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What is Single-Payer Health Care?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What Is a Single-Payer Health Care System?

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

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

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

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

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

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

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

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

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

The Bottom Line

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

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

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Mental Health and Oral Health

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

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

Oral Health and Mental Health: A Two-Way Street

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

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

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

Can Oral Health Affect Mental Health?

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

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

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

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

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

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

The Need for Systems-Level Change

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

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

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

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

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

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

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

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

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

Why Oral Health Care Provider-Administered HPV Vaccines?

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

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

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

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

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

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

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

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

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

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

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

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

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

What’s Next?

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

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

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

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

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

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

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

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

COVID-Oral Health Connection

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

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

Loss of Taste and Smell

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

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

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

Treatment for COVID-related Loss of Taste and Smell

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

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

Dry Mouth and Oral Lesions

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

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

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

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

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

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

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

Understanding COVID-19 and Its Oral Manifestations

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

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

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

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

COVID-19 and Oral Health Equity

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

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

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

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

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

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

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

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

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

NCOHC and our incredible coalition of partner organizations and advocates are taking strides to map out the future of oral health care – a. future that includes everyone, everywhere. Learn more about current initiatives and ways you can get involved today at oralhealthnc.org/nc4change.

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

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How To Become a Dental Hygienist in North Carolina

It is time to celebrate! National Dental Hygienist Week is the second week of April each year (April 4-10). During this week, NCOHC wants to celebrate the students excited about becoming future registered dental hygienists. This is the time of year potential dental hygiene students are preparing and submitting applications and anxiously awaiting acceptance letters. Let’s explore the process prospective dental hygiene students must go through to prepare and apply to a dental hygiene program and the road they travel to become dental hygienists.

Dental Hygiene Programs

North Carolina has thirteen Commission on Dental Accreditation (CODA) approved dental hygiene programs. These include 12 Associate of Applied Science degree programs at community colleges throughout the state and one baccalaureate program at the University of North Carolina Adams School of Dentistry.

For dental hygienists to practice in North Carolina, they must graduate from a CODA-approved dental hygiene program. CODA is the sole agency that accredits dental and dental-related education programs and is nationally recognized by the United States Department of Education (USDE).

Dental hygiene programs must go through accreditation — a rigorous self- and peer-reviewed process — every seven years to ensure they provide a quality education and comply with CODA’s Accreditation Standards and Commission Policies.

Prerequisite Admission Requirements

The education process for a dental hygienist is quite extensive. Before being accepted into a CODA-approved dental hygiene program, it is strongly recommended that students complete required general education/dental hygiene prerequisite courses due to the rigorous nature of the dental hygiene curriculum.

Prerequisite courses for dental hygiene programs include but are not limited to:

  • anatomy and physiology (one or two courses)
  • microbiology
  • chemistry (class and lab)
  • communications
  • English (two courses)
  • math
  • psychology
  • sociology
  • a humanities/fine arts elective (i.e., critical thinking)

These courses can take a student a year or two to complete prior to being accepted into a hygiene program.

Dental Hygiene Program Admission Process

Admission into dental hygiene programs is very competitive due to the limited number of students each program accepts. For example, 80-100 students may apply to a dental hygiene program that only has 20-30 seats available.

The selection process is usually based on a point system. Points are awarded for specific requirements, including but not limited to:

Applicants with the highest number of points are admitted into the program.

Dental Hygiene Curriculum and Program Requirements

After being accepted into a dental hygiene program, students begin an intensive two-year program that requires them to complete traditional classroom and hands-on clinical coursework with a grade of “B” or better.

The dental hygiene curriculum includes:

  • orofacial anatomy
  • infection/hazard control
  • medical emergencies
  • preclinic lecture and lab
  • dental radiography
  • general and oral pathology
  • periodontology
  • nutrition/dental health
  • dental pharmacology
  • community dental health
  • dental materials and procedures
  • professional development
  • dental hygiene theory courses
  • clinical courses throughout the program

In clinical courses, students are required to treat patients in dental hygiene clinics located on their school’s campus. They learn to manage and treat patients’ needs and provide preventive oral health care.

When I was the program director for Catawba Valley Community College’s dental hygiene program, dentists and even one pharmacist were constantly surprised to learn about the rigorous nature of hygiene programs. One dentist told me that she wasn’t aware of the extensive knowledge hygienists gain in school, and teaching our students gave her even more respect for dental hygienists.

Examinations and Licensure

During the last semester of dental hygiene school, students apply for and complete national and regional exams and begin the licensure requirements. The National Board of Dental Hygiene Examination (NBDHE) is an eight-hour comprehensive exam administered by the Joint Commission on National Dental Examinations (JCNDE).

Exam Requirements for Dental Hygienists in North Carolina

There are state-specific exam requirements for dental hygiene students, as well. In North Carolina, dental hygiene students take the American Board of Dental Examiners (ADEX) exam administered by the Council of Interstate Testing Agencies (CITA), a regional testing agency. The ADEX exam consists of two components – the Patient Treatment Clinical Exam (PTCE) or the Manikin Treatment Clinical Exam (MTCE) and the Computer Simulated Clinical Examination (CSCE).

Licensure

After students complete the national and regional examinations, they must complete a North Carolina State Board of Dental Examiners (NCSBDE) licensure application. The application process requires completing an extensive application, a background check, a nominal licensure fee, a passing score on the NBDHE and CITA exams, and successful completion of the Infection Control/Sterilization and Jurisprudence examinations.

Finally…a Registered Dental Hygienist

The NCSBDE issues a candidate a dental hygiene license once their application is completed and approved. At last, the dental hygiene student has earned the status of a Registered Dental Hygienist!

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

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Meeting Mary Otto, Journalist and Author of “Teeth”

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

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

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

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

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

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

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

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

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

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

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

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

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

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What is a Dental Assistant?

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

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

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

What is a Dental Assistant?

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

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

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

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

How Do You Become a Dental Assistant?

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

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

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

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

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

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

What Else Should I Know About Dental Assisting?

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

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

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

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

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

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

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

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

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

The Shift to Managed Care

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

Managed Care and Oral Health

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

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

Oral Health Transformation Initiative

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

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

 
 

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

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

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What Are Dental Sealants?

Sometimes, the best prevention is a layer of protection. Take a baking sheet out of the oven and you’ll probably protect your hand from the heat with an oven mitt or towel. Go out in the rain and a raincoat or umbrella is your best bet if you want to stay dry. In this blog post, we’ll explain what dental sealants are — and how they function in a similar way.

Protecting our teeth is essential. Dental sealants add a layer of protection to your teeth, helping ward off decay-causing acids, sugars, and bacteria. They are an especially effective option for children, in part because insurance often covers them up to a certain age. Sealants are about as simple as they sound, and they are a great way to keep your teeth healthy and protected from cavities. When it comes to prevention, sealants are a fantastic option.

How Do Sealants Work?

Dental sealants act as coatings, filling in any pits or grooves on a chewing surface to form a protective layer over a tooth’s enamel.

Typically, sealants are applied to the chewing surfaces of molar teeth, but they can be applied elsewhere as needed. For example, sometimes sealants can be placed on the back surface of a front tooth that has exceptionally deep grooves.

Sealants may be applied by a dentist or, depending on the specific state’s laws, a dental hygienist or dental assistant. In some states, physicians and other medical staff may also apply dental sealants.

What are Sealants Made of?

Sealants are typically applied in the form of a liquid resin that becomes hard when cured. If you ever had a sealant applied, a cavity filled, braces attached, or any similar dental procedure, you may remember your dentist or hygienist using a tool that almost looks like an electric toothbrush without any bristles.

That tool is what “cures” the liquid sealant, leaving behind a rigid, protective layer.

Do Sealants Work?

Yes, sealants are very effective. According to the CDC, dental sealants can prevent 80 percent of cavities for two years. They have been proven to protect against 50 percent of cavities for up to four years, and there is evidence that they can work for up to nine years.

It is easy for a provider to tell when a sealant either falls off or is worn away, and fortunately they are easy to replace!

Are Dental Sealants Safe?

It is important to note concerns about BPA entering a patient’s system from dental sealants. Fortunately, several studies have been conducted to measure BPA exposure from sealant application, and the widespread consensus is that they are completely safe.

Some BPA may be detectible in a patient’s saliva hours after a sealant is applied, but no associated increase in BPA levels has been detected in patients’ blood at any time post-sealant application.

BPA can imitate a person’s naturally produced hormones, causing an array of health issues. It is an important environmental concern, but fortunately, dental sealants are not a source for concern.

In fact, breathing in dust or touching a receipt will expose a person to much more BPA than a dental sealant application.

How Much Do Sealants Cost?

Some dental plans cover sealants, especially for children. For patients without insurance or with insurance that doesn’t cover sealants, they typically cost between $30 and $75 per tooth. This is a lot more affordable compared to the price of a filling ($150-$450) or other more invasive treatment.

The cost can vary by provider, insurance, and material used, so it is important to ask your dentist to get a better idea of the price tag for dental sealants.

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

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Augmented Reality in the Dental Office

The year is 2021. At the turn of the century, kids trading playing cards could never have imagined that in 20 short years they would be able to walk among the Pokémon printed on their cards, finding creatures in their backyards and battling other trainers on street corners around the world.

Picture of Pokemon cards (left) by Minhimalism

Scientists haven’t managed to actually bring fictional animals to life, but technological advances in Augmented Reality (AR) have made it possible to merge digital environments with the real world. And while AR is already used for entertainment purposes, developers are finding new and innovative ways to incorporate the technology into a wide variety of work settings.

For example, The Weather Channel has used AR technology to bring and extra dimension to newscasts about extreme weather events like hurricanes.

 
The world of medicine is no exception—researchers and developers see a bright future for AR technology in a variety of medical settings.

Parth Patel, a UNC Chapel Hill neuroscience student who has studied AR, specifically exploring its potential medical uses, said, “This modern piece of technology is slowly becoming common in various dental practices, particularly oral surgery and prosthodontics.”

“AR allows a dental practitioner to view a three-dimensional model in front of them while operating on the patient,” said Parth. “This reduces any error that may occur glancing back and forth between the screen and the patient.”

Parth also mentioned the potential for AR technology to enhance dental education, allowing students to truly see what a procedure looks like before operating on a patient.

Parth sees a potential for AR-informed dentistry to increase access to care. He said that the technology can allow dental professionals to perform more procedures outside of the dental office. Even in a traditional setting, using AR technology to guide procedures could significantly increase the efficiency of a dentist’s workflow.

“Though literature is limited on AR, results of existing research are very promising,” said Parth. “AR is likely a form of technology that we will see commonly at the dentist’s office in the coming years.”

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