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2021 Year in Review

2021 was quite the year!

Of course, we could write an entire book about the ways that COVID-19 continues to impact people’s daily lives, not to mention the incredible strain that the pandemic is still placing on all facets of our health care system. Back in January, we certainly had high hopes that we were beginning to see a light at the end of the tunnel. But the struggle continues.

Fortunately, the shadow of COVID-19 didn’t stop our progress. The NCOHC team and our incredible network of partners and fellow advocates had a productive year, and North Carolina was able to take significant steps toward greater access and equity in oral health care.

Legislative Progress

Early in the year, Governor Roy Cooper signed Executive Order 193, authorizing dentists to join the COVID-19 vaccination effort.

In July, Session Law 2021-95 was enacted, codifying teledentistry in the North Carolina Dental Practice Act and authorizing hygienist-administered local anesthesia. The law also aligned regulations, allowing hygienists to deliver preventive care more efficiently in community settings. No less significant, for the first time, Federally Qualified Health Centers (FQHCs) were recognized in state law.

More recently, the state budget passed in November included an extension of the North Carolina Medicaid for Pregnant Women (MPW) program, expanding health benefits — including those for oral health — to birthing parents up to one year postpartum.

We are thrilled to have been a part of a productive 2021 legislative session. This year was certainly a testament to the power of collaboration. If we were to thank everyone involved individually, this blog post would easily turn into a novel. The North Carolina Dental Society, however, deserves recognition for its partnership in co-creating lasting change. So does Senator Jim Perry, who filed Senate Bill 146 (now Session Law 2021-95) in the North Carolina Senate and worked hard to ensure its passage.

Oral Health Day 2021

This year’s Oral Health Day was a spectacular success!

Rear Admiral Timothy L. Ricks DMD, MPH, FICD, Assistant Surgeon General and Chief Dental Officer of the United States Public Health Service (USPHS), joined NCOHC to give the keynote address. RADM Ricks covered everything from what the USPHS is and the work that the agency does, to the state of COVID-19 progress on equity in the dental world, and more.

Amy Martin, DrPH, MSPH, who chairs the Department of Stomatology and directs the Division of Population Oral Health at the Medical University of South Carolina (MUSC), also joined Oral Health Day to discuss the innovative ways that MUSC is approaching community-based oral health care in South Carolina.

Finally, William Donigan, DDS, MPH, and Melissa Boughman, RDH, spoke about Kintegra Health’s experience employing patient navigators. Kintegra Health has been on the forefront of innovations in care coordination and case management, and Dr. Donigan and Ms. Boughman provided great insight into the benefits of these care models.

Staff Growth

Have we said that 2021 was a busy year? With all the work on NCOHC’s plate, it was past time for the team to grow. This year, we welcomed two new full-time staff members — Sarah Heenan and Crystal Adams.

Sarah joined the NCOHC team back in April as our new program coordinator, and Crystal came onboard in September as our associate director.

And So Much More…

The reality is, there are just too many highlights to fit into a single blog post. Check out some of the videos we published this year, especially this one about the NCOHC Teledentistry Fund and this one, where we envision a “more perfect oral health ecosystem.” And don’t forget to peruse a year’s worth of updates, storytelling, and analysis on our blog!

No Slowing Down

While 2021 was a year to remember, we are sure that 2022 will bring even more advances in oral health access in equity across North Carolina. NCOHC has some big news to share very soon, and we are so excited to include you in the next phase of the work!

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.

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Happy Holidays From the NCOHC Team

Happy holidays from the NCOHC Team!

We hope that you are having a festive, relaxing holiday season. Here’s what our team is up to:

What is your favorite part of the holidays?

Zach: Oh, where to start? There are so many things, so I’ll just pick one. I love the lights. We’re fortunate to live in a neighborhood where people get very into the holidays, and it’s fun to drive around and see what folks have come up with. My husband and I also like to decorate, and we’ve (maybe) gone a little overboard this year :) 

Sarah: My favorite part of the holidays is the overall joyfulness I feel when I am spending time with the people I love so dearly. The season brings a lot of comfort and coziness for me with decorations, smells, gifts, and dedicated time to spend with those I love.

Crystal: When I think about the upcoming holidays drawing near, excitement fills my heart. I will spend quality time with my family and friends in a few short weeks. Throughout the year, everyone is so busy, but during the holidays, everyone will slow down enough to enjoy some memorable moments. It is a time of year I will have all three of my boys under one roof for a whole week. Then the night before Christmas, my extended family and friends will gather at my sister’s house. It is a time that I catch up with my aunts, uncles, cousins, sisters, nieces, nephews and friends. The highlight of the night is when Santa makes a surprise visit before he heads out to deliver the gifts to all the children.

Brady: I love taking time to relax, rest, and gather with family and friends. I also really enjoy getting a Christmas tree each year. My dad is allergic to pine, so we grew up with an artificial tree. Now, every year my fiancé and I get a real tree, and I love the smell of pine throughout our house!

Do you have any special family traditions or events?

Zach: My husband and I like to choose a special cause to donate to every year, and it’s fun to find something we’re both passionate about where we can help.  

Sarah: My sister’s birthday is Christmas Eve; she lives her whole year looking forward to her birthday, so we celebrate her on Christmas Eve- it’s my favorite day of the year. Her joy is infectious and on her birthday, her cup overflows with so much joy — it’s truly the best.

Crystal: A holiday tradition that I cherish is going to my dad’s house for breakfast on Christmas morning. On Christmas morning, everyone wakes up to Santa’s surprises. After everyone discovers what Santa left for them, my four sisters and their families, along with my family (a total of 22), travel to my dad and stepmother’s house. We go in our pajamas and, of course, freshly brushed teeth. My dad demonstrates his cooking skills in front of all the kids and grandkids by throwing eggs up in the air to flip them to the other side. The kids love it! I love this time because we spend quality time with my family while enjoying fantastic food.

Brady: My favorite tradition is Christmas morning breakfast with my family—actually, the entirety of Christmas day. The whole family gets together on Christmas morning for steak and eggs. I try and eat a mostly vegetarian diet throughout the year, so the Christmas morning “cheat day” is extra special. Then, in the evening we all gather again at my grandparent’s house for a very eclectic Christmas dinner. We like to joke that anyone my grandmother happens to meet that week at the grocery store is invited. It’s an all-around great time with family and friends, and I always seem to meet someone new!

What are you looking forward to in the new year?

Zach: I’m excited about opportunities to continue advancing access and equity in oral health care across North Carolina. I’m really passionate about the work we’re doing at NCOHC and FHLI, and there’s a lot of positive momentum right now. I’m also hopeful that more people will get vaccinated! 

Sarah: I am looking forward to a year full of more and more hugs! As I think about the new year and what that means to me, I reflect upon the lessons and gifts of the previous year while being hopeful for joy-filled days ahead. In 2022, I am really looking forward to my upcoming wedding and spending those special moments with my partner and those who love us!

Crystal: NCOHC had a lot of success creating system change for oral health care access in 2021. As a new addition to the NCOHC team, I am looking forward to working on various initiatives and seeing what NCOHC accomplishes in 2022. Personally, I am excited to see my son, Chase, graduate high school in 2022 and see where life takes him.

Brady: I have so much to look forward to in 2022, both in my personal and professional life! I’m excited to see the ways that NCOHC can leverage the work we did this year to create more positive change for folks across North Carolina.

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Postpartum Medicaid Boost is in the Budget!

On Nov. 18, Governor Roy Cooper signed the 2021 North Carolina state budget into law, the first budget the state will have since 2018.

There are many reasonable provisions in this year’s budget — thanks to American Rescue Plan funds, an historic amount of money has been allocated to improve the lives of North Carolinians. There are other provisions that were unfortunately left out as well, most importantly from a public health perspective being full Medicaid Expansion.

At NCOHC, our staff has been focused on one particular provision: expansion of the Medicaid for Pregnant Women program to one year postpartum (after birth).

Earlier this year, one of NCOHC’s fantastic interns, Hannah Archer, wrote a policy brief outlining the benefits of expanding postpartum Medicaid services and analyzing its political feasibility.

The policy was originally proposed as a standalone bill by Senators Jim Burgin, Joyce Krawiec, and Kevin Corbin. It goes without saying that NCOHC was thrilled to see the policy incorporated into the 2021 budget.

The Details

The postpartum Medicaid service expansion will go into effect on April 1, 2022. After that date, North Carolinians with incomes up to 196 percent of the federal poverty level will be able to access Medicaid services for the duration of pregnancy and one full year after giving birth.

The policy, as laid out in the 2021 budget, is set to expire on March 31, 2027. NCOHC is fully confident that the benefits of the expansion will speak for themselves over the course of the next five years, and we look forward to working with stakeholders to make the policy a permanent change in the future.

What Comes Next

It will be important to stay tuned as the postpartum Medicaid service expansion is implemented. Currently, the Medicaid for Pregnant Women program includes all medical services, including oral health. Under the current framework, traditional medical services are available for 60 days postpartum, while oral health services end at birth.

The text in the 2021 budget is broad, and language limiting coverage for services “related to pregnancy and to other conditions determined by the Department as conditions that may complicate pregnancy” is removed. This bodes well for oral health’s inclusion in the postpartum expansion (although we would also argue that the negative outcomes that result from a lack of oral health care absolutely fall into the category of conditions that could complicate pregnancy).

The details will be ironed out in the coming months, and we will be sure to keep you up to date on any news as it arises.

NCOHC is a program of the Foundation for Health Leadership & Innovation. To get involved, find out more information, and to stay up to date, head over to NC4Change to sign up for our newsletter and see what events and other opportunities are on the horizon.

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Social Justice, Dentistry, and Forensic Testimony in the Courtroom

On April 8, 2002, Ray Krone was released from prison after serving 10 years for a murder he did not commit.

A decade earlier, a woman’s body was found at the bar Krone frequented. Officers identified Krone as a person of interest, and they took a Styrofoam impression of his teeth to see if they matched bite marks on the victim’s neck.

Krone had distinctly crooked teeth, so after an American Board of Forensic Odontology-certified diplomate testified that Krone’s teeth were a match and he was convicted of the murder, he was dubbed the “Snaggle Tooth Killer.”

Years later, DNA evidence proved that Krone was not involved in the murder – the bite marks were not his.

Bite-mark analysis is used in courtrooms across America, and unfortunately, it is responsible for hundreds of years in wrongful convictions.

“There has been no scientific research that has adequately established basic premises in bite mark comparison work, including whether an examiner can even, with sufficient accuracy, identify a mark as a human-created bite, much less opine on whether a particular set of dentition produced that bite,” said Brandon Garrett, director of the Wilson Center for Science and Justice and the L. Neill Williams, Jr. Professor of Law at Duke University.

The Innocence Project has documented more than 30 instances of people wrongfully indicted or imprisoned in part due to the use of bite-mark analysis.

In total, more than 424 combined years of wrongful incarceration have been served as a result of these convictions.

In fact, bite-mark analysis is so unreliable that it has even been used to convict in cases where bites were later proven to be from animals, not humans.

Garrett mentioned a case in Mississippi in 1995 where Kennedy Brewer was given the death penalty after a bite-mark analysis linked him to marks left on a victim’s body. Years later, a reexamination led to the discovery that the 19 bite marks were actually the result of insect bites, not a human’s teeth. Brewer still served 15 years before his exoneration.

As it stands today, there is little, if any, scientific evidence in support of bite-mark analysis. Beyond that, dentists who serve as forensic odontologists do not have to demonstrate a level of proficiency in the matter at hand: linking marks on a human’s skin to the teeth in someone’s mouth.

“Local courts have even permitted local pediatric dentists and persons with no prior background in forensic work to testify,” said Garrett, adding that even odontologists with decades of experience have made testimony resulting in wrongful convictions. “It is not clear that experience over many years in a technique with unknown reliability makes one better than a novice; the technique may be so unreliable that experience is irrelevant.”

Time to Reconsider Bite-Mark Analysis

The issue of bite-mark analysis is a question of equity and social justice. As NCOHC and our partners work to increase access and equity in oral health care, it is worth considering this social injustice that so closely involves the dental community.

The number of dentists who serve as expert witnesses in the courtroom is small – and the number who provide bite-mark testimony is even smaller. Nevertheless, the impact, especially on those who have been wrongly convicted, is immeasurable.

Learn more: Brandon Garrett recently spoke in depth about bite mark analysis, other social justice issues that stem from forensic sciences, and his book, “Autopsy of a Crime Lab: Exposing the Flaws in Forensics” on the podcast Pod Save the People.

NCOHC is a program of the Foundation for Health Leadership & Innovation. To get involved, find out more information, and to stay up to date, head over to NC4Change to sign up for our newsletter and see what events and other opportunities are on the horizon.

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Pregnancy and Oral Health: Postpartum Care

Changes may be coming to help pregnant women in North Carolina access the care they deserve.

Have you heard of Medicaid for Pregnant Women (MPW)? For those in North Carolina with incomes up to 196 percent of the federal poverty level, people can access Medicaid services for the duration of a pregnancy through the MPW program, and they retain access to medical services for 60 days postpartum (after birth).

While the MPW program offers important services at a time when people need reliable access to care, the range of benefits and time constraints are simply not enough.

For example, oral health services unfortunately don’t extend into the postpartum period at all.

Pregnancy is a busy time for anyone. It is especially busy when you have limited access to resources—financial and otherwise. Between preparing a home for a new baby, attending pregnancy classes, going to regular checkups, and more, things like dental care can easily go by the wayside.

Just as it is during the rest of a person’s life, but especially during pregnancy, oral health care is not a luxury. It is absolutely essential.

Hormone imbalances that result from pregnancy make expecting mothers especially susceptible to tooth decay and gum disease, as does vomiting from morning sickness—stomach acid is not friendly to your mouth.

And the negative impacts of poor oral health stem beyond the parent-to-be. For example, research into the oral-systemic connection has found that gum disease is related to low birthweight in newborns.

Fortunately, there is hope for an expansion of services, allowing women to retain all MPW benefits for a full 12 months postpartum. While an extension of benefits even longer than one year would certainly be even better for new mothers—the first year after birth isn’t a particularly relaxing period of time—a 12-month expansion would mark a big step in the right direction.

Earlier in 2021, Senators Jim Burgin, Joyce Krawiec, and Kevin Corbin filed Senate Bill 530, extending MPW benefits 12 months postpartum. While that bill has stalled in committee, its contents appear to be up for negotiation in the 2021 budget.

An early version of the 2021 budget included the full 12-month postpartum MPW expansion. The most recent update cut that section of the bill, but that does not mean all hope is lost.

There are legislators in the majority party who appear to have taken on this issue, and as negotiations continue, NCOHC will keep a close eye on MPW expansion in the state budget.

Stay up-to-date by joining us as a North Carolinian for Change, and take a moment to learn more about the policy options on the horizon. One of NCOHC’s fantastic interns during the 2021 summer, Hannah Archer, wrote this policy brief outlining MPW expansion and policy implications.

NCOHC is a program of the Foundation for Health Leadership & Innovation. To get involved, find out more information, and to stay up to date, head over to NC4Change to sign up for our newsletter and see what events and other opportunities are on the horizon.

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PFAS: An Oral Health Perspective

From pizza boxes to shampoo, and even some dental floss, PFAS (per-and polyfluoroalkyl substances) are everywhere. These “forever chemicals” are so widespread that it is virtually impossible to avoid exposure. While they have been commercially used since the 1940s, the scientific community is just beginning to learn about the adverse health effects that PFAS exposure can cause.

PFAS are a group of manmade chemicals widely used in a variety of industries. The story of PFAS calls to mind the history of asbestos. While we are aware of the danger that asbestos poses today, decades of prior use exposed many to adverse health effects, and its ubiquity has made removing the substance from everyday life a difficult and still incomplete, task.

In 2016, North Carolina became the center of attention after a joint study published by scientists from North Carolina State University, the University of North Carolina at Charlotte, the EPA, and other local agencies shed light on PFAS pollution in the Cape Fear River.

The Chemours Company, a spin-off of DuPont, had been releasing PFAS pollutants into the Cape Fear River for decades.

More recently, Pittsboro and other communities along the Haw River in North Carolina have been added to the high exposure list.

The most-studied PFAS chemicals, PFOA and PFOS, have been linked to low infant birth weight, immune system deficiencies, multiple forms of cancer, thyroid hormone disruption, and they can negatively impact the liver and kidneys.

To underscore just how serious and widespread PFAS contamination is, an agreement reached by the Southern Environmental Law Center and the Chemours Company in 2018 includes the “largest fine ever levied by the North Carolina Department of Environmental Quality,” $12 million on top of funding for studies regarding the health impacts of PFAS chemicals.

From an environmental health perspective, PFAS are a nightmare. They were given the name “forever chemicals” because of their durability. They are so persistent that the EPA simply states that the chemicals don’t break down in the human body or in the natural environment.

From a public health perspective, PFAS pollution also underscores the importance of integrated care, especially when managing a health crisis.

It isn’t obvious at first glance that oral health providers have any significant role to play in responding to PFAS contamination. There are no known direct oral health impacts, after all.

However, one of the recommendations for anyone living in an area impacted by PFAS pollution is to install a water filter, specifically a reverse osmosis two-stage filter. Reverse osmosis filters remove around 99 percent of PFAS chemicals, a great preventive step for anyone in an impacted area. Unfortunately, those filters also remove fluoride from drinking water.

Preventing the negative health impacts of PFAS pollution is priority number one. But down the line, it would be tragic for tooth decay and gum disease to emerge as an adverse side-effect.

From simply adding discussion of water filtration devices to dental health questionnaires, to potentially boosting supplemental fluoridation programs in areas heavily impacted by PFAS contamination, dental providers have an important role to play.

NCOHC had the pleasure of working with Dr. Kelly Bailey as she completed her public health practicum for the UNC Gillings School of Global Public Health during the summer of 2021. Dr. Bailey created this toolkit to help the dental community better understand PFAS contamination and the role that oral health providers can play in helping impacted communities remain healthy, from head to toe.

NCOHC is a program of the Foundation for Health Leadership & Innovation. To get involved, find out more information, and to stay up to date, head over to NC4Change to sign up for our newsletter and see what events and other opportunities are on the horizon.

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How in the World Does Dental Insurance Work?

Let’s talk about annual maximums.

The difference between an annual maximum and a deductible is arguably the most significant distinction between a typical dental insurance plan and a typical medical insurance plan, especially when it comes to your wallet.

It is important to note that many of the aspects of dental and medical coverage discussed in this article do not pertain to Medicaid insurance. Medicaid insurance operates differently (even though in North Carolina it does cover medical and dental, for children AND adults). We will discuss Medicaid specifically in a future post.

Additionally, this blog post should not be taken as medical or dental advice. When considering personal care and the cost of that care, consult your provider and insurance company to ensure that you fully understand all costs associated with different treatment options.

A traditional medical insurance plan usually includes what’s known as a deductible. If your deductible is $1,000, for example, once you reach $1,000 in out-of-pocket medical expenses (meaning dollars that you, not your insurance company, pay for covered medical procedures), your insurance company pays 100 percent of in-plan procedures for the rest of your annual insurance period.

Dental insurance generally works in the opposite manner. Most dental plans have “annual maximums,” not deductibles. With a maximum of $1,000, once you reach $1,000 in expenses that the insurance company has paid, you as the individual are responsible for 100 percent of your oral health care costs for the remainder of the contract year.

If you were to enroll in a dental insurance plan today, it may look something like this:

Services Coverage
Type 1, Preventive
Oral exams (1 per 6-month period)
Cleanings (1 per 6-month period)
Bitewing x-rays (1 per 12-month period)
100% covered by insurer, up to contract year maximum
Type 2, Basic services
Fillings
Full mouth x-rays
Periodontal maintenance
Injection of antibiotic drugs
80% covered by insurer, up to contract year maximum
Type 3, Major Services
Endodontics
Anesthesia
Simple and Surgical Extractions
Oral Surgery
Periodontics and Periodontal Surgery
Crowns
Inlays/Onlays
Dentures
Bridges
50% covered by insurer, up to contract year maximum
Annual Contract Year Maximum $1,000

 

On first glance, the tiered system of dental insurance clearly incentivizes regular preventive care. This is good, because nearly all dental disease can be entirely prevented, and regular visits to an oral health care provider are important steps in warding off cavities and gum disease.

On the other hand, however, what happens when you do experience more serious dental issues? Take a scenario where an old cavity filling fails, a new cavity forms underneath the failed filling, and you now need a root canal.

A single root canal on average will cost between $700 and $1,400, depending on the tooth requiring treatment and varying by location and provider. Once you receive a root canal you will also need a crown — an additional $800 – $1,500, depending on the crown material.

Say you end up right in the middle of those cost ranges: $1,050 for the root canal and $1,150 for the crown. Both are Type 3 procedures under the hypothetical insurance coverage above, meaning the insurance company will pay for 50 percent and you will be responsible for the other 50 percent. For both procedures, the total cost would be $2,200.

But don’t forget the annual maximum. The insurance company only pays $1,000 (assuming no other costs have been paid by the insurance company prior to your root canal) and you would be responsible for the additional $1,200. And if you need any other work done for the rest of the contract year, you will pay 100 percent of the cost.

That is a large out of pocket cost for someone who has insurance!

Unfortunately, the solution is not as simple as increasing the amount an insurance company pays for. More extensive policies would cost more and would quickly become more expensive than would make sense for most individuals who do not experience severe oral disease.

Dental insurance poses a complex question — how do we keep insurance costs low enough to incentivize people to: 1) get insurance; and 2) use that insurance to receive regular care, without leaving those with more severe needs hanging out to dry?

On the other hand, how do we create a structure where people with severe needs can see those needs met without crippling bills, while simultaneously keeping costs low for preventive care?

Neglect absolutely leads to tooth decay, gum disease, and eventually more expensive treatments. Some may argue that you reap what you sow, but those of us at NCOHC believe that everyone, with no exceptions, should be able to access quality, affordable oral health care.

It is also important to consider the fact that people can end up with severe dental needs by no fault of their own. In a case like mine, your loyal NCOHC blog author, you could end up on the wrong end of a golf club in high school and need years of surgeries and restorative work to get your two front teeth back.

My case is an example of the stark difference between dental and medical insurance. I was fortunate enough to have great medical insurance through my mother’s state employee health plan, which at the time included a clause for “accidental dental” needs (an uncommon clause in medical insurance). All of my countless dental visits for root canals, bone grafts, restorative work, surgeries, implants… (the list goes on and on) were entirely covered by medical insurance once we reached our deductible.

Our luck was rare. If all of that work had instead been covered by dental insurance, which would be the common scenario, we would have paid tens of thousands of dollars after reaching our $1,000 annual maximum.

At NCOHC, we are curious about your thoughts as a reader. We truly believe that solutions to the biggest problems will be discovered through collaboration, and we want you to be a part of it! Have an idea, a thought, or a question about the future of dental insurance? Click here and let us know!

NCOHC is a program of the Foundation for Health Leadership & Innovation. To get involved, find out more information, and to stay up to date, head over to NC4Change to sign up for our newsletter and see what events and other opportunities are on the horizon.

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A Conversation with Public Health Expert Extraordinaire, Dr. Rhonda Stephens

Dr. Rhonda Stephens, the North Carolina Department of Health and Human Services, Division of Public Health Oral Health Section’s Dental Public Health Residency Director, recently became the newest Dental Public Health Diplomate in North Carolina. A dedicated public health specialist, Dr. Stephens is well-known in the world of North Carolina dental public health for her dedication to improving the oral health status of all North Carolinians.

We sat down with Dr. Stephens to discuss her role in the Oral Health Section, access to care, and what it means to be a Dental Public Health Diplomate.

What do you do in your current position in the Department of Health and Human Services Oral Health Section?

This may be a long answer because my role has shifted quite a bit. I started off with the general title of a Public Health Dentist Supervisor, but I had many responsibilities under that: supervising some of our public health dental hygienists in the field, supervising our four program managers who are responsible for developing the programs that we implement in the field, and managing our grants.

In the last year or so I have shifted to doing all of that, except no longer supervising field staff, and I took on additional roles and responsibilities with our Dental Public Health Residency training program. I am now the Residency Director and will continue managing grants, in addition to temporarily still supervising our program managers.

Why did you choose a career in public health?

That’s a story that I tell quite often. I practiced in Federally Qualified Health Centers for 11 years as a dental director. That’s a safety-net setting, right, and we’re typically seeing the most vulnerable of the most vulnerable. It felt like a revolving door of the same issues day in and day out, and that I was only making an impact one person at a time, if that.

I think by about 2012 I felt like there had to be a better way — a way to impact change on a broader scale. So, I went back for my Master’s in Public Health while I worked part-time clinically, and then I knew from there that I wanted to move on to a more administrative role in dentistry.

You recently became an American Board of Dental Public Health Diplomate. What is a diplomate, and why did you pursue this distinction?

Each of the specialties in dentistry — like orthodontics, oral maxillofacial surgery, dental public health — all of these specialties require specialty training, and then there’s the opportunity to become certified as diplomates.

You can get any specialty training and opt not to become certified. For me, being certified was more of a personal professional desire, to get that final stamp or seal of approval. It’s a standardized test just like any standardized test, and it says that you have met the requirements established by the particular specialty board.

In dental public health, you can easily be just as qualified of a dental public health practitioner by having gone through a residency and not getting certified; but I wanted to be at the top of my professional game, having that seal of official approval.

Broadly, outside of my job, there isn’t yet a clear understanding among employers — whether its government employers, institutions, nonprofits — about the significance or the value of having the certification. But I wanted to be at that level so when employers do start to value the certification, I’m already there.

My job as the Dental Public Health Residency Director is the only role within our program that requires the certification. I’m fortunate that we have the residency, otherwise there honestly wouldn’t be a role for me to step into. It would just be an extra certification that I just happen to have.

Could you tell me a bit more about the role that dental public health plays within the broader network of dental professionals?

I’ll admit, many of our colleagues in dentistry don’t understand what it means exactly. Public health is very different than understanding how to provide clinical care to a patient. You’re focused on prevention first and foremost. Prevention at a community or population level.

So, some of the things that a clinician, a dental clinician, might do for a patient one-on-one in a clinical setting, aren’t actually effective at a population level. Going through the specialty training for dental public health helps you to understand that.

It’s a little-known specialty, like I said even within our own dental community. Then, more broadly, the general public really has no idea what dental public health specialists do. But we’re here, behind the scenes, working to help people prevent diseases that warrant them going in for emergency and urgent care.

I don’t know the raw numbers, but North Carolina in general seems to be a Mecca for dental public health specialists. We have quite a few who have played a major role in dental public health in North Carolina and beyond at some point. I think North Carolina is unique in a lot of aspects when it comes to dental public health.

NCOHC is a program of the Foundation for Health Leadership & Innovation. To get involved, find out more information, and to stay up to date, head over to NC4Change to sign up for our newsletter and see what events and other opportunities are on the horizon.

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Introducing Our New Associate Director, Crystal Adams

We are thrilled to introduce the newest member of the NCOHC team! Crystal Adams, a lifelong advocate for access and equity in oral health care, will join us as our Associate Director.

Crystal is a career educator, transitioning to NCOHC from her position as department head of Catawba Valley Community College’s (CVCC) dental hygiene program. Over the course of her career at CVCC, Crystal launched a dental assisting program, a Community Dental Health Coordinator program, and a school-based program allowing dental hygiene students to care for middle school-aged children in Alexander County.

Crystal brings with her a wealth of knowledge and experience in education, paired with years of statewide advocacy and representation on committees like the North Carolina Dental Society Council on Prevention and Oral Health. She is also the former president of the North Carolina Dental Hygienists’ Association (NCDHA).

We recently sat down with Crystal to talk about her career and experience in oral health, and her vision for increasing access and equity in North Carolina.

Can you tell us a bit about your career path in the dental field?

I started in dentistry as a dental assistant. My passion kept getting stronger and stronger, and I felt like I wanted to grow, so I went back to dental hygiene school. After working as a dental assistant for four years and a hygienist for almost ten years, I felt like there was something inside of me that I could share.

I love people — I love helping people. I started working in education to share my passion about oral health care. I wanted to help new graduates prepare for the dental field, and I felt like my experience as a dental assistant and a dental hygienist allowed me to go in and share my technical skills, as well as my personal knowledge working with patients.

I feel like everything begins with education, no matter what. And, with NCOHC, I am excited to work on initiatives and programs to ensure that dental literacy is continued, to help people see that they need that overall health, and that their teeth are part of their bodies!

Why did you choose a career in dentistry in the first place?

I always knew that I wanted to go into the health field. I did not have any dental care until I was 16 years old. Luckily, my family had great genes, so I was one of those lucky people who didn’t have a lot of dental issues.

Now, when I look back, I see that my personal story can help people. Especially when people come in and say, “Oh my gosh, I haven’t been to the dentist. I focused on my family, I focused on my children, and now I’m here and my mouth is a mess.” I have that personal story to share.

What is your vision for North Carolina’s oral health future?

I was born and raised in North Carolina, and I want to see my neighbors, my friends, my family throughout the state get the care that they need. My vision starts with a quality workforce. First, making sure that our stakeholders and partners are on board so that we’re all working toward the same goal. Everybody’s goal in dentistry is hopefully to help our residents in North Carolina to improve their oral health.

I envision collaboration with our stakeholders to ensure that we have a quality workforce delivering equitable oral health care to the residents of North Carolina. Working on the programs that I did at CVCC, I feel like a lot ties into the initiatives, vision, and mission of the North Carolina Oral Health Collaborative.

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.

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Meet NCOHC’s Summer Interns Part 2: Hannah Archer

Hannah Archer is an MPH student at UNC-Chapel Hill with a passion for public health dentistry. This summer, she worked with us at NCOHC to develop a policy brief on postpartum health benefits, while continuing to develop a research project to study the value of online resources for oral health care.

Could you tell me a bit about your career/education path prior to pursuing your current degree?

I studied Education and Biology in undergrad and was always interested in healthcare. I knew I wanted to pursue a career in dentistry, but wanted to learn more about the social components that play a role in oral health outcomes prior to starting dental school. So, I decided to apply to the Master of Public Health program at UNC Gillings. While here, I fell in love with oral health policy, and learned about NCOHC during a class I took on Dental Public Health. In August, I will begin my final year of my MPH, and recently applied to dental school in the hopes of attending dental school following my MPH.

Where are you in school, what are you studying, and why did you choose that program?

I am at the UNC Gillings School of Global Public Health studying to receive my Master of Public Health with a concentration in Health Policy. I chose this program because of the incredible opportunities at UNC, ranging from the incredible faculty, diverse peers, community-based learning experiences, and connections to organizations with a dedicated mission to improve public health.

What’s one fun fact about yourself?

I played tennis in college.

Where did you first hear about the North Carolina Oral Health Collaborative, and why did you want to pursue an internship with NCOHC?

I first heard about NCOHC when Dr. Zachary Brian spoke in two different health policy courses I was taking at UNC Gillings. His presentations were incredibly interesting and encapsulating. Even with an already established interest in oral public health, Dr. Brian made me feel inspired and driven to advocate for change. Later in the semester, I established a research project with a UNC Adams School of Dentistry professor and had the fortune to also partner with NCOHC. Given the extensive work and incredible opportunities I had over the past year to work with NCOHC, I knew there was no other place I wanted to pursue an internship and I feel incredibly fortunate to be here.

What about public health dentistry is intriguing to you?

While I aspire to have a career in dentistry and to spend time in clinical settings, I appreciate the broader focus of dental public health. I want to make an impact on dentistry at both the individual and population level. I particularly appreciate the focus of dental public health on increasing equal access to oral health care for all individuals. Through my position at NCOHC, I have seen just how significant the disparities in oral health outcomes are across the state and I aspire to make significant changes in my professional career.

Tell me a little about what you have worked on as an NCOHC intern. What do you hope to take away from the work you have been doing?

My internship revolves around two primary projects. In my first project, I am learning about public health communication by establishing a website to provide oral health information to providers and patients across North Carolina. The website includes oral health education for various populations, including pregnant mothers, children, individuals with intellectual and developmental disabilities, adults, and older adults. In the next stages of this project, I hope to provide this website to a majority of safety net clinics across NC without dental services.

In my second project, I am writing a policy advocacy paper on Senate Bill S530 that was presented to the NC General Assembly in April. The bill proposes to increase postpartum Medicaid coverage from 0 days to 1 year for North Carolina mothers.. In my policy brief, I am advocating to pass this bill so that postpartum mothers can receive both medical and dental Medicaid benefits. Through my research, I am learning a lot about the legislative process and the necessary components of advocacy (i.e., stakeholder support, lobbying, grassroots mobilization, etc.) necessary to pass a bill like this. In addition, I am learning about the social determinants of health that influence poor oral health in mothers and children, along with the significant health implications a bill like this could have.

If you could tell North Carolinians one thing you have learned that you think is important for everyone to know, what would that be?

Oral health starts before birth. I did not realize what a profound impact a mother’s oral health can have on their child, and that a child should be going to the dentist as early as one year of age. Unfortunately, the presence of oral health care and education is severely lacking in North Carolina, and this is something I hope to advocate for and address in my future dental public health career.

What’s next for you?

I just completed my applications to dental school. I hope to hear back from schools in December and I intend to pursue a residency in dental public health (and potentially pediatrics) following dental school.