Author: NC Oral Health Collaborative

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Access Blog Equity Public Health Social Determinants of Health

Expanding Access: Pending Rule Change Will Allow More Children to Receive Preventive Oral Health Care

Oral health care will soon be more accessible for young North Carolinians who have been systemically underserved.

On December 13, 2019, the North Carolina Board of Dental Examiners unanimously voted to approve an important rule change that will increase access to quality, affordable oral health care. The change to Occupational Licensing Boards and Commissions Rule 16W will allow dental hygienists to further practice to the full extent of their licensure. The rule change has the potential to increase preventive services such as sealants and fluoride treatments to children, in high-need settings, without a dentist’s prior exam.

“With 74 of 100 North Carolina counties deemed as dental health provider shortage areas (HPSA), the state has a crisis of access to oral health services, primarily affecting our most vulnerable populations. This rule change means that we will have a real opportunity to increase access for those who are chronically underserved and ultimately prevent detrimental oral health outcomes later in life.”

—Dr. Zachary Brian, director of the North Carolina Oral Health Collaborative (NCOHC), a program of the Foundation for Health Leadership & Innovation

Before it goes into effect, this rule change, co-sponsored by the FHLI’s NCOHC and the North Carolina Dental Society (NCDS), must receive final approval from the Rules Review Commission. Approval is currently anticipated in mid-January 2020.

Here’s what the rule change means and how it could impact oral health care in North Carolina.

A Preventable Oral Health Crisis

Tooth decay is the single most common chronic childhood disease, disproportionately affecting low-income populations. Nationwide, roughly 50 percent of children in low-income families experience tooth decay, and dental disease is responsible for a collective 51 million hours of school missed each year.

Only 16 percent of children ages 6 to 9 have received a sealant on a permanent tooth.

Cost of care is a significant barrier that prevents children and families from accessing oral health care. At one-third the cost of a cavity filling, dental sealants are a low-cost solution that can dramatically reduce the likelihood that an individual will develop a cavity during childhood.

Unfortunately, North Carolina’s requirement that a child have a prior exam from a dentist before a dental hygienist can apply a sealant adds additional cost and delays to the process.

Dental Sealants and Dental Hygienist Licensure

A dental sealant is a thin coating applied to the chewing surfaces of a child’s back teeth. The application of a sealant is a simple and painless procedure that adds an extra layer of protection to the molars, teeth which are most susceptible to decay because of the pits and grooves on their chewing surfaces. A dental sealant protects against 80 percent of cavities for two years, and 50 percent of cavities for up to four years.

In 39 states across the country, dental hygienists can apply dental sealants without a prior exam or direct supervision from a dentist. This procedure is part of a dental hygienist’s education, but in states like North Carolina, hygienists can be hindered due to administrative barriers of the prior examination requirement.

How Will This Rule Change Impact Access to Care?

Without the requirement for a prior exam by a dentist, dental hygienists can offer sealants in alternative settings like schools or after-school clinics rather than at a dentist’s office. School sealant programs, in particular, are a very effective method for reaching children who would otherwise not see a private dentist.

According to the CDC, each tooth sealed saves more than $11 in treatment costs down the road. With just over one million low-income children in North Carolina, expanded access to dental sealants has the potential to prevent costly restorative treatment needs like dental fillings later in life.

What Comes Next?

NCOHC and NCDS have engaged in a new and productive partnership to co-sponsor this rule change, and NCOHC will continue to engage NCDS for productive changes to North Carolina’s oral health care landscape.

Similar to the restrictions on providing sealants and other preventive services, dental hygienists in North Carolina are also hindered in the ability to administer local anesthesia, a clinical skill that is valuable to patient comfort and whole-person care. In fact, North Carolina is one of just six states that prevents dental hygienists from administering anesthesia. NCOHC is currently evaluating this regulation for potential advocacy engagement in the future.

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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Access Education Public Health

Our New Year’s Resolution: Great Oral Health in 2020

At NCOHC and the Foundation for Health Leadership & Innovation (FHLI), we are reflecting on 2019 and planning for 2020. Here are our highlights from last year and our plans for the year ahead.

What NCOHC Accomplished in 2019

In 2019 we supported communities across North Carolina, helping local leaders build relationships and collaborate with provider networks, educators, and more, to positively impact oral health outcomes.

We increased NCOHC’s educational impact, piloting an oral health practicum experience with Campbell University public health students and leading roundtable sessions at the UNC Gillings School of Global Public Health. Director Dr. Zachary Brian spoke at more than 40 workshops and presentations across North Carolina and around the country.

On the policy front, NCOHC worked hard to develop a fruitful partnership with the North Carolina Dental Society (NCDS). Together, we sponsored a regulatory rule change that will allow dental hygienists to practice to the full extent of their licensure, a change that will expand access to affordable health care for those who need it most.

Stay tuned, as the rule change is expected to be approved by the Rules Review Commission later this month!

Finally, with help from the oral health and policy advisers who make up our Collaborative Acceleration Team (CAT), NCOHC developed a Strategic Plan, setting ambitious goals to guide our work for the next five years.

be sure to check out our full Year in Review in NCOHC’s December Newsletter.

What We’ll Do in 2020

With guidance from our Strategic Plan, NCOHC will hit the ground running in the new year. We expect to see the regulatory rule change that we co-sponsored with NCDS signed into effect in the next few weeks, and we will continue to positively impact the oral health of North Carolinians through state-level advocacy.

We will continue to work with communities across the state to help local leaders increase access to oral health care. We will provide resources to these leaders, oral health care providers, and to the general public, and we will leverage our newly expanded capacity to increase NCOHC’s organizational effectiveness

stay tuned to our developing Resource Center—part of our newly redesigned website—for the latest oral health news and information for providers, policymakers, and the public.

All our work will impact NCOHC’s overall goal of advancing systemic change in oral health care. Our aim is to promote a value-based approach, recognize social determinants of health and barriers to equitable oral health care, and promote solutions to create an equitable landscape for all North Carolinians.

These are Our Oral Health Care Resolutions for 2020. What are Yours?

NCOHC is a program of the Foundation for Health Leadership & Innovation (FLHI). 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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Access Blog Equity Public Health

Myth vs. Fact: Fluoride and Your Health

Fluoridation is one of the greatest public health successes of the 20th century.

Despite the overwhelming success of community water fluoridation at improving oral health outcomes, misinformation continues to circulate about its risks and benefits. From those that call fluoride a communist plot (really) to others that call it a deadly killer, myths about the element are widespread. In fact, over the last few decades, anti-fluoride movements have gained large followings across the country.

Separating Fact from Fiction

In reality, fluoride in municipal water supplies is one of the most important and effective advances in the history of public health.

Since its first application in Grand Rapids, Michigan in 1945, the addition of fluoride to municipal water supplies has dramatically improved oral health outcomes across income levels, age groups, racial lines, and geographic areas.

(To learn more about how income, race, and geography impact oral health, check out our previous blog post on systemic barriers impeding oral health care access)

Is fluoride expensive?

At less than 50 cents per person per year, water fluoridation is an incredibly cost-effective treatment that has proven to reduce cavities in children and adults, even helping repair tooth decay in its early stages.

But isn’t fluoride an unnatural substance we shouldn’t consume?

No. Fluoride occurs naturally in a wide variety of foods and beverages. In fact, if you’ve ever eaten fried shrimp, mashed potatoes and gravy, or raisins, you have consumed fluoride at higher concentrations than you do when drinking fluoridated tap water!

If you want to know more, check out this USDA report on foods and beverages that contain naturally occurring fluoride.

The truth is that we naturally consume fluoride every day.

However, while there is fluoride in all sorts of foods and beverages, it generally doesn’t naturally occur at high enough levels to benefit our teeth.

Adding fluoride to tap water hasn’t subjected us to a toxic hazard. On the contrary, community water fluoridation has simply ensured that many people have the same access to it in healthy, beneficial quantities.

If fluoride is in our water at higher concentrations than occur naturally, does that make it dangerous?

Not at all. Consider this:

For a 165-pound adult, 12 standard glasses of water consumed quickly is considered a lethal dose. By comparison, in order to obtain a lethal dose of fluoride, you would have to consume more than 15 12-ounce glasses of fluoridated tap water in rapid succession.

So how does fluoride work?

In the course of a day, we all consume foods and beverages that introduce cavity-causing bacteria to our mouths. That bacteria weakens our enamel — the hard, outer coating that protects our teeth.

When we brush our teeth with fluoridated toothpaste, eat fluoride-containing food, or drink fluoridated tap water, fluoride replaces hydroxide ions in our enamel. This process strengthens our teeth, prevents decay, and can even help reverse existing decay in its early stages.

How can I make sure I’m getting enough fluoride?

The best thing you can do to protect your teeth is to make sure that you brush for two minutes twice a day with a fluoride toothpaste. You can also use fluoride mouthwash, and make sure to drink fluoridated tap water to keep your teeth happy and healthy!

And yes, kids can use fluoride too. The rule of thumb is, “smear up to three years,” which means you should use just a smear of fluoride toothpaste to brush a child’s teeth until they are three years old. From 3-6 years old, use a pea-size amount of fluoride toothpaste.

Source: American Dental Association


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

Sources for more information:

Categories
Blog Equity Social Determinants of Health

Systemic Barriers and Oral Health Equity in North Carolina

There aren’t many people who really enjoy going to the dentist.

Who wants to have someone poking around in your mouth, drilling into your teeth, and telling you to floss more?

Reluctance to enter an uncomfortable setting is far from the only barrier keeping North Carolinians from going to the dentist. Hundreds of thousands of North Carolinians experience systemic barriers that keep them out of a dental chair.

The Foundation for Health Leadership & Innovation’s (FHLI) North Carolina Oral Health Collaborative (NCOHC) works to dismantle systemic barriers to oral health care, addressing social determinants of health to create a more equitable landscape for everyone in North Carolina.

Geographic Barriers

Where you live has a lot to do with how easy or hard it is to see a dentist. Five of North Carolina’s 100 counties are home to most of our state’s practicing dentists.

Did you know?

As of 2019, 74 of North Carolina’s 100 counties are designated Dental Health Provider Shortage Areas (HPSAs).

So, if you are in Raleigh, you might have a choice between the dentist five minutes up the road and another one on the way to work, giving you the flexibility to fit oral care seamlessly into your schedule. But if you live in Tyrell County, you may have to plan an hour-long trip to access the closest dental office.

Income

Cavity fillings, tooth extractions, implants, and crowns can be expensive treatments, and hundreds of thousands of North Carolinians are uninsured. Without the means to access oral health care from childhood, low-income North Carolinians often don’t receive preventive treatment early on, leaving them at higher risk of negative outcomes later in life. Beyond oral health, this has far-reaching impacts that influence a cycle of poverty that is hard to escape.

Poor teeth, I knew, beget not just shame, but more poorness: people with bad teeth have a harder time getting jobs and other opportunities. People without jobs are poor. Poor people can’t access dentistry—and so goes the cycle.

Sarah Smarsh, “Poor Teeth”

Be sure to check out NCOHC’s Resource Center for more content, like the incredibly personal and compelling essay about poverty and oral care, “Poor Teeth,” by Sarah Smarsh.

Compounding Effects

These systemic barriers to oral health care don’t occur in a vacuum. They compound, making access harder and harder. Imagine the difficulty of seeing a dentist if you live in a rural community and must schedule an hour-long trip to access care. Now imagine how much harder that would be to fit into your schedule if you are working two or three jobs to make ends meet. What would you do if, on top of all that, the dentist doesn’t accept your Medicaid insurance, forcing you to budget time for a two- or three-hour trip?

On a positive note, North Carolina’s oral care Medicaid benefits are among the best in the country. Unfortunately, they are incredibly underutilized. 76% of North Carolina’s dentists are in private practice, and few accept Medicaid insurance, making it difficult to find an in-network provider.

Language Barriers

According to the Modern Language Association of America, nearly 900,000 North Carolinians speak a primary language other than English. Most of these individuals speak Spanish, but other primary languages include French, German, Chinese (including Mandarin), Vietnamese, Arabic, Korean, and more.

For non-native English speakers, and for those who may not speak English at all, understanding dental care, finding a dentist, scheduling appointments, and coordinating with insurance companies can be daunting tasks. Making it even more difficult is the fact that many dentists in North Carolina don’t have bilingual staff or translated paperwork.

For dentists, language barriers can pose issues regarding informed consent. Even with a translator present, ensuring that the patient truly understands a procedure can be a major concern for providers.

Intellectual and Developmental Disabilities

Individuals with intellectual and developmental disabilities (IDD) have a higher chance of suffering from poor oral health for a variety of reasons. The IDD population often has a harder time finding transportation to and from a dentist, many are non-ambulatory, and physical ailments can inhibit good personal oral hygiene habits. In addition, most dentists don’t have training to provide services for those with special needs.

In the Community

NCOHC recently partnered with Campbell University public health students for a practicum experience in oral health. As part of the program, the students worked to incorporate oral health into Harnett County’s MedFest event, a program of Special Olympics North Carolina that provides medical services to Special Olympics participants.

Read more about the program in, “Building Oral Health Champions: Reflecting on a Semester with Campbell University Public Health Students” or watch our video spotlight on Campbell University.

These are just a few of the factors that impact the IDD community. For a more in-depth analysis, check out this 2018 study by the Eunice Kennedy Shriver Center on oral health care for adults with IDD.

Racial Disparities

Oral health outcomes and access to care differ widely along racial lines. Non-white North Carolinians are far more likely to have lower household incomes, and many live in “food deserts,” meaning they lack access to healthy foods. These factors affect oral health, as well as health in general.

According to the CDC, non-white Americans have higher rates of poor oral health, with the largest disparities occurring between 2-4 years old and 6-8 years old. Childhood tooth decay is a serious issue in minority communities, and it is an issue that continues to affect oral health and whole-body health throughout adulthood.

How Do We Address These Barriers and Achieve Oral Health Equity?

Achieving equity will take a multi-faceted approach, involving people in all levels of health care, community leaders, advocates, and more. NCOHC is partnering with innovative professionals to address needs, specifically working to increase North Carolina’s dental workforce, expand service areas in underserved communities, and increase accessibility to marginalized groups.

NCOHC is currently partnering with the North Carolina Dental Society to encourage a state-level rule change that would allow dental hygienists to provide critical preventive services in high-need settings. North Carolina is one of the most restrictive states for dental hygienists. This simple rule change will help better utilize North Carolina’s existing dental hygiene workforce, increasing access in under-served parts of the state.

Other avenues to increase equity include:

  1. Working with nontraditional organizations to increase access points outside of the traditional dental office (often known as a “dental home”). This means incorporting dental care in schools, nursing homes, primary care offices, and more.
  2. Coordinating with dental offices to provide translated consent forms, descriptions of procedures, and other helpful content to non-native English speakers and those who don’t speak English at all.
  3. Encouraging innovative ways to utilize the workforce with technological solutions like teledentistry.

Stay up-to-date by signing up for NCOHC’s newsletters, and if you are interested in becoming an NCOHC member for free, join us today!

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Blog Equity

Equity in Oral Health: What Does it Mean?

What is Equity?

You may have seen the comic below, which depicts three individuals watching a baseball game over a fence. It’s a simple image, but it shows important differences between equality and equity.

In the first panel, everyone is given the same assistance. They are treated equally, each with one box to stand on. But, as you can see, the people in this situation do not start on an equal playing field, and the outcomes are inherently unequal.

To achieve the same outcomes—everyone enjoying the ability to watch the baseball game—the shortest person in the group needs an extra leg up.

Equality vs. Equity
Image courtesy of Interaction Institute for Social Change and artist Angus Maguire.

In the second panel of this comic, the tallest person no longer has a box to stand on and the shortest person now has two. While the tallest person is not receiving any additional assistance, his ability to watch the baseball game has not been diminished. Since the shortest person has received additional assistance, all three are now able to experience the same outcome: enjoying the baseball game.

Equity vs. Equality

While equality means treating everyone the same, equity means providing everyone with the resources and assistance they need to achieve successful outcomes. Equal treatment is important, but in a world where we all are different, with different experiences, abilities, disabilities, and resources available for our use, we inherently need different things in order to be successful. Equity addresses our differences to ensure that all people, no matter where they start, can have the opportunity to achieve successful outcomes.

Oral Health Equity in North Carolina

The Foundation for Health Leadership & Innovation’s North Carolina Oral Health Collaborative (NCOHC) is working to change the conversation toward a focus on equitable oral health care.

North Carolina is experiencing an oral health crisis that is felt disproportionately across the state. NCOHC has identified several drivers of inequity, including long distances to reach the nearest dentist, high treatment costs (and lack of insurance to mitigate those costs), and language and cultural barriers.

To ensure that all North Carolinians have the opportunity and ability to access quality oral health care, hundreds of thousands of people are going to need additional resources. These resources include, but are not limited to, Spanish language forms and bilingual staff, financial assistance, and more dental offices in rural communities.

NCOHC is collaborating with oral health professionals and community leaders across the state to plan and implement equitable solutions to our oral health crisis. If you want to learn more, be sure to check out NCOHC’s resources on Oral Health Equity. Join our email list to receive regular updates on NCOHC’s work and learn how you can get involved.

Be sure to tune in next week for our breakdown of the systemic barriers to oral health and how we can reach the equitable landscape depicted in the third panel of the comic strip below!

Equality vs Equity vs Justice Comic
Image courtesy of the City for All Women Initiative’s guide, “Advancing Equity and Inclusion.”
Categories
Blog Education Spotlight

Building Oral Health Champions: Reflecting on a Semester with Campbell University Public Health Students

“The more questions I asked, the more interested I became,” said Devin Olden to his fellow public health students at Campbell University as he spoke on the importance of oral health to overall health.

Olden was one of four students to participate in Team Oral Health, a practicum experience led by the Foundation for Health Leadership and Innovation’s (FHLI) North Carolina Oral Health Collaborative (NCOHC), designed to introduce Campbell University public health students to oral health issues in the state.

On Nov. 21, four of Campbell’s first-year public health students took turns sharing what they learned during the semester-long practicum in which they dove deep into some of the most pressing public health issues facing North Carolina.

Olden and his classmates, Chinenye Odobo, Hannah Faulkner, and Kristen Lamberth, spoke about several pressing topics, including:

  • Disparities in access between urban and rural communities 
  • How language barriers prevent significant portions of the population from seeking care 
  • How interconnected oral health is to a myriad of health issues, from diabetes and cardiovascular disease to Alzheimer’s.  
  • How increasing dental hygienists’ scope of practice can significantly increase access to affordable oral health care among marginalized communities.

“This just opened my eyes into this whole community that I didn’t even know existed, and the challenges they face.”

—Chinenye Odobo

Medfest: Impacting Oral Health in Harnett County

Earlier in the semester, the four Campbell students who made up Team Oral Health stepped out of the classroom to interact directly with the Harnett County community, providing oral health services at Medfest, a pre-event leading up to the Special Olympics.

MedFest events are hosted by Special Olympics North Carolina to help participants receive sports physicals and health examinations before taking part in athletic events.

Campbell’s Team Oral Health worked to add dental screenings and fluoridation treatments to the agenda, as well as fun activities to promote oral health literacy.

At the front of the class, from left to right, Olden, Lamberth, Odobo, and Faulkner talk with fellow students about oral health in North Carolina.

The Takeaway: Prevention is Key for Good Oral Health

Looking back on a semester of learning and service, Team Oral Health made sure to point out the importance of preventive treatment to increase positive oral health outcomes.

Oral health can be incredibly expensive, especially if tooth decay, gum disease, and other issues are left untreated. North Carolinians visit emergency rooms for oral care at twice the national rate, and in operating rooms over 40 million dollars is spent annually.

That cost could be significantly reduced if more North Carolinians had early access to preventative care.

NCOHC and FHLI are working hard, engaging unique partners like the students in Campbell’s MPH program to address disparities in oral health care and increase access to preventive treatments.

“If you recieve preventive treatment early, you significantly reduce costly oral health issues down the road. Unfortunately, so many in North Carolina simply can’t access that first step. We are working to address systemic barriers that limit this type of access”

—Dr. Zachary Brian, Program Director, NCOHC

Dental sealants and fluoridation treatments can significantly reduce the risk of negative oral health outcomes, and they are far more affordable than cavity fillings, tooth extractions, or other restorative procedures.

To learn more, be sure to check out NCOHC’s resources, like our Portrait of Oral Health and our tips for individuals seeking care. To stay up to date, be sure to join our email list.