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By Jared Weber

For many rural North Carolinians, there’s no quick fix for a nagging toothache.

Last year, the state Department of Health and Human Services reported that only 18.8 percent of the state had a sufficient number of dentists. Three counties — Camden, Hyde and Tyrell — lack a single dentist within their boundaries.

Overall, North Carolina has 3.9 dentists for every 10,000 people. Nationally, that number is closer to 6.1 per 10,000.

Zulayka Santiago, who emceed Tuesday’s event, wraps up Oral Health Day with some closing remarks. Santiago, a first-generation immigrant who grew up without access to adequate oral health care, said the issue is more than cosmetic. “Oral health impacts peoples’ economic viability; it impacts their children’s ability to concentrate in school; it’s a massive issue in rural areas,” Santiago said. “It has massive ripple effects, both on individuals and communities.” Photo credit: Jared Weber

About 135 advocates gathered on Bicentennial Mall in front of the General Assembly building on Tuesday morning to voice their concerns at their second annual legislative Oral Health Day.

The event was put on by the North Carolina Oral Health Collaborative, a program which partners with organizations that share a common goal of providing affordable oral health care to all North Carolinians.

Zulayka Santiago, the program’s director, said the oral health issues stem from the state’s restrictive dental hygiene laws.

According to North Carolina’s Dental Hygiene Act, licensed dental hygienists can only perform their work if a “licensed dentist directs in writing” to do so.

Santiago said those dentists tend to be protective of this privilege, limiting the scope of practice for dental hygienists. Allowing hygienists to provide care to more people is at the core of her program’s initiative.

“There’s no reason — and this is supported by science and evidence — that hygienists shouldn’t be able to do more,” Santiago said.

‘A good starting way to come together’

It’s unlikely that any bills will be passed this year to extend affordable health care to rural North Carolinians, as lawmakers are racing toward the end of this year’s legislative work session.

Lawmakers sent their approved state budget proposal to Gov. Roy Cooper’s desk on Friday evening. That budget made no change to the amount of money appropriated for oral health preventive services in 2017, with just under $5 million set aside.

Republican legislators hold veto-proof supermajorities in the House and the Senate, so regardless of what action the governor takes, the budget is expected to become law.

That didn’t worry Santiago and the other advocates on Tuesday, though. Santiago said the day was “generally about awareness.”

“[Oral Health Day] is a reminder about the importance of integrating oral health into these conversations, which are getting a lot more traction, around whole-person care,” Santiago said.

For now, Santiago said the program’s goal is to maximize access to oral health care under the state’s current laws.

“Who wouldn’t get behind more access to preventive oral health care for children in school systems?” she said. “We’ve been having conversations with the oral health section, with the North Carolina Dental Society, to figure out how we can come together around our goal.”

Both sides of the aisle did come together for the event when Rep. Donny Lambeth (R-Winston Salem) and Rep. Gale Adcock (D-Cary) gave a joint speech about the importance of oral health.

Lambeth is a primary sponsor of the Carolina Cares bill, a Medicaid expansion bill proposed last year.

He said that since his reform plan would pay for patients having better outcomes, rather than just paying for services rendered, it will encourage better oral health care from a younger age.

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“If you can educate people that there’s a role for the dental care early on, you can prevent 10 times the cost later in life,” Lambeth said.

Adcock urged the attendees to continue the fight when they return home, because the annual day of advocacy “can’t be the only thing [they] do.”

“If you come down one day and you blitz us in the short session, where we’ve got all kinds of things going on, and you go home and you think ‘Well, I’ve done everything I can do, see you next year’ … you just can’t affect change that way,” she said.

Language justice

Since poor oral health adversely affects communities of color, the collaborative made an effort to make Tuesday as inclusive as possible.

One of the ways they ensured a welcoming environment was by striving for “language justice,” said outreach coordinator Suzanne Martin.

Suzanne Martin scribbles down audience suggestions to consider for next year’s Oral Health Day. “My background is as a social worker … focused on social justice issues,” said Martin, the event’s outreach coordinator. “So, for me, oral health is about the disparities between different communities in regards to their oral health outcomes.” Photo credit: Jared Weber

The collaborative hired two professional Spanish translators for the day, who alternated with one another to provide a live translation of all English speakers to Spanish-speaking attendees through headsets, which were handed out at the start of the day.

Martin said the decision was a no-brainer.

“We espouse that we value inclusive environments,” she said. “This is really acting on that.”

Iareli Renteria, a Spanish speaker and mother of three, attended the event with the group from El Pueblo, Inc., a Raleigh-based Latinx advocacy group.

She said she really appreciated the bilingualism of the event.

“Using my own language is always easier. Without it … you only more or less understand what the others say,” Renteria said.

Moving forward, differently

The collaborative has a busy next year planned after the short session wraps up, including a complete shift in the way they provide disadvantaged communities with financial support.

In the past, Martin said, they have identified issues, partnered with community organizations, and then given them money to make changes, with no additional oversight.

“We’re flipping that model,” she said. “We’re working with community partners from the onset and saying ‘We have money. What do you self-identify as the issues?’”

Martin said the change is being made because of a lack of progress in spreading oral health awareness in recent years. She’s encouraging anyone who’s interested to get involved with the program in their own community.

“It’s important to know that you’re not alone; that there’s a place to go to find basic information about oral health, and to find out who else is a part of the conversation,” she said.

Jared Weber

Jared Weber is NC Health News' 2018 legislative intern. He is a rising junior at UNC Chapel Hill where he's majoring in journalism and global studies with a minor in Spanish.