North Carolina Oral Health Collaborative

Practicing dentistry in WNC

Meet Dr. Alice Jamison, DDS, MPH. Raised in Asheville, NC, she currently practices in her hometown at a general dental office that serves children up to 18 years of age.

After graduating from UNC Dental School in 2020, she completed a one-year general practice residency at Mountain Area Health Education Center while earning her master’s in public health.

Join us for a conversation with Dr. Jamison about what inspired her to pursue dentistry, her typical schedule, patient education, and more, below.

At the intersection of science and art

Dr. Jamison knew she wanted to be a dentist early on because it combined her two passions: science and art. “When I was looking around at careers, I knew I wanted to do science. My parents are artists, and I knew I wanted to do something with art or something creative,” she said.

“When I was shadowing my dentist in high school, I saw her working on a crown, and it’s just so detailed, so delicate that I was like, ‘oh, that’s beautiful.’ It’s so beautiful, and it’s beautiful to be able to create, and it’s beautiful that your creations can help people.”

Dr. Jamison sees connections between what she does in and out of the office, including her creative hobbies. “When you remove a cavity from a tooth, and then you put the filling material back in, you are essentially trying to re-create the anatomy of what you removed, so you’re re-creating the grooves and the cusps of the tooth,” she said.

“I feel like it’s similar to a very, very minute sculpture technique, and that’s also why I think I would be a jeweler and why I love jewelry (making) so much, it’s fine, detailed art. That’s why I feel like dentistry has such an art aspect to it, and that’s why I originally got into it.”

For Dr. Jamison, beauty meets function in dentistry. “I do think it’s very beautiful, and then you learn about the anatomy of the teeth, and you learn about the function and everything, and that’s where science comes in,” she said.

“Then, you’re sculpting it, knowing that this person is going to be biting on it and knowing the best ways in which what you are creating needs to function, and that’s how the intersection happens.”

A typical week at Best Bites dental office

Dr. Jamison sees an average of 40 to 60 patients daily. She said she is constantly busy, from taking notes to performing fillings and extractions, placing crowns, and checking cleanings; the work is fast-paced.

In her experience, many people have misconceptions about dentistry, “A lot of people think that the dentist is the one who just comes in and looks in their mouth after they get their cleaning, and they’re like, ‘good to go,’” she said. “And so, they’re like, what are you doing with your day? You come in for three minutes, and then you leave.”

Her week typically involves three days at the dental office and one day at the Asheville Surgery Center, handling operating room (OR) cases. On her OR days, she sees three to four patients who need “full-mouth work,” such as multiple extractions, crowns, or fillings. These patients cannot receive care at the office because they are either very young, experience high dental anxiety, or have an intellectual or developmental disability.

“They wake up and everything’s done, and it’s a very lovely service to be able to provide for the patient and for the parent because, in my mind, it decreases the trauma associated with dentistry,” she said. “The parents often hold a lot of anxiety, so, for them, it’s a little bit easier.”

Serving pediatric patients in Western North Carolina

About 75% to 80% of Dr. Jamison’s patients have Medicaid insurance. “In western North Carolina, we are one of a very few number of offices that are constantly accepting new patients on Medicaid,” she said.

Medicaid reimbursement rates in North Carolina have not seen a meaningful increase since 2008, leading many providers to avoid accepting the insurance, as it can be challenging to operate without a loss.

“We have people drive from Tennessee. We have people who drive from down the Piedmont area up,” she said. “Not as much, but sometimes down from near South Carolina. I know a family that comes two hours to us.”

Dr. Jamison’s boss and the owner of Best Bites, Dr. Paynich, started the practice about twenty years ago. “When I initially opened, the vast majority of my patients came in as Medicaid patients. I’ve never been a quote-unquote Medicaid office or limited to Medicaid only,” he said.

“Obviously, there’s essentially massive demand for dentists to treat these kids. Word very quickly got out, and I found myself to be very, very busy, quickly,” he continued. “If you can be efficient, you can get more done in a quality manner.” In addition to Medicaid, Dr. Paynich said they accept various insurance types and payment options, from cash to care credit.

The current Medicaid reimbursement rate is 34 cents on the dollar, and most private practice oral health providers do not accept a meaningful number of patients with Medicaid insurance (billing over $10,000 annually).

“So, as far as the Medicaid side of it goes, the only way that you can make it work is to be very busy. I mean, you have to do twice the work to earn the same amount of money, if not more, and that’s basically how I’ve done it,” he said.

“I have always just worked incredibly hard. I’ve trained my staff to be relatively efficient to, you know, do things like if a child comes in for a cleaning and they have a cavity to try and go ahead and set up for it and take care of it that day.”

Dr. Paynich emphasized that his goal has always been to provide a dental home for kids, rather than increase production and collection. “My practice has always been focusing on patient care, good visits for the kids, treating parents well, and providing a good service,” he said. “My primary thing has always been the dentistry, not the metrics of the practice.”

Despite the challenges posed by stagnated reimbursement rates, Dr. Paynich said the reason he continues to operate his practice this way is because he likes it. “I think encouraging providers to accept Medicaid is important. I think encouraging Medicaid to treat providers well is very important,” he said.

As a public health advocate, Dr. Jamison said, “I do wish that our field did have more compassion for acting as a safety-net for folks.” However, she recognized that everyone has their own path and said, “Everything I say is just my take on dentistry, and there’s no right way or wrong way to practice it and to be a dentist.”

Top concerns about pediatric oral health in the region

One of Dr. Jamison’s biggest concerns is misinformation or lack of information about oral health care and hygiene. “I wish that it was taught in school or combined with nutrition,” she said. “It’s not just sugars; it’s carbs that stick on your teeth and cause cavities as well.”

Along with motivating teenagers to care for their teeth, Dr. Jamison spends significant time educating parents and caregivers. “A lot of young parents don’t know how much sugar is in breast milk, and so they will just breastfeed for a very long time and may not be cleaning their kid’s teeth when they start coming in when they should,” she said.

“The teeth come in around six months; the first ones and the last baby teeth erupt around two years,” she said. “I’ll see two-year-olds or three-year-olds who have cavities on almost every tooth. These young parents, first-time parents [are] distraught because they didn’t know, and they’ll blame themselves, and they beat themselves up. It’s a conversation I have again and again of telling them it’s not your fault.”

Continue the conversation with Dr. Jamison in Part 2

Whether you work in the dental field, are considering a career in oral health, or simply want to learn more, we hope you find this provider profile insightful. In part two, Dr. Jamison will discuss Hurricane Helene’s impact on oral health, her passion for her work, the importance of patient education, and her perspective on care integration.

NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. Sign up for our monthly newsletter to join the network and get involved!

Related reading

• 2024 Portrait of Oral Health

“The consequences of inaction are severe, but so are the opportunities for meaningful change. That’s why the work we do here matters—because when we invest in oral health, we invest in a healthier, more prosperous North Carolina.”

— Representative Maria Cervania

NCOHC joined fellow programs at the Foundation for Health Leadership & Innovation for our annual legislative breakfast on February 18, 2025. Alongside the North Carolina Rural Health Association (NCRHA) and the Center of Excellence for Integrated Care (COE), we unveiled and advocated for a robust slate of policy priorities for the 2025-2026 legislative session.

A standing-room-only crowd of more than 120 elected officials, health professionals, and advocates from across North Carolina joined us to hear from state legislators and health experts, network, and find opportunities to work together for a healthier future.

Speaking to rural health priorities, Representative Timothy Reeder and North Carolina Healthcare Association President & CEO Josh Dobson shared their thoughts on topics ranging from prior authorization to the state of health under the current federal administration.

On the topic of behavioral health, doctors, Alexandra Cupito and Lauren Hanley spoke about COE’s primary policy objective—providing mental health well checks for youth in North Carolina—and shared personal experiences trying to provide, and be reimbursed for, preventive mental health services.

For more on NCRHA and COE’s priorities and legislative breakfast speakers, check out FHLI’s recap post.

Oral Health: A Human Right and Priority for Overall Well-Being

Representative Maria Cervania, an epidemiologist and biostatistician, took to the podium to speak to NCOHC’s slate of policy priorities, focusing significant attention on the recently filed House Bill 60, which would increase Medicaid dental reimbursement rates if passed into law.

“This bill focuses on appropriations and budgeting for dental services, aiming to enhance funding for oral health programs within the state’s Department of Health and Human Services,” said Rep. Cervania. “It is not a perfect bill, though it is a step in a positive direction.”

Rep. Cervania also spoke to the importance of advocacy from all corners of North Carolina. She said that everyone has a role to play in turning advocacy into action. If communities work together, she continued, they can change policies to expand access to care, invest in education and workforce development, and strengthen collaboration between providers and communities to provide more holistic care.

“At the end of the day, oral health is not just about smiles–it is about dignity, opportunity, and justice,” she said.

NCOHC’s 2025 Policy Agenda

This year, NCOHC is advocating for:

• Codifying revisions to General Statute 90-233 to allow for alignment of dental rules 16W and 16Z
  Dental rules 16W, regulating public health hygienists, and 16Z, regulating limited supervision hygienists, conflict and create inefficiencies in practice. By updating General Statute 90-233 and establishing regulations to support it, we can create efficiencies and better allow hygienists in public health and limited supervision settings to care for North Carolinians.
• Increasing North Carolina Medicaid dental reimbursement rates
  With low reimbursement rates, which haven’t seen a meaningful increase since 2008, North Carolina’s safety net is weakened, creating gaps in care that can lead to dental disease and costly surgical procedures. By modernizing reimbursement rates, the North Carolina Legislature can help retain and strengthen the safety net, providing more preventive, cost-effective care.
• Beginning to reimburse for necessary school-based dental examinations
  NC Medicaid reimburses dental providers for limited oral evaluations through teledentistry, but it currently does not reimburse for periodic oral evaluations, negatively impacting the sustainability of school-based programs. By reimbursing for teledental periodic oral evaluations, safety net providers can more effectively and affordably provide care in non-traditional settings like schools and elder care facilities.
• Collecting data to inform workforce development needs
  Dental workforce data, especially for hygienists and assistants, is limited in North Carolina. By collecting data to illuminate a detailed view of the dental provider landscape through the licensure renewal process, North Carolina can better understand and prepare for its future workforce needs.

Already in the 2025-2026 legislative session, a bipartisan slate of legislators have filed House Bill 60, which would provide the first meaningful increase in Medicaid dental reimbursement rates since 2008.

This legislation is vital and would accomplish NCOHC’s primary legislative objective this session. Oral health providers across North Carolina are in desperate need of an increase to Medicaid reimbursement rates. At NCOHC, we are thrilled by the opportunity this legislation would provide, allowing more dental teams to offer quality care to more North Carolinians.

Get Involved

Here are a few ways you can act today:

• Contact your representatives about House Bill 60. As of February, the North Carolina legislature is preparing to engage in budget negotiations. Whether House Bill 60 passes on its own or is incorporated into the full state budget, we are asking our network to tell their legislators to support Medicaid dental reimbursement rate increases in 2025. Use this resource to find your representative, and see the sample script at the bottom of this post for additional guidance.
• Download and read the 2024 Portrait of Oral Health to learn more about the state of oral health in North Carolina.
• Download and read NCRHA’s 2025 Rural Health Snapshot for a broader perspective on health and health care across North Carolina.

Personalize this sample script and contact your legislators about House Bill 60

Senator or Representative (Insert Name),

To improve access to quality dental care for North Carolinians who need it most, I urge you to support the inclusion of HB 60, Modernize Medicaid Dental Rates, in the state budget.

The cost of providing dental services continues to rise. Still, Medicaid reimbursement rates in North Carolina are the same as in 2008, forcing dentists to limit the number of Medicaid patients they can treat. Patients struggle to access critically crucial oral health care without dental providers. Poor oral health is associated with poor systemic health, including diabetes, dementia, heart disease, stroke, and colon cancer.

Increasing reimbursement rates could strengthen the provider network and improve access to quality care for children and adults. HB 60 would increase dental Medicaid reimbursement rates for child and adult dental services by 30%. I urge you to support this vitally important legislation to improve access to quality dental care for North Carolinians.

Thank you,
(Insert Name)
(Insert Address)

The NCOHC team traveled to Sylva in January 2025 for a much-anticipated in-person convening with Western North Carolina (WNC) Steering Committee members. The original meeting, scheduled for October 2024, got postponed after Hurricane Helene devastated the region.

Before discussing 2025 policy priorities and taking a tour of Southwestern Community College’s brand-new dental facility, providers across WNC shared their experiences during and after Hurricane Helene.

Strength in unity in the wake of a natural disaster

Everyone spoke about bright lights during the storm, highlighting ways their personal and professional communities united to support each other. Several people talked about losing their own homes, family members who were displaced, and the difficulty of dealing with loss while simultaneously meeting with colleagues and working hard to resume patient care.

“Her house flooded, and she was taken out in a boat,” said Dr. Katherine Jowers, speaking about her mother’s harrowing escape from Helene’s floodwaters.

Dr. Jowers talked about how moving it was to see her colleagues come together and immediately start working to get the Mountain Area Health Education Center (MAHEC) back online, despite her absence as she worked to ensure her family’s safety.

Denise Collier, a public health hygienist with the Mountain Community Health Partnership, said, “There are some places in Yancey County that just recently (four months after the hurricane hit) got their power back on.”

“The immediate aftermath of the hurricane was very uncertain,” she said. “We didn’t even know if our dental building was still standing. Our patients have high levels of toothaches and abscesses, so we were very concerned about them. Even if the building was still standing, how were they going to get to us?”

Resource delivery and coordination to meet children’s dental needs

Mellie Burns, RDH, the children’s dental program manager for the Eastern Band of Cherokee Indians Public Health and Human Services, spoke about how lucky her part of Western North Carolina was. The farthest western counties were largely spared from Helene’s devastation.

Burns also said that the Qualla Boundary quickly became a focal point for coordinating relief supplies, and it was inspiring to witness the volume of support that came in from across the country.

She specifically spoke about receiving an anonymous truckload of toothbrushes.

“I have no idea where they came from,” she said. “Our tribal relations director reached out to me and asked me to help get them where they need to go.”

Burns said she helped coordinate deliveries across WNC, prioritizing schools and other facilities that could distribute the toothbrushes to children who needed dental supplies.

After discussing Hurricane Helene, the WNC Steering Committee turned its attention forward. The committee discussed policy opportunities to invest in disaster resilience, ease the regulatory burden on providers in a disaster setting, and improve overall conditions for public health care across the region.

Learn more and get involved

To learn more about the impact of the storm and opportunities to improve oral and rural health, check out our 2024 Portrait of Oral Health and our FHLI partner program the North Carolina Rural Health Association’s 2025 NC Rural Snapshot report. In it, you will also find an interview with Dr. Rob Temple about the value of integrated care.

The oral health workforce has long struggled with racial, ethnic, gender, and socioeconomic diversity. According to a recent North Carolina Institute of Medicine task force report, White males continue to represent the majority of dentists, while White females have long dominated the dental hygiene profession. This disproportionate representation is especially prominent in North Carolina.

Many factors contribute to the disproportionate race, ethnicity, gender, and socioeconomic representation in the oral health industry and leadership today. This lack of diversity plays a part in the oral health disparities we continue to see. We need systems-level changes to create a future where access and equity in the oral health workforce and care delivery are the norm.

This blog post explores oral health workforce demographics, the key role of integrated care, and more.

Racial & Ethnic Demographics of Oral Health Providers

Research shows historically underrepresented racial and ethnic (HURE) dentists provide care to a significantly higher number of patients who share their race and patients with Medicaid insurance compared with White dentists.

In 2017, 25% of White dentists treated at least one Medicaid patient compared with 46% of Black/African American dentists and 33% of Hispanic dentists. Additionally, 30% of Black/African American dentists and 22% of Hispanic and Asian dentists, respectively, treated 100 or more Medicaid patients compared with just 12% of White dentists.

These numbers underscore the critical role HURE dentists play in advancing oral health access and equity for HURE patients and patients with low incomes by providing disproportionately higher rates of care to these communities.

Improving, yet still, a long way to go to achieve true representation

Sheps Health Workforce NC reports, “Of the recent graduates of NC dental schools between 2017 and 2022, 6% identified as Hispanic, and 14% identified as Black/African American, compared to 2% of NC dentists in 2022 who identified as Hispanic and 9% who identified as Black/African American.” Despite this increase, the dental workforce does not yet reflect the state’s racial and ethnic diversity.

Gender Demographics of Oral Health Providers

When it comes to gender diversity, ADA Health Policy Institute data shows that nationally, “the percentage of dental school graduates who are women grew from 46% to 50.6% between 2009 and 2019, and the percentage of dentists in the workforce who are women grew from 24.1% to 34.5% between 2010 and 2020.”

Although more women are entering dental school and the workforce, they remain unrepresented in leadership positions. Cindy Roark, DMD, of Florida, writes in a Dentistry Today article:

“At its most basic level, a diverse leadership team means a health care organization will naturally have a greater understanding of the populations it serves.”

This highlights the immense value of having both a diverse workforce and diverse leaders within it. From improving health outcomes to increasing access and equity and advocating for systems change, we need representative voices at every level of the health system driving decisions.

Building Wealth & Addressing Inequities

In 2024, the North Carolina Institute of Medicine (NCIOM) Oral Health Transformation Task Force released 14 recommendations in a comprehensive report. The seventh recommendation is: “Increase the number and improve distribution and diversity of members of the dental team in North Carolina with a focus on Medicaid-serving and rural practices.”

Two strategies for the seventh recommendation include:

1. Evaluating the Forgivable Education Loans for Service (FELS) program.
2. Convening oral health education programs to “identify best practices to address challenges and opportunities to increase the diversity of the oral health workforce.

The FELS program is a crucial component of making paths to dental careers accessible. Although dental school costs are a barrier for many prospective students, according to the American Dental Association (ADA) Health Policy Institute, educational debt levels for dental school graduates vary significantly by race. Black/African American dentists, by far, graduate with the highest levels of educational debt.

When our team spoke with Jen Zuckerman from the Duke World Food Policy Center about equity work, she emphasized the need to consider who financially benefits from a given industry like oral health. Throughout American history, Black/African American communities and communities of color have been structurally left out of many, if not most, opportunities to build generational wealth.

From the GI Bill and redlining to college admissions, loans, and more, “the white community has continually gotten investment through policies, programs, and initiatives,” said Zuckerman. “And communities of color have continually gotten programs and services, which do not build wealth.” Income is a major social driver of health (SDOH) that more diverse employment in high-paying industries like dentistry can significantly impact.

Advancing Equity Through Education & Integrated Care

Education and integrated care are other key components of addressing persistent health disparities and health access and equity issues. Along with supporting a more diverse oral health workforce that represents the population it serves, educating all oral health professionals about SDOH can lead to a greater understanding of how to provide whole-person, whole-community care.

Several of the NCIOM Task Force’s 14 recommendations to deliver equitable, accessible, integrated, high-quality oral health care in our state discuss the need for a diverse oral health workforce and culturally responsive care:

“The composition of the oral health workforce can also influence disparities. Racial and ethnic minorities, as well as individuals from lower socioeconomic backgrounds, are underrepresented in the dental profession. This lack of diversity can lead to cultural and linguistic barriers that impede effective communication and trust between patients and providers. By strengthening the oral health workforce and addressing disparities in access to care, we can work toward achieving equitable oral health outcomes for all populations.” (page 26)

Research shows that up to 80 percent of a person’s overall health can be attributed to SDOH or non-medical factors. These can pose intractable barriers for countless North Carolinians seeking oral health care. Care integration (e.g., social work in dentistry) has been shown to increase access and equity in oral health, benefiting patients and providers alike.

For parts one and two of our Oral Health Care Integration Case Study blog posts, our team sat down with Kelsey Yokovich, MSW, FHLI Community Voice Program Manager, and Jamie Burgess-Flowers, MSW, LCSW, Assistant Professor and the Director of Integrated and Applied Behavioral Sciences at High Point University, 2022-202 Bernstein Fellow, and member of our advisory team, to talk about the value of integrating social work into dental care and education to improve patient care.

They met at the University of North Carolina (UNC) Chapel Hill, where they supported the School of Social Work and Adams School of Dentistry (ASOD) program that provides students with interprofessional workforce development and learning opportunities related to SDOH. Yokovich spoke about the experiences many people face when accessing oral health care and asked an important question:

“What are we doing to serve those communities that don’t look like the oral health providers, that don’t look like the hygienists, that don’t look like the dental assistants? Because that can all create a very traumatic environment for those who even just show up to the dentist.”

Having a health provider who can understand and validate a patient in various ways, including experiences impacted by gender, ethnicity, race, language, and culture, has been shown to improve quality of care.

How Integrated Care Can Bridge Gaps

Social workers bring invaluable knowledge and expertise to dental offices and other medical care settings. By providing education, consultation, and support, they can help oral health professionals deliver better, culturally attuned care to patients and create more accessible, equitable, and inclusive spaces.

Ultimately, this can create a ripple effect, enabling people to develop new relationships with oral health providers and have different experiences in dental offices. Paired with targeted approaches to increasing diversity in the oral health workforce and enabling HURE students to build wealth, these are paths to advancing access and equity.

The Critical Need for Cultural Attunement

In addition to working together through the interdisciplinary UNC program, Yokovich and Burgess-Flowers collaborated on a research paper, Is Competence Enough? Promoting Cultural Attunement in Dental Education, focused on the Hispanic/Latine population, which “is the largest and fastest-growing non-majority ethnic group in the United States but bears one of the highest oral disease burdens in the country.”

According to the abstract:

“Providing culturally attuned care has been shown to be imperative in addressing widespread health disparities for racial and ethnic minority populations across the United States.”

Yokovich describes culturally attuned care models as “focus[ed] on the ability of systems to provide care to patients with their unique experiences in mind, such as their ethnic background and cultural beliefs.”

The term demonstrates a provider’s commitment to adapting to care for each patient’s unique needs and lifelong learning. In comparison, ‘culturally competent’ care denotes a one-size-fits-all approach with a point of completion.

Integrating social work into dental education and social workers into oral health care settings can transform how providers engage with patients and how patients access and experience care.

Opportunities for Action

To build a more equitable oral health system for all North Carolinians, we need policies that address ongoing issues like those rooted in structural racism and create pathways for a more diverse oral health care workforce.

Oral health providers, educational institutions, governmental agencies, and other partners can:

• Read the NCIOM Oral Health Transformation Task Force recommendations to learn about systems-level change strategies to create a patient-centered future.
• Read NCOHC’s 2024 A Portrait of Oral Health for the latest data and research to better understand the oral health landscape in our state.
• Advocate for policies that make dental education more affordable, including loan forgiveness programs, especially for serving rural communities.
• Seek training for yourself and your office on topics like cultural attunement.
• Learn about ways to implement care integration into your practice and work with a social worker to improve patient care.

NCOHC is working alongside our statewide partners to support oral health workforce development. Part of our efforts are guided by some of the NCIOM Task Force recommendations. Stay tuned and engage with us!

NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. Sign up for our monthly newsletter to join the network and get involved!

Related Content

• Oral Health Care Integration Case Study Part I: Social Work in Dentistry
• Oral Health Care Integration Case Study Part 2: Social Work in Dentistry
• Racism, Food, and Your Mouth: Parallels Between Food and Oral Health Equity

If you’ve ever experienced pain or discomfort in your jaw, you might have heard someone casually refer to it as “TMJ.” But what does that really mean? And is it accurate? It’s common for people to mix up TMJ, which refers to the temporomandibular joint itself, with TMD, which stands for temporomandibular joint disorders.

Understanding the difference is crucial because while everyone has a TMJ, not everyone experiences the pain and complications that come with TMD. Let’s dive into what these terms mean, how to recognize a TMD, and what you can do if you’re suffering from jaw pain.

TMJ vs TMD

TMJ stands for temporomandibular joint, which is a joint in our mouths. There is one TMJ on both sides of your mouth, and it connects the jawbone to the skull. TMJ Disorders (TMD), on the other hand, may cause pain in your jaw or mouth.

How Do You Know if You Have a TMD?

Signs of TMJ Disorders (TMD) may vary from person to person. The Mayo Clinic provides the following list of symptoms for TMJ Disorders:

• Pain or tenderness in the jaw
• Pain in the TMJ joint
• Pain in the ear area
• Pain while chewing
• Pain or ache in the face
• Locking of the jaw
• A clicking sound in the jaw accompanied by pain

There are many causes of TMJ Disorders, including injuries, teeth grinding, arthritis, or general wear on the joint, and every case is unique.

Diagnosing & Treating TMD

If you have any signs of TMD, you should see your dentist. They can evaluate your jaw and determine the best course of action. During your appointment, they will examine your jaw, feel for pain, and check the alignment of your jaw bones. If necessary, they may order an X-ray, MRI, or scan to examine your jaw more closely.

According to The Cleveland Clinic, there are many treatments for TMD, and your dentist will determine which is best for you. These include cold/heat therapy, bite guards/night splints, medications, and/or dental treatments. If needed, the dentist may recommend other treatments for more severe cases of TMD, such as injections, ultrasound or radio wave therapy, or surgery.

How Long Does TMD Pain Last?

According to the experts at the Mayo Clinic, most TMD pain is temporary. It can range from mildly annoying to severely painful, but the good news is that it’s often treatable, especially when caught early.

While it’s easy to confuse TMJ with TMD, understanding the distinction can help you better identify and describe the pain or discomfort you might be experiencing in your jaw. If you have jaw pain, clicking, or locking symptoms, contact your dentist or doctor for an evaluation. They can suggest at-home care or recommend more advanced treatments to get you feeling better!

NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. Sign up for our monthly newsletter to join the network and get involved!

Natural disasters impact every aspect of our lives in obvious and unexpected ways—oral health is no exception. As the climate crisis continues, we see increasingly catastrophic storms worldwide, and areas such as Western North Carolina (WNC) that were previously considered climate-safe face levels of destruction never experienced before.

In the aftermath of Helene, a remarkable combination of community response and federal and state support has coalesced to aid recovery across the region. Despite monumental effort across the board, the disaster has exposed vulnerabilities and existing disparities that will take significant time to fix.

While oral health might not be among the most pressing needs immediately after a natural disaster like Hurricane Helene, addressing dental needs as Western North Carolina recovers will be vital for overall health and ensuring people have access to the care they deserve.

In this blog post, we’ll discuss common effects of natural disasters on oral health, short- and long-term responses, and opportunities for meeting dental needs across WNC.

How Natural Disasters Can Impact Your Oral Health

Hurricane Helene exceeded all storm damage predictions, and many people found themselves unprepared, trapped, or otherwise suddenly cut off from the world. When a natural disaster shuts down everything from power to the internet and access to drinkable (also known as potable) water for an unknown amount of time, simple daily tasks like teeth brushing and oral hygiene routines quickly get upended.

Here are a few ways events like natural disasters can affect oral health:

• Disrupted Oral Hygiene Routines: Disasters can restrict access to clean water, including municipal water systems that provide fluoride and hygiene products, impacting oral care routines. These interruptions increase the risks of developing cavities, gum disease, and infections, especially in prolonged emergencies.
• Stress-Related Dental Issues: High-stress situations often lead to teeth grinding (bruxism) or jaw clenching, which can cause worn enamel, cracked teeth, and TMJ (temporomandibular joint) pain.
• Reduced Access to Dental Care: Disaster-impacted areas may have limited or no access to dental clinics, causing minor dental issues to worsen over time due to a lack of immediate treatment options. This is especially true in communities already facing various barriers to accessing oral health care before the event.
• Nutritional Challenges: Emergency food supplies often contain processed, sugary items, elevating the risk of decay and gum issues over time, especially without clean water to wash away excess sugar particles.

Daily routines like oral health may be forgotten in the immediate aftermath of a disaster, but that doesn’t mean it is any less critical. Preparing a dental hygiene kit with an extra toothbrush, toothpaste, floss, and water bottle for yourself and your family can help you maintain your oral hygiene routine during a natural disaster or other emergency.

Remember to drink water during and after eating, especially sugary and processed foods, when possible.

Addressing Oral Health Needs During a Natural Disaster Public Health Emergency

As we learned during the COVID-19 pandemic, systems-level measures can help mitigate risks and support long-term well-being during a public health emergency (PHE).

After Hurricane Helene, traditional and non-traditional points of care stopped in Western North Carolina. Without access to reliable electricity and water, dental offices were forced to suspend services, and with schools shut down and roads closed, mobile dentistry was (and in many places remains) an unfeasible option to access care.

Delays in otherwise routine care will create backlogs, especially in public health settings where providers already face heavy patient caseloads.

Temporary NC Medicaid Direct Flexibilities

Part of North Carolina’s state response has been to implement temporary NC Medicaid Direct flexibilities for dental providers during the Hurricane Helene PHE, including:

• Teledentistry
  • Adds a code for telephone or audio-only encounters that don’t result in a diagnosis
  • Expands a code for synchronous encounters, with or without a dentist present
  • Allows a code for asynchronous encounters using recorded video or photos
• Radiographic Images
  • Allows an override for the one-year limit for bitewing radiographic images and the five-year limit for panoramic radiographic images
• Denture Replacement
  • Allows an override of the 8-year limit on partial dentures and the 10-year limit on complete dentures for appliances lost in the hurricane
• Fluoride Varnish
  • Allows topical application of fluoride varnish for all ages

Keep an eye out for more information from the NC Department of Health and Human Services regarding Hurricane Helene recovery measures.

Mobile Dental Clinics & Teledentistry

In the coming months, deploying more mobile dental clinics and using teledentistry whenever possible will be important in addressing the long-term oral health care needs of impacted communities.

These access points are already vital for people in rural and underserved areas. Expanding them even further is crucial as the impacts from Helene pose additional barriers, exacerbating access and equity issues even more.

As roads re-open, classes resume, and internet access is restored, mobile dentistry and teledentistry will play essential roles in providing care missed during the immediate aftermath of the hurricane.

Trauma-Informed Oral Health Care

Natural disasters are traumatic to live through. “There is no right or wrong way to feel when a disaster hits, and people will continue to experience the emotional impact long after the storm has passed,” said NC Health and Human Services Secretary Kody H. Kinsley. “Helping western North Carolinians rebuild means also helping them heal.”

In the wake of a disaster, trauma-informed care becomes especially important across disciplines to support whole-person health. For oral health providers, it will continue to be critical to account for additional layers of dental fear and anxiety that patients may experience.

Trauma-informed care is an approach that acknowledges the impact of trauma and its effects on health and well-being. Oral health providers can take steps to support themselves, their patients, and their staff, aimed at avoiding re-traumatization. Here are a few ideas:

• Maintain open communication with patients and engage them throughout the treatment process, including asking what they need to feel more comfortable (e.g., wearing earplugs, headphones, or sunglasses, taking breaks when needed, etc.)
• Schedule trauma-informed training for all staff members (e.g., dentists, hygienists, assistants, technicians, receptionists, and security personnel)
• Consider making sensory-friendly changes to the office environment (e.g., calming music, soothing scents, etc.)
• Collaborate with local organizations and other providers, share valuable information about accessing resources, and make helpful referrals to address pressing needs

You can learn more in the Trauma-Informed Care and Oral Health: Recommendations for Practitioners from the Illinois ACEs Response Collaborative.

Stay Tuned for More on Oral Health Care in WNC Post-Helene

In the coming months, NCOHC and our partner organizations at the Foundation for Health Leadership & Innovation will publish more information about Hurricane Helene and access to care in Western North Carolina. Stay tuned for more about:

• Food and nutrition after a natural disaster.
• Lessons learned from past natural disasters.
• Future implications and opportunities for public health.
• How Hurricane Helene has further exposed existing Internet access and equity gaps.

NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. Sign up for our monthly newsletter to join the network and get involved!

Resources

• NCRHA Hurricane Helene Relief Resources
• Donate Oral Health Care Supplies to WNC
• NC Medicaid Direct Temporary Flexibilities
• How Natural Disasters Can Affect Your Oral Health
• Guidance on How to Safely Reopen Your Practice
• Trauma-Informed Care and Oral Health: Recommendations for Practitioners [PDF]
• Trauma-Informed Care in Oral Health Care: The role of dental hygienists

Related Content

• Children’s Dental Health Post-COVID 19
• Dental Anxiety and The Role of Providers in Facilitating Approachable Care
• Oral Health Care Integration Case Study Part I: Social Work in Dentistry
• Oral Health Care Integration Case Study Part 2: Social Work in Dentistry

Visiting the dentist can be anxiety-inducing, leading people to avoid seeking care. The common fear of the unknown, financial concerns, and past negative experiences can intensify these worries. Luckily, there are many ways to address dental anxieties and help improve access to oral health care.

Trust and Communication

Whether stories come from family and friends or social media, adverse experiences at the dentist are easy to find. This reality is important for providers to understand. There will be patients who come to an appointment afraid of what may happen. There will also be people who never seek out care due to dental anxiety, fear, and shame about the condition of their oral health.

A provider who actively builds patient relationships can create a more comfortable environment that puts people at ease. Through genuine, trusting relationships, dentists can better understand patient concerns, answer questions with kindness and compassion, and clearly explain dental terminology. This dialogue and information exchange can help people weigh the pros and cons of proposed treatments.

Individuals who trust their dentist will also feel more comfortable sharing personal information without fear of judgment. These additional details can give the provider a better idea of which treatments to recommend and identify any potential obstacles. Establishing a relationship will increase the patient’s willingness to seek help from their provider to improve any conditions that may develop and keep existing ones in check.

Understanding Treatments

Quality patient-centered care is paramount. Not everyone knows why fluoride is beneficial, why teeth become sensitive, how a cavity gets filled, or the root canal process. However, understanding these procedures can help people feel safe when receiving care.

Dentists, hygienists, and assistants can often explain these treatments. Clear explanations can help patients build trust with the entire dental team by ensuring they have a positive experience throughout the ongoing process of receiving care.

When thinking of ways to develop positive relationships with patients, providers should consider the following:

1. Make sure to thoroughly explain procedures before the appointment day, if possible. 
2. Allow adequate time for patients to ask any follow-up questions.
3. Offer guidance on at-home hygiene practices and product recommendations.
4. Discuss key ingredients to look for in toothpaste and mouthwash to equip patients with the information they need to look for the best products.
5. Learn about, seek training in, and incorporate trauma-informed care and motivational interviewing practices.

Over time, as treated conditions improve, patients will feel more confident in their provider, encouraging them to follow any routine adjustments they recommend.

A trusting, collaborative patient-provider relationship is essential for positive outcomes. The role of a health care provider is to educate patients while providing high-quality care aimed at improving overall quality of life in the short- and long-term.

NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. Sign up for our monthly newsletter to join the network and get involved!

Related Content & Resources

• Dental Anxiety and The Role of Providers in Facilitating Approachable Care
• Oral Health Care Integration Case Study Part I: Social Work in Dentistry
• Oral Health Care Integration Case Study Part 2: Social Work in Dentistry
• NCIOM Task Force: 14 Recommendations for Patient-Centered Oral Health
• Trauma-Informed Care in Oral Health Care: The role of dental hygienists
• Using Motivational Interviewing in Dentistry Video Series

Dentists, dental assistants, and dental hygienists work together as a team, making sure a dental office functions like a well-oiled machine. Have you ever considered a career as a dental assistant? If you have, NCOHC has some tips for you!

As a dental assistant, you can fill plenty of different roles. Some work chairside, helping dentists and hygienists care for patients. You can also work as:

• An office manager, helping schedule appointments, handling day-to-day activities, and managing the business side of dentistry.
• A sterilization technician, keeping dental instruments and treatment rooms clean and ready to use.
• A treatment plan coordinator, working with providers and patients to map out health care needs and keep track of appointments and follow-up care
• And more!

Becoming a Dental Assistant

There are several paths you can take to become a dental assistant. If you enroll in a program at an accredited school, you can graduate and enter the workforce as a DAII (Dental Assistant II).

Proprietary school programs also provide a condensed form of dental assistant training. You graduate ready to enter the workforce as a DAI (Dental Assistant I) through these programs or programs offering National Entry Level Dental Assisting (NELDA) certification.

Alternatively, dental assistants can jump in and train chairside, taught by a dentist in a dental office.

What’s the difference?

A DAI is an entry-level assistant. While the training is quicker for DAIs, DAIIs earn higher salaries and have more options for the roles they can fill in a dental office.

If you want to learn more, check out our interview with Kati Garrett, a dental assistant and educator overseeing Catawba Valley Community College’s dental assisting program.

This blog post was originally written by NCOHC intern Sydney Patterson and later edited by Allison Hackman

“It’s uncomfortable to think of a social worker in your space, and it’s uncomfortable to think about asking patients the questions that we ask. So, if it feels uncomfortable, lean into it because there’s going to be something good that comes from it.”

The University of North Carolina (UNC) Chapel Hill School of Social Work and Adams School of Dentistry (ASOD) partnered to provide dental and social work students with interprofessional workforce development and learning opportunities related to social drivers of health (SDOH). Integrating dental and social work education provides students from both cohorts with valuable experiences they will carry into their future practices.

Jamie Burgess-Flowers, MSW, LCSW, Kelsey Yokovich, MSW, and Lisa de Saxe Zerden, MSW, PhD published a research paper titled “The social determinants of health, social work, and dental patients: a case study” to document the first-year implementation of this model at the dental school. If you haven’t already, read part one of this case study for more background information to join us in the conversation with Burgess-Flowers and Yokovich from the beginning.

In this blog post, Burgess-Flowers and Yokovich share insights into the value of social work integration in dental care, the need for buy-in to promote sustainable systems-level changes, and the importance of continual learning.

Case: Social Work Consultation at a Dental Clinic

Burgess-Flowers told a story about one of her first days working in a dental clinic that demonstrates how integrating dental education and social work can transform patient and provider experiences for the better. A dental student approached her seeking guidance after completing a young adult patient’s health history intake. He noticed significant decay throughout their whole mouth, “I’m really concerned because this patient in their health history interview said that they don’t do any drugs.”

Although that patient had a level of decay often seen in patients with methamphetamine substance use disorder, Burgess-Flowers consulted with the student. She encouraged him to continue asking questions rather than jumping to conclusions. As it turned out, the patient worked extended Emergency Medical Services (EMS) shifts, drank Mountain Dew for the caffeine and hydration without water, and had little to no time for personal oral hygiene.

Though a patient may be struggling with a substance use disorder, this dental student learned to challenge his assumptions and remain open to other possibilities. Social drivers of health (SDOH) come in many forms, including employment type, dietary choices, and more, as this patient experienced.

The student will carry what he learned from this firsthand work experience long after graduating from dental school. “Having [this] foundational educational piece is going to be important for shaping a generation of providers that really think about the care of an individual as whole rather than siloed,” said Yokovich.

Buy-in: Driving Sustainable Change

Social work and oral health integration remains a fairly new concept that Yokovich and Burgess-Flowers hope will expand in the future. They discussed the importance and challenges of getting buy-in from students, educators, university leaders, providers, policymakers, and anyone else involved in the care system.

Burgess-Flowers spoke about the challenge of getting buy-in from some folks in dental education who have yet to see value in integrating social work into the curriculum. “When I started at UNC, one of the faculty members who was an oral medicine specialist looked at me, and he said, ‘You need to understand that what you’re doing is incredibly valuable. You are also asking a group of folks who have been trained to use a two-millimeter point of view to look at a tiny piece of disease on the surface of a tiny tooth to back up to a two-thousand-foot view of a patient,” she said.

Yokovich, the final and only macro (aka community management policy practice) social work student to participate in the UNC School of Social Work and ASOD program, said, “There was a lot of push-back, especially when I was talking about racism and the influence that has over practice.” Building on that, Burgess-Flowers said, “Now, social work is more synonymous with social justice, and people think that we’re going to be bringing up the uncomfortable things.” She told us it takes time to overcome “people’s perceptions of what a social worker is and what we bring to the table.”

When it comes to integrating social work and dental education, Burgess-Flowers said, “Buy-in is a really slow process for me, but it’s also all about that end goal that requires a lot of patience to get there.” Her vision is that as social work becomes embedded into dental education and dental practices, the holistic approach will trickle down until new employees, faculty, and students “say, well, this is just the way we do things.”

Key Takeaways: Lean in & Keep Learning

In their closing statements, Yokovich and Burgess-Flowers encouraged anyone in health care and education to stay open to continual learning. “An overarching message is for providers and folks who are in the educational space to keep an open mind when they feel uncomfortable. Usually, good things come out of that,” said Yokovich.

“It’s uncomfortable to think of a social worker in your space, and it’s uncomfortable to think about asking patients the questions that we ask,” said Burgess-Flowers. “So, if it feels uncomfortable, lean into it because there’s going to be something good that comes from it.”

They both hope to see this interdisciplinary work continue and care integration implemented across all areas of health care.

NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. Sign up for our monthly newsletter to join the network and get involved!

Related NCOHC Blog Posts

• Oral Health Care Integration Case Study Part I: Social Work in Dentistry
• Diversity in the Workforce: An Opportunity for Change
• Racism, Food, and Your Mouth: Parallels Between Food and Oral Health Equity
• How the World Around Us Impacts Our Oral Health: An Intro to the Social Determinants of Health
• Social Determinants of Health: How the World Around Us Impacts our Mouths
• Social Determinants of Health – Structural and Governmental Influences