Local & State Voices

Why NC must meet its oral health challenge

school-aged children are particularly affected by poor oral health.
school-aged children are particularly affected by poor oral health. AP



It is a highly preventable disease, yet it affects millions of people across the Carolinas. It dramatically impacts quality of life and employability, and research links it to major chronic illnesses such as diabetes, cardiovascular disease and stroke.

Did you guess oral health? We wouldn’t be surprised if dental problems didn’t spring to mind as a major public health issue. But poor oral health is a significant and consequential problem in the Carolinas.

In our work across the Carolinas we have found that oral health is one of the top health challenges in many communities. While these challenges aren’t unique to our region, we know we can do better. Our two states rank in the bottom third when it comes to the number of dentists per resident. However, access to dentists is just part of the challenge — there are other barriers like transportation, affordability, lack of integration with overall health, traditional clinic hours, and even fear, that can make it difficult for many Carolinians to get the care we all need.

Why does poor access to oral health care matter? When people don’t get the care they need to treat disease early, and can’t afford extensive care when dental problems arise, they often end up in the emergency department, swapping treatment by a dentist for expensive hospital visits that rarely resolve the issue. In fact, North Carolina’s rate of emergency department dental visits is more than twice the national average, and is the fastest growing compared to other southeastern states. Additionally, from October 2017 to September 2018, South Carolina emergency departments reported more than 31,000 visits for disorders of the teeth and jaw, resulting in nearly $43.5 million in charges.

School-aged children are particularly affected by poor oral health. Dental problems and pain impact performance at school. Oral health-related illness continues to be the number one reason for school absences in low-income communities. Tooth decay remains the most common chronic disease among children. Research has even found that acute dental disease has a comparative (and in some respects greater) impact on a child’s quality of life than acute asthma.

For these reasons, The Duke Endowment, the Blue Cross and Blue Shield of North Carolina Foundation and another funder have decided to commit more than $35 million in a major multi-faceted push to improve oral health in the Carolinas.

The investment supports a range of strategies to develop systems supporting improved oral health for all Carolinians, including:

  • New and expanded school-based programs to deliver preventive services such as sealants and fluoride applications, as well as to address restorative treatment through a variety of models that provide a dental home in schools.

  • New efforts to research and promote evidence-based solutions. Funding will go to the N.C. Oral Health Collaborative to lead a diverse coalition to explore and promote new policies and practices for improving oral health care access and delivery.

  • New patient-centered and value-based models that incorporate oral health. Over time, the partnerships will help spur development of models that integrate medical and dental services, while showing the value and clinical effectiveness of such efforts.

We believe this is a good start. But philanthropy can’t do it alone. To achieve lasting impact for generations, it will take policymakers, pediatricians, school nurses, public health officials, and others – as well as dentists and hygienists – to implement policies and practices that ensure everyone can access affordable oral health care. Working together, we can better prevent oral disease and protect children and families from its damaging and far-reaching consequences.

Katie Eyes is vice president for program and strategy at the Blue Cross and Blue Shield of North Carolina Foundation. Stacy Warren is a program officer for The Duke Endowment’s health care program area. To learn more about how to improve oral health in North Carolina, visit dukeendowment.org or bcbsncfoundation.org.
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