for 2020. What are Yours?

NCOHC is a program of the Foundation for Health Leadership & Innovation (FLHI). For more information and to stay up to date, subscribe to the NCOHC Newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!

Access Blog Equity Public Health

Myth vs. Fact: Fluoride and Your Health

Fluoridation is one of the greatest public health successes of the 20th century.

Despite the overwhelming success of community water fluoridation at improving oral health outcomes, misinformation continues to circulate about its risks and benefits. From those that call fluoride a communist plot (really) to others that call it a deadly killer, myths about the element are widespread. In fact, over the last few decades, anti-fluoride movements have gained large followings across the country.

Separating Fact from Fiction

In reality, fluoride in municipal water supplies is one of the most important and effective advances in the history of public health.

Since its first application in Grand Rapids, Michigan in 1945, the addition of fluoride to municipal water supplies has dramatically improved oral health outcomes across income levels, age groups, racial lines, and geographic areas.

(To learn more about how income, race, and geography impact oral health, check out our previous blog post on systemic barriers impeding oral health care access)

Is fluoride expensive?

At less than 50 cents per person per year, water fluoridation is an incredibly cost-effective treatment that has proven to reduce cavities in children and adults, even helping repair tooth decay in its early stages.

But isn’t fluoride an unnatural substance we shouldn’t consume?

No. Fluoride occurs naturally in a wide variety of foods and beverages. In fact, if you’ve ever eaten fried shrimp, mashed potatoes and gravy, or raisins, you have consumed fluoride at higher concentrations than you do when drinking fluoridated tap water!

If you want to know more, check out this USDA report on foods and beverages that contain naturally occurring fluoride.

The truth is that we naturally consume fluoride every day.

However, while there is fluoride in all sorts of foods and beverages, it generally doesn’t naturally occur at high enough levels to benefit our teeth.

Adding fluoride to tap water hasn’t subjected us to a toxic hazard. On the contrary, community water fluoridation has simply ensured that many people have the same access to it in healthy, beneficial quantities.

If fluoride is in our water at higher concentrations than occur naturally, does that make it dangerous?

Not at all. Consider this:

For a 165-pound adult, 12 standard glasses of water consumed quickly is considered a lethal dose. By comparison, in order to obtain a lethal dose of fluoride, you would have to consume more than 15 12-ounce glasses of fluoridated tap water in rapid succession.

So how does fluoride work?

In the course of a day, we all consume foods and beverages that introduce cavity-causing bacteria to our mouths. That bacteria weakens our enamel — the hard, outer coating that protects our teeth.

When we brush our teeth with fluoridated toothpaste, eat fluoride-containing food, or drink fluoridated tap water, fluoride replaces hydroxide ions in our enamel. This process strengthens our teeth, prevents decay, and can even help reverse existing decay in its early stages.

How can I make sure I’m getting enough fluoride?

The best thing you can do to protect your teeth is to make sure that you brush for two minutes twice a day with a fluoride toothpaste. You can also use fluoride mouthwash, and make sure to drink fluoridated tap water to keep your teeth happy and healthy!

And yes, kids can use fluoride too. The rule of thumb is, “smear up to three years,” which means you should use just a smear of fluoride toothpaste to brush a child’s teeth until they are three years old. From 3-6 years old, use a pea-size amount of fluoride toothpaste.

Source: American Dental Association

NCOHC is a program of the Foundation for Health Leadership & Innovation (FHLI). For more information and to stay up-to-date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!

Sources for more information:

Blog Equity Social Determinants of Health

Systemic Barriers and Oral Health Equity in North Carolina

There aren’t many people who really enjoy going to the dentist.

Who wants to have someone poking around in your mouth, drilling into your teeth, and telling you to floss more?

Reluctance to enter an uncomfortable setting is far from the only barrier keeping North Carolinians from going to the dentist. Hundreds of thousands of North Carolinians experience systemic barriers that keep them out of a dental chair.

The Foundation for Health Leadership & Innovation’s (FHLI) North Carolina Oral Health Collaborative (NCOHC) works to dismantle systemic barriers to oral health care, addressing social determinants of health to create a more equitable landscape for everyone in North Carolina.

Geographic Barriers

Where you live has a lot to do with how easy or hard it is to see a dentist. Five of North Carolina’s 100 counties are home to most of our state’s practicing dentists.

Did you know?

As of 2019, 74 of North Carolina’s 100 counties are designated Dental Health Provider Shortage Areas (HPSAs).

So, if you are in Raleigh, you might have a choice between the dentist five minutes up the road and another one on the way to work, giving you the flexibility to fit oral care seamlessly into your schedule. But if you live in Tyrell County, you may have to plan an hour-long trip to access the closest dental office.


Cavity fillings, tooth extractions, implants, and crowns can be expensive treatments, and hundreds of thousands of North Carolinians are uninsured. Without the means to access oral health care from childhood, low-income North Carolinians often don’t receive preventive treatment early on, leaving them at higher risk of negative outcomes later in life. Beyond oral health, this has far-reaching impacts that influence a cycle of poverty that is hard to escape.

Poor teeth, I knew, beget not just shame, but more poorness: people with bad teeth have a harder time getting jobs and other opportunities. People without jobs are poor. Poor people can’t access dentistry—and so goes the cycle.

Sarah Smarsh, “Poor Teeth”

Be sure to check out NCOHC’s Resource Center for more content, like the incredibly personal and compelling essay about poverty and oral care, “Poor Teeth,” by Sarah Smarsh.

Compounding Effects

These systemic barriers to oral health care don’t occur in a vacuum. They compound, making access harder and harder. Imagine the difficulty of seeing a dentist if you live in a rural community and must schedule an hour-long trip to access care. Now imagine how much harder that would be to fit into your schedule if you are working two or three jobs to make ends meet. What would you do if, on top of all that, the dentist doesn’t accept your Medicaid insurance, forcing you to budget time for a two- or three-hour trip?

On a positive note, North Carolina’s oral care Medicaid benefits are among the best in the country. Unfortunately, they are incredibly underutilized. 76% of North Carolina’s dentists are in private practice, and few accept Medicaid insurance, making it difficult to find an in-network provider.

Language Barriers

According to the Modern Language Association of America, nearly 900,000 North Carolinians speak a primary language other than English. Most of these individuals speak Spanish, but other primary languages include French, German, Chinese (including Mandarin), Vietnamese, Arabic, Korean, and more.

For non-native English speakers, and for those who may not speak English at all, understanding dental care, finding a dentist, scheduling appointments, and coordinating with insurance companies can be daunting tasks. Making it even more difficult is the fact that many dentists in North Carolina don’t have bilingual staff or translated paperwork.

For dentists, language barriers can pose issues regarding informed consent. Even with a translator present, ensuring that the patient truly understands a procedure can be a major concern for providers.

Intellectual and Developmental Disabilities

Individuals with intellectual and developmental disabilities (IDD) have a higher chance of suffering from poor oral health for a variety of reasons. The IDD population often has a harder time finding transportation to and from a dentist, many are non-ambulatory, and physical ailments can inhibit good personal oral hygiene habits. In addition, most dentists don’t have training to provide services for those with special needs.

In the Community

NCOHC recently partnered with Campbell University public health students for a practicum experience in oral health. As part of the program, the students worked to incorporate oral health into Harnett County’s MedFest event, a program of Special Olympics North Carolina that provides medical services to Special Olympics participants.

Read more about the program in, “Building Oral Health Champions: Reflecting on a Semester with Campbell University Public Health Students” or watch our video spotlight on Campbell University.

These are just a few of the factors that impact the IDD community. For a more in-depth analysis, check out this 2018 study by the Eunice Kennedy Shriver Center on oral health care for adults with IDD.

Racial Disparities

Oral health outcomes and access to care differ widely along racial lines. Non-white North Carolinians are far more likely to have lower household incomes, and many live in “food deserts,” meaning they lack access to healthy foods. These factors affect oral health, as well as health in general.

According to the CDC, non-white Americans have higher rates of poor oral health, with the largest disparities occurring between 2-4 years old and 6-8 years old. Childhood tooth decay is a serious issue in minority communities, and it is an issue that continues to affect oral health and whole-body health throughout adulthood.

How Do We Address These Barriers and Achieve Oral Health Equity?

Achieving equity will take a multi-faceted approach, involving people in all levels of health care, community leaders, advocates, and more. NCOHC is partnering with innovative professionals to address needs, specifically working to increase North Carolina’s dental workforce, expand service areas in underserved communities, and increase accessibility to marginalized groups.

NCOHC is currently partnering with the North Carolina Dental Society to encourage a state-level rule change that would allow dental hygienists to provide critical preventive services in high-need settings. North Carolina is one of the most restrictive states for dental hygienists. This simple rule change will help better utilize North Carolina’s existing dental hygiene workforce, increasing access in under-served parts of the state.

Other avenues to increase equity include:

  1. Working with nontraditional organizations to increase access points outside of the traditional dental office (often known as a “dental home”). This means incorporting dental care in schools, nursing homes, primary care offices, and more.
  2. Coordinating with dental offices to provide translated consent forms, descriptions of procedures, and other helpful content to non-native English speakers and those who don’t speak English at all.
  3. Encouraging innovative ways to utilize the workforce with technological solutions like teledentistry.

Stay up-to-date by signing up for NCOHC’s newsletters, and if you are interested in becoming an NCOHC member for free, join us today!

Blog Equity

Equity in Oral Health: What Does it Mean?

What is Equity?

You may have seen the comic below, which depicts three individuals watching a baseball game over a fence. It’s a simple image, but it shows important differences between equality and equity.

In the first panel, everyone is given the same assistance. They are treated equally, each with one box to stand on. But, as you can see, the people in this situation do not start on an equal playing field, and the outcomes are inherently unequal.

To achieve the same outcomes—everyone enjoying the ability to watch the baseball game—the shortest person in the group needs an extra leg up.

In the second panel of this comic, the tallest person no longer has a box to stand on and the shortest person now has two. While the tallest person is not receiving any additional assistance, his ability to watch the baseball game has not been diminished. Since the shortest person has received additional assistance, all three are now able to experience the same outcome: enjoying the baseball game.

Equity vs. Equality

While equality means treating everyone the same, equity means providing everyone with the resources and assistance they need to achieve successful outcomes. Equal treatment is important, but in a world where we all are different, with different experiences, abilities, disabilities, and resources available for our use, we inherently need different things in order to be successful. Equity addresses our differences to ensure that all people, no matter where they start, can have the opportunity to achieve successful outcomes.

Oral Health Equity in North Carolina

The Foundation for Health Leadership & Innovation’s North Carolina Oral Health Collaborative (NCOHC) is working to change the conversation toward a focus on equitable oral health care.

North Carolina is experiencing an oral health crisis that is felt disproportionately across the state. NCOHC has identified several drivers of inequity, including long distances to reach the nearest dentist, high treatment costs (and lack of insurance to mitigate those costs), and language and cultural barriers.

To ensure that all North Carolinians have the opportunity and ability to access quality oral health care, hundreds of thousands of people are going to need additional resources. These resources include, but are not limited to, Spanish language forms and bilingual staff, financial assistance, and more dental offices in rural communities.

NCOHC is collaborating with oral health professionals and community leaders across the state to plan and implement equitable solutions to our oral health crisis. If you want to learn more, be sure to check out NCOHC’s resources on Oral Health Equity. Join our email list to receive regular updates on NCOHC’s work and learn how you can get involved.

Be sure to tune in next week for our breakdown of the systemic barriers to oral health and how we can reach the equitable landscape depicted in the third panel of the comic strip below!

Equality vs Equity vs Justice Comic
Image courtesy of the City for All Women Initiative’s guide, “Advancing Equity and Inclusion.”