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What is Fluoride Varnish?

Have you heard of fluoride varnish? This preventive treatment helps strengthen and protect teeth, reducing risk of tooth decay. Next time your child is at the dentist, or even at your pediatrician, you may want to ask about a fluoride varnish.

We know that fluoride is good for teeth, and we can get it in many ways. From fluoride toothpastes and mouth rinses (which you should use daily), to drinking water, regular fluoride intake is an important component of good oral health habits.

Fun fact: Fluoride is even present naturally in many foods and drinks, like bananas, avocados, coffee, wine, shrimp, and more.

So, what is a fluoride varnish?

Simply put, fluoride varnish is a more concentrated form of fluoride, painted onto the top and sides of a patient’s teeth. The varnish itself is not a permanent layer—it stays on a patient’s teeth for several hours, allowing the fluoride to seep into the enamel and strengthen the teeth. To visualize the process, it may help to understand how fluoride works in the first place.

The outer coating of your teeth, the enamel, is the hardest substance in your body, even stronger than your bones. But that protective layer gets weakened and eaten away when we consume foods and beverages high in sugars and carbohydrates, leading to tooth decay and cavities.

When fluoride is introduced, through toothpastes, mouth rinses, drinking water, varnish, or other sources, it actually works to “remineralize” your enamel. Additionally, before tooth decay even occurs, fluoride acts to further strengthen enamel, adding additional protection down the road.

To sum it all up, a fluoride varnish is a great way to add a serious layer of protection to your teeth, which can help you avoid costly dental procedures in the future.

Who can get a fluoride varnish?

Fluoride varnishes are mainly used for children, but the truth is that anyone at risk of tooth decay could benefit from the preventive treatment. However, most insurers, including Medicaid, only cover fluoride varnish for children. In North Carolina, in response to the COVID-19 pandemic, children on Medicaid can receive a fluoride varnish a maximum of once every three month period.

Given topical fluoride varnish’s important protective benefits, it will be important that Medicaid permanently adopt policies to reimburse fluoride placement for all age groups, even after the pandemic.

If you are an adult and are interested in a fluoride varnish, have a conversation with your dentist—they can likely help you find out if your insurance will help pay for it.

A similar treatment: dental sealants

Similar to a fluoride varnish, dental sealants create a protective layer to ward off tooth decay.. Unlike a varnish, sealants are actually semi-permanent (they do wear off eventually), sealing off grooves in your teeth and providing a protective layer against foods and drinks that can cause decay.

While fluoride varnish must be applied several times each year to be effective, sealants on children’s teeth are effective up to nine years, though they should be checked by a dentist regularly as they can wear away.

The bottom line

At the end of the day, dental sealants and fluoride varnish are two effective preventive treatments that are powerful tools to prevent tooth decay and costly dental treatments necessary to repair damaged teeth.

Unfortunately, we don’t live in a world where everyone who could benefit from preventive treatments can access them. If you have access to a dentist, they can work with you to identify the mix of preventive measures that best fits your needs. And if you don’t have a dentist, check NCOHC’s access map here to find an affordable access to dental services near you!

NCOHC is working to build a more perfect oral health ecosystem, one where all people, no matter where they live, how much they earn, what language they speak, or what their life circumstances are, can access the care they deserve. You can take action and join the movement today by visiting NC4Change.

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Teaching Equity in Dentistry

MLK Jr Quote: "Of all the forms of inequality, injustice in health is the most shocking and the most inhumane because it often results in physical death"

When creating equitable health care systems, especially at a statewide level, policy plays an important role in driving sustainable, system-wide change. Before policy can be implemented, however, advocates must start by changing peoples’ mindsets.

We recently sat down (virtually) with Dr. Sylvia A. Frazier-Bowers to discuss her role as Assistant Dean of Inclusive Excellence and Equity Initiatives at the University of North Carolina Adams School of Dentistry. Dr. Frazier-Bowers’ goal entering her position was to be an advocate working to change the mindsets of stakeholders when it comes to equity. Her goal was to teach people to be conscious of inclusivity and equity, which is now being incorporated into the Adams School of Dentistry’s curriculum.

Headshot of Dr. Sylvia A. Frazier Bowers

“Equity refers to fairness,” said Dr. Frazier-Bowers, speaking about the importance of the word equity in health care and how it differs from the word “equality.”

While equality means treating everyone the same, or providing the same inputs into a system, 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 are all different, with different experiences, abilities, disabilities, and resources available for our use, we inherently need different things in order to be successful. When all stakeholders have the opportunity to be successful, everyone benefits.

It is no secret that historically, people in the United States have been discriminated against because of race. While we have undoubtably made huge strides toward a more just society, the impact of historical injustice lives on, and there are still structures and individuals today who perpetuate inequity along racial lines.

For a non-oral health example of system-level equity with important ties to the dental world, see NCOHC’s interview with Duke Wold Food Policy Center Director of Strategic Initiatives Jen Zuckerman.

Dr. Frazier-Bowers explained that if two groups are given the same amount of a given resource, one may still be at a disadvantage if they started out further behind. When it comes to health care, equity may actually mean giving some people more help just to overcome existing disparities.

The Adams School of Dentistry curriculum is currently being revised, and the Office of Inclusive Excellence and Equity Initiatives is working to incorporate equity education into the dental school’s coursework.

“Instead of having an insular experience of, ‘Okay everyone, we’re now going to learn about equity and justice,'” said Dr. Frazier-Bowers, “It’s going to be integrated more seamlessly throughout the four-year curriculum.”

Working with experts in equity and justice education, the school designed the Advocate, Clinician, and Thinker (ACT) framework to integrate knowledge of racial equity throughout the four years of schooling, rather than as a small section.

Text of a 2018 Adams School resolution declaring UNC Dentists as "Activists, Clinicians, and Thinkers"

To further incorporate equity education into the student experience, the Adams School of Dentistry was the first to coin an Inclusive Excellence Week, offering weeklong experiences to promote equity. Working with a community of scholars from different disciplines, the Adams School of Dentistry is able to communicate regularly with content experts who can influence new ideas and portray the interconnectedness of their work. The Adams School of Dentistry’s Inclusive Excellence Week influenced dental schools at other universities to do the same.

According to Dr. Frazier-Bowers, when it comes to equity and inclusion, “Mindset is the key.”

“When I say the mindset, this refers to every time you engage in any activity,” said Dr. Frazier-Bowers. “Whether its teaching, seeing patients, being a student, or being a classmate even—think about it from a lens that considers inclusivity and equity.”

When asked about the most prevalent social injustices in dentistry, Dr. Frazier-Bowers explained how the fact that not everyone has access to reliable care is an issue. Unlike a second home or expensive car, “education and health care should not be considered luxuries,” she said.

For that reason, the Adams School of Dentistry is currently working on self-assessment and accountability measures where people can have an opportunity to reflect and search for improvement in the pursuit of equity.

“People must be willing to open their minds to truth and history,” said Dr. Frazier-Bowers.

Many oral health professionals already advocate for change and understand what needs to be done to create a lasting impact. For those who don’t, there are always ways to get involved, but you have to be willing to put in the work. The DOCSpeaks program was created by Frazier-Bowers to bridge the “knowing-doing” gap for well-meaning professionals.

In-depth blurb about the creation of DOCSpeaks

According to Dr. Frazier-Bowers, it all starts with education and an open mindset. The UNC DOCSpeaks sessions are a resource that can serve as a good starting point, and they will soon be open to the public. Outside of the education system, any community with the right leaders and the right mindset can be a catalyst for racial equity.

Want to get involved and elevate your voice? From diversity and inclusion in health care to the rising cost of health care, NC4Change is a platform for a diverse, inclusive group of oral health practitioners, public health professionals, community members, and other stakeholders who share a common goal: increasing equity and access in oral health care.

Head over to the brand new NC4Change page today and sign up for a focus group, give us feedback on our policy brief, and more!

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Fluoride Access in Western North Carolina

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

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

Image of water taps

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

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

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

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

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

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

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

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

So, what is being done to enact change?

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

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

Image of bottles of water

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

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

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

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

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

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

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

Graphic titled "Fluoridated tap water & Toothpaste"

Want to get involved and elevate your voice? From fluoridated water and teledentistry to the rising cost of health care, NC4Change is a platform for a diverse, inclusive group of oral health practitioners, public health professionals, community members, and other stakeholders who share a common goal: increasing equity and access in oral health care.

Head over to the brand new NC4Change page today and sign up for a focus group, give us feedback on our policy brief, and more!

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2020 Year in Review

"NCOHC Year in Review"

What a year…

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

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

Rule 16W Change

NCOHC kicked off 2020 with a bang.

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

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

COVID-19 & Access Map

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

Picture of NCOHC's statewide provider access map

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

Read more about the access map here.

The NCOHC Teledentistry Fund

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

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

NC Medicaid Teledentistry Billing Changes

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

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

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

Oral Health Day(s)

Graphic of Paul Glassman, the "father of teledentistry"

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

What’s Next?

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

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

Will you join us in the movement?

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

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10 Things You Should Know About Your Teeth

1. Brushing Your Tongue Can Help Bad Breath

The tongue may actually hold more bacteria than your teeth. With its many crevices, your tongue does a great job of trapping bacteria and can cause your entire mouth to smell bad. Similarly, the roof of your mouth can store bacteria, so make sure you brush them both. During the COVID-19 pandemic, “mask breath” can be a serious inconvenience. So, make sure you’re taking the necessary steps to maintain proper oral hygiene!

For more tips and tricks, download this helpful guide.

2. Keep a Routine

No matter what your habits may be, maintaining a dental routine is what really matters. While elaborate toothbrushes and other oral health tools each have their own function and benefits, they will not work without consistency. Similarly, a standard, run-of-the-mill toothbrush, if used for two minutes twice a day, can keep your mouth clean and healthy.

No matter the toothbrush or toothpaste you use, keeping up with a morning and evening routine for oral hygiene, along with healthy eating habits, are the most important steps to keeping your teeth happy and healthy.

3. Start Young

If you have children, the best time to visit a dentist is no later than their first birthday, or after their first tooth erupts. Taking preventive action early can help ensure that your children’s teeth stay healthy and strong as they grow, without major dental complications. Be sure to schedule regular dental examinations once every six months.

For more information on what to expect during your child’s dental appointments, visit this helpful page from the Mayo Clinic.

4. Oral Health Isn’t Just a Mouth Problem

Poor oral health disproportionately affects low-income families and people of color. Unfortunately, studies have shown that it is harder for people with underdeveloped hygiene or missing teeth to secure employment. Increasing education, access, and equity in oral health care can help mend some of these societal concerns.

5. Dental Anxiety

Fear and anxiety surrounding dental treatment is very common. As medical professionals begin to bridge the gap between health care services, therapists are able to work with patients to screen for common conditions like this. They can then implement breathing and relaxation techniques to provide a more comfortable visit. If you are not asked, but suffer from dental anxiety, tell your dentist and dental hygienist.

Anxious about the dentist? Try taking a stress ball with you to your next appointment. During your visit, implement mindfulness strategies, such as slowing and counting your breaths.

For more ways you can learn to cope with dental anxiety, visit https://www.mouthhealthy.org/en/az-topics/a/anxiety

6. Be Wary of Acidic and Sugary Drinks

Fun fact: enamel is the hardest substance in the human body, but it isn’t invulnerable!

Too many acidic or sugary drinks may be harming your teeth. Some beverages have higher levels of acidity than others. These drinks can eat away at the enamel that covers the outer layer of your teeth, leaving them more vulnerable to plaque and bacteria.

Too much sugar can also lead to tooth decay, and soda is one of the easiest ways to consume large amounts. Try to limit your weekly number of sugary and acidic drinks to protect your enamel.

For more on how you can prevent tooth erosion, visit https://www.deltadentalins.com/oral_health/acid_wear.html

7. Vaping and Cigarettes Can Damage Your Teeth

No smoking sign

Did you know that smokers are twice as likely to develop gum disease? Not only does smoking affect your breath, it can stain your teeth and lead to more serious complications, such as oral cancer. Similarly, the nicotine in both cigarettes and e-cigarettes can interfere with blood circulation and damage gum tissue.

Learn more about smoking and periodontal disease at https://www.cdc.gov/tobacco/campaign/tips/diseases/periodontal-gum-disease.html

8. Your Saliva is Important

Your saliva is not just for drooling. It helps naturally wash away debris from the food you’ve eaten and can defend against the acid in some of those sugary drinks. You can also thank your saliva for killing some of those germs that cause bad breath.

Without saliva, your mouth would be more vulnerable to tooth decay and gum disease. Be sure to drink water and stay hydrated to maintain sufficient saliva production.

Got dry mouth? Visit https://www.deltadental.com/us/en/protect-my-smile/basics/oral-anatomy/the-importance-of-saliva.html for more information on xerostomia (dry mouth).

9. You Can Brush Too Hard

Most toothpastes contain abrasive ingredients such as calcium carbonate that help rid your teeth of plaque and bacteria. Similarly, the bristles on your toothbrush do a good job of scraping away these harmful elements. However, brushing too hard can actually damage the enamel on your teeth, leaving them more vulnerable to tooth decay.

When brushing, use about as much pressure as you would when writing with a pencil on paper. Make sure to use a soft-bristled brush instead of a medium- or hard- bristled brush. Brush in small circles for two minutes and don’t forget to floss.

10. Don’t Ignore Your Dentist

Regular dental appointments are not just for children. The recommended timeline for teeth cleanings is twice a year or once every six months. Even with good habits, consistent dental cleanings and checkups are essential. Oral health professionals will screen for oral cancers and other diseases in your mouth that are not easily caught. So, be proactive and keep your teeth and mouth healthy and safe.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!

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NCOHC’s Policy Brief: Payment Reform

The North Carolina Oral Health Collaborative (NCOHC) released its first policy brief earlier this year, outlining a broad array of policy changes that, if enacted, would improve access and equity in oral health care for all North Carolinians.

Read the full policy brief here

Improving payment models can have a considerable impact on the care people receive, increasing efficiency and improving health outcomes. Payment reform refers to health care models that use reimbursement from insurers to providers to promote greater value for patients, purchasers, payers, and providers.

This third and final deep dive into NCOHC’s policy brief will focus on the payment reform section, elaborating on changes that can be made to make oral health care more efficient and affordable.

Teledentistry and Parity of Payment

Teledentistry has proven to be an effective means of connecting patients with their providers, especially during the COVID-19 pandemic. While remote care has proven to be invaluable in ensuring patient and provider safety, it is also a useful tool to increase equity in care, even in a post-pandemic world.

Unfortunately, some insurance plans do not reimburse for teledental services similarly to how they pay for in-person care.

Providers, especially in safety-net settings with thin profit margins, already frequently use teledentistry, sometimes without reimbursement. Safety-net providers will continue to use teledentistry to provide patients with essential care, and it is important that payment systems support this innovation in care delivery through equitable payment schedules.

Data suggest that patients receive the same quality of care via teledentistry as they do in person. For this reason, NCOHC recommends parity of payment across insurers.

Silver Diamine Fluoride

During the pandemic, there has been an increased focus on preventive care that reduces the amount of close-contact dental visits. One valuable resource in the realm of non-aerosolizing cavity management is the use of Silver Diamine Fluoride (SDF).

Aerosolizing refers to anything that can convert material into a fine spray that can be suspended in the air. Some dental procedures run the risk of aerosolizing the COVID-19 virus, leading providers to look to other, non-aerosolizing options.

When applied directly to a cavity, SDF can have a significant impact on reducing future urgent or emergent dental needs. As an efficient and cost-effective tool that doesn’t risk aerosolizing anything in the mouth, SDF is an ideal treatment to use during the ongoing pandemic.

Prior to COVID-19, payment for SDF varied widely. While NC Medicaid covered SDF, reimbursement was limited for patients five years old and younger. In vulnerable populations, however, many children may not even see a dentist before that age.

While NCOHC commends NC Medicaid for lifting all age restrictions for SDF reimbursement in response to COVID-19, it is important that these payment policies continue post-pandemic.

NCOHC recommends that NC Medicaid reimburse SDF placement for patients of any age. This will allow for more equitable access to this evidence-based treatment for both vulnerable children and adults.

NCOHC also recommends that the private payer sector incentivize SDF as a viable treatment through enhanced reimbursement policies.

Interim Therapeutic Restoration

Other viable options for non-surgical treatment of dental caries include Interim Therapeutic Restorations (ITRs). ITRs are non-permanent restorations placed on teeth to prevent cavities from progressing. Even though they are temporary, ITRs are effective reducing the negative impacts of caries until more permanent treatments can be administered.

Keeping in mind that many children rely on school-based care, this method of addressing tooth decay is particularly important because it could be delivered by hygienists, often at a lower cost. ITRs can dramatically help offset emergent needs in the immediate future. However, in North Carolina, this would be contingent on revision of delegated duties for dental hygienists.

Although many private payers currently reimburse for ITRs, a payment analysis should be done to ensure that they are incentivized as effective treatments through adequate payment models. Post COVID-19, NCOHC encourages NC Medicaid to also reimburse for ITRs.

Value-Based Oral Health Care Payment

As oral health care shifts toward a more value-based approach, focused on improving patient outcomes and lowering costs, it is necessary to think holistically about both the quality of care being delivered and how the care is delivered.

Care coordination management, addressing appointment compliance, motivational interviewing, and patient education to improve oral health literacy are services that should be covered by public and private payer sources to enhance patient-centered care.

These can be useful tools in helping people navigate treatment plans, coordinate transportation, and generally feel more comfortable engaging in social service support. All of these efforts can impact successful delivery of quality oral health care and improvement of patient outcomes.

Fact sheet titled "flip the incentive structure" about value-based care

Patient-centered care also means a patient-centered approach to financing.

When it comes to oral health management, emphasis should be placed on prevention. For vulnerable populations, it is often unknown when patients will be able to return for care. Bundling payment for services such as comprehensive oral health evaluations, prophylaxis for adults and children, topical application of fluoride and varnish, and sealants would incentivize providers to cover necessary services in a single visit.

NCOHC also recommends bundling nutritional counseling, tobacco counseling, and oral hygiene instruction as adjunctive non-paid services.

Payment reform and public policy must work in conjunction with one another to achieve long-lasting results. More often, payment reform drives changes in public policy. This means that Medicaid and private payers play a particularly important role in facilitation innovation in public health. As we begin to find new measures of success in value-based care, implementing these necessary changes will help improve peoples’ health and transform the oral health landscape.

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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Preventive Care During a Pandemic

The importance of preventive oral health care is often underestimated. There are many basic habits that can be implemented daily to reduce the risk of decay and other serious dental issues. During COVID-19, when there are more challenges to being seen by healthcare specialists, preventive care is critical.

Consistent dental exams are necessary during childhood; this is the time when issues are most treatable, and hygiene education can be implemented for long-term oral and overall health.

According to the American Dental Association, a child’s first dental exam should be scheduled no later than the first birthday or after the first tooth erupts. The American Academy of Pediatric Dentistry also recommends regular visits every six months after this.

The American Academy of Pediatrics has also developed a schedule of well-child visits to reinforce the overall well-being of developing children. This entails a recommended visit within the first week of birth, and then once a month for the first two months. After that, the child should be seen once every two months until the child is 18 months old. It is recommended the child be seen twice a year at age two, and then once a year until they are 21 years old.

Oral health education can have a significant impact on overall well-being. A common source of dental issues includes improper drinking and eating habits. If education is implemented at a young age to combat some of these dangerous patterns, future health concerns such as diabetes and obesity can be avoided. Other health risks associated with smoking and chewing tobacco can also be discussed during counseling in dental exams as children get older.

The pandemic has posed challenges to many, if not all, healthcare fields. COVID-19 has made it more difficult for patients to receive oral health care in a dentist’s office. Early guidelines from the World Health Organization advised people to delay their visits for non-essential oral health care like preventive care. This was a safety concern because dentists and dental hygienists work in close contact with their patients, and have a higher chance of spreading and contracting the virus. However, this has negative implications for peoples’ oral health.

The American Dental Association has emphasized the need for consistent dental care with safety precautions in place. During this pandemic, that means more PPE and sanitization. It is recommended that certain instruments which spray large amounts of water not be used. Dental hygienists and dentists are not able to see as many patients, due to increased time requirements between patients in accordance with surface sanitization protocols. Additionally, -travel and symptom questionnaires patients complete can also result in appointment postponements.

So, is it safe to go to the dentist now?

Many dental offices are open for routine care again, with significant safety measures in place. If you have any concerns about safety before your visit, give your dentist’s office a call and ask them a few questions, such as:

 

  1. What are your current COVID-19 protocols? doing to make sure that patients and providers are not spreading COVID-19?
  2. What kind of screening measures can I expect when I come in for my visit?
  3. How are you dealing with aerosolizing procedures? (This refers to the tools mentioned above that spray large amounts of water, a potential risk of “aerosolizing” the virus if it were present.)

What about mask breath? Can I do anything at home?

Due to prolonged periods of mask usage during the pandemic, many are becoming increasingly concerned about their own oral health.

Halitosis, a technical term for bad breath, is a preventable condition. One way to reduce “mask breath” is to brush your teeth at least twice a day, paying close attention to the tongue, which can hold large amounts of bacteria. Using fluoride toothpaste, fluoride mouthwash, and consistent flossing are also ways to prevent halitosis.

Do you have kids at home? Download this helpful guide and hang it in their bathroom to help keep their teeth healthy and happy!

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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Dental Professional-Administered Vaccines

Dentists in North Carolina are uniquely positioned to begin administering some vaccinations, like those for the Human Papillomavirus (HPV) and Influenza. Currently only three states – Oregon, Illinois and Michigan – have existing legislation that allows dentists to administer vaccines. During the 2009 Swine Flu (H1N1) pandemic, dentists were temporarily added to the pool of flu vaccine administrators in certain states, such as Massachusetts. As scientists race to create an effective COVID-19 vaccine, the dental workforce could offer important support to the medical community, helping administer the vaccine to the public as efficiently and effectively as possible.

Dentists are highly qualified health providers, and are well poised to administer vaccines. Dental students attend the first two years of dental school training in coursework mirroring that of their medical student counterparts, and thus have congruent training regarding the use of medications and management of adverse reactions. Within their daily practice, dental providers routinely administer injections in anatomically difficult positions, ensuring that they are capable of administering intramuscular injections such as vaccinations into the deltoid muscles of the upper arm.

Approximately 79 million Americans are infected with Human Papillomavirus (HPV), making it the most prevalent sexually transmitted infection (STI) in the United States. HPV is responsible for approximately 70 percent of oropharyngeal cancers and more than 90 percent of cervical cancers. However, studies have shown that cancers associated with the virus are all but entirely preventable in patients that have completed the series of HPV vaccines prior to virus exposure.

In Australia, mass HPV vaccination has been correlated with a significant reduction in cervical cancer rates. While it may never be possible to completely eradicate cervical cancer, morally it is negligent not to fully utilize every avenue to contribute in the reduction of HPV associated cancers.

Many barriers restrict rural residents’ access to primary care. According to the Agency for Health Research and Quality (AHRQ), in 2017, approximately nine percent –or nearly 31 million people–sought care from a dental provider but not a medical provider. The barriers to accessing routine medical care disproportionately affect rural children, particularly in regards to vaccination. Rural children are approximately 30 percent less likely to have completed the full series of HPV vaccines. By enabling dentists to administer vaccines within their practices, rural residents will have an additional means by which to obtain these vaccinations.

Patients will benefit from the added convenience of being able to receive vaccines within the dental setting, minimizing travel burdens for patients.

Advocating for dental providers to be able to administer vaccines must start by raising the public’s awareness of the importance of HPV vaccination and promoting their understanding of dentists’ qualifications regarding vaccine administration. If successful, this policy opportunity has the potential to positively impact rural communities statewide.

Amanda Assante, Alexis Davis, Astha Patel, and Jessica Sharrow are students in Campbell University’s public health master’s program. In the fall 2020 semester, as a part of their coursework, Amanda, Alexis, Astha, and Jessica participated in an oral health practicum experience in which they dove deep into dental professional-administered vaccines with the North Carolina Oral Health Collaborative.

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Mental Health Care in a Dental Clinic?

Mental Health and Oral Health services have traditionally been thought of as separate entities. To better provide efficient, affordable care, Greene County Health Care (GCHC) is bridging the gap, integrating medical, dental, and behavioral health services for its patients.

As a Federally Qualified Health Center (FQHC), GCHC serves patients across Greene, Pitt, and Pamlico counties in North Carolina. Their focus resides in increasing access to high-quality care for the underserved, uninsured, and underinsured.

Cori Davis, a MedFT at GCHC, went into detail about her role in connecting oral and mental health.

In the time between when a patient fills out their paperwork and is seen by a dental hygienist or assistant, Davis performs behavioral health screenings and interventions. This involves sitting down with a patient to evaluate their overall mental health.

 

 

She screens for common mental health concerns such as anxiety and depression. Davis also assesses dental pain and pain management, eating and sleeping patterns, as well as social and basic needs.

Though her brief interventions on managing chronic conditions and mental health issues can go a long way, Davis often makes referrals to other GCHC therapists, if needed.

“We have a lot of great therapists here that can devote more time to a long-term case,” Davis stated.

Additionally, Davis makes referrals to GCHC’s medical clinic for patients who need medical care.

Working closely with a social worker, therapists at GCHC can work through common issues like transportation and medication affordability. Ride-sharing services and other programs to help patients access the care they need are often covered by Medicare or Medicaid.

We asked Davis if she thought her work had a genuine impact on the overall health of the patients she met with, to which she responded, “Definitely, yes.” She explained that before patients even leave the room, they are given handouts and techniques so they may leave with tangible and practicable information.

Afterwards, there is more to be done.

“Connecting them to a healthcare system that can be with them and work with them long-term is really valuable so they have all of their services they need in one building.” Davis continued, “That really helps with continuity of care and making sure they can have sustained healthcare.”

 

 

One example of how these health screenings are linked to the oral health practice is when a patient suffers from dental anxiety. Evaluating this condition allows for the therapist to work through breathing exercises and relaxation techniques. This information is then communicated to the dental assistant or dentist so that they may implement these practices throughout the appointment.

“We’re really filling the gaps with the services we do here,” said Davis, “Because the population we serve in dental isn’t the same population for the medical side.”

Behavioral health, general health care, and oral health care are often siloed, which exacerbates barriers that many face to accessing the care they need.

“We emphasize your whole health here and we want to make sure that all of you is doing well”, Davis said.

 

 

Addressing Oral Health disparities in North Carolina is tied with improving the overall health and well-being of its citizens. Combining medical, dental, and behavioral health services has become increasingly important in this process. Collectively, these related health fields strive to better the lives of everyone, especially those who have not had the privilege of reliable health insurance and access to care.

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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School-Based Care During a Pandemic

The most important element of childhood development is overall health. With schools nationwide facing unprecedented challenges during the current pandemic, setting children up with proper oral health treatment and education early on can be a determinant of their future success.

Many children, especially in communities that traditionally lack access to care, rely on school to get the oral health treatment they require. This means that during these times, it is more difficult for many children to receive the care they deserve. In a socially distanced interview, we spoke with representatives of Kintegra Health about challenges regarding school-based care during COVID-19.

Dr. William Donigan, general dentist and dental director at Kintegra Health, and Melissa Boughman, dental hygienist and dental ACCESS program director for Kintegra Health, both touched on the importance of providing school-based care to those who do not traditionally have access to oral health care.

Transportation issues are a common theme in Title I schools. Because many parents are not able to regularly bring their children to oral health appointments due to work conflicts or lack of transportation, Kintegra Health’s mobile dentistry units are essential parts of their operation. Operating out of Gastonia, North Carolina, there are two of these mobile units, as well as a dental van for follow-up visits and sealants.

“It’s so wonderful that we’ve been blessed with these mobile dental units that we can drive right up, park, and they bring the children out to us,” Boughman said.

Donigan also emphasized the importance of comprehensive oral care in the areas they serve. “Kintegra has been very responsive to the communities that we are involved in,” Donigan said. “Our mobile dentist unit goes anywhere within thirty minutes of one of our clinics.”

When asked how Kintegra is able to provide patient care during the COVID-19 pandemic, Donigan highlighted the use of intraoral photographs submitted by parents of the children, a supplement to the care provided by the mobile dental units. This increases conservation of personal protective equipment (PPE), lowers chair time, and allows patients to avoid leaving the house altogether for non-emergencies.

However, due to the use of cell phone pictures in these virtual exchanges of information, there have been concerns about image quality.

“The advantage of talking to the parent at that point is we can have them retake and resend the photograph if it’s not good,” Donigan said. “In most instances, we can get a pretty good photograph in those environments.”

Complications in oral hygiene at a young age can extend far into the future. Taking a further look at the world of oral health through the lens of a pandemic provides information about the links between COVID-19 and future health problems in children.

“Just recently, 90 percent of the people on a ventilator with COVID had periodontal disease,” said Donigan. He also mentioned that many diseases, like diabetes and high blood pressure, have relationships with what happens in the mouth. Donigan explained that many of the children Kintegra sees are already prediabetic in elementary school, and good education early in life is vital to helping them begin to lead healthier lives.

“We see the difference in the children we have seen for many years versus the newcomers, like the kindergarteners, and in some schools, pre-k,” said Boughman. “When we see them yearly, we see a big difference. We also provide education because we all know that education is the most important part of all of this. Once we clean their teeth, [plaque and tartar] will come back quickly. But if we teach them how to take care of their teeth, they can have a lifetime of great [oral health].”

Kintegra Health now works with more than 60 schools in seven school systems ranging from Gaston County to Iredell County.

“Today, at Battleground Elementary in Lincoln County, we’ll probably see about 30 children,” Boughman said. Kintegra expects to reach nearly 7,000 children this year, provided that schools are able to maintain traditional classroom meetings.

Kintegra Health staff place an emphasis on creating a relationship with their patients. “We don’t let them fall through the cracks,” Boughman said. “We call them at least three times, and then even send a postcard.” If further dental work is needed, the dental access program assistant will contact parents to explain what was done and make appointments to return if necessary.

Now more than ever, maintaining consistent communication — and being able to provide oral health treatment, when possible — is crucial to school-based care. Kintegra Health’s practice model has become a prime example of how dedicated oral health professionals can overcome the challenges posed by COVID-19.

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!