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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.

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Fluoride Access in Western North Carolina

In North Carolina, nearly 90 percent of the population is serviced by fluoridated water. This is not the case in Western North Carolina, where rates are estimated to be much lower. Limited access to fluoride means detrimental consequences for many people in the western region of the state, where people are more likely to suffer from tooth decay and other oral health complications. Without sufficient fluoride access, people are more vulnerable to these conditions.

Along with the lack of regular access to fluoridated water, there are other drivers that lead to the negative oral health conditions that are so prevalent in WNC. Consuming large amounts of sugar can be a major component for accelerating tooth decay. The acids in sugar damage the enamel on the outer layer of the teeth, leaving them more vulnerable to bacteria, which leads to cavities and gum disease.

Image of water taps

Fluoride, however, plays a significant role in overall oral health outcomes in a given area. Fortunately, even in places like WNC where access to fluoridated tap water is not as widespread, there are other means of accessing the preventive mineral.

Regular brushing is important to keep bacteria under control. There are many fluoridated options for toothpaste, which are more effective in protecting teeth than non-fluoridated options.

For children in North Carolina, physicians in primary care medical offices can apply fluoride varnish that sticks to hard-to-reach areas of the teeth. Dentists can also paint on sealants for patients to help shield teeth from bacteria and prevent cavities. Fortunately, the public health division in North Carolina has also trained dental hygienists to be able to provide some of these preventive services.

Click here to see how Kintegra Health is improving WNC children’s oral health with its Dental Access Program, sending hygienists into schools to provide preventive care, including dental sealants.

We recently spoke in a virtual interview with University of North Carolina Distinguished Professor Gary Slade about the consequences of inadequate access to fluoride. Dr. Slade, who has worked in the Division of Pediatric and Public Health at the Adams School of Dentistry since 1994, works largely on epidemiological research that focuses on oral health and dental diseases in populations.

Dr. Slade explained that data show that children with access to fluoridated water have 30 percent fewer cavities in their baby teeth. As adolescents, they have 12 percent fewer cavities. Fluoride provides clear preventive oral health benefits, which makes the low rates of fluoridated water in WNC especially alarming.

“Because fluoridation rates in Western North Carolina do not count well water or sources that are not from tap water, the numbers we have from data with regard to tooth decay and other oral health conditions are probably worse than they appear,” Dr. Slade said.

As is the case with many small towns in Western NC, cost plays an important role when it comes to providing fluoride for communities. After being accustomed to living without fluoridated water, introducing it is not always seen as a priority. Engineering obstacles in some of these rural areas may also be a deal-breaker for many.

So, what is being done to enact change?

The first and most important step is advocacy. Whether it be a dentist, engineer, public health agency, or parent who speaks up first, change must begin at a local level. Dr. Slade explained that change is not guaranteed to happen just because it seems like the right thing to do. An effort like increasing access to fluoridated water begins with someone championing the cause.

Dr. Slade also spoke about important research he will be conducting in 2021 in Kinston, North Carolina, on the preventive effects of fluoridated bottled water. It is estimated that 115 million Americans do not have access to fluoride in their drinking water at home. That is roughly one-third of the American population, a number that Dr. Slade says will not significantly change in the near future.

Image of bottles of water

Kinston resides in Lenoir County, located in eastern North Carolina. Dr. Slade described it as a prime example of a city that will not likely introduce fluoride into the public water system anytime soon.

Traditionally, dentists and oral health professionals have discouraged people from drinking bottled water due to the lack of fluoride, since most companies do not include it. However, with the rise in popularity of bottled water, Dr. Slade is taking a different approach. Rather than encouraging people to avoid bottled water, the upward trend in popularity would suggest that promoting the inclusion of fluoride in bottled water may be the best approach to improving access to better oral health.

There are many reasons why fluoride access is limited in some parts of the country, but one of them may be the criticism it receives. Dr. Slade suggested that some skepticism may be due to the fact that there has not been a randomized controlled trial of fluoridated water. His study in Kinston will be the first.

The study will include 200 participants, divided into two groups. One group will be given fluoridated bottled water, and the other will be given unfluoridated bottled water. After a period of three and a half years, each participant will receive a dental examination. Because of the true randomized design, no participant or researcher will know who had fluoridated water and who had unfluoridated water until the study is complete.

Dr. Slade expects the resulting data to speak for itself.

Today, it has become increasingly more difficult to implement public fluoridated water systems. There is a significant amount of advocacy from individuals and interest groups on both sides of the issue.

Dr. Slade said that with lower levels of health literacy, it is also more likely that misinformation will stick in people’s minds. Changing that starts with advocacy and education in schools at an early age. There are a lot of questions that surround the topic of fluoride in the United States, but more importantly, there are a lot of answers. Fluoridated water as we know today, provides the easiest and most efficient form of preventive care for lifelong oral health benefits.

Graphic titled "Fluoridated tap water & Toothpaste"

Want to get involved and elevate your voice? From fluoridated water and teledentistry 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!

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2020 Year in Review

"NCOHC Year in Review"

What a year…

Needless to say, 2020 has been a year for the history books. At NCOHC, we are so incredibly thankful for the front-line health care workers and essential workers who put their lives on the line day in and day out to keep communities healthy and safe. And our hearts go out to all who have lost loved ones and friends.

Despite its challenges, this year has also been a testament to the power of diverse coalitions oriented toward positive change. Here’s a brief recap of what was accomplished to improve oral health in North Carolina in 2020.

Rule 16W Change

NCOHC kicked off 2020 with a bang.

The North Carolina Rules Review Commission gave its final approval to a rule change that we co-sponsored with the North Carolina Dental Society. The change to Rule 16W eased restrictions on dental hygienists, increasing access to preventive oral health care in high-need settings, moving us one step closer toward a more equitable landscape.

You can read about the rule change and the incredible coalition that worked for decades to make it happen here.

COVID-19 & Access Map

…and yet, the 2020 we anticipated shifted dramatically in early March. As heroic health care workers across the globe turned on a dime to fight the COVID-19 pandemic, and our community partners adjusted their workplans for maximum support, NCOHC adjusted our services in support of NC’s our most vulnerable communities.

Picture of NCOHC's statewide provider access map

NCOHC quickly published and continues to maintain a COVID-19 information page. This page includes our interactive COVID-19 Access Resource Map, which connects at-risk communities with safety-net dental providers across the state. As of December, nearly 30,000 people have engaged with the map.

Read more about the access map here.

The NCOHC Teledentistry Fund

In the initial months of the COVID-19 pandemic, most dental offices closed for routine services, only seeing emergency patients. As offices began to grapple with reopening, we partnered with the Blue Cross and Blue Shield of North Carolina Foundation to launch an NCOHC Teledentistry Fund.

With $60,000 to purchase teledentistry software subscriptions, NCOHC has provided more than 15 safety-net clinics with an innovative tool to help maintain patient care while prioritizing patient and provider safety.

NC Medicaid Teledentistry Billing Changes

Prior to the pandemic, NCOHC intended to focus on teledentistry policy in 2020. While teledentistry has incredible potential in a pandemic-free world, COVID-19 made its application even more relevant.

In response to the pandemic, NC Medicaid modified its billing policies to temporarily allow providers to be reimbursed for services provided across asynchronous, synchronous and telephonic teledentistry modalities. You can read about the billing code updates here. NCOHC was thrilled when NC Medicaid announced its temporary teledentistry provisions and, as we move forward, we are hopeful that these payment changes will be made permanent.

Even in a post-pandemic world, teledentistry will play a critical role in increasing access and equity in oral health care.

Oral Health Day(s)

Graphic of Paul Glassman, the "father of teledentistry"

Despite having to cancel the in-person portion of our annual advocacy event, Oral Health Day, we were still able to host not one but two successful virtual events this year! Oral Health Day Parts 1 and 2 focused on teledentistry and its potential in North Carolina, convening 230+ participants. Catch up on the events and hear from our star-studded lineup of special guests here.

What’s Next?

In 2020, NCOHC and the communities we serve had many successes, but there is much to do as we dive into 2021. As we look forward to the New Year, we are ready to hit the ground running, and we need your help!

While 2020 was fruitful for our coalition’s expansion in size and diversity, we always have additional room for all who are interested in working together to create a more equitable oral health landscape. We believe access to quality, affordable oral health care shouldn’t be a privilege or luxury, but a right.

Will you join us in the movement?

To kick off 2021, we’re excited to announce our new online platform to provide a more efficient and effective way to join the movement — North Carolinians for Change! Please join us over at oralhealthnc.org/nc4change/

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Recap: Oral Health Day Part 2

Last week we had the opportunity to take an in-depth look at teledentistry at Oral Health Day Part 2. Three North Carolina dental directors and a panel of national experts took questions and presented to a crowd so large that we had to upgrade our Zoom subscription mid-event!

The dental directors at Kintegra Health, Piedmont Health, and Greene County Health Care (GCHC) kicked off the day, talking about the many ways their Federally Qualified Health Centers (FQHCs) use teledentistry to improve patient care. All three directors took questions from the audience.

“Know where you’re going and have a roadmap,” said Dr. Mattison-Chalwe, answering a question about the planning process to successfully begin using teledentistry technology in a practice.

The dental directors answered questions and discussed everything from the planning process, to tips and tricks, to getting diagnostic-quality patient information, and the ways that new technology has increased clinic efficiency.

“We got a lot closer to medical,” said Dr. Doherty, referring to the relationship GCHC’s dental facility was able to make with their medical counterparts as they implemented teledentistry protocols. “It is very easy for a provider to give us a call — a medical provider, and we just jump right in on the call and get those patients seen very quickly.”

 

Watch Drs. Donigan, Mattison-Chalwe, and Doherty in three live teledentistry demonstrations.

 

After the dental directors spoke, three nationally recognized teledentistry experts took the virtual stage. Dr. Paul Glassman, the “father of teledentistry” and professor and associate dean for research and community engagement at California Northstate University College of Dental Medicine, spoke about the process of actually “doing teledentistry,” and the future of remote care.

“This is really based on calibration and communication,” said Dr. Glassman. “It’s based on the idea that you’re going to trust the hygienist who is in the community.”

Dr. Scott Howell, assistant professor and director of teledentistry at the A.T. Still University Arizona School of Dentistry & Oral Health, walked the audience through several examples of the various ways he uses teledentistry in his clinical practice.

Dr. Howell mirrored Dr. Glassman, saying that collaboration and communication is key to successfully using teledentistry technology.

“The field team must be calibrated,” said Dr. Howell. “There has got to be trust. Trust between dentist and hygienist; the dentist has to trust the technology. And as I tell my students, this is not something that you develop overnight. It is something that takes time to develop.”

Brant Herman, CEO of MouthWatch — a provider of teledentistry software and equipment — spoke about the actual technology necessary to practice via teledentistry. He also covered common misconceptions about what it takes to incorporate remote care in a clinical setting.

One of the bigger misunderstandings highlighted by Herman is the idea that there is only one way to do teledentistry.

“It’s really just the tool. You’re just using the technology as the tool,” said Herman. “You’re facilitating the other approaches to care coordination, care delivery, through this technology. It can be all of these different services that really just use teledentistry as the backbone to connect patients, providers, and care.”

MouthWatch, LLC, was generous enough to donate four intraoral cameras for the event, which NCOHC raffled off live.

NCOHC has worked collaboratively alongside diverse stakeholders in jointly drafting teledentistry legislation, which is slated to be introduced during the 2021-2022 legislative session. This bill will work to improve providers’ ability to incorporate teledentistry technology in their practices, and will ensure that quality oral health services, aided by teledentistry, are delivered equitably throughout North Carolina.

Stay tuned as we move forward. We encourage and welcome all voices at the table, so please consider signing up to receive our newsletter, and help us create a more equitable oral health landscape in our state.

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!

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Reducing the Rate of Childhood Caries in WNC

From the highest peaks east of the Mississippi to the unique sounds of bluegrass music, Western North Carolina is a one-of-a-kid region. But like many rural areas across North Carolina and the United States, the communities that make up WNC face pressing challenges when it comes to oral health.

 

Across the western region, children on Medicaid receive less preventive oral health care than their peers across the state. In Regions 1 and 2, as reported by the North Carolina Department of Health and Human Services Oral Health Section, only 43 and 42 percent (respectively) of children ages 1-2 receive any preventive oral health care.

We could rattle off statistics and conclude that there simply aren’t enough dentists in WNC, but the problems faced are not so simple. While the workforce numbers and the distribution of providers across our state are an important issue, there are several layers of barriers preventing many in WNC from accessing the care they need.

When looking at third grade students, the data suggests that initiatives to reach children outside of the traditional dental home are at least partially responsible for a higher-than-average rate of dental sealants among third graders. Across Regions 1 and 2, nearly 49 percent of third graders surveyed in the 2017-18 school year had received dental sealants, compared to a statewide average of 45.9 percent.

Even with the rate of sealants in Regions 1 and 2, however, only 41.8 percent of surveyed students had no tooth decay, compared to the statewide average of 54.5 percent.

So what do all these numbers mean?

There are unique issues that vary across WNC, and each individual community faces its own challenges. For example, if you look at Region 1, only 13 percent of the population is serviced by fluoridated water. For comparison, nearly 90 percent of North Carolinians have access to fluoridated water.

So, whether the problem be access to providers, adequate oral health education, access to basic preventive measures like fluoride, or any number of other issues, significant effort is needed to improve children’s oral health in WNC.

In 2017, the Duke Endowment, Mission Children’s Hospital, and the WNC Health Network partnered to conduct an oral health needs assessment and further explore the specific issues facing WNC communities. From there, stakeholders identified strategic focus areas and formed the WNC Children’s Oral Health Initiative.

Earlier this year, NCOHC absorbed the WNC Children’s Oral Health Initiative, now called the WNC Steering Committee, to help specifically tailor efforts to increase equity and access in the region.

Meet the steering committee and further explore the barriers to access in WNC here.

As we continue our work, keep an eye out for breakdowns of the issues that WNC communities face, and the innovative approaches leaders in dentistry are taking to tackle them.

Get started by exploring how Kintegra Health is pushing forward, even during the COVID-19 pandemic, with a plan to use teledentistry and school-based care to provide preventive services to more than 6,000 elementary school students in the counties west of Charlotte this year alone.

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!

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NCOHC’s Policy Brief: Care Delivery

NCOHC released its first policy brief in the summer of 2020 to provide an overview of the many policy changes that could increase equity and access to oral health care in North Carolina. This is the second of three deep dives to further expand on the policies within the brief. You can read the first one here.

Read the full policy brief here

As North Carolina grapples with an oral health workforce imbalance, there are several opportunities to improve the efficiency and effectiveness of care delivery. The opportunities in this section are relatively simple—not requiring a change to scope of practice, but rather simply modernizing the Dental Practice Act to better utilize technology for patient care, and to open doors for collaboration between medical and dental providers.

Adoption of teledental service utilization

During the COVID-19 pandemic, teledentistry has proven to be an invaluable tool allowing patients and providers to connect in safe, socially distanced settings. Prior to the pandemic, teledentistry served as a vital tool for increasing access to oral health care, as well. Providers across North Carolina have effectively leveraged the use of technology in community-based and school-based settings, allowing those who traditionally would not see a dentist to receive care through teledentistry.

To learn more about teledentistry and the many ways it is used, join us for Oral Health Day Part 2 on Oct. 23 and hear from some of North Carolina’s dental directors and three renowned experts in remote care technology.

Although health clinics and other providers — in both public and private sectors — regularly have provided teledental services, NCOHC advocates that to ensure future use of teledentistry as a care modality, stakeholders need to take steps to codify its use in North Carolina.

First, NCOHC recommends permanently adopting language to include electronic service delivery within the definition of dentistry, under Chapter 90, Article 2. These changes would simply update the Dental Practice Act, since remote care technology wasn’t even on the radar when the original language was drafted. Not only will the addition of language to Article 2 further define and codify teledentistry as a care delivery modality in our state, but it will also add in consumer protections for the provisions of remote care.

Finally, and specifically to payment reform, NCOHC urges both NC Medicaid and the commercial dental benefit plans to allow for the reimbursement of teledentistry both synchronously and asynchronously. These codes, D9995 and D9996, respectively, have been a part of the national billing nomenclature since 2018. Because of the lasting impact that teledentistry could make — even beyond a pandemic setting — it makes prudent sense to permanently adopt these billing codes.

Integration of Care

NCOHC is a strong advocate for integrated care, another area where teledentistry technology could play an important role. Tools like intraoral cameras are easy to use, and simply capturing images of a patient’s mouth can assist in connecting that patient to the care they need. NCOHC sees a big opportunity for using teledentistry technology in primary care settings to capture supplementary patient information for referral to dental providers.

Finally, NCOHC outlined several options to expand the dental workforce, including the community care coordinator.

Check out what one of NCOHC’s interns, Parker Norman, recently wrote about care coordination, and take a look at how Kintegra Health, a Federally Qualified Health Center west of Charlotte, uses teledentistry and care coordination to complete a network of care for children in Title I schools.

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!

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Teledentistry in Action: Medical-Dental Integration at Greene County Health Care

In eastern North Carolina, Greene County Health Care (GCHC) is embracing teledentistry, one of many innovative steps they are taking to improve patient care and meet the needs of traditionally underserved populations.

“I think the thing that’s most exciting about teledentistry is the integration of medical and dental,” said Dr. Rob Doherty, chief dental officer at GCHC. “I’m looking at the patient and I’m talking to them face-to-face, and I also have that medical provider there in case there are questions.”

Dr. Doherty and Chi Nguyen, a physician assistant at GCHC, recently filmed a joint teledentistry appointment with a patient, which you can watch during Oral Health Day Part 2, a follow up to NCOHC’s annual oral health advocacy event. Learn more, register, and join the virtual event on October 23 from 1-3 p.m.

During a screening with Nguyen, the patient mentioned experiencing pain in his mouth. Rather than schedule a separate appointment with a dental provider, Nguyen was able to loop Doherty into the video call.

Picture of Dr. Rob Doherty talking to a patient via a computer webcam

Doherty consulting with Nguyen and her patient through GCHC’s teledentistry software platform.

“Chi had a patient on the line who she was just checking on. He had made a comment that he had a hard time sleeping because a tooth was bothering him, and it was a little bit swollen,” said Doherty. “So, she just sent me an email and I was able to speak with him face-to-face and really get an idea of what the problem was. I had the schedule right in front of me and I was able to get him an appointment at 2:30 that afternoon.”

Doherty said that the video call helped him get a much better idea of the problem, something he wouldn’t have been able to do had the patient just called in and said he had tooth pain.

“It is awesome, us being able to see a patient and have a three-way appointment,” said Doherty. “We can get so much done, we can be so convenient for that patient, and it’s just plain better care.”

Of the benefits that teledentistry provides, Doherty highlighted just how important time saved can be. Health centers like GCHC see large volumes of patients who otherwise wouldn’t have access to affordable care.

“Every time we open up a new site, we’re swamped,” said Doherty. “We have a long waiting list, and we have to limit the number of patients that we see.”

With technological innovations like teledentistry, providers can increase efficiency, provide care to more patients, and work through those waiting lists.

“I think the horizons are really opening up for us in teledentistry,” said Doherty.

Join NCOHC, Doherty, and the dental directors for Kintegra Health and Piedmont Health on October 23, 2020 to explore the many ways clinics in North Carolina are using teledentistry to improve patient care. At the virtual event, you will also hear from national experts, including the “father of teledentistry,” Dr. Paul Glassman, and more! Register today!

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FAQ With Dr. Zachary Brian


 

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Teledentistry in Action: Completing a Network of Care

Thousands of young children in the counties west of Charlotte receive annual dental care in their schools’ parking lots. With an active, and growing, mobile dental network, Kintegra Health’s Dental ACCESS Program is improving children’s oral health, and teledentistry is a vital piece of the puzzle.

On board one of Kintegra Health’s mobile buses, complete with three chairs, an x-ray room, and plenty of cartoons to keep children occupied.

“The program has just blossomed,” said Melissa Boughman, director of the ACCESS Program. “We have 60 schools that we work with now, and we saw 5,500 children last year.”

If schools remain open this fall and avoid COVID-19 outbreaks, the ACCESS Program is on track to see between 6,000 and 7,000 students this year, according to Boughman.

Students now receive temperature scans to screen for COVID-19 symptoms at the beginning of their visits to the Dental ACCESS Program.

“Parents working (with limited) access, specifically transportation access, means that parents sometimes can’t get to the dental office, or they can’t get time off of work to come to the dental office,” said Dr. William Donigan, dental director at Kintegra Health. “We need these children to get as much care as we can give them without the parents having to be here.”

“In Title I schools, transportation is such a major issue,” said Boughman. “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.”

In one day at Battleground Elementary in Lincoln County, the hygienists and assistants on this mobile bus will see around 30 kids.

The ACCESS Program has two mobile dental buses, complete with three dental chairs and an x-ray room, as well as a dental van for follow-ups and dental sealants.

Once a child is on the bus, Kintegra’s dental team takes a series of nine photographs of the child’s teeth as well as x-rays, if necessary. While the dental hygienists and assistants can only provide preventive care on the mobile buses, the care doesn’t stop once a child goes back to class. Thanks to the Kintegra’s teledentistry software, those photos and x-rays are automatically uploaded, made immediately available to dentists and staff at one of their brick-and-mortar sites.

The computers on Kintegra Health’s mobile buses transmit data in real time to staff at clinic sites.

“Literally immediately, we can view all of that information at one of our sites,” said Donigan. “So, our Dental ACCESS Program navigators can then talk to the dentist and direct the parents to get the patient in for the care that they need.”

Dental navigators are another vital piece of the puzzle. Kintegra employs navigators to help parents and patients efficiently get the care that they need. For parents experiencing any of a slew of social determinants of health that make accessing care more difficult, having someone there to guide the process along can have a big impact on the care a child receives.

For more on dental navigators and how they increase access to care, check out a blog by one of our summer interns on community care coordination.

With a complete network, connecting the staff on Kintegra’s dental buses to the dentists at their clinic locations, children who may have not received care otherwise now have the opportunity to receive regular care.

“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 do 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).”

Want to see teledentistry in action?

Join NCOHC for Oral Health Day Part 2 to see how clinics like Kintegra Health use teledentistry to improve access to patient care. We just announced a change of plans. Instead of in-person tours, we will bring tours of clinics, including Kintegra Health, to you virtually on [DATE], along with a star-studded panel of teledentistry experts from across the country!

Learn more and register here.

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!

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Racism, Food, and Your Mouth: Parallels Between Food and Oral Health Equity

“Historic and systemic structural racism are inherent parts of the United States,” said Jen Zuckerman, director of strategic initiatives at the Duke World Food Policy Center. “This means every single system that exists within the United States is rooted, designed, and based in racism, and has been built on the system of oppression. Nobody alive today is to blame for the unfairness of our history, but we each hold a responsibility to create a better future.”

Continuing NCOHC’s series on the social determinants of health and how they impact equity in oral health, we spoke with Zuckerman to discuss how the Duke World Food Policy Center approaches inequities in food systems and the policy work that can make a lasting impact.

 

Click here for more on equity in oral health.

 

Access to food is an important social determinant of health, and healthy food options can significantly impact oral health. Unlike other posts in this series that directly break down relationships between the social determinants and oral health, this post will focus on food systems, underscoring how Zuckerman and the Duke World Food Policy Center are addressing inequities, while drawing parallels to oral health systems.

 

Oral Health Takeaway

Lack of access to affordable, healthy food options means consumption of less healthy food, often high in sugar and carbohydrates. This is an important concern, as these kinds of foods increase risk of tooth decay, gum disease, and other oral health issues.

 

The Center for Assessment and Policy Development defines racial equity as “the condition that would be achieved if one’s racial identity no longer predicted, in a statistical sense, how one fares.”

Racial inequity plagues food production, distribution, financing, ownership, and access in the U.S., so much so that Zuckerman said there is no true working example of an equitable food system. To understand the fundamental role that racism plays in creating systems of inequity, the World Food Policy Center looks toward ownership structures.

“An equitable food community is one where there is an equitable distribution of ownership as it relates to the ability to grow food, distribute food, and provide retail,” Zukerman said. “An equitable food community would also have equitable access to capital.”

 

Food Deserts vs. Food Apartheid

The Duke World Food Policy Center uses the term “Food Apartheid” to refer to areas with limited access to healthy food options. Food Apartheid broadens the conversation to include various factors and root causes of inequities in the food system such as historic disinvestment from communities of color.

 

The term “food desert” insinuates that the phenomenon is naturally occurring. Zuckerman pointed out that to truly understand the underlying structures that create food inequity, we must understand how points of limited access are influenced by generations of intentional disinvestment.

 

The ability — or lack thereof — to build generational wealth has been fundamental in creating inequities. According to the Duke World Food Policy Center, barriers to building generational wealth should also be front and center in policy work to address and reverse inequities.

“When we think about food, or when we think about anything in the United States, history has demonstrated that the white community has continually gotten investment through policies, programs, and initiatives,” said Zuckerman. “And communities of color have continually gotten programs and services, which do not build wealth.”

While programs and services for those who lack access are incredibly valuable, it is simultaneously important to take conversations of equity a step further to encompass the financial, policy, and power structures at play.

 

Oral Health Takeaway

What does ownership look like in the oral health space? According to a 2015 ADA report, 74.2 percent of licensed dentists are White, while only 3.8 percent are Black, 5.2 percent are Hispanic, 15.7 percent are Asian, and 1.1 percent are other non-White ethnicities.

 

Zuckerman pointed to housing as an example of racist policies that have created lasting impacts on generational wealth. White veterans returning from World War II were able to buy homes through the GI bill, while returning Black veterans were disproportionately blocked from homeownership due to redlining and other policies rooted in racism.

“Broadly speaking, instead of home loans, Black veterans got public housing from government support,” said Zuckerman. While policies like redlining are illegal today, “think about the wealth built over generations of homeownership versus the wealth you cannot build by living in public housing.”

 

Oral Health Takeaway

In North Carolina, the racial disparity among dentists is even wider. Around 82 percent of practicing dentists in North Carolina are white, according to a 2005 report from the UNC Sheps Center for Health Services Research. Which communities have been able to benefit most from generational wealth thanks to the dental industry, and which communities have not?

 

Racist policies, no matter when they were enacted or ended, have contributed to an historic disparity in wealth between white and BIPOC communities. Because of this, a lack of direct racism is not enough to reverse past racism. Whether we are aware of it or not, there are still people, policies, and structures in place today that have disproportionate negative impacts on communities of color.

So, how do we actually change racist systems and create equitable structures?

According to Zuckerman, ownership, which refers to both wealth creation and agenda setting, is a central piece of the puzzle.

“There need to be changes in financing and philanthropic investments,” Zuckerman said. “More philanthropic dollars need to be invested in BIPOC-led organizations, and those community organizations need to be able to set the agenda for what they would like their community to have.”

In oral health, significant focus is given to providing low-cost oral health services to those who have historically lacked access. While these programs and services are incredibly important, and this post is not in any way meant to downplay the hard work that so many people do to extend access, oral health champions can learn a lot from the Duke World Food Policy Center’s perspective.

As oral health policy champions, how can we help create more equitable structures that include a diverse workforce more representative of the population as a whole? Where is wealth being built in the dental industry, and how can we work to increase access to and equity in that side of the equation?