The State of North Carolina Oral Health in 2023

As of January 2022, the U.S. Health Resource and Services Administration has partially or fully designated all 100 North Carolina counties as Dental Health Professional Shortage Areas. This means many North Carolina residents still struggle to find oral health care today.

Medicaid Access in North Carolina

As we enter the summer of 2023, North Carolina is on the brink of finalizing a huge public health victory. The state legislature finally voted to expand Medicaid after more than a decade of hard work and advocacy from countless organizations and individuals across the state.

While the legislation has passed through both chambers of North Carolina’s legislature and was signed into law by Governor Roy Cooper, a provision prevents it from going into effect until all parties agree on and enact a state budget.

Medicaid Expansion became available for individual states to adopt after Congress and former President Barack Obama enacted the Affordable Care Act in 2010. Medicaid is health insurance program for low-income individuals jointly funded by states and the federal government. North Carolina was one of only nine states that had not yet expanded their Medicaid program. An estimated 600,000 North Carolinians will gain access to quality health care once the state legislation goes into effect.

The work toward equitable access to health care doesn’t end with Medicaid Expansion. For people with Medicaid insurance, the oral health crisis the entire state is experiencing could worsen in the short run. Only 35.1% of North Carolina dentists participate in Medicaid. This puts North Carolina 37th out of all 50 states in dentist participation in Medicaid. As more North Carolinians gain access to Medicaid insurance which includes oral health care coverage, our state must work to ensure an adequate supply of dental providers.

The bottom line: Dentist participation in Medicaid, and the many underlying factors that contribute to our current manpower shortage in our already oral health-compromised state, must be addressed. We believe North Carolina residents deserve to have access to oral care, and North Carolina must do better for its low-income and marginalized citizens.

Rural-Urban Divide

More than half of North Carolina’s counties have fewer than four dentists per 10,000 people, an access disparity that skews heavily toward rural parts of the state. In fact, five Eastern North Carolina counties have no practicing dentists.

This forces resident of these counties to travel long distances to receive oral care, making the likelihood of someone going to the dentist for a routine checkup dramatically decrease.

While a routine appointment in Charlotte – which is still inaccessible to many urban residents – could be as easy as a 15-minute trip up the road, a brief wait, and a 30-45-minute appointment, a dental visit in Tyrrell County could include an hour or more of travel time both ways.

For people with children and jobs that make it difficult to take time off, travel time alone can be a significant barrier. Add in access to transportation and consider more intensive oral health needs, such as fillings or root canals that could take several appointments to complete, and you can see how so many who may even have access on paper can’t visit a dentist simply because they live in a rural area.

Movement in the Right Direction

There are bright spots for the state of North Carolina in 2023. During the COVID-19 public health emergency, state level teledentistry policy changes made access to oral health services more accessible for many. People can do check-ups, ask questions, and have follow-up appointments remotely using online virtual technologies..

Teledentisty services lessen the burden of going to in-person appointments for care.

Teledentistry is especially beneficial for individuals who don’t have a dentist in their county, as they can still receive the basic care they deserve without making multiple trips to an office far away.

Spotlight: Bill Milner and Access Dental Care

Bill Milner is a dentist who deserves a spotlight for his work. Access to oral health care is one of North Carolina’s largest issues especially for institutionalized individuals and special needs patients. Milner and the organization he founded, Access Dental Care, are working to fix that. He recently received the 2023 ADA humanitarian award for his diligent work in oral health.

Access Dental Care is a non-profit mobile dentistry organization that Milner founded.

The organization works to bring oral health care to “residents of retirement homes, individuals with intellectual and developmental disabilities, and the community-at-large.”

People like Milner, and organizations like Access Dental Care, are doing all they can to provide N.C. residents with the oral health resources they deserve. While what they are doing is heroic, individual action alone can’t solve some of these system-level problems. There will continue to be a significant need for policy action. Our goal at NCOHC is to create a North Carolina where providers, community organizers, and advocates don’t have to be heroes because true access is the standard, not an anomaly.


Recap: Oral Health Day 2023

Bright-spots, pressing issues, and goals moving forward for oral health in North Carolina were on full display during Oral Health Day on June 21, 2023. The theme for this year’s event was, “Challenges and Opportunities for the Dental Team.” Keynote speaker Kathy Colville and the other wonderful panelists brought expertise and ideas for how North Carolina can become a healthier, more equitable state.

If you missed Oral Health Day 2023 and want to watch the webinar, click here.

Teeth are important, but providers struggle to meet the need

“We have truly amazing and exceptional people holding up an inadequate system.”

This quote from Kathy Colville, president and CEO of the North Carolina Institute of Medicine, underscored an important point restated throughout Oral Health Day 2023.

Colville spoke at length about the necessity of a systems-level approach to improving oral health. She began with an analogy about movie tickets, comparing price increases to the cost of an education and health care reimbursement for providers.

Colville said that if she bought a movie ticket today in Burlington, “it will set me back about $11.50. In 2007, around 15 years ago, the average price of a movie ticket was $6.88.”

“Undergraduate in-state tuition for two semesters at UNC-Chapel Hill in 2022-23 was $7,518. In 2007, it was $3,455. That one has more than doubled,” Colville said. “Some of you already know why I’m talking about 2007. It’s because that was the year reimbursement rates to North Carolina’s oral health providers stopped increasing.”

“Keep your health, that’s number one. Teeth are important.”

Colville brought this quote up numerous times throughout her speech during Oral Health Day. The quote comes from her Aunt Anne, who she asked for advice on living a long, healthy life.

“The mouth communicates, eats, smiles, frowns, and makes silly faces,” said Colville.

“Our mouth and teeth allow us to show emotion, communicate our thoughts, and be human. With proper oral health, our mouth can do all of these things better.”

Kathy Colville’s Ideas for High Quality Oral Health Care

  • Clinically Advanced
  • Culturally-Attuned
  • Accessible
  • Integrated with Overall Health and Social Care
  • Starts with “Oral Health Home” by Age 1
  • Based in Trusting Relationships Aligned with Patient Values and Mutual Respect

Medicaid Expansion and Dental Reimbursement Rates

Medicaid was a heavily discussed topic during the panel and Q&A portions of Oral Health Day 2023.

“Medicaid reimbursement rates are frozen in time,” said Rhonda Stephens, Acting Section Chief and Dental Public Health Residency Director at the North Carolina Department of Health and Human Services, Oral Health Section. “The rates have barely increased since 2007 and have not increased with inflation.”

With low Medicaid reimbursement, there isn’t much of an incentive for private practices to accept Medicaid insurance. This means individuals on Medicaid have difficulty finding providers which leads to less frequent visits and sub-par oral health.

Medicaid Expansion is also a topic on the horizon for North Carolina oral health providers.

More than 600,000 North Carolina residents are set to gain access to oral health care through Medicaid Expansion. The impact that could have is huge for individuals as well as providers.

For individuals, they will have new opportunity to receive the care they deserve.

For providers, they will need to increase their capacity to be able to serve increased demand.

Improving North Carolina’s Dental Workforce

In order to effectively care for everyone who needs oral health services in North Carolina, the state needs an adequate workforce and infrastructure in place.

As Colville said during her keynote, our current system is inadequate, forcing exceptional people to move mountains to keep it running. Safety net providers make daily sacrifices and work long, grueling hours to care for those in need, creating a system fraught with high turnover rates and difficulty hiring staff.

The panelists brought up topics like flexible hours, more focus on work-life balance, “4/10” work schedules as ways to ensure the existing workforce is better supported. They also discussed the importance of exposing more high school and college students to the dental field and the opportunities within it to help support workforce growth.

Trust in Communities

This year’s Oral Health Day speakers brought up several points about building trust in communities, discussing how essential trust is to ensuring patients get the care they need.

From speaking intentionally and accounting for anxiety, fear, and shame to personalizing care and becoming part of your community, they offered many strategies to build trust with the people providers serve.

Teeth Are Important!

Teeth are important. North Carolina needs better infrastructure so exceptional people do not have to continue holding up an inadequate system. Looking forward, several opportunities are on the horizon as we look past Oral Health Day 2023.

First and foremost, NCIOM and NCOHC have partnered on the Oral Health Transformation Initiative, a multi-sector task force to evaluate, assess, and recommend potential options regarding oral health system transformation.

Since January, 2022, the Oral Health Transformation Task Force has brought together key oral and health care stakeholders, policymakers, academics, and other influencers in the collaborative design, development, and messaging of oral health care transformation opportunities in North Carolina.

In the coming months the task force will be releasing a final report with their findings and recommendations for North Carolina. To learn more about the task force, click here.