Preventive Care During a Pandemic

The importance of preventive oral health care is often underestimated. There are many basic habits that can be implemented daily to reduce the risk of decay and other serious dental issues. During COVID-19, when there are more challenges to being seen by healthcare specialists, preventive care is critical.

Consistent dental exams are necessary during childhood; this is the time when issues are most treatable, and hygiene education can be implemented for long-term oral and overall health.

According to the American Dental Association, a child’s first dental exam should be scheduled no later than the first birthday or after the first tooth erupts. The American Academy of Pediatric Dentistry also recommends regular visits every six months after this.

The American Academy of Pediatrics has also developed a schedule of well-child visits to reinforce the overall well-being of developing children. This entails a recommended visit within the first week of birth, and then once a month for the first two months. After that, the child should be seen once every two months until the child is 18 months old. It is recommended the child be seen twice a year at age two, and then once a year until they are 21 years old.

Oral health education can have a significant impact on overall well-being. A common source of dental issues includes improper drinking and eating habits. If education is implemented at a young age to combat some of these dangerous patterns, future health concerns such as diabetes and obesity can be avoided. Other health risks associated with smoking and chewing tobacco can also be discussed during counseling in dental exams as children get older.

The pandemic has posed challenges to many, if not all, healthcare fields. COVID-19 has made it more difficult for patients to receive oral health care in a dentist’s office. Early guidelines from the World Health Organization advised people to delay their visits for non-essential oral health care like preventive care. This was a safety concern because dentists and dental hygienists work in close contact with their patients, and have a higher chance of spreading and contracting the virus. However, this has negative implications for peoples’ oral health.

The American Dental Association has emphasized the need for consistent dental care with safety precautions in place. During this pandemic, that means more PPE and sanitization. It is recommended that certain instruments which spray large amounts of water not be used. Dental hygienists and dentists are not able to see as many patients, due to increased time requirements between patients in accordance with surface sanitization protocols. Additionally, -travel and symptom questionnaires patients complete can also result in appointment postponements.

So, is it safe to go to the dentist now?

Many dental offices are open for routine care again, with significant safety measures in place. If you have any concerns about safety before your visit, give your dentist’s office a call and ask them a few questions, such as:


  1. What are your current COVID-19 protocols? doing to make sure that patients and providers are not spreading COVID-19?
  2. What kind of screening measures can I expect when I come in for my visit?
  3. How are you dealing with aerosolizing procedures? (This refers to the tools mentioned above that spray large amounts of water, a potential risk of “aerosolizing” the virus if it were present.)

What about mask breath? Can I do anything at home?

Due to prolonged periods of mask usage during the pandemic, many are becoming increasingly concerned about their own oral health.

Halitosis, a technical term for bad breath, is a preventable condition. One way to reduce “mask breath” is to brush your teeth at least twice a day, paying close attention to the tongue, which can hold large amounts of bacteria. Using fluoride toothpaste, fluoride mouthwash, and consistent flossing are also ways to prevent halitosis.

Do you have kids at home? Download this helpful guide and hang it in their bathroom to help keep their teeth healthy and happy!

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Dental Professional-Administered Vaccines

Dentists in North Carolina are uniquely positioned to begin administering some vaccinations, like those for the Human Papillomavirus (HPV) and Influenza. Currently only three states – Oregon, Illinois and Michigan – have existing legislation that allows dentists to administer vaccines. During the 2009 Swine Flu (H1N1) pandemic, dentists were temporarily added to the pool of flu vaccine administrators in certain states, such as Massachusetts. As scientists race to create an effective COVID-19 vaccine, the dental workforce could offer important support to the medical community, helping administer the vaccine to the public as efficiently and effectively as possible.

Dentists are highly qualified health providers, and are well poised to administer vaccines. Dental students attend the first two years of dental school training in coursework mirroring that of their medical student counterparts, and thus have congruent training regarding the use of medications and management of adverse reactions. Within their daily practice, dental providers routinely administer injections in anatomically difficult positions, ensuring that they are capable of administering intramuscular injections such as vaccinations into the deltoid muscles of the upper arm.

Approximately 79 million Americans are infected with Human Papillomavirus (HPV), making it the most prevalent sexually transmitted infection (STI) in the United States. HPV is responsible for approximately 70 percent of oropharyngeal cancers and more than 90 percent of cervical cancers. However, studies have shown that cancers associated with the virus are all but entirely preventable in patients that have completed the series of HPV vaccines prior to virus exposure.

In Australia, mass HPV vaccination has been correlated with a significant reduction in cervical cancer rates. While it may never be possible to completely eradicate cervical cancer, morally it is negligent not to fully utilize every avenue to contribute in the reduction of HPV associated cancers.

Many barriers restrict rural residents’ access to primary care. According to the Agency for Health Research and Quality (AHRQ), in 2017, approximately nine percent –or nearly 31 million people–sought care from a dental provider but not a medical provider. The barriers to accessing routine medical care disproportionately affect rural children, particularly in regards to vaccination. Rural children are approximately 30 percent less likely to have completed the full series of HPV vaccines. By enabling dentists to administer vaccines within their practices, rural residents will have an additional means by which to obtain these vaccinations.

Patients will benefit from the added convenience of being able to receive vaccines within the dental setting, minimizing travel burdens for patients.

Advocating for dental providers to be able to administer vaccines must start by raising the public’s awareness of the importance of HPV vaccination and promoting their understanding of dentists’ qualifications regarding vaccine administration. If successful, this policy opportunity has the potential to positively impact rural communities statewide.

Amanda Assante, Alexis Davis, Astha Patel, and Jessica Sharrow are students in Campbell University’s public health master’s program. In the fall 2020 semester, as a part of their coursework, Amanda, Alexis, Astha, and Jessica participated in an oral health practicum experience in which they dove deep into dental professional-administered vaccines with the North Carolina Oral Health Collaborative.


Mental Health Care in a Dental Clinic?

Mental Health and Oral Health services have traditionally been thought of as separate entities. To better provide efficient, affordable care, Greene County Health Care (GCHC) is bridging the gap, integrating medical, dental, and behavioral health services for its patients.

As a Federally Qualified Health Center (FQHC), GCHC serves patients across Greene, Pitt, and Pamlico counties in North Carolina. Their focus resides in increasing access to high-quality care for the underserved, uninsured, and underinsured.

Cori Davis, a MedFT at GCHC, went into detail about her role in connecting oral and mental health.

In the time between when a patient fills out their paperwork and is seen by a dental hygienist or assistant, Davis performs behavioral health screenings and interventions. This involves sitting down with a patient to evaluate their overall mental health.



She screens for common mental health concerns such as anxiety and depression. Davis also assesses dental pain and pain management, eating and sleeping patterns, as well as social and basic needs.

Though her brief interventions on managing chronic conditions and mental health issues can go a long way, Davis often makes referrals to other GCHC therapists, if needed.

“We have a lot of great therapists here that can devote more time to a long-term case,” Davis stated.

Additionally, Davis makes referrals to GCHC’s medical clinic for patients who need medical care.

Working closely with a social worker, therapists at GCHC can work through common issues like transportation and medication affordability. Ride-sharing services and other programs to help patients access the care they need are often covered by Medicare or Medicaid.

We asked Davis if she thought her work had a genuine impact on the overall health of the patients she met with, to which she responded, “Definitely, yes.” She explained that before patients even leave the room, they are given handouts and techniques so they may leave with tangible and practicable information.

Afterwards, there is more to be done.

“Connecting them to a healthcare system that can be with them and work with them long-term is really valuable so they have all of their services they need in one building.” Davis continued, “That really helps with continuity of care and making sure they can have sustained healthcare.”



One example of how these health screenings are linked to the oral health practice is when a patient suffers from dental anxiety. Evaluating this condition allows for the therapist to work through breathing exercises and relaxation techniques. This information is then communicated to the dental assistant or dentist so that they may implement these practices throughout the appointment.

“We’re really filling the gaps with the services we do here,” said Davis, “Because the population we serve in dental isn’t the same population for the medical side.”

Behavioral health, general health care, and oral health care are often siloed, which exacerbates barriers that many face to accessing the care they need.

“We emphasize your whole health here and we want to make sure that all of you is doing well”, Davis said.



Addressing Oral Health disparities in North Carolina is tied with improving the overall health and well-being of its citizens. Combining medical, dental, and behavioral health services has become increasingly important in this process. Collectively, these related health fields strive to better the lives of everyone, especially those who have not had the privilege of reliable health insurance and access to care.

NCOHC is a program of the Foundation for Health Leadership & Innovation. 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!


School-Based Care During a Pandemic

The most important element of childhood development is overall health. With schools nationwide facing unprecedented challenges during the current pandemic, setting children up with proper oral health treatment and education early on can be a determinant of their future success.

Many children, especially in communities that traditionally lack access to care, rely on school to get the oral health treatment they require. This means that during these times, it is more difficult for many children to receive the care they deserve. In a socially distanced interview, we spoke with representatives of Kintegra Health about challenges regarding school-based care during COVID-19.

Dr. William Donigan, general dentist and dental director at Kintegra Health, and Melissa Boughman, dental hygienist and dental ACCESS program director for Kintegra Health, both touched on the importance of providing school-based care to those who do not traditionally have access to oral health care.

Transportation issues are a common theme in Title I schools. Because many parents are not able to regularly bring their children to oral health appointments due to work conflicts or lack of transportation, Kintegra Health’s mobile dentistry units are essential parts of their operation. Operating out of Gastonia, North Carolina, there are two of these mobile units, as well as a dental van for follow-up visits and sealants.

“It’s so wonderful that we’ve been blessed with these mobile dental units that we can drive right up, park, and they bring the children out to us,” Boughman said.

Donigan also emphasized the importance of comprehensive oral care in the areas they serve. “Kintegra has been very responsive to the communities that we are involved in,” Donigan said. “Our mobile dentist unit goes anywhere within thirty minutes of one of our clinics.”

When asked how Kintegra is able to provide patient care during the COVID-19 pandemic, Donigan highlighted the use of intraoral photographs submitted by parents of the children, a supplement to the care provided by the mobile dental units. This increases conservation of personal protective equipment (PPE), lowers chair time, and allows patients to avoid leaving the house altogether for non-emergencies.

However, due to the use of cell phone pictures in these virtual exchanges of information, there have been concerns about image quality.

“The advantage of talking to the parent at that point is we can have them retake and resend the photograph if it’s not good,” Donigan said. “In most instances, we can get a pretty good photograph in those environments.”

Complications in oral hygiene at a young age can extend far into the future. Taking a further look at the world of oral health through the lens of a pandemic provides information about the links between COVID-19 and future health problems in children.

“Just recently, 90 percent of the people on a ventilator with COVID had periodontal disease,” said Donigan. He also mentioned that many diseases, like diabetes and high blood pressure, have relationships with what happens in the mouth. Donigan explained that many of the children Kintegra sees are already prediabetic in elementary school, and good education early in life is vital to helping them begin to lead healthier lives.

“We see the difference in the children we have seen for many years versus the newcomers, like the kindergarteners, and in some schools, pre-k,” said Boughman. “When we see them yearly, we see a big difference. We also provide education because we all know that education is the most important part of all of this. Once we clean their teeth, [plaque and tartar] will come back quickly. But if we teach them how to take care of their teeth, they can have a lifetime of great [oral health].”

Kintegra Health now works with more than 60 schools in seven school systems ranging from Gaston County to Iredell County.

“Today, at Battleground Elementary in Lincoln County, we’ll probably see about 30 children,” Boughman said. Kintegra expects to reach nearly 7,000 children this year, provided that schools are able to maintain traditional classroom meetings.

Kintegra Health staff place an emphasis on creating a relationship with their patients. “We don’t let them fall through the cracks,” Boughman said. “We call them at least three times, and then even send a postcard.” If further dental work is needed, the dental access program assistant will contact parents to explain what was done and make appointments to return if necessary.

Now more than ever, maintaining consistent communication — and being able to provide oral health treatment, when possible — is crucial to school-based care. Kintegra Health’s practice model has become a prime example of how dedicated oral health professionals can overcome the challenges posed by COVID-19.

NCOHC is a program of the Foundation for Health Leadership & Innovation. 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!