An Oral (Health) History of the HIV Epidemic

“It just kept happening, over and over and over again. Patients of record, patients I’d known for years. Either they come in complaining about something or I see something. All of the classic oral manifestations of HIV disease, there they were.”

Dr. Lewis Lampiris is a retired dentist and educator. Over the course of his career, he:

  • Served as a dentist in the U.S. Army
  • Owned and operated a private practice
  • Served as the president of the Association of State and Territorial Dental Directors
  • Served as the director of the American Dental Association’s Council on Access, Prevention, and Interprofessional Relations
  • Served as the chief of the Illinois Department of Public Health Division of Oral Health
  • Retired as associate dean for community engagement and outreach at the UNC Adams School of Dentistry.

Lampiris is also a gay man, and he was early in his career practicing dentistry in downtown Chicago when the HIV epidemic hit. Here, in his own words, is Lampiris’ story about the years that followed:

“People like to go to providers who look like them or sound like them or understand who they are. So, I as a gay man ended up having quite a few LGBTQ patients in my practice, mostly other gay men.”


June 1981: The U.S. Centers for Disease Control and Prevention (CDC) published an article outlining five cases of a rare lung infection in young gay men, the first cases of what would become known as AIDS.

On the same day, a New York dermatologist reported multiple cases of Kaposi’s sarcoma, a rare form of cancer. These cases would later be linked to AIDS.

It wouldn’t be until 1984, three years later, that scientists would discover the cause of AIDS: a virus that would be named HIV.


“Anyway, around 1985 I got a call from a physician who was a patient of mine. He was a resident at Northwestern. He comes into my office, and I had never seen it before. I had only read about it. He had a Kaposi’s sarcoma lesion, no question about it.”

That man was Lampiris’ first HIV-positive patient. His case and its oral manifestations would play a large role in re-orienting Lampiris’ career toward providing care for HIV-positive individuals and educating other dental professionals to do the same.

“I felt an obligation to take care of my patients and there was so much hysteria about HIV at that time, both in the general public as well as among the dental community. I was one of the few dentists in Chicago who would get referrals for patients with HIV from the Chicago Dental Society. There were only three of us in the beginning.”


1985: More people were diagnosed with AIDS than in all earlier years of the epidemic combined, according to the CDC.

In 1985, 51 percent of adults and 59 percent of children with AIDS died from the disease.


“And as a dentist I feel responsible for taking care of everybody who walks through that door, regardless of who they are, what they look like, what kind of condition they are in. It’s an obligation to take care of people. That comes part and parcel with your degree as a dentist, as a physician.”

Lampiris saw a moral imperative when it came to providing care for HIV-positive individuals. But in many ways, his work was also driven by societal disregard for the wellbeing of LGBTQ people. He went on to discuss just how alone his community was as this new disease spread.

“In my opinion, and I think there’s a lot of evidence to support it, we really were undesirables. We were a stigmatized population. Reagan was president during that whole period of time, and he wouldn’t mention the word ‘AIDS.’ We had to take care of ourselves.”

“I remember marching in gay pride parades giving out brochures about oral sex and HIV disease transmission. Somebody had to talk about it. So, we had to educate folks, and we had to do it ourselves.”


March 12, 1987: Gay rights activist and playwright Larry Kramer founded ACT UP (the AIDS Coalition to Unleash Power) in New York City.


“I was a member of Act Up. Dr. Fauci was the director of the National Institute of Allergy and Infectious Diseases at that time. We were demonstrating. We were in front of him arguing about clinical trials – that they needed to be opened up right away.”

Lampiris paused here to mention the similarities and differences he sees between the HIV epidemic and COVID-19. Where trials were fast-tracked and the full weight of the scientific community was thrown behind finding vaccines for COVID-19, activists had to fight to secure federal funding and research for HIV treatment.

“Then after my own personal tragedy, where my own husband, my partner, died of AIDS in 1991, I needed to change my direction. Shortly thereafter I ended up selling my practice and going to get my master’s in public health degree from the University of Illinois in Chicago.”


1992: AIDS became the #1 cause of death for men in the U.S. ages 25 – 44.

1994: AIDS became the leading cause of death for all Americans ages 25 – 44.

Image taken from the movie Philadelphia (1993), the first major Hollywood film about AIDS.


“I ended up becoming the dental director for the Midwest AIDS Training and Education Center while I was in school, because they were affiliated with the university. I traveled around Wisconsin, Illinois, Indiana, Iowa, Michigan, giving talks about the oral manifestations of HIV disease, managing HIV disease in your practice.”

On his new trajectory, Lampiris set out to educate his peers in the dental community, preparing others to understand the oral manifestations of HIV and treat their patients accordingly. It wasn’t easy, however. HIV/AIDS would continue to be stigmatized for some time – the disease still results in discrimination today – and many members of the dental community would prove reluctant to provide care to HIV-positive people.

“There was a lot of hostility that came at me. I had a lot of teaching to do. But people showed up because they knew they needed to understand. There were dentists out there who were also treating HIV-positive patients in their practices, and they had no community – they had no place to go to learn. They would come to my lectures, so we said, ‘OK let’s set up a study group, so if you have something you see in your practice, we can all learn from each other.’”


1996: The U.S. Food and Drug Administration (FDA) approved the first HIV home testing kit.

1996: Scientists discovered a combination of HIV medicines that effectively suppress the virus’ spread.

1996: The first decline in AIDS diagnoses since the beginning of the epidemic is recorded.


Fast forward to today and HIV is a much more manageable disease. Most HIV-positive people in parts of the world with access to health care services can live full, vibrant lives. Parallel to advances in HIV treatment, Lampiris also saw positive changes in dentistry driven in part by the HIV epidemic.

“Absolutely HIV had something to do with universal precautions or standard precautions. Masking was not a standard protocol when I trained as a dentist. The CDC came out with precautions for infection control in the dental practice and they were adopted by the American Dental Association. That became the standard of care, and that emerged from the epidemic.”


2017: The CDC reported that U.S. HIV-related deaths fell by half between 2010 and 2017, largely due to early testing and diagnosis.

2022: Researchers announced that a woman’s HIV had been cured thanks to a new treatment approach. This new treatment is the first with potential for more widespread use.


“Going back to that first patient with Kaposi’s sarcoma, he was a patient of record. I’m responsible for taking care of everybody who walks through that door. The idea in terms of one of the basic ethical principles in our code of ethics is, ‘Justice, to treat everybody fairly.’ So that’s what I said back then but I’ll say it again. That translates to what we’re dealing with here in North Carolina with Medicaid patients, with the IDD community. There are similarities in treating folks that don’t fit into the mold.”

Just before this story was published, two new cases of individuals potentially cured of HIV were announced at the 2022 International AIDS Conference in Montreal. One case is of an 88-year-old man who was first diagnosed with HIV in 1988. After a stem cell transplant, he has been apparently cured of both HIV and leukemia.

In the other case, a woman who received an immune-boosting regimen in 2006 has been in what researchers characterize as “viral remission” ever since. In this case, the woman still harbors the HIV virus, but her immune system has been able to control its replication.

Researchers emphasized that both of these cases are not options for widespread treatment of HIV. Stem cell transplants are highly toxic and potentially fatal, and as such are typically not used unless a patient is facing a fatal and otherwise untreatable cancer. The immune system-boosting approach has not been widely researched, so much more needs to be done before it would be considered to be a replicable cure.


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.


The Medicaid Access Gap for Children in North Carolina

It’s no secret that there is an oral health care access gap for North Carolinians with Medicaid insurance. It’s practically a rule of thumb that if you are born poor, you will have less access to health care services (medical and dental), and in turn will likely end up with greater incidence of dental disease.

There are many reasons why this is true. From the food on your table (click here to learn more about how where you live can impact access to healthy food) to the transportation you can access, the distance between your home and the nearest oral health care facility, and more, social determinants of health can significantly impact access to care.

In fact, an estimated 80 percent of a person’s health is the result of factors outside of a medical office.

That isn’t to say that the oral health care system itself is an insignificant factor. For a variety of reasons, there simply are not enough providers who accept Medicaid insurance, which creates large areas where adults and children alike cannot access the care they need and deserve.

North Carolina Medicaid Oral Health “Secret Shopper” Survey

The NCOHC team recently conducted an internal secret shopper survey in Western North Carolina, a region with significant oral health care access issues for Medicaid-insured individuals. Over the course of several weeks, NCOHC staff contacted oral health care providers listed on the website Insure Kids Now to inquire about an appointment for a seven-year-old child with Medicaid insurance.

Of 119 WNC locations, 50 were listed as accepting children with Medicaid insurance. Fifty-seven were listed as not accepting Medicaid, and 12 did not indicate whether or not they accept Medicaid. Upon calling each location, NCOHC found that only 35 locations were currently accepting Medicaid-insured children. A total of 70 did not accept Medicaid, and NCOHC staff were unable to reach the remaining 14 locations. Three counties were found to not have a single Medicaid-accepting oral health care provider.

Note: The NCOHC survey was conducted to serve as a preliminary look at the oral health care landscape in Western North Carolina, an area with significant access concerns. And while it was not conducted as a comprehensive research project, NCOHC’s findings do reflect some of the access gaps identified in the recent American Dental Association Health Policy Institute’s report on Medicaid access in North Carolina. Particularly, maps in the report of meaningful pediatric Medicaid dental office locations starkly visualize the relative scarcity of providers in the western part of the state compared to North Carolina’s urban centers.

Increasing Medicaid Acceptance by Oral Health Providers in North Carolina: What Can We Do?

It’s important to ask why these access gaps occur. Even when there are dental providers in an area, why do so many not accept Medicaid insurance?

Addressing Payment Disparities

Medicaid reimbursement rates for oral health care tend to be lower than the rates private insurers pay, often falling below the actual cost of performing some procedures. For many private practices, this can pose a significant financial issue.

Possible paths forward include increasing reimbursement rates to a level where Medicaid is on par with private insurers and simplifying the filing and appeals processes.

Strengthening the Oral Health Care Safety-Net

Another option is to patch up the holes in our “safety-net” facilities. Across North Carolina, Federally Qualified Health Centers (FQHCs), local health departments, and other safety-net facilities care for large numbers of our state’s residents who have Medicaid insurance or are uninsured or underinsured.

FQHCs, for example, receive federal funding that helps reduce the financial gap between Medicaid reimbursement rates and private insurance rates (as well as the gap between patients with insurance and those who can’t pay at all). Despite this support, many FQHCs still struggle to cover their costs. Additional funding will be needed to ensure the sustainability of these organizations’ efforts.

Similarly, local health departments and other safety-net facilities often receive funding from the government, charitable organizations, and private donors that help them see any patient, regardless of their ability to pay.

Systems-Level Reform to Address Medicaid Oral Health Care Access in North Carolina

To solve the Medicaid access gap issue, we must ask the right questions — and address the systemic challenges driving these disparities. For example:

  • What policies or other initiatives could strengthen the safety-net environment, allowing facilities like FQHCs to expand into regions that are underserved?
  • Can we achieve policy reform to increase reimbursement rates?
  • If so, how long will that take, and what can we do to help those in need in the meantime?

The solution to North Carolina’s Medicaid oral health care access issues will likely require organizing to build support for changes to the Medicaid system while also driving policy change to better support the safety net. No less important, however, and as NCOHC always emphasizes, we are far more likely to solve the problem through collaboration.

Doing nothing simply isn’t an option.

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.


Oral Health Day 2022: Equity in Action Recap

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

Oral Health Day 2022 centered the work necessary to create a truly equitable oral health system. Following the theme “Equity in Action,” speakers discussed disparities and the actionable steps we can all take to improve oral health for everyone, from pursuing racial equity to increasing access for individuals with disabilities, and more.

If you missed the event and want to enjoy the full experience, you can find the event recording here.

Dr. Eleanor Fleming’s Keynote Address

Dr. Eleanor Fleming kicked off the first day with rousing remarks on race and racism in oral health, highlighting systemic factors that impact our teeth and the need for antiracist collaboration to overcome barriers to care. Dr. Fleming currently serves as assistant dean of equity, diversity, and inclusion at the University of Maryland School of Dentistry and is a nationwide leader in this work.


Fleming discussed the social determinants of health and the many ways that the world around us can impact our health. Most of her remarks, however, centered around antiracism, tying the need for antiracist effort to the ultimate goal of equity in oral health care.

Fleming identified ways that racism goes beyond hurting individual people or groups to “actually sap the strength of the whole society.” She said that we all have skin in the game when it comes to actively challenging racism at the personal, structural, and systemic levels.


Panel Discussion

After Fleming’s keynote address, Dr. Lewis Lampiris, associate adjunct professor at the University of North Carolina Adams School of Dentistry, moderated a lively panel discussion that included representatives from community, insurance, philanthropy, academia, and more.

Marie Helms, a mother of two, kicked off the panel talking about her experience finding oral health care for her daughter, who was diagnosed with spastic quadriplegic cerebral palsy at 6 months old.


Panelist Rachel Radford followed with examples of hardships her family has experienced finding oral health care for her two children, both of whom have autism.


Radford also talked about her own experience with oral health care. She didn’t see a dentist until she was 22 years old and was made fun of by her first provider for being nervous. She talked about the way this made her feel and how dental anxiety stemming from that incident made it difficult to continue seeking oral health care.

Continuing the conversation, Dr. Amadeo Valdez gave perspectives on equity issues from his roles as an oral health care provider and dental residency program director. Valdez works for the Mountain Area Health Education Center, the AHEC program serving Western North Carolina.


Lampiris asked Curt Ladig, president and CEO of Delta Dental of North Carolina, how private insurers can contribute to equity in oral health care. Ladig explained that his core beliefs center around access for everyone, something he brings to his work as he guides the direction of the insurance company.


Yazmin García Rico, director of Hispanic/Latinx policy and strategy at the North Carolina Department of Health and Human Services, joined the panel discussion to speak from her perspective within government. She talked about the need for a more robust workforce spanning the entire state.


García Rico also talked about diversity among providers as an important priority and mentioned language access as a major need in oral health spaces.

Finally, Dr. Susan Mims spoke from her perspective both as a pediatrician and as the current president and CEO of the Dogwood Health Trust. Dogwood Health Trust funds programs to improve the health and wellbeing of Western North Carolinians, including the Patient Advocate Pilot, an NCOHC-led initiative advancing care coordination and case management for vulnerable populations.

Mims spoke about the opportunities that philanthropic organizations have to advance equity in oral health, especially when it comes to pushing boundaries and trying new things. She also told personal stories from her time as a health care provider, witnessing the toll that poverty takes on people’s health.


Many panelists examined a specific and pressing policy need in North Carolina: Medicaid Expansion.

Radford’s final remarks during the discussion took a personal note. She enrolled in Medicaid coverage during the COVID-19 pandemic, but she and many others stand to lose that coverage unless Medicaid Expansion is passed.


Day Two: Equity in Action

This year’s Oral Health Day was the first to span two days. On the second day, participants from across the United States reconvened to participate in a collaborative workshop, identifying policy solutions to the inequities discussed the day before.

Prior to the workshop portion, NCOHC Director Dr. Zachary Brian kicked off the day with a data-based overview of disparities faced in North Carolina. With that background in mind, attendees split into four groups to discuss current realities and actionable solutions.

The NCOHC team was blown away by the level of engagement during the solutions workshop, and we are hard at work developing a comprehensive “Equity Action Framework” to share publicly. The framework will outline achievable, collaborative solutions to the problems facing communities across North Carolina, and will guide NCOHC’s work heading into 2023.

If you would like a copy of the report, make sure to sign up to receive NCOHC emails here.

You can find the full event recording below:


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.


What is Single-Payer Health Care?

On March 28, 2022, the Poor People’s Campaign held its first Moral Monday march in Raleigh since the COVID-19 pandemic began. The rallies, which began in North Carolina in 2012 and have radiated across the United States since, have long covered a wide range of issues that disproportionately impact those living in poverty.

Covering issues ranging from fair housing to union-friendly labor policy, prison reform, and more, the Poor People’s Campaign describes itself as a “national call for moral revival,” building on the movement of the same name launched by Rev. Dr. Martin Luther King Jr. in 1967.

The March 28th rally in Raleigh came in preparation for a Poor People’s March on Washington, again echoing Dr. King’s movement, expected to take place on June 18, 2022.

As he did for many Moral Mondays prior to the COVID-19 pandemic, Dr. Howard Eisenson attended the March 28th rally in Raleigh. He plans to attend the March on Washington on June 18th as well.

Before heading over to Raleigh, Eisenson sat down with NCOHC to talk about his career as a physician, his advocacy work, and a health care policy proposal that an increasing share of Americans support: single-payer health insurance.

While NCOHC has no position on national health care reform policies like single-payer or a public option, our work centers around structural reforms that promise to increase access and equity in oral health care. This blog post is not an endorsement of any national policy reform initiative. Rather, it is meant to explore what single-payer insurance is and why many Americans are working to change the way health care is administered in the United States.

“What many of us feel it’s time for in the wealthiest country on earth is a health care system that serves everybody, that provides for the common good,” said Eisenson.

Eisenson was the Chief Medical Officer for the Lincoln Community Health Center (CHC) from 2012 to 2021. Today, in semi-retirement, he still works for a program called “Just for Us,” a collaboration between the Lincoln CHC and the Duke Division of Community Health.

Working in home health care has been an eye-opening experience for Eisenson. Insurance plans often have very narrow networks, high co-pays, and other barriers that prevent homebound patients from accessing the services they need.

“I’ll give you a quick example from last week,” he said. “I went out to see a patient one morning. ‘How are you doing?’ ‘Terrible,’ she said. I asked her, ‘well, what’s the matter? What’s going on?’ She said, ‘I heard that my insurance won’t pay for my insulin anymore. Pharmacy tells me that.’”

Another call to the pharmacy revealed that her insurance no longer covered her Lantus insulin.

“No doubt what happened is the pharmaceutical manufacturer raised the price,” said Eisenson. “So, we had to find a substitute insulin product. We did, but it took much worry on the part of the patient, phone calls to the pharmacy, a fair amount of my time, re-writing the prescription, a lot of downstream administrative work that would have been avoided had there been one insurance plan that served everybody.”

The Poor People’s Campaign’s list of demands includes the expansion of Medicaid in every state and adoption of a single-payer health insurance system. Eisenson believes that this step is vital if the United States is to achieve equitable access to health care services.

“When you have a publicly funded plan, their main mission at the end of the day is to provide value to the public. That’s what we need. Health care is not your typical consumer product. It’s not like buying a refrigerator where you can shop around for as long as you want,” said Eisenson. “A market-driven approach to health care is inadequate – it leaves too many people out.”

“And we need to cover things like dental care. Who wants to have a mouth full of rotting teeth, or no teeth? And yet dental care is accessible to so few people,” he said. “Dental emergencies occasion so many emergency room visits. Untreated dental problems make so many chronic health problems worse. Not to mention what they do to quality of life. Dental care, vision care, hearing aids, all of these things ought to be included in a comprehensive health package and made available to everyone.”

What Is a Single-Payer Health Care System?

In single-payer health care systems, one entity — usually a government — is charged with administering health insurance for an entire population. Basically, a national insurance system would take the place of our current network of private insurance companies. The actual delivery of health care would remain private, but the financing mechanisms would be controlled by the federal government.

Essentially, a single-payer system would operate like the current Medicare system, only everyone would have access to it.

Supporters argue that a single-payer health care system provides many benefits, including:

  • Savings created by increased efficiencies
  • Access for everyone, regardless of employment status or financial situation
  • Reduced health care spending per capita

However, a transition to a single-payer system wouldn’t be easy or without downsides. For instance, more than 600,000 people in the U.S. currently work in the health and medical insurance industry. Many jobs would be lost in a transition to a single-payer system.

“You can’t just push people out of their jobs without making provisions for them to land on their feet,” said Eisenson.

Lateral transitions and re-training programs are a tall order for those who have made careers in the insurance industry. Yet, creating these opportunities is a need that many prominent advocates for single-payer health care do recognize.

Agreement on Principle: A First Step Toward Single-Payer Health Care

“There are so many details to work out, but the first step is to agree on the common principal,” said Eisenson. “I think most Americans would agree that access to quality health care should be a human right. If someone has a fire in their house, the fire department doesn’t check to see first whether they have paid their fire insurance. If someone is having an emergency and needs the police or an ambulance, nobody is checking to see if they deserve to have help. Everyone gets to send their children to school. These are common goods. Those of us working toward single-payer think that health care should also be a common good.”

The Bottom Line

At the end of the day, change must happen to achieve equitable access to health care. At NCOHC, we believe that diverse coalitions of advocates passionate about improving our health care systems are the key to discovering and implementing the best solutions. That means diversity in cultures, backgrounds, experiences, and viewpoints, and we welcome all to take a seat at the table in this conversation.

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.


Mental Health and Oral Health

At NCOHC, we see integrated care structures at the center of a more equitable, accessible health care system. Oral health is an important part of a person’s overall health, and our bodies benefit most when our medical and dental needs are met in a “whole-body” approach.

The same goes for mental health, another often siloed health care practice. Not only do our medical, dental, and mental health needs overlap, but deficiencies in any of the three can have serious impacts on the rest of our bodies.

Oral Health and Mental Health: A Two-Way Street

Many social determinants of health have significant impacts on both oral and mental health. For example, while food access has well-documented impacts on oral health, it also affects mental health. One study conducted during the COVID-19 pandemic found a 257 percent higher risk of anxiety and a 253 percent higher risk of depression among food-insecure individuals.

The same goes for economic stability. Societal forces like income, housing, and transportation that can prevent someone from accessing oral health services often carry negative mental health consequences as well.

The comedian Moses Storm discussed his own poverty in his recent HBO Max special, saying that “poverty is a disease, and its most sinister symptom is fear. It’s something that I carry with me to this day… It’s no revelation that poverty is a major stressor, and we know that chronic stress causes damage to the cerebral cortex, the part of your brain that’s in charge of risk/reward, long-term planning.”

Can Oral Health Affect Mental Health?

Oral health itself can impact mental health, too. Poor oral health is strongly associated with fear, anxiety, and shame. Among children, untreated tooth decay can lead to school absenteeism, learning deficiencies, and difficulty socializing and making friends. Among adults, similar impacts can be seen maintaining employment, relationships, and more.

Similarly, people living with mental illnesses like anxiety and depression can face difficulty maintaining daily routines. This and other effects of mental illnesses, such as excessive smoking or drinking as coping mechanisms, impact oral health.

A 2016 article in the Canadian Journal of Psychiatry discussed the fact that “many psychiatric disorders, such as severe mental illness, affective disorders, and eating disorders, are associated with dental disease.”

The bottom line is that poor oral health and mental illnesses are often, in a way, symptoms of each other, results of a network of stressors, barriers to care, and societal factors that many people face. As such, they are intertwined, both impacting each other in many ways.

According to Storm, “Basically all the tools that get you out of poverty get damaged by being poor.”

That sentiment is reflected by the compounding effects of poor health, and poor health and poverty are also intertwined in this kind of feedback loop.

The Need for Systems-Level Change

Whether brushing teeth and visiting the dentist to improve oral health or adopting mindfulness routines and seeking behavioral health care to improve mental health, self-care routines are vital. But, the burden of improvement can’t always be placed on the individual.

Many of the societal factors that impact mental health are structural in nature. While they are important, meditation sessions, mindfulness routines, and daily walks must be accompanied by structural improvements to health care access, income, affordable housing, transportation, and so much more.

The same goes for oral health, and health care in general. Too many people simply cannot access the care they deserve. Solving this problem is one of the most important things health care professionals can do to improve and ultimately save lives.

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.


One Step Closer to Oral Health Care Provider-Administered HPV Vaccines

Dentists may be one step closer to administering HPV vaccines in pursuit of whole-person health. Earlier this year, the American Dental Association (ADA) Code Maintenance Committee approved new CDT codes for oral health care provider-administered HPV vaccinations. This is a crucial step in addressing HPV, the most common sexually transmitted infection and a leading cause of oropharyngeal cancer.

The human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. At first glance, it may seem harmless compared to other sexually transmitted infections and diseases. In many cases, people don’t even know when they have contracted HPV.

But HPV is responsible for 12 percent of cancers worldwide, including cervical cancer, penile cancer, and many oral cancers. In fact, according to the CDC, HPV is thought to be responsible for 70% of all oropharyngeal cancers. 70%!

The vaccine has been proven to prevent both HPV and associated cancers. Specifically, of the 36,500 annual cancer cases caused by HPV, it has been found that 33,700 could have been prevented through vaccination.

Why Oral Health Care Provider-Administered HPV Vaccines?

“HPV is the leading cause of oropharyngeal cancers (cancers in the throat, back of the mouth, base of the tongue, and tonsils) in the United States,” said NCOHC Director Dr. Zachary Brian, who serves on the Code Maintenance Committee as a representative for the American Association of Public Health Dentistry (AAPHD) . “It’s more than appropriate that oral health care providers not only educate about HPV-associated risks but also serve on the frontlines to administer this life-saving vaccine.”

Brian, along with Dr. Sharon Perlman, a dental provider and CCARE Lynch Syndrome co-founder, drafted the new HPV vaccine code. Perlman also served on the Code Maintenance Committee as an AAPHD representative.

“We are lucky to have a strong advocate in Dr. Perlman,” said Brian. “She was a critical component in the drafting and passage of this new code.”

With oropharyngeal cancers claiming one life every hour in the U.S., and just over 50 percent of adolescents not completing the HPV vaccine series, there is clear room for improved prevention through increased access and education.

In 2021, NCOHC spoke with Dr. Jennifer S. Smith, a vaccine epidemiologist who has worked to improve HPV vaccine acceptance to prevent cervical cancer. She said that while the HPV vaccine has proven to be a valuable preventive tool for many forms of cancer, acceptance continues to be an issue.

One of Smith’s colleagues, Dr. Noel Brewer, found that informed providers who understand potential outcomes need to be part of the vaccination process. For example, the pediatricians who often administer HPV vaccines may not be as familiar with the realities of cervical cancer compared to oncologists who take care of cervical cancer patients. The perspective of a health care professional familiar with the disease endpoint – in this example cervical cancer – is vital in answering questions and encouraging vaccine acceptance.

Similarly, dental professionals can play a valuable role in educating people about oropharyngeal cancers and the benefits of HPV vaccination.

The best time to vaccinate against HPV is between 11 and 14 years old. Parents will understandably have questions, not just about the vaccine itself but about the health outcomes it can help prevent.

“Dental professionals already play a vital role in early detection and oral cancer literacy,” said Brian. “This uniquely positions us to engage in direct prevention as well.”

What is the Code Maintenance Committee, and Why is an HPV Code Important?

The ADA’s Code Maintenance Committee evaluates and votes on changes to the CDT Code, or the Code on Dental Procedures and Nomenclature. The procedural codes are meant to ensure a level of consistency in dental treatment, and they are used to file insurance claims for oral health care services.

“The adoption of the code marks the first of many steps, and it opens several doors,” said Brian. “It signals broad agreement on oral health care provider-administered HPV vaccines to payers and policymakers, and it provides a framework to integrate HPV vaccination into the practice of dentistry.”

At NCOHC, we’re pleased to see the dental profession moving in this direction, and we believe these changes can make a profound difference in preventing HPV and, ultimately, oropharyngeal cancers.

What’s Next?

The adoption of the new CDT codes alone won’t allow oral health care providers in most states to begin HPV vaccination.

In some states such as Illinois and Oregon, where dentists are already authorized to administer various vaccines, there likely won’t be much delay in adjusting their regulatory frameworks to allow for HPV vaccination. However, in most states, including North Carolina, state law will need to change for oral health care providers to be authorized to administer the vaccine. \

“We will need to modify state law to incorporate HPV vaccination into the scope of practice for oral health care providers,” said Brian. “For that to happen, it will be critical that we work closely with our partners across the state, including our medical counterparts and other advocacy groups.”

Insurers will also be important partners in this effort. While the necessary legal changes are being made, payers will also need to engage to encourage and support oral health care providers’ administration of the HPV vaccine.

“Once the policy has been updated and the reimbursement framework is in place, the dental profession will have a significant opportunity to improve population health,” said Brian. “The dental community could rapidly increase the availability of the HPV vaccine and add a much-needed perspective to cancer prevention efforts.”

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.


Update: What We Know About the Oral-COVID Connection in 2022

COVID-19 has impacted virtually every aspect of human life for the past two years. From retaining steady employment and income to maintaining preventive medical care, healthy habits, and more, things got a bit more difficult for most everyone, and a whole lot harder for many.

COVID-Oral Health Connection

Earlier in the pandemic, we published an initial overview of the ways that the virus has impacted oral health. As we enter 2022, with a hopeful light at the end of the tunnel, we are taking another look at the connection between COVID-19 and oral health to break down the many ways the pandemic impacts our mouths.

Here’s a brief review of what we know so far.

Loss of Taste and Smell

From the beginning of the pandemic, loss of taste and smell have been prominent symptoms of COVID-19. As the first recognized oral manifestation of the virus, loss of taste was an early indicator of infection, even as testing and other precautionary measures were still ramping up.

Loss of taste and smell, which are typically grouped together in part due to the similar nature of the two senses, continue to be significant issues for many diagnosed with COVID-19. They are also often among the longer-lasting impacts of the disease. Like many COVID-19 symptoms, however, people who have contracted the virus have a wide range of experiences with the loss of these senses.

In some cases, loss of taste and smell lasts a short period of time before returning to normal, and many who contract COVID-19 don’t lose these senses at all. But in others, sensory loss lasts months, and there are even some cases where the loss of taste and smell seems to be permanent.

Treatment for COVID-related Loss of Taste and Smell

“There are frustratingly few interventions” to treat taste and smell loss, according to a Journal of the American Medical Association (JAMA) commentary. One of the only successful options is olfactory (smell) training. This treatment basically involves regularly smelling a variety of scents. While the mechanisms that make this remedy work are still largely unknown, it has demonstrated a significant level of success.

Physicians and researchers at Thomas Jefferson University Hospital are currently developing another potential treatment: topical platelet-rich plasma (PRP). PRP, which is commonly used for injuries like tennis elbow and muscle pulls, has shown promising results in early trials for treatment of loss of taste and smell.

Dry Mouth and Oral Lesions

While loss of taste and smell were among the first widely known symptoms of the virus, dry mouth has become the most common oral manifestation of COVID-19, present in 43 percent of cases.

Dry mouth has the potential to lead to or intensify existing oral disease. Saliva is an oral health powerhouse — it helps defend against decay-causing acids and bacteria. With less saliva, people who contract COVID-19 and experience dry mouth are at greater risk of tooth decay and gum disease.

Researchers have also found a significant correlation between COVID-19 infection and oral lesions. Again, the exact mechanisms connecting the virus and the oral manifestation are not clear, and there is a wide variety of types of lesions that have been documented. Ranging from canker sores to herpes-like sores, oral thrush, and more, these lesions were found in 20.5 percent of patients in a study surveying 2,491 cases of COVID-19.

Treatment for Dry Mouth and Oral Lesions Due to COVID-19

According to the Mayo Clinic, dry mouth treatment options include:

  • Stay hydrated
  • Reduce caffeine intake
  • Don’t use alcohol-based mouthwashes
  • Stop using tobacco
  • Use a humidifier at night
  • Use an over-the-counter dry mouth mouthwash

Oral lesion symptoms associated with COVID-19 vary widely. Minor canker sores generally clear up on their own with no treatment, and there are a variety of mouth rinses and topical products available for more persistent sores. For other symptoms like oral thrush, antifungal medicines may be necessary. Because of the wide variation in lesions, the best approach if you are experiencing these symptoms is to consult your dentist.

Understanding COVID-19 and Its Oral Manifestations

To say the least, COVID-19 is an incredibly confusing virus. The list of potential effects is seemingly endless and disconnected, ranging from flu-like symptoms like fever, cough, and sore throat to:

  • Shortness of breath, and difficulty breathing
  • Headaches
  • Loss of taste and/or smell
  • Oral lesions
  • Brain fog
  • Pink eye, light sensitivity, and sore or itchy eyes
  • Rashes
  • Swollen or discolored extremities
  • And more

Some of the most prominent symptoms are very similar to the flu, suggesting that COVID-19 is a respiratory disease. But researchers are continuing to find evidence indicating that COVID-19 might be a vascular virus – a disease of the blood vessels.

Looking at COVID-19 as a blood disease can help demystify the variety of seemingly disconnected symptoms. In the dental community, we are familiar with the important role of blood vessels in the mouth-body connection. With COVID-19, blood vessels could be the link between stroke-like brain impacts, respiratory problems, and oral manifestations.

COVID-19 and Oral Health Equity

Beyond direct connections between COVID-19 and the mouth and the nearly endless list of symptoms associated with the virus, there is another long list of impacts that make their way back to our mouths. Nearly every social determinant of health has been exacerbated during the COVID-19 pandemic, and they all have oral health repercussions.

Prior to the pandemic, the U.S. poverty rate was at its lowest point since 1959. Despite supplemental programs to offset income loss early in the pandemic, poverty rates for adults and children alike have increased. Many people struggled (and continue to struggle) to get enough food, retain steady employment, and maintain stable housing — all of which have known links to oral health and overall health.

The bottom line: Outside of the dental office, it has been much harder for millions of people to maintain good oral health habits during the pandemic.

Inside the dental office, things also became harder when the pandemic hit.

  • There is a plethora of anecdotal evidence from dentists across the country who have seen more patients with stress-induced cracked teeth.
  • Fear of seeking care due to possible COVID-19 exposure continues today, putting people at risk of more extensive treatment needs down the road.
  • The widening income gap and shaky employment situations have left many without the insurance necessary to maintain regular preventive appointments.
  • Dental staffing shortages, a problem before COVID-19, have become more severe during the pandemic, especially among hygienists and assistants.

Oral Health & COVID-19: Where Do We Go from Here?

The list of connections between COVID-19 and oral health could go on and on. For example, dental researcher Faleh Tamimi is leading a study of similarities between COVID-19 and periodontal disease co-morbidities, finding that people with COVID-19 and gum disease are 3.5 times as likely to be admitted to an ICU and 4.5 times as likely to be put on a ventilator. In the months and years ahead, we’ll continue to keep a close eye on this and other research exploring the link between COVID-19 and oral health.

At the end of the day, however, one thing is clear: the many ways COVID-19 impacts oral health continue to be significant.

The pandemic could, and should, be an opportunity as well. With so many in need, and with so much focus on health care, we have an incredible opportunity to look at structural changes to dramatically increase access to care.

NCOHC and our incredible coalition of partner organizations and advocates are taking strides to map out the future of oral health care – a. future that includes everyone, everywhere. Learn more about current initiatives and ways you can get involved today at

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.


Meeting Mary Otto, Journalist and Author of “Teeth”

The NCOHC team recently had the rare opportunity to venture out of our homes and wipe the dust off our desks. With masks in hand, we made our way to our Foundation for Health Leadership & Innovation office to meet Mary Otto, journalist and author of the critically acclaimed book “Teeth” while she was here in North Carolina.

Otto is a health care reporter and a leading voice in oral health journalism. If you haven’t read “Teeth,” the book is an eye-opening account of the pervasive inequities that exist in oral health care and their devastating impacts.

Otto didn’t begin her career as a health care journalist. In fact, when she first began to dive into the oral health space, she was a general assignment reporter for the Washington Post.

“I was covering social issues at the Washington Post, writing a lot about poverty issues—housing, programs for low-income families,” said Otto. “I ended up writing about this family that was struggling—the Driver family—and I met Deamonte Driver.”

Driver’s struggle, rooted in a lack of access to oral health care, made waves across the nation and around the world. The 12-year-old would eventually die after bacteria from an untreated tooth infection spread to his brain.

Otto’s book tells Driver’s story, outlines the structural inequities that plague millions of Americans, and traces the roots of our current system through the history of dentistry.

The light that Otto and other journalists helped shine on inequities in oral health eventually led to change in Maryland, where Deamonte lived.

“It really took on a life of its own and they were really able to make some meaningful reforms.” said Otto. “Elijah Cummings became a powerful voice for adding a guaranteed dental benefit to the Children’s Health Insurance Program and for reforming Medicaid’s pediatric dental program. He himself grew up poor in Baltimore, and he would talk about how dental pain was expected – it was a part of life for him.”

In the years following Driver’s death, Maryland made significant reforms to its Medicaid program, becoming one of the better states in the nation for Medicaid beneficiaries. There are still plenty of opportunities for improvement, however, especially with regards to adult dental coverage and equitable access to care.

Today, Otto is working on a new project, exploring the history of a union-driven, patient-centered medical system in coal country in the 1950s and ‘60s. Though her newest project is focused on health care as a whole, Otto remains plugged into the oral health space. During our meeting, we spoke about everything from teledentistry to an innovative clinic in Seattle dedicated to helping patients navigate anxiety and fear related to oral health care.

Expect to hear more from Otto in the near future! We’re excited to learn more about her current investigative work, and we have high hopes to keep her plugged into the oral health space here in North Carolina.

If you haven’t read Mary’s book, “Teeth,” you can find it here.

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.


What is a Dental Assistant?

Dental offices are team operations. Take away your dentist or hygienist and the work will grind to a halt. The same goes for dental assistants. They are vital — but often underappreciated — members of the dental team. To learn more about what dental assistants are and the roles they fill, we sat down for a conversation with dental assistant and educator Kati Garrett.

Garrett has worked as a dental assistant, a job she pursued because of her passion for improving oral health, for more than a decade. On top of her day job, Garrett also oversees Catawba Valley Community College’s (CVCC) dental assisting program.

“It’s nice to see the difference you can make working in dentistry. I saw growing up how much dental health can affect you as an individual,” she said. “Both of my parents had dentures, my grandparents had dentures. It wasn’t something stressed for me growing up. But the older I got I realized just how important it is.”

What is a Dental Assistant?

Dental assistants are important members of any dental team, primarily tasked with helping dentists and hygienists perform their jobs efficiently. Assistants fill a variety of roles, however, ranging from directly assisting dentists and hygienists chairside to sterilizing equipment, performing infection control duties, helping patients navigate insurance and billing, working as office managers, and more.

“The role a dental assistant fills can vary—they play a lot of different parts in the dental office,” said Garrett. “When you are trained as a dental assistant you are trained to sit chairside and directly help a dentist or hygienist get their job done quicker and more efficiently. But dental assistants also work as office managers, sterilization technicians, treatment plan coordinators, insurance gurus, you name it.”

One thing that Garrett loves about dental assisting is the opportunities that exist for growth and movement. With all the different jobs that assistants can do in a dental office, there is something for everyone. That versatility — from finances and insurance to everyday logistics — also means that assistants play an important role in keeping an office functioning like a well-oiled machine.

“I think I could probably speak for every dental assistant when I say this. If you keep your dental assistants happy, you can get a lot of work done,” said Garrett. “Dental assistants are so much a part of keeping things rolling in the dental office that if you treat them well and make sure their hard work is appreciated, they can really keep the dental office moving.”

How Do You Become a Dental Assistant?

There are several paths to becoming a dental assistant, and a variety of programs train dental assistants at various levels.

“There are accredited schools – you come out of those as a Certified Dental Assistant,” said Garrett. “There are also a ton of proprietary schools that offer 8-week or 12-week courses, but the education can also be as simple as receiving all of your training chairside. You’ll have to get certifications of course, but as far as learning the skills of a dental assistant, that can be done in the dental office, taught by your dentist.”

The program that Garrett oversees at CVCC offers a new path to becoming a dental assistant, in between the shorter 8-12-week courses from proprietary schools and the longer accredited programs. Students who complete CVCC’s 6-month dental assisting program can apply to take the National Entry Level Dental Assisting (NELDA) certification, a new certification from the Dental Assisting National Board (DANB).

NCOHC’s associate director, Crystal Adams, launched the NELDA certification program when she worked for CVCC. She said that her hope is for the program to offer an expedited path to dental assisting that includes a more comprehensive and accountable baseline education compared to other, faster programs.

In North Carolina, dental assistants are classified as “DA I” or “DA II” depending on their education and training. A DA II can take the DANB examination to become a Certified Dental Assistant. In some states, dental assistants are registered with Dental Boards for consumers and providers to confirm their credentials; however, North Carolina does not. Dental assistant education and training requirements can be found on the North Carolina State Board of Dental Examiners website.

While there are numerous routes to becoming a dental assistant, graduating from a Commission on Dental Accreditation (CODA) Dental Assistant Program allows a dental assistant the most comprehensive education and training for the dental field. These programs are offered at North Carolina Community Colleges throughout the state and a list of programs can be found on DANB’s website.

What Else Should I Know About Dental Assisting?

“I think that we should probably hold proprietary schools more accountable,” said Garrett.

Garrett said that more attention should be paid toward the institutions training assistants, ensuring that they are providing quality education.

“If you work for a great dentist, you are shown appreciation and know that your job is important,” said Garrett. “That has certainly been the case for me, but sometimes dental assistants are forgotten.”

Overall, Garrett thinks that dental assisting is a great profession with lots of opportunities. She also said, however, that they are sometimes underappreciated and underpaid.

“When I came in as an assistant 10 years ago, I was making $11.50 an hour,” she said. “Man have I grown since then, but there are plenty of dental offices out there where that pay range is still the case.”

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.


Managed Care for Oral Health: What’s Next for North Carolina’s Medicaid Transformation?

“Managed Care” is transforming Medicaid in states across the country. In many cases, including in North Carolina, oral health is not included in the programs that promise a shift toward value-based care. As North Carolina approaches the next phase in its Managed Care program, could, and should, oral health be included? NCOHC’s newest partnership plans to convene stakeholders across the state to find out.

A collection of state-run programs, Medicaid has traditionally been operated on a “fee for service” basis, in which government agencies across the country pay out claims for health services based on volume. For decades, this model has prevailed in both medical and oral health care.

The Shift to Managed Care

Recently, however, state-administered Medicaid programs have begun to embrace an alternative payment model. In its simplest form, “managed care” turns management of Medicaid health plans over to private insurers, paying them a set rate per patient to deliver all services necessary to keep beneficiaries healthy. Ideally, managed care supports a shift to “value-based care,” in which reimbursement policies incentivize prevention and improved patient outcomes.

Managed Care and Oral Health

Unfortunately, the national shift to Medicaid managed care has in many cases reinforced long standing “siloes” that artificially separate medical care from oral health care. In North Carolina, for instance, the state’s Medicaid program transitioned to managed care on July 1, 2021, but the initial launch only included primary care and behavioral health services. As seen in various other states, oral health care was essentially “carved out” of the new system.

With the health of so many at stake and the investment so significant, we at the North Carolina Oral Health Collaborative (NCOHC) felt it critical to ensure that consideration of the potential shift to oral health managed care includes the voices and perspectives of diverse stakeholders. While the consensus among North Carolina providers and policymakers seems to be that oral health care will be integrated into Medicaid managed care in the future, we hope that collective engagement will help inform and support the potential transition as seamlessly and effectively as possible.

Oral Health Transformation Initiative

To that end, NCOHC is partnering with the North Carolina Institute of Medicine (NCIOM) on a Medicaid Oral Health Transformation Initiative, designed to evaluate best practices and make recommendations for oral health’s potential inclusion in NC Medicaid Managed Care efforts.
The two-year, three-phase project will be led by multi-disciplinary, cross-sector stakeholders and Task Force members engaged in oral health and health care across North Carolina.

The Task Force will draw upon a systematic literature review and key informant interviews with those in and outside North Carolina. Recommendations will be compiled in a final report to be delivered to policymakers and legislators as they consider a potential transition to Medicaid managed care for oral health. This work will be completed just in time for the 2024 expiration (and subsequent renewal) of the federal 1115 Demonstration Waiver that paved the way for the current iteration of North Carolina’s Medicaid Managed Care.


To learn more, please visit our Oral Health Transformation Initiative page.

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.