Good oral health is essential for maintaining good overall health. According to the American Dental Association, 1 in 5 adult North Carolinians avoid smiling due to the condition of their mouth and teeth, and 15% of adult North Carolinians experience anxiety due to the condition of their mouth and teeth. Furthermore, the North Carolina Department of Health and Human Services Public Health Division reports that 15.3% of NC kindergarten children have untreated tooth decay. Children from poorer and more rural counties tend to have the highest rates of decay. In addition to low self-esteem, mental distress, and mouth dysfunction, gum disease is specifically linked to chronic diseases, including cardiovascular disease. Poor oral health is increasingly associated with diabetes, cancer, lung and heart disease, premature births, and progression of mental illnesses such as depression, anxiety, and dementia.
Two decades ago, a seminal public health report was released highlighting the need for essential services to improve oral health in the United States. U.S. Surgeon General David Satcher, M.D., Ph.D., released “Oral Health in America” in 2000, and described a “silent epidemic” of oral health diseases that largely impacted the nation’s poorer and non-white population. These outcomes were documented even in an era where fluoridation in most public water sources was complete, and further highlighted the delineation of income and wealth as a critical factor in the prevalence of dental disease. In 2010, the passage of the Affordable Care Act (ACA) expanded Medicaid benefits in the U.S., providing dental care for millions of Americans and 90% of all children. However, NC is one of 11 states nationwide that have failed to take advantage of this federal funding to close the “coverage gap.”
Sadly, oral health outcomes have not improved enough in the intervening twenty years. Some key metrics include:
More than 1 in 3 U.S. residents do not have dental insurance.
There is a shortage of dentists in the U.S., especially practitioners of color.
The CDC reports that oral health continues to be worse for Blacks, Hispanics, Native Americans, and Alaska Native people compared to White Americans.
Black and Hispanic adults, ages 35-44, develop tooth decay at twice the rate of White counterparts.
Other oral health problems, such as gum disease, also run much higher in communities of color.
Oral health disease incidence is much worse in rural communities, compared to urban settings.
Dental education is one key to long-term improvement in oral health outcomes, including seeking allies from the dental community and educating the general public. Implementing a dental therapy model would be a feasible strategy for mitigating the practitioner shortage, particularly for rural or disadvantaged communities.
Tooth decay is a preventable disease that can exacerbate health and social concerns, and has even been documented as a potential cause for pediatric deaths. Working from both upstream and downstream perspectives is essential to reducing pain, discomfort and promoting good long-term health outcomes, especially for the state’s more than 2 million children. Reducing oral health disparities for children at high risk for tooth decay is a good place to start.
The North Carolina Community Action Association (NCCAA) has been working hard to provide dental health education and access for high-need families across North Carolina, particularly in rural communities. NCCAA received a grant from Delta Dental of North Carolina in 2021 to partner with local Community Action Agencies and community stakeholders to support families by providing oral health information, dental screenings, and oral health care supplies at NCCAA’s signature The Big Pop Up events across the state. In 2021, NCCAA’s engagement events impacted 7,000 families and more than 14,000+ individuals, including 3,200 children in 22 counties. Additional funding was received from Delta Dental for 2022 grant programming, with even more community impact planned in the coming year.
To impact the determinants of health and health inequities, community action agencies work at the local, state, and national levels, to create positive, long-term change in the social, built, and natural environments of our clients and our communities. Stay tuned to this space and our monthly updates for more information and progress of NCCAA’s SDOH grant initiatives. We will be sharing success stories from NCCAA’s Social Determinants of Health programming from around the state and opportunities to collaborate in the weeks and months to come. For more details, contact Elle Evans Peterson, Director of Health Policy and Equity, at the NCCAA state offices: firstname.lastname@example.org
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