Upon graduation from ECU's dental school, Lumberton native Kasey Oxendine plans to return to serve her community. Photo credit: Taylor Sisk

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<p>The ECU School of Dental Medicine is expanding its statewide network of clinics that offer sliding-scale services and unique educational opportunities.

By Taylor Sisk

Kasey Oxendine always knew she wanted to come back and serve her community. It’s just happening a little sooner than she’d planned.

Rural Rx: NC Health News coverage of rural health issues. This week: Robeson, Bertie, Brunswick, Davidson, Harnett, Hertford, Jackson, Mitchell, Pasquotank, Pitt and Robeson counties.

Oxendine, a third-year student in East Carolina University’s School of Dental Medicine, was back in her hometown of Lumberton last Tuesday for a ribbon-cutting ceremony at ECU’s Community Service Learning Center-Robeson County.

The center is a 7,700-square-foot state-of-the-art facility that will offer dental services to anyone in the county while providing an opportunity for students to gain experience in an underserved community.

Oxendine will be among those students next year.

“Being from Lumberton, I know what a rural area is all about,” she said, “and I know the dental needs in rural areas.”

The university is already administering four CSLCs – in Ahoskie, Elizabeth City, Lillington and Sylva – with two more, in Davidson County and Spruce Pine, opening this winter, and an eighth, in Brunswick County, targeted to open around this time next year.

Since the first one, in Ahoskie, opened about two and a half years ago, patients from 71 counties have been seen at the four centers.

Upon graduation from dental school, Lumberton native Kasey Oxendine plans to return to serve her community. Photo credit: Taylor Sisk

The CSLC initiative aligns with the dental school’s mission to “provide educational opportunities for academically qualified individuals from historically underrepresented groups, disadvantaged backgrounds and underserved areas,” and to “provide and enhance oral health services for underserved North Carolinians.”

In their fourth, and final, year of dental school, students do eight- or nine-month rotations at three of the CSLCs.

The CSLC in Lumberton will open its doors in January and the first round of students will then arrive to live and work in the community. Housing is provided by the N.C. Area Health Education Centers Program, or AHEC as it’s most commonly known.

The center includes treatment rooms, conference rooms and educational space. Initially, there will be one full-time and one part time dentist, and four or five students who also will see patients, as will faculty members. There will be two hygienists and five dental assistants.

Services will be offered on a sliding scale, starting at free. The center will also accept Medicaid.

A particular need

According to a report  published in the N.C. Medical Journal by University of North Carolina-Chapel Hill researchers, in 2010 there were 4.4 dentists per 10,000 people in the state, compared with a national average of six. The researchers found that North Carolina has for the past decade consistently ranked 47th in the nation in dentists per capita.

Greg Chadwick, dean of ECU’s School of Dental Medicine, said that of some 4,500 dentists in the state, about 1,500 are over the age of 54.

Map courtesy NC Medical Journal.

The state’s rural areas are in particular need of dental services. Chadwick said that Hertford and Bertie counties – with populations of more than 20,000 – have one dentist each.

“We realized that we really needed to do something to get more dentists into the rural and underserved counties, and that’s 85 counties out of 100,” he said.

Thus the CSLC initiative. Complementing the effort are loan repayment incentives offered by the N.C. Office of Rural Health & Community Care to dental school graduates who choose to practice in underserved communities.

Wired back to Greenville

Teledentistry will play a key role in the new CSLC’s efforts to improve dental heath in this underserved community.

Conference rooms are equipped with video equipment, and portable gear that takes images of the inside of the mouth will be available. The center will have a feed back to the dental school for consultations and observation.

The ECU School of Dental Medicine will open the doors on its fifth state-of-the-art community service learning center, in Lumberton, in January, with three more scheduled within the next year or so.
Photo credit: Taylor Sisk

And recognizing that many of their patients rarely, if ever, see a primary care physician, staff will be vigilant for indications of high blood pressure, diabetes and other conditions to which underserved communities are particularly susceptible, and make referrals accordingly.

Rep. Charles Graham (D-Lumberton) said the center will be a “great asset to our county,” and that he’s confident the legislature will continue to recognize the value of the CSLC program.

“As we look at the health care needs of our counties statewide,” Graham said, “I think moving forward this will continue to receive the funding it will need. It certainly will be something we’ll keep our attention on.”

Measuring success

Chadwick said the dental school recently hired an associate dean for research and is beginning to gather baseline data on the CSLCs. He said the school also has a statewide database of electronic health records that allows practitioners at one CSLC to compare the incidence of particular conditions and outcomes with those at another.

Greg Chadwick, dean of ECU’s School of Dental Medicine, at a ribbon-cutting ceremony for the school’s new community service learning center in Lumberton. The center in Lumberton will offer a full range of onsite and teledentistry services. Photo credit: Taylor Sisk

“I think this is an incredible model,” said Robin Cummings, the state Department of Health and Human Services’ deputy secretary for health services and head of the state Medicaid program. “I think it’s a visionary model. I think it’s in keeping with what East Carolina [University] has set out as their goal, and that’s to bring health care to rural North Carolina.”

“Health care’s got to change,” Cummings said. “It’s getting more and more expensive, it’s getting more complicated, and the model that we’ve used in the past is not going to be a model that will work in the future.

“So visionary ideas like this – the use of technology, which they use quite a bit of – that’s what we’ve got to do in health care to try to control costs and take care of more people.”

Bill Smith, Robeson County’s public health director, appreciates the sliding fee scale.

“People who don’t have the ability to pay for dental upfront – which a lot of people have to do – can now be seen,” he said. “And at the same time, it’s teaching dentists and expecting those people to remain in this region.”

Which is exactly what Kasey Oxendine intends to do.

“Some people want to get away and stay away,” she said. “I enjoy the experience of being away, but it’s always been my desire to come back.”

And that’s music to Greg Chadwick’s ears.

[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]

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