Supporting Oral Health in Schools

Impact

In November 2018, the Endowment funded the first cohort of 10 grantees to work with our technical assistance teams. The first group secured 102 Head Start centers, elementary, middle and high schools as partners for the 2019 – 2020 academic year. They began services in September 2019, and during the seven months before schools were closed in March 2020 due to the pandemic, they served 9,700 children with over 18,000 treatment services. This significantly exceeded our projections.

In 2019, we selected 12 new grantees for the second readiness and planning cohort. Eleven of the 12 successfully completed the requirements and are prepared for implementation. In the fall of 2020, we selected 10 grantees for the third cohort, for a total of 31 grantees in this initiative. Blue Cross and Blue Shield of North Carolina Foundation and BlueCross BlueShield of South Carolina Foundation have partnered with the Endowment and contributed $1.4 million to fund the readiness and planning phases for the second and third cohorts. As of 2022, 28 organizations have successfully implemented or have expanded school-based oral health programs and are providing services in hundreds of high risk schools throughout North Carolina and South Carolina.

Policy efforts supporting the expansion of school-based oral health services 

To strengthen our school-based Oral Health Expansion Initiative and to ensure that this program could be scaled and sustained, we recognized that policy and reimbursement changes were critical. Our investments in this area have increased our understanding of oral health disparities and opportunities to improve the delivery system. We have learned that advocacy and policy work takes time and that success depends on building relationships and trust.

Our first significant policy win was on February 16, 2020, when a rule change was passed to expand dental hygienists’ scope of practice regulations, which increased the efficiency and viability of our program in schools. The change allows dental hygienists to practice to the full extent of their licensure by providing preventive services such as sealants and fluoride treatments without a dentist’s prior exam. This milestone, supported by the North Carolina Oral Health Collaborative and the North Carolina Dental Society, is one that we had aspired to for nearly a decade. The victory ensures that our school-based programs are more sustainable, and it has established the North Carolina Oral Health Collaborative as a credible resource for policy.

Years of groundwork have paved the way to an environment that is more open to change. This, coupled with the pandemic, is providing an opportunity to make lasting advances in the field. Two examples include:

• North Carolina and South Carolina Medicaid approved the use of tele-dentistry during the pandemic which is allowing for increased access to dental services in community settings such as school-based oral health programs. The Endowment has been working with the North Carolina Oral Health Collaborative and the three dental schools to educate stakeholders about tele-dentistry and demonstrate how it can be used to improve access and reduce disparities.
• North Carolina and South Carolina Medicaid approved the expanded application of minimally invasive treatments such as Silver Diamine Fluoride (a topical treatment that arrests tooth decay). There is a movement to use fewer surgical interventions in dentistry while optimizing preventative and restorative measures. To make further gains, we need to continue to educate providers and consumers and reform payment models to incentivize non-surgical interventions.