Oral Health

Facing New Realities in Oral Health

August 17, 2020
By: Brady Blackburn - NC Oral Health Collaborative

North Carolinians visit emergency departments for tooth pain at twice the national rate. This is not just a problem because emergency department visits can be prohibitively expensive, or because it points to a deep underlying oral health crisis. It is a systemic issue that has created a cycle of oral disease, because emergency departments are not equipped to effectively treat oral health issues.

If you visit an emergency department for a toothache, you are likely to receive a prescription for an antibiotic and an opioid, and the physician will tell you to follow up with your dentist. The root cause of your toothache, however, will not be addressed.

For many, this is the beginning of a cycle of debt, poor oral health, and at its worst, opioid addiction. The antibiotic will likely resolve the acute infection, and the opioid will lessen the pain. However, since neither of these medications treat the underlying cause of the toothache, one may end up landing right back in the emergency department a second time.

Innovative Responses to COVID-19

With increased patient loads and strain caused by heightened safety protocols as hospitals scrambled to prepare for COVID-19, the issue of oral health-related emergency department visits has become even more pressing.

To help divert oral health care and decrease non-COVID-19 patient load for hospitals as the pandemic first took hold this spring, the North Carolina Oral Health Collaborative (NCOHC) developed a statewide access map to connect patients with North Carolina’s extensive network of safety-net dental clinics. The map has been viewed nearly 20,000 times since March, helping patients with urgent needs find nearby safety-net clinics.

The immediate response to the pandemic is the first step in a longer-term structural shift needed to help address access barriers and increase equity in oral health care delivery—particularly for those with limited financial resources. Safety net clinics are equipped to meet the needs of patients for their comprehensive oral health needs, and they offer care on sliding fee scales, making access to affordable, quality care more attainable.

Teledentistry is another innovation that can help increase access for underserved populations, especially in rural North Carolina. Seventy-four of North Carolina’s 100 counties are dental Health Provider Shortage Areas (HPSAs). In these underserved counties, many face long drives, child care costs, and time off from work if they want to see a dentist. Virtual appointments for screenings, consultations, and follow-ups can significantly reduce the burden of dental care in these settings.

Maintaining Safety and Accessibility

As all dental offices were advised to cancel non-urgent appointments, the North Carolina Division of Health Benefits (NC Medicaid) published a special bulletin outlining temporary teledentistry billing codes. NCOHC is currently advocating to make these changes permanent.

There are significant safety concerns as dental offices across the state begin the reopening process. Many dental procedures involve equipment that can produce higher concentrations of airborne particles, including COVID-19 if a patient were to have the virus. Additionally, the supply of proper safety equipment, both for providers and patients, will continue to be a concern as dental offices ramp up their operations.

To further assist in deploying remote technology to help providers reach more patients without in-person contact, NCOHC launched a teledentistry fund that supports safety net practices to develop their capacity to offer teledentistry. As of June 30, the fund has been used to purchase annual teledentistry software subscriptions for 17 safety net clinics across North Carolina.

Building Momentum for the Future

As COVID-19 cancelled all large gatherings, NCOHC hosted its fifth annual, and first virtual, Oral Health Day on June 3, 2020. The event brought advocates, providers, community members, policymakers, and more together to discuss virtual oral health care and the policy changes necessary to expand teledentistry in North Carolina. Speakers from across the state, including two state legislators, had a clear message: there is momentum building behind teledentistry in North Carolina.

We will learn more about the oral health impacts of the pandemic as dental offices continue to re-open. At NCOHC, we are committed to leveraging opportunities in this time of crisis to innovate the field of oral health, advance access, and promote equity in oral health care.


About the Author

Brady Blackburn is the Communications Associate and Content Marketing Specialist for the NC Oral Health Collaborative. Learn more at