A Reason to Smile. A Reason to Do More.
November 2, 2021
This summer, Senate Bill 146 (SB 146) was signed into law, a significant step toward creating a better oral health care system in North Carolina. It was a long time coming, yet it’s also just a single milestone on a much longer journey to ensure everyone in North Carolina has access to quality, affordable oral health care.
To achieve this longer-term goal, we will have to do oral health differently — particularly by meeting patients where they are and increasing access to preventive services and the providers who deliver them. Two specific components of SB 146 go a long way to making care available outside the dental office (which many have difficulty accessing) while still ensuring patients have a dental home:
- Formalizing the practice of exam by teledentistry — allowing a hygienist caring for patients where they are (in a school or other community setting, for example) to collect x-rays, photos, and other needed diagnostic information. This information is then used by a dentist working at a “distant” location from the patient, such as in their dental practice, to evaluate and examine the patient remotely.
- Streamlining rules for public health hygienists — creating new opportunities to deliver preventive care in schools and other community-based settings in underserved areas.
These changes were achieved thanks to the persistence of committed partners, including lawmakers, dentists, hygienists, and advocates such as the North Carolina Oral Health Collaborative (NCOHC).
We have been part of this campaign for accessible, affordable oral health care for nearly a decade. Our foundation began focusing on oral health in 2013. At that point, in partnership with the State’s Office of Rural Health, the Oral Health Section of the Division of Public Health, and Division of Medicaid Assistance, we supported a task force — convened by the NC Institute of Medicine — that made policy recommendations to increase access to preventive oral health care among children enrolled in Medicaid.
Although only two of the 14 taskforce recommendations were fully implemented as of 2020, the legacy of the collaboration lives on in 2021’s Senate Bill 146 and other endeavors. Leadership by task force members and others has resulted in some significant changes since 2013, including many that weren’t even envisioned then:
- NC Medicaid has changed payment policy to cover teledentistry and increase access to re-mineralizing treatments, including Silver Diamine Fluoride
- The North Carolina Dental Society (NCDS) has convened a Council on Oral Health and Prevention, with active work groups on school-based care, teledentistry, and special needs dentistry
- Our state’s dental schools have convened symposia focused on teledentistry
- NCOHC has grown from a dozen-person workgroup to a network of more than 200 advocates from a variety of professional backgrounds and lived experiences that has become a leading voice on oral health in the state with a policy agenda of its own
While all of this is significant, there is much more to be done. These policy changes mark the beginning of our work together, not the end.
First, we must ensure that clinical and workforce practices designed to increase access and lower the cost of care (including delivering more care in community settings such as schools) are adopted in the areas that need them most. Too many adults and children have been failed by the system we have: patients often have a hard time getting an appointment, getting to an appointment, and/or affording the care that they need. Recent evidence in North Carolina shows that adoption of new, prevention-centered practices happens first in areas where patients have relatively good health and low social needs and then spreads more slowly to the areas where access is lower. We can accelerate the spread of these practices by targeting our efforts regionally.
Second, we must ensure that our system supports prevention and value with a focus on preserving tooth structure. Creating new access points and incentives for preventive and less invasive care is a first step to long-term improvements in quality of life and decreased out-of-pocket costs.
Finally, we must evaluate whether these practices are working to change outcomes and — just as importantly — reduce the inequities in oral health that exist today by race, geography, and income. To this end, we will need more data to know whether, and to what extent, these efforts impact inequities. Such data and analysis will allow us to better focus future efforts.
We know our Foundation has a continued role to play as well, and we are committed to this work over the long term. As we embark on a soon-to-be second decade of funding in oral health, we are deepening our focus on value in the care delivery system. This includes a partnership with CareQuest Institute and the North Carolina Oral Health Collaborative to support dental practices implementing medical-dental integration and value-based approaches to care. We are also recommitting to the spread of school-based oral health care alongside The Duke Endowment and BlueCross BlueShield of South Carolina Foundation.
The latter initiative will place high priority on ensuring that school-based models spread from the 200 North Carolina schools they serve now to areas where there are persistent barriers to access and significantly worse outcomes than other areas of our state. We are currently soliciting proposals to support new school-based programs in both states.
Beyond the tangible outcomes of the bill, the legacy of SB 146 will also be in what it symbolizes — that change can happen when stakeholders with varying perspectives find common ground for common good. What lies ahead of us all is continued opportunity — to look forward with curiosity and united around shared purpose, until good oral health is the expected outcome for all.