With strong research connecting dental disease with diabetes, heart and lung diseases, stroke, and low-birth weight, we know that oral health is a critical part of a person’s overall health. We also know that with adequate preventive care and education, dental disease is 100 percent preventable. But many people in the Carolinas, including those with Medicaid coverage, struggle to access dental care.
The Duke Endowment’s oral health initiative seeks to support system reform and policy change; to promote prevention by expanding school-based oral health services; and to support oral health integration.
Across the United States, lack of access to oral health care disproportionately affects the low-income and uninsured, those living in rural areas, the elderly, the disabled and children. Public health and safety-net providers offer limited relief, but they struggle to deliver enough care to manage the overwhelming needs in many communities.
Local hospital emergency departments have increasingly become a place for emergent dental care for vulnerable populations. In 2012, for example, South Carolina emergency departments reported more than 15,000 visits for dental reasons, resulting in nearly $11 million in charges. A recent North Carolina report ranked acute dental needs as the 10th most common reason for emergency department visits.
Exacerbating this problem is the fact that few emergency departments can provide preventive or restorative care. Treatment generally consists of prescribing an antibiotic to fight infection, and/or prescribing pain medication.
A primary barrier to care is a limited workforce infrastructure and a poor distribution of dentists. Nationally, over 49 million people live in Federally Designated Dental Shortage Areas; in South Carolina, 44 of 46 counties are classified as shortage areas. Amplifying access disparities is the fact that many dentists do not accept Medicaid, and those who do often accept a limited number of Medicaid patients.
Through a three-pronged strategy, the Endowment is working to improve oral health in the Carolinas.
System Reform and Policy Change
System reform and policy change are essential to the overall strategy of improving oral health. The Endowment has two primary investments that are contributing to reform efforts.
- The Carolinas Oral Health Research and Policy Consortium includes leaders from the Medical University of South Carolina, UNC Chapel Hill, East Carolina University, UNC Charlotte, and the Rural Health Research Centers from both states. The goal of this consortium is to promote research and advance evidence-based policies for improving oral health care delivery.
Thirty interviews with high-level policymakers and influencers such as Medicaid officials, public health leaders and third-party payers were completed in 2017. The three most common needs identified were to better understand oral health workforce models, integrated care models, and the impact of an adult Medicaid dental benefit program.
After prioritizing topics and identifying potential research grants, the consortium expects to submit its policy research agenda for publication.
- The North Carolina Oral Health Collaborative convenes diverse stakeholders to identify and resolve systemic barriers to good oral health. Strategies to accomplish these goals include promoting public awareness and supporting advocacy and coalition building.
School-based oral health programs have demonstrated effectiveness, yet widespread replication has not been achieved.
The Endowment has funded a case study of eight school-based oral health programs to evaluate their comparative effectiveness in improving dental outcomes in school children. The evaluation has focused on assessing capacity building, collaborative referral management practices, and financial performance.
Insights from the programs are being used to develop standards for expanding school-based oral health services.
Oral Health Integration
The Endowment has been working with partners to promote medical-dental integration models. One example of this work is a South Carolina pilot that will demonstrate the effectiveness of providing advanced dental therapies within a health care system to improve clinical outcomes for people living with diabetes.