Few vendors mean dental deserts across North Carolina
The COVID-19 pandemic has changed processes and protocols in the medical profession, with the risk of exposure becoming a top priority for frontline health workers.
For oral health professionals, the once routine act of looking in the mouth has become an occupational hazard, even life threatening.
To avoid the risk, some dentists have turned to tele-dentistry connect with patients via video chat, encouraging them to use their phones to photograph their mouths and offering them consultations through screens.
The practice, born out of necessity amid a global health crisis, has offered a way to help meet a long-standing and pervasive need in North Carolina’s healthcare system: access to healthcare. oral.
In September 2019, an estimated 2.4 million North Carolinians were struggling to get adequate dental care, according to the Administration of health resources and services from the US Department of Health and Human Services.
Residents of 98 of the state’s 100 counties live in an area designated by the federal government as Dental health professional shortage area, or HPSA.
“This has been a problem for years, and it continues to be a problem in our state,” said Dr. Darryl Smith, program coordinator for Friendly Dental Van, an organization that provides access to oral health care. -dental to communities across North Carolina.
Too few suppliers
Over the past 40 years, the number of practicing dentists in the state has doubled, but the increase has not kept pace with the state’s population growth.
Although the number of practicing dentists increased from 2,207 providers in 1979 to 5,112 providers in 2017, the state’s dentist-to-population ratio was lower than the national average, according to data from the University of North Carolina Sheps Center for Health Services Research.
“The population of North Carolina is growing exponentially. It’s one of the fastest growing states in the country, which makes it difficult to keep pace, ”said Dr. Zachary Brian, program director of NC Oral Health Collaborative.
In eight counties, the shortage affects patients of all income levels as there are not enough dental providers regardless of the patient’s ability to pay. Three counties in the state – Hyde, Tyrrell and Gates – do not have working dentists, according to 2019 data by Sheps Health Workforce NC.
Increasing the number of dentists in the state, especially in non-metro areas, could help meet the needs, but dentist training and retention remain complex challenges.
Recruiting and training North Carolina residents can improve the likelihood of them remaining in the state to practice.
On average, 90% of graduates from Adams School of Dentistry at UNC Chapel Hill stay in North Carolina to practice, so an increased number of students will most likely translate into an increased number of dentists, according to data from the Sheps Center.
The total number of dentists in North Carolina has grown over the past decade, spurred in part by the opening in 2011 of the state’s second dental school at East Carolina University, which focuses on rural populations. and underserved.
Other providers, such as North Carolina’s more than 6,000 dental hygienists, could help meet the critical need, but state regulations limit who can provide certain services without the direct supervision of a dentist.
“We’re not using our workforce efficiently,” Brian said. Relaxing restrictions could allow hygienists to travel to underserved populations to perform simple preventive and restorative procedures, he said.
A complex challenge
A shortage of suppliers is only part of the problem. “I think we have a shortage, but it’s a lot more nuanced and complicated than that,” Brian said. Cost, geography, and misconceptions about culture all contribute to inequalities in dental care statewide.
Cost is the number one barrier to accessing dental care for adults nationwide. Some areas, called population-based HPSA, have enough providers for the population, but those without financial resources have difficulty accessing care. In 87 counties in North Carolina, people cannot access dental care due to income issues.
“You can live in an area with a dentist on every corner; it still doesn’t mean you automatically have access to care, ”said Brian.
The declining fee structure of the 42 health centers qualified at the federal level of the state, community organizations that provide care to underserved populations, allows certain low-income populations to access dental services.
Low-income patients can benefit from Medicaid, which covers “medically necessary” dental care, but patients often have difficulty finding providers to accept Medicaid.
“There are already few Medicaid oral health providers in our state and region, and even fewer are true Medicaid providers,” said Dr Amanda Stroud, dental director of AppHealthCare, a district health service. accredited for several counties in northwestern North Carolina.
“Offices may be registered as Medicaid providers, but they may not be accepting new Medicaid patients, or they may only provide it until a certain age or one day per month.”
Cost considerations are factored into treatment decisions long before a person receives a dental bill. Hourly workers may not be able to take time off to visit a dentist, fear loss of income or penalties for being absent from work, and some people may not have access to transportation or child care necessary to attend an appointment.
“I see people in their 40s who have never visited a dentist,” Stroud said. “They chose between paying for the groceries or their electric bill for the month instead of removing this cavity.”
Beyond cost and access
Providing access to dental services is only part of the puzzle, said Smith, whose Friendly Dental Van provides regular child care statewide. The quality of care depends on the public understanding of the importance of oral health.
“There are a lot of adults who are still terrified of the dentist and don’t see the need for dental treatment unless pain is involved,” Smith said. “People believe preventative dentistry is unnecessary when it is far from the truth.”
Bringing dental care into schools is one way to improve understanding of the importance of oral health care, Smith said.
“Half of the kids we see who go to college it’s the first dental visit of their lives,” he said. “We are working hard to create a relaxed and friendly atmosphere. The impression they have of us is so important to prevent them from becoming dental phobic.
Stroud, the dental director of AppHealthCare, first saw a dentist as a college student, and the experience encouraged her to provide this same service to others.
“Children have eye exams at school. Children take hearing tests in schools. They aren’t billed for these, so why can’t we bring in more dentists to meet the kids where they are? ” she said.