2021 Legislative Perspective

Graphic with text, "2021 NC Legislative Perspective"

As we move forward into the new year, it is important to be aware of policy changes that may directly affect access and equity in oral health care for North Carolinians. We sat down virtually with Ben Popkin, The Foundation for Health Leadership & Innovation’s political strategist, to gain insight into what health care professionals, providers, and patients should be on the lookout for in 2021.

Health policy consultant Ben Popkin began his career as a staff attorney in the North Carolina General Assembly’s Research Division. He has also worked in the legislature’s bill drafting division. Popkin has experience in the Medicaid transformation space, and has helped the North Carolina Oral Health Collaborative achieve great strides through his lobbying and strategic planning advice for public health groups.

Popkin will assist NCOHC in several key areas of focus during the coming year. With the COVID-19 pandemic still impacting daily life, creating a more defined structure for telehealth, specifically teledentistry, is particularly important among the oral health community.

Teledentistry and Dental Hygienist Regulations

Teledentistry is not currently prohibited, but in North Carolina there are a lack of guardrails for those who use it. Popkin says that it is important that there be “a safer and more defined structure that includes standards of the practice, such as patient protection and informed consent.” It is critical to move toward legislative changes that support the permanent adoption of teledentistry models.

Read more about teledentistry in NOCHC’s policy brief

There are several North Carolina counties that do not have any practicing dentists. Lack of oral health care is not aided by the fact that North Carolina is particularly restrictive when it comes to the services dental hygienists are able to provide. Popkin notes that allowing hygienists to provide more services — like administration of local anesthesia — would increase productivity and efficiency in dental care.

“We want to reduce obstacles to dental hygienists and even to dentists who want to provide care to underserved areas,” Popkin says. Along with moving teledentistry forward, placing a priority on giving dental hygienists an increased ability to do the job they are qualified and trained for, would lead to meaningful victories for providers and patients alike.

Regulatory vs Legislative Policy Changes

NCOHC achieved several policy victories in the past year, most notably the 16W rule change, which allowed dental hygienists to provide preventive care services to individuals without having to have first received a prior examination by a dentist.

This was a regulatory policy change, as opposed to a legislative policy change.

“The typical structure is to have the required details for an initiative laid out in statute. Once the legislature has enacted law, a respective agency would adopt the rules. After the underlying framework is provided in statute, then the rules would provide the specific details for how to implement the initiative,” explains Popkin.

In other words, a legislative policy change involves the North Carolina General Assembly support and enactment on a bill, whereas a regulatory change involves a board, such as the North Carolina State Board of Dental Examiners (NCSBDE) approving an amendment to rules they have authority over.

Changing policy through the regulatory process involves making a specific rule proposal, which would first be either approved or denied by the rulemaking body in question. If approved, the rule would then go through the Rules Review Commission, which either approves or denies the rule after checking for precise legal authority.

“When it comes to teledentistry, our focus is on the legislative approach to enact statutes because of the detail needed to guide the rules,” Popkin says.

Popkin is optimistic about a teledentistry bill being approved in 2021. When asked about the specifics needed to push a bill forward, he mentioned the importance of issue experts like Dr. Zachary Brian, NCOHC’s program director, speaking directly with policymakers.

Events like NCOHC’s Oral Health Day helped to disseminate information to legislators and the general public about the importance of teledentistry. Collaborating with high-level universities, creating public awareness, and continuous contact with decisionmakers are crucial elements of successful policy change.

NC Government in the 2020 Election

In North Carolina’s 2020 elections, the outcome was fairly stable. The Republican party remains in control of the State Senate and House of Representatives. In the Executive Branch, Democratic Governor Roy Cooper was re-elected, meaning that the Health and Human Services Department staff also remains the same.

Popkin is hopeful that NCOHC’s goals will be treated in a non-partisan way.

“In North Carolina, we have a great health policy community…My goal is to bring consensus among parties and get a win for everybody.”

National Perspective: Future of the Affordable Care Act

At the federal level, there has been a very public shift in the Supreme Court. As far as the future of the Affordable Care Act, Popkin says, “It remains a very politicized topic. We will have to wait and see what happens.”

North Carolina was awarded nearly 90 million dollars to implement systems that would help provide people with healthcare. Popkin explains that there is yet to be a viable alternative proposal and, should it be repealed, many North Carolinians could be in danger of losing their insurance coverage.

“When politics infiltrates a subject, it is difficult to have a nonpartisan discussion,” Popkin said.

However, he is doubtful that the Affordable Care Act will completely disappear any time soon.

Get Involved

When asked how readers who are passionate about increasing access and equity in oral health can get involved, Popkin encourages people to reach out to their elected officials. “Email or call your legislators and let them know what’s important to you. It’s not uncommon for a member of the public to initiate an effort that can become law.”

You can now engage with the legislative process easier than ever. The General Assembly’s website allows you to follow chamber discussions, committee meetings, read up on actual drafts of bills, look up regulations, and find your legislators.

Want to get involved in building a more accessible, equitable oral health landscape in North Carolina? Become a North Carolinian for Change today! Our new platform will connect you with the most impactful opportunities to get engaged in efforts to change policy and build a future where all North Carolinians can get the care they deserve.


0-5: A New Parent’s Guide to Oral Health

A newborn’s growing teeth are crucial to their overall development as a child. Baby teeth are the foundation for a strong set of adult teeth because they act as placeholders for permanent teeth. Poor oral health when your child is young can often result in crooked teeth and more serious oral health complications.

For more on why baby teeth matter and how to protect them, visit this American Dental Association resource.

So, when should I start brushing my child’s teeth?

It is safe to clean your baby’s mouth shortly after birth. Using a clean, moist washcloth, wrapped around one finger, carefully massage the gums. This can be done after every feeding until their teeth start to appear at around six months.

After the first teeth start to appear, brushing with a soft bristled toothbrush can significantly reduce the risk of tooth decay. Be sure to regularly check inside your child’s mouth and under their lips for white or brown spots that may be indicative of cavities.

Figure displaying a smear of toothpaste for children under 3 and a pea sized amount for children and adults 3 and up

Brush with a small amount of fluoride toothpaste (about the size of a grain of rice) until your child is three years old. After the age of three, a pea-sized amount of fluoride toothpaste can be used to brush their teeth. By this age most children will have all 20 primary teeth. Begin teaching them to spit to avoid swallowing the toothpaste.

Allowing your child to pick their own toothbrush and toothpaste can encourage regular brushing. Just be sure to check for the American Dental Association (ADA) seal of approval.

A consistent routine is the single most important thing you can do to ensure your child has a healthy mouth; but how teeth are brushed can also make an impact. Try to use small, circular motions as well as you can — it can be tough, especially when you begin teaching your child to brush their own teeth.

Brushing should be supervised twice a day until the age of six, when children are typically able to do it alone. Clean the inner, outer, and chewing surfaces for a total of at least two minutes every time.

Check out these handy guides for parents and children about developing good oral health habits. You can even print one for your children and hang it in the bathroom.

Graphic for children with five steps to a good brushing routine

Click the image to download a printable version or to see an additional guide for parents

What is teething?

Did you know babies are already born with all their tooth buds?

Teething is when your baby’s teeth begin to push through the gums. This typically occurs between months four and seven. However, it is important to remember every child is different and for some, this can even occur at 12 months. Slower rates of growth are not necessarily a means for concern.

The two bottom front teeth are often the first to appear, followed by the four top front teeth. The last to erupt are generally the molars and eyeteeth, which are located in the upper jaw.

For some children, teething can be a frustrating process that may cause irritability. For others, it may appear painless. You will likely notice more frequent drooling and the desire to chew on different objects. This is perfectly normal and is a form of coping with the new feeling.

To relieve some of the symptoms of discomfort, give your baby safe toys such as a rubber teething ring with no liquid inside. A wet washcloth that has been frozen for about 15 minutes may also be helpful. Continually clean around your baby’s mouth to prevent rashes if there is excessive drooling.

When should I take my child to the dentist?

It is possible for cavities to appear in the mouth as soon as the first teeth erupt. Therefore, it is important to be proactive with oral care. One of the best ways to do this is to schedule a dentist appointment.

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, typically around month six. The American Academy of Pediatric Dentistry also recommends regular visits every six months after this.

During these visits, the dentist will clean the teeth and can apply a fluoride solution to fight cavities. They will also check on teeth development and give advice on how to maintain proper hygiene.

For more information about early childhood preventive solutions like fluoride varnish and dental sealants, click here to see last week’s blog post.

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.

If you notice anything concerning about your child’s teeth, or hear your child complain about pain, you should also make an appointment with the dentist.

For more information about well-child visit schedules, click here.

Caring for your child’s teeth at home

A healthy diet is important for a developing child and can have a direct impact on their teeth. Too much sugar can eat away at the enamel that covers the outer layer of the teeth, leaving them more vulnerable to plaque and bacteria.

Try to limit your child’s sugar consumption to avoid the risk of tooth decay and other health complications.

If you do not have access to fluoridated tap water at home, using a fluoride toothpaste is especially important. Fluoride is safe for young children and is one of the most effective forms of preventive care. The dentist may also prescribe chewable tablets or fluoride drops for your child if necessary; another great reason to schedule regular dental appointments!

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!


What is Fluoride Varnish?

Have you heard of fluoride varnish? This preventive treatment helps strengthen and protect teeth, reducing risk of tooth decay. Next time your child is at the dentist, or even at your pediatrician, you may want to ask about a fluoride varnish.

We know that fluoride is good for teeth, and we can get it in many ways. From fluoride toothpastes and mouth rinses (which you should use daily), to drinking water, regular fluoride intake is an important component of good oral health habits.

Fun fact: Fluoride is even present naturally in many foods and drinks, like bananas, avocados, coffee, wine, shrimp, and more.

So, what is a fluoride varnish?

Simply put, fluoride varnish is a more concentrated form of fluoride, painted onto the top and sides of a patient’s teeth. The varnish itself is not a permanent layer—it stays on a patient’s teeth for several hours, allowing the fluoride to seep into the enamel and strengthen the teeth. To visualize the process, it may help to understand how fluoride works in the first place.

The outer coating of your teeth, the enamel, is the hardest substance in your body, even stronger than your bones. But that protective layer gets weakened and eaten away when we consume foods and beverages high in sugars and carbohydrates, leading to tooth decay and cavities.

When fluoride is introduced, through toothpastes, mouth rinses, drinking water, varnish, or other sources, it actually works to “remineralize” your enamel. Additionally, before tooth decay even occurs, fluoride acts to further strengthen enamel, adding additional protection down the road.

To sum it all up, a fluoride varnish is a great way to add a serious layer of protection to your teeth, which can help you avoid costly dental procedures in the future.

Who can get a fluoride varnish?

Fluoride varnishes are mainly used for children, but the truth is that anyone at risk of tooth decay could benefit from the preventive treatment. However, most insurers, including Medicaid, only cover fluoride varnish for children. In North Carolina, in response to the COVID-19 pandemic, children on Medicaid can receive a fluoride varnish a maximum of once every three month period.

Given topical fluoride varnish’s important protective benefits, it will be important that Medicaid permanently adopt policies to reimburse fluoride placement for all age groups, even after the pandemic.

If you are an adult and are interested in a fluoride varnish, have a conversation with your dentist—they can likely help you find out if your insurance will help pay for it.

A similar treatment: dental sealants

Similar to a fluoride varnish, dental sealants create a protective layer to ward off tooth decay.. Unlike a varnish, sealants are actually semi-permanent (they do wear off eventually), sealing off grooves in your teeth and providing a protective layer against foods and drinks that can cause decay.

While fluoride varnish must be applied several times each year to be effective, sealants on children’s teeth are effective up to nine years, though they should be checked by a dentist regularly as they can wear away.

The bottom line

At the end of the day, dental sealants and fluoride varnish are two effective preventive treatments that are powerful tools to prevent tooth decay and costly dental treatments necessary to repair damaged teeth.

Unfortunately, we don’t live in a world where everyone who could benefit from preventive treatments can access them. If you have access to a dentist, they can work with you to identify the mix of preventive measures that best fits your needs. And if you don’t have a dentist, check NCOHC’s access map here to find an affordable access to dental services near you!

NCOHC is working to build a more perfect oral health ecosystem, one where all people, no matter where they live, how much they earn, what language they speak, or what their life circumstances are, can access the care they deserve. You can take action and join the movement today by visiting NC4Change.


Teaching Equity in Dentistry

MLK Jr Quote: "Of all the forms of inequality, injustice in health is the most shocking and the most inhumane because it often results in physical death"

When creating equitable health care systems, especially at a statewide level, policy plays an important role in driving sustainable, system-wide change. Before policy can be implemented, however, advocates must start by changing peoples’ mindsets.

We recently sat down (virtually) with Dr. Sylvia A. Frazier-Bowers to discuss her role as Assistant Dean of Inclusive Excellence and Equity Initiatives at the University of North Carolina Adams School of Dentistry. Dr. Frazier-Bowers’ goal entering her position was to be an advocate working to change the mindsets of stakeholders when it comes to equity. Her goal was to teach people to be conscious of inclusivity and equity, which is now being incorporated into the Adams School of Dentistry’s curriculum.

Headshot of Dr. Sylvia A. Frazier Bowers

“Equity refers to fairness,” said Dr. Frazier-Bowers, speaking about the importance of the word equity in health care and how it differs from the word “equality.”

While equality means treating everyone the same, or providing the same inputs into a system, 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 are all different, with different experiences, abilities, disabilities, and resources available for our use, we inherently need different things in order to be successful. When all stakeholders have the opportunity to be successful, everyone benefits.

It is no secret that historically, people in the United States have been discriminated against because of race. While we have undoubtably made huge strides toward a more just society, the impact of historical injustice lives on, and there are still structures and individuals today who perpetuate inequity along racial lines.

For a non-oral health example of system-level equity with important ties to the dental world, see NCOHC’s interview with Duke Wold Food Policy Center Director of Strategic Initiatives Jen Zuckerman.

Dr. Frazier-Bowers explained that if two groups are given the same amount of a given resource, one may still be at a disadvantage if they started out further behind. When it comes to health care, equity may actually mean giving some people more help just to overcome existing disparities.

The Adams School of Dentistry curriculum is currently being revised, and the Office of Inclusive Excellence and Equity Initiatives is working to incorporate equity education into the dental school’s coursework.

“Instead of having an insular experience of, ‘Okay everyone, we’re now going to learn about equity and justice,'” said Dr. Frazier-Bowers, “It’s going to be integrated more seamlessly throughout the four-year curriculum.”

Working with experts in equity and justice education, the school designed the Advocate, Clinician, and Thinker (ACT) framework to integrate knowledge of racial equity throughout the four years of schooling, rather than as a small section.

Text of a 2018 Adams School resolution declaring UNC Dentists as "Activists, Clinicians, and Thinkers"

To further incorporate equity education into the student experience, the Adams School of Dentistry was the first to coin an Inclusive Excellence Week, offering weeklong experiences to promote equity. Working with a community of scholars from different disciplines, the Adams School of Dentistry is able to communicate regularly with content experts who can influence new ideas and portray the interconnectedness of their work. The Adams School of Dentistry’s Inclusive Excellence Week influenced dental schools at other universities to do the same.

According to Dr. Frazier-Bowers, when it comes to equity and inclusion, “Mindset is the key.”

“When I say the mindset, this refers to every time you engage in any activity,” said Dr. Frazier-Bowers. “Whether its teaching, seeing patients, being a student, or being a classmate even—think about it from a lens that considers inclusivity and equity.”

When asked about the most prevalent social injustices in dentistry, Dr. Frazier-Bowers explained how the fact that not everyone has access to reliable care is an issue. Unlike a second home or expensive car, “education and health care should not be considered luxuries,” she said.

For that reason, the Adams School of Dentistry is currently working on self-assessment and accountability measures where people can have an opportunity to reflect and search for improvement in the pursuit of equity.

“People must be willing to open their minds to truth and history,” said Dr. Frazier-Bowers.

Many oral health professionals already advocate for change and understand what needs to be done to create a lasting impact. For those who don’t, there are always ways to get involved, but you have to be willing to put in the work. The DOCSpeaks program was created by Frazier-Bowers to bridge the “knowing-doing” gap for well-meaning professionals.

In-depth blurb about the creation of DOCSpeaks

According to Dr. Frazier-Bowers, it all starts with education and an open mindset. The UNC DOCSpeaks sessions are a resource that can serve as a good starting point, and they will soon be open to the public. Outside of the education system, any community with the right leaders and the right mindset can be a catalyst for racial equity.

Want to get involved and elevate your voice? From diversity and inclusion in health care to the rising cost of health care, NC4Change is a platform for a diverse, inclusive group of oral health practitioners, public health professionals, community members, and other stakeholders who share a common goal: increasing equity and access in oral health care.

Head over to the brand new NC4Change page today and sign up for a focus group, give us feedback on our policy brief, and more!