Oral Health

Back to School Means More Than…

October 4, 2022
By: Daijah Davis, Program Officer, Oral Health

If the GPS commute time seems too good to be true, it probably is – a lesson I learned the hard way a few months back as I traveled to Bertie County Middle School to spend time observing their school-based dental clinic, operated by the ECU School of Dental Medicine and grant-funded by the Duke Endowment. I plugged the address into Google Maps and received an estimate of two hours from the Raleigh-Durham area. Just to compare, I decided to plug the address into another common maps system (that will not be named) – it said an hour and forty-five minutes. “Great!” I thought, “There must be a quicker route.” Spoiler alert: there was no other route. As the computerized voice proclaimed, “you’ve arrived!” I was in front of a wooded area, with no school in sight. Confused, I pulled over and quickly discovered the route I was following was missing the last 10 minutes of the drive.

When I finally arrived, a little flustered from running late and apologizing profusely, a school staff member reassured me that I was not the first, nor would I be the last person to get turned around by my GPS out in rural Bertie County. She led me to a cozy room filled with portable dental equipment where I was greeted by dental hygienists, Jennifer Buck and Rachel Stewart. The positivity in the room immediately eased my frustration.

Rachel was leaning over a dental chair, working in the mouth of a little girl in sunglasses who cheerfully served as a “helper” during the process of setting her sealants and holding the light used for curing. Jennifer sat at the well-worn teacher’s desk that had been placed in the room, serving as a second set of hands, meticulously documenting information that Rachel called out. As it turns out, the positive energy on display during this patient interaction was not unique. In fact, Rachel and Jennifer shared that the typical response from children who participate in the program is largely positive and explained, “They come to us when they have oral concerns or pain and ask for a consent form so they can become enrolled in the program.” Rachel continued, “Occasionally, there is some hesitancy from very young children, those that have never seen a dentist, or the ones that have had poor dental experiences in the past,” but they love having the opportunity to give children a positive first experience or a fresh start with a better one.

Bertie County has 19,000 residents, yet only has one dentist - who primarily sees adults.

Unfortunately, too many school-age children in our state haven’t had regular, or even any experience with oral health care. 90% of the children enrolled in the Bertie County School-based dental program have Medicaid or North Carolina Health Choice insurance. Only 66% of children enrolled in NC Health Choice and 60% enrolled in Medicaid, used at least one oral health or dental service in 2019. A big reason is access. Bertie County has 19,000 residents yet has only one dentist - who primarily sees adults. To put this into perspective, the threshold to be defined as a dental provider shortage area – a federal designation used to identify populations that are experiencing a shortage of care providers – is a population to provider ratio of 5,000 to one. Bertie County is experiencing a shortage almost four times over this threshold.

The Bertie County School-based oral health program helps to alleviate some of the pressure coming from this provider shortage by serving 25% of students in kindergarten through 12th grade. Additionally, a significant number of pre-k and private school students receive care via the outreach program, which periodically operates out of the local health department. Recent legislative rule changes now allow public health dental hygienists (practicing in community settings like schools and clinics of dental provider shortage areas) to provide preventive care – such as cleanings, sealants, and fluoride varnish – under a standing order of a dentist, rather than requiring a prior exam from a dentist. With a dentist not required on-site for every patient seen, the efficiency of many school-based programs, including the Bertie County School-based clinic, has increased and more children are able to be served.

My experience in Bertie County prompted a moment of reflection for me on just how invaluable these programs can be. As a busy, working parent, I’m not sure how I could manage making a 45-minute trip to another county for a dental visit for my child. I’d likely need to take time off work given typical dental office hours, combined with the commute time. That trip would address my child’s dental needs, but what about my own? I’d need to repeat this whole process, while also ensuring that childcare is available to go and be seen myself.

School-based oral health services are a convenient way for children to access oral health care services.  When children maintain optimal oral health, they have a better opportunity to learn, grow, and thrive without the distraction of oral pain

I am fortunate enough to have paid leave time, so although it would be incredibly inconvenient, this would not be impossible. But what about those who don’t? Less than 20% of working people in the United States have access to paid parental and caregiver leave. School-based dental clinics are a source of care for children, but they also act as a system of support for parents, making it a bit easier on them to ensure their children receive the essential preventive care they need. It also supports a continuity of care that is disrupted in many provider shortage areas. Parents of students in the Bertie County program often reach out with questions or concerns about their child’s oral health and refer friends and family to the program.  Parents want the best for their kids. This authentic engagement and trust in the program providers highlight the value and quality that they see in it.

How do school leaders feel about this program? Rachel said, “The majority of school leaders and teachers are very supportive of the program.” While there are some who have concerns about the interruption of class time, she explained, “Jennifer and I take care to be cognizant of interruptions and minimize any impact on student learning.” Data shows that it is worth the investment. On average, children with poor oral health status are about three times more likely to miss school because of dental pain, and those absences are also associated with poorer school performance. The services that the clinic is providing for students helps ensure they are receiving preventive care and referral for intervention on minor issues before they become more serious ones that will distract from learning for far longer than 30 minutes.

After spending just a few hours visiting at the Bertie Middle School dental clinic, I found myself deeply inspired. To build such strong rapport and provide services at such a high quality that children request them, and parents also recommend them, all without prompting – is incredible. It is what we should strive for – the gold standard of community care.

“School-based oral health services are a convenient way for children to access oral health care services.  When children maintain optimal oral health, they have a better opportunity to learn, grow, and thrive without the distraction of oral pain,” said Rachel.

The Blue Cross NC Foundation, The Duke Endowment, and the BlueCross BlueShield of South Carolina Foundation have an on-going partnership to support the development of school-based oral health programs in the Carolinas. With financial and technical support from this partnership, 27 dental clinics have established dental programs like the one described above and serving 35 counties in North Carolina.  Applications for the next cohort of grantees will begin in Fall 2022.

About the Author

Daijah Davis
Program Officer, Oral Health

Daijah leads the Foundation’s focus on oral health, working to ensure that everyone in North Carolina has access to quality, affordable oral health services. Learn more about Daijah.