North Carolina Oral Health Collaborative

As the monkeypox outbreak continues to spread, we sat down to explore what oral health connections exist, what is currently being researched, and what you should know about monkeypox with relation to oral health

What is Monkeypox?

Monkeypox is a viral disease with symptoms similar to, but much milder than, smallpox. It is rarely fatal, and is primarily spread by close personal contact, often skin-to-skin.

Monkeypox was first discovered in 1958 in monkeys being kept for research. The first human case was recorded in 1970.

Common symptoms of monkeypox include fever, fatigue, and flu-like symptoms. The disease also presents with a rash on the skin reminiscent of smallpox. While it should be taken seriously, it is much less deadly. In fact, of the 14,000 cases worldwide as of July 20, 2022, only five deaths had been reported.

Oral Symptoms of Monkeypox

Overall, oral manifestations of monkeypox appear to be relatively rare. A recent report in the Journal of Oral and Maxillofacial Surgery did outline two cases of oral lesions associated with monkeypox.

In both cases, the oral lesions appeared before the skin rash. In the first case, oral lesions were the first symptom.

The Centers for Disease Control and Prevention (CDC) is urging providers to be on the lookout for symptoms that could be associated with monkeypox, including oral manifestations. Although oral symptoms seem to be relatively uncommon as of August 2022, providers with patients presenting oral lesions might consider monkeypox among potential causes.

What Else Should Oral Health Providers Know?

The CDC has published guidance for providers treating patients with monkeypox. The organization outlines considerations for infection control and provider safety, including PPE, waste management, and other precautions to prevent transmission.

Learning from the Past

Many are discussing the similarities between the current monkeypox outbreak and HIV. For many providers, it is easy to look back on the early 1980s with regret for how the community responded to the emerging HIV epidemic. Too many patients with HIV were met with fear and shame, unable to receive the care they needed, including oral health care.

We recently sat down with Dr. Lewis Lampiris, who was a practicing dentist in the 1980s as the HIV epidemic emerged. His story offers insight into the important role oral health providers need to play when a new disease emerges, and we believe it can offer guidance as we navigate the monkeypox outbreak.

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

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.

Teeth aren’t the only things in your mouth that need to be cared for. From your gums to your tongue, molars to canines, everything in your mouth needs proper care to stay healthy. In this blog post, we’ll take a look at what you can do to care for your gums — and why it’s so important.

How to Care for Your Gums

When it comes to gum health, you fortunately don’t have to learn a bunch of new rules. The basics are pretty much the same:

1. Brush twice per day with fluoride toothpaste
2. Floss consistently
3. Visit the dentist regularly for a routine checkup

While the routines are the same, there are a few tips and tricks you can learn to take better care of your gums.

But First, Why Does Gum Health Matter?

Your gums and underlying bone play an important role in your mouth: they keep your teeth in place. If they aren’t healthy, that job can be a harder one to do. Poor gum health can lead to disease that can affect other parts of your body. In fact, gum disease has been linked to heart disease, diabetes, and even dementia, among other conditions.

The bottom line: healthy gums reduce risk of oral infections, tooth loss, and cavities along with heart disease, diabetes, and other negative health impacts associated with the oral-systemic connection.

There are two main types of gum disease:

• Gingivitis — Gingivitis is a rather mild gum infection with symptoms like swelling and bleeding. It can typically be treated easily, just by following the three steps above (brush, floss, visit the dentist).
• Periodontitis — Periodontitis, on the other hand, is the more serious gum disease that comes about when gingivitis is left untreated. Its symptoms include the same swelling and bleeding caused by gingivitis, along with tooth sensitivity, pain while chewing, receding gums, and bone loss that can lead to loose teeth or tooth loss.

Treatment for Gingivitis and Periodontitis

With periodontitis, the infection impacts your gum tissue as well as the bones that hold your teeth in place. These cases can sometimes be treated non-surgically if they aren’t too far advanced.

Gingivitis or periodontitis can usually be treated without surgery. Advanced cases of periodontitis may require more invasive care, however, potentially including surgery. Depending on the severity, the disease may require a variety of different surgeries, bone grafts, and other methods of regenerating lost tissue.

Habits for Good Gum Health

• Brushing — To avoid gum disease, make sure to brush all sides of your teeth in a circular motion. Be gentle along your gumline, but make sure that you brush where your gums meet your teeth. Bacteria can easily build up along the gum line, which is a recipe for gum disease and tooth decay if left unattended.
• Flossing — When you floss between your teeth, don’t just go straight in and out. Move the floss back and forth as you ease in. This helps make sure you are dislodging any food residue or bacteria that has built up between your teeth, and it will help clean and strengthen your gums.
• Fluoride — Finally, consider adding a fluoride mouthwash to your oral health care routine. Mouthwash isn’t a replacement for brushing and flossing, but it can help add an extra layer of cleaning and protection.

Other Factors Impacting Gum Health: Food & Drink

A well-balanced diet can help strengthen your gums. Nutrients like vitamin C, vitamin D, omega-3 fatty acids, various B vitamins, and zinc have all been linked to gum health. Vitamin C, for example, plays a major role in collagen production, an important component of gum tissue. Vitamin C deficiency can result in bleeding or inflamed gums.

Smoking and drinking are also important considerations when it comes to gum health. The best recommendation is always to quit smoking altogether — both for cancer prevention and overall oral health management — and limit alcohol consumption. If you do smoke and/or drink, however, staying hydrated is a good way to mitigate some of the negative effects.

Drinking water won’t prevent the oral and pharyngeal cancers that smoking causes, but it will help with dry mouth that can result from tobacco or alcohol consumption. Click here for more about the ways that dry mouth can lead to tooth decay and gum disease.

All in all, gum disease and the habits that help prevent it follow the same narrative of most oral disease. While it is entirely preventable, if left unattended, gum disease can get seriously out of hand, leading to poorer overall health and more invasive, expensive treatments. Good personal habits go a long way, but they must be paired with affordable, accessible, preventive care.

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.

She vividly remembers waking up with a swollen jaw, tooth pain that wouldn’t go away, and a sinking feeling as she realized what it meant.

Melinda Johnson of Hayesville, North Carolina, whose name has been changed to respect her privacy, does not have insurance of any kind, including dental insurance. Her children are currently on Medicaid.

Johnson usually begins panicking when she thinks about dental care. She knows that she does not have enough money to afford it, as she is already living paycheck to paycheck just to account for basic needs.

She said she usually must resort to the emergency room for dental care, where she is typically not treated kindly. In past experiences, staff thought she was seeking opioids instead of care for dental pain, so she always told them she’s not an addict so they would give her a fair chance.

Johnson says that there is an income-based dental clinic in Hayesville, but it doesn’t offer the kind of care that she needs, like multiple extractions, fillings, and implants. Most importantly, she needs multiple teeth removed so that decay doesn’t spread.

Searching for Care

Johnson vividly remembers a recent experience waking up with a swollen jaw and excruciating tooth pain that continuously got worse. Since she had no financial means to get the tooth pulled, she went to the emergency room and was prescribed an antibiotic for the infection and Toradol for pain.

After she finished the antibiotic, the pain subsided but swelling persisted. Her next step was to go see a regular doctor, who gave her higher dose shots of antibiotics. She has now finished those antibiotics, as well, but still does not have enough money to have the tooth fully treated.

Today, Johnson is still trying to find a dentist in her price range. She is looking for a dentist out-of-state while waiting on her paycheck.

Fear, Anxiety, and Shame

This experience has made Johnson feel self-conscious and embarrassed. Her feelings about it are so strong that she can’t speak about it without crying.

She admits that drugs, which are a huge issue in rural North Carolina, are a factor contributing to her dental issues. According to the Western North Carolina Health Network, 50.5 percent of adults in Clay County, where Hayesville is located, have been negatively affected by substance use.

According to Johnson, pregnancy was also very hard on her teeth. Hormone changes and morning sickness that result from pregnancy, for example, can negatively impact oral health. She recounts that she did not have a single cavity until her first child, and then after her second and third children it was as if her teeth were just breaking off one by one.

Impossible Choices

Johnson said that she doesn’t understand why dental care is so expensive and inaccessible. She said that she is trying to get her life back together and doesn’t want to have to beg for money “because of her poor choices.” She isn’t looking for a “free ride” by any means; she just doesn’t want to have to choose between “feeding her family and getting a tooth pulled.”

For Johnson and too many others in North Carolina and across the United States, this story is a daily reality. Oral health issues that for many are nothing more than a minor annoyance (perhaps an extra dental appointment and a filling away from a full resolution) disrupt the daily lives of those who can’t afford the care they deserve, deteriorating and developing into major health concerns.

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.

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

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

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

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

North Carolina Medicaid Oral Health “Secret Shopper” Survey

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

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

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

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

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

Addressing Payment Disparities

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

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

Strengthening the Oral Health Care Safety-Net

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

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

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

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

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

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

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

Doing nothing simply isn’t an option.

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

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

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

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

Dr. Eleanor Fleming’s Keynote Address

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

 

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

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

 

Panel Discussion

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

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

 

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

 

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

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

 

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

 

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

 

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

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

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

 

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

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

 

Day Two: Equity in Action

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

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

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

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

You can find the full event recording below:

 

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

A root canal is a dental procedure in which the soft center of the tooth, the pulp, is removed. The pulp is a collection of nerves, blood vessels, and connective tissue that aid the tooth’s growth.

A person will need a root canal if the pulp is inflamed or infected, commonly called pulpitis. The procedure eliminates bacteria and can save the natural tooth by preventing reinfection. Unlike other parts of your body, a tooth’s pulp cannot heal on its own. Once it has been damaged or infected, the only option is to remove it, either with a root canal or a whole tooth extraction. 

A tooth’s pulp can be damaged in a number of ways. The most common are decay from an untreated cavity, a chipped or cracked tooth, or too many dental procedures on the same tooth. The pulp can also be damaged by a tooth injury that does not break the tooth.

You may need a root canal if you have severe pain while chewing or biting, gum pimples, intense sensitivity to hot or cold, or gum problems such as swollenness, tenderness, decaying, or darkening.

Performing a Root Canal

A root canal can be performed on a person of any age who has experienced damage to a tooth’s pulp. General dentists (non-dental specialists) can perform root canals on any tooth, but they commonly refer patients to an endodontist if the procedure is needed on a more complex tooth, such as a molar. An endodontist is a specialist who has completed two or more additional years of training after dental school. Part of their additional training focuses on root canals.

A root canal can be completed in one or two appointments and is a rather painless procedure. It begins with an anesthetic to numb the tooth, with the patient remaining awake. The pulp is then removed through a small opening in the top of the tooth.

After the pulp has been removed, the dentist may use a topical antibiotic on the tooth to prevent reinfection. The dentist then fills the tooth with a sealer paste and gutta-percha, a rubber-like material. The procedure is ended by the dentist filling the opening with a temporary sealant.

The temporary sealant will need to be replaced with a permanent restoration, typically a crown, after a root canal. Your dentist will likely schedule the restoration a week or more after the root canal. The extra time helps to make sure that if any problems with the root canal arise, they can be identified and fixed before the restoration is in place. 

Your mouth will usually be numb for around 2-4 hours following a root canal procedure, but you should be able to return to normal activities such as school or work directly afterward. However, if you have a root canal, you should not eat again until the numbness has completely gone away. You also may experience soreness and mild discomfort for a couple of days.

Cost of a Root Canal

Root canal pricing will vary by geographic region, the complexity of the root canal procedure to be performed, as well as other factors. Since molar root canals are more challenging and often performed by an endodontist, the fee is typically higher.

Without insurance, a front tooth root canal can cost an average of $600-$1,100, while a molar ranges from $800-$1,500. With insurance, the price for a front tooth procedure can go down to just $200 and a molar procedure at least $300. Click here for more information about dental insurance.

The price can also differ depending on where you live, as there is a higher demand and less access for dentists in smaller cities and towns.

Preventing Root Canals

As with most oral disease, dental issues that can lead to a root canal are almost entirely preventable. Good oral hygiene and regular preventive dental visits are two important steps to reduce the chance of needing a root canal. 

Beyond tooth decay, however, oral trauma can also lead to the need for root canals. For anyone playing contact sports or other activities that risk a blow to the face, consider wearing a mouth guard to protect your teeth. 

Where Do I Get a Root Canal?

If you have a dentist and think you may need a root canal, your regular provider should be your first stop. If you don’t have a dentist or can’t afford to see one, there are many options across North Carolina for free or reduced-cost care. 

You can find access points that accept Medicaid insurance and offer care on sliding fee scales for those without insurance by visiting NCOHC’s access map. Not all clinics on the map provide surgical procedures like root canals, but most should be able to diagnose the problem, discuss different treatment options, and point you in the right direction to receive the care you need. 

About the author: Sydney Patterson is a senior at East Carolina University studying public health. She plans to attend dental school following graduation. Sydney is from Hayesville, North Carolina, and she works as a dental assistant at Staton Family Dentistry.

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

Oral Health Day will look different this year. As the first two-day Oral Health Day event, you can expect new and exciting opportunities to engage with experts and also play a role in shaping the future of oral health in North Carolina.

Click here to register today and join us on June 22 and 23!

We are thrilled to announce that Dr. Eleanor Fleming will headline Oral Health Day 2022 as the keynote speaker. As the assistant dean of equity, diversity, and inclusion at the University of Maryland School of Dentistry, she is the perfect person to keynote this year’s event, themed “Equity in Action.”

Keynote: Dr. Eleanor Fleming

Fleming earned her PhD at Vanderbilt University, DDS at Meharry Medical College, and MPH at East Tennessee State University. She also completed a Dental Public Health Residency at Boston University. She has worked in a variety of positions, including as Dental Officer for the Centers for Disease Control and Prevention and Associate Professor of Dental Public Health at the Meharry Medical College School of Dentistry.

Fleming is a subject matter expert in infectious disease and chronic disease epidemiology. She has been a principal investigator in numerous studies and has informed public health surveillance at state, national, and international levels. Fleming holds leadership positions in the American Association of Public Health Dentistry and the American Public Health Association.

Among numerous accolades, she has been recognized as one of the American Dental Association’s (ADA) “10 under 10” (2021), recognizing leaders in the dental field who are less than 10 years out of dental school. She has also received the National Dental Association New Dentists Colgate Leadership Award (2020), the ADA Foundation Henry Schein Cares Dr. David Whitson Leadership Award (2018), and the Ernest Eugene Buell Award (2016).

Equity in Action

NCOHC believes that health care is an inherent right for all. In North Carolina, there are severe disparities in oral health care access and outcomes, often driven by social drivers of health such as financial difficulties and inadequate access to transportation.

Oral Health Day 2022: Equity in Action will focus on the structural changes we need in order to create a future where all have access to the care they deserve.

Click here to register today and join us on June 22 and 23!

Along with Fleming’s keynote on June 22nd, Dr. Lewis Lampiris will moderate a panel of leaders in health care to discuss equity issues and policy solutions. Head over to the Oral Health Day 2022: Equity in Action page to meet this year’s panelists.

Lampiris received his DDS from Temple University’s Kornberg School of Dental Medicine and MPH from the University of Illinois at Chicago. Early in his career, Dr. Lampiris served as a dental officer in the U.S. Army Dental Corps.

Later, he worked in private practice in Chicago before serving as chief of the Illinois Department of Public Health, Division of Oral Health for nine years. Immediately after, he served as the Director of the ADA’s Council on Access, Prevention, and Interprofessional Relations.

Lampiris recently retired from the University of North Carolina Adams School of Dentistry where he served as Associate Clinical Professor and the Director of the Dentistry in Service to Community (DISC) program. He is the recipient of the American Association of Public Health Dentistry’s Distinguished Service Award (2013), the ADA’s Presidential Citation (2010), and the Association of State and Territorial Dental Directors Distinguished Service Award (2007).

Hands-On Workshop

On June 23rd (Day 2), all participants are invited to join NCOHC for a thought-provoking and interactive workshop. In this unique session, we will work together to identify actionable solutions to increase access and equity in oral health care in North Carolina and beyond.

As a collaborative organization, we believe it is vital to hand the microphone over to you. Sustainable solutions to our biggest challenges can only be found — and achieved — when we work together. We fully expect Oral Health Day 2022: Equity in Action to be a catalyst for system-wide change!

Click here to register today and join us on June 22 and 23!

2022 NCOHC Oral Health Equity Award

We are also thrilled to announce the 2022 NCOHC Oral Health Equity Award. On Day 1 (June 22nd) of Oral Health Day, NCOHC will present this signature award to an organization that has implemented solutions reducing disparities and improved oral health outcomes in North Carolina. To find out more about the award, please click here.

We look forward to seeing you at Oral Health Day 2022: Equity in Action on June 22 and June 23!

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.

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.