By Anne Blythe
State health officials issued a bleak observation this month about the oral health of North Carolina children: Nearly one in five kindergartners has untreated tooth decay.
That rate is the highest it’s been in five years — partially because many dental offices scaled back their work during the early days of the pandemic. Add in the long-standing barriers to health care access that put children from low-income families and communities of color at a disadvantage, and it’s easy to understand why Susan Kansagra, assistant secretary for public health in the state Department of Health and Human Services, is calling for action.
“It is our responsibility to address these disparities and ensure all children have access to quality dental care, regardless of their background,” Kasangra said.
The news isn’t all grim, though.
Students from the UNC Adams School of Dentistry spent an entire day last week working to improve access to dental care for children up to 17 years old. The aspiring dentists organized and took part in the 10th annual Give Kids A Smile Day.
“To me, coming from a public health background, I saw a stark need for dental care across our state,” said Niki Lanka, a third-year UNC dental student involved with the setup and caregiving. “So many of the kids we see here, it might be their first time.”
Give Kids A Smile is a national program launched in 2003 by the American Dental Association Foundation to give free screenings, fillings, caps and other restorative care to underserved children.
Its roots are in St. Louis, where two dentists used a dental clinic that was about to be demolished to open up 15 dental chairs to provide care to almost 400 children.
“The ADA recognized that this grassroots effort had great potential to raise awareness nationally about the importance of oral health to overall health, and about the staggering need that exists among millions of children who go without care,” according to the foundation website. “So, in 2003, Give Kids A Smile evolved into a nationwide program with the goal of providing free oral health care to underserved children.”
Now, nearly 6,500 dentists across the country participate each year in programs that provide care to more than 300,000 children.
At the Chapel Hill event on Feb. 2, more than 50 UNC dental school faculty and staff members saw almost 200 children from Orange, Durham and Wake counties. They provided nearly $40,000 in care.
“It’s an excellent opportunity to reach out to the community,” said Miguel Simancas-Pallares, from the school’s division of pediatric and public health. “We know we are surrounded by a huge population of unmet needs.”
Dental students spent five hours the day before the event decorating three floors at their school with colorful streamers, balloons, toys and art projects that fit their “Under the Sea” theme.
A ‘favorite day’
Bree Smith, a third-year student who has participated in every Give Kids A Smile Day during her time in dental school, said the student organizers hit on that after noticing in 2023 that many of the children would come into the building’s atrium after having their teeth cleaned or worked on and gather around a screen where Disney movies were playing.
The students went from using an outer space theme in 2023 to the depths of the sea this year.
“I just love how everybody gets so excited about treating these kids,” Smith said.
There were inflatable swimming pools filled with small toys instead of water. Tiny fishing poles rested on the pool for children to cast out a plastic hook and reel in a special treat.
Artistically inclined youngsters could choose from an array of colorful crayons and markers to decorate kid-friendly handouts about good diets and teeth care.
Children also got electric and Spiderman toothbrushes.
The little ones also got well wishes from a Carolina blue shark — or a mascot in an inflatable costume trying to convince an apprehensive and quizzical audience that a hug would not lead to a sharp bite. Rameses, the UNC mascot, also made an appearance.
Grayson, an empathic and trained Golden Retriever with a knack for knowing when to snuggle a child in a dental chair to ease anxiety about a screening, cleaning or filling, was on hand.
Kanine Jucoski brought her children Clara and Lucca Graciano to the Chapel Hill event from Wake County after her daughter had a “bad experience” at a dental visit elsewhere. A friend told Jucoski about Give Kids A Smile Day, and Clara, 10, was all smiles after her visit with the UNC dentists. They liked what they saw, too, according to the girl’s report.
“This looks good,” she said they told her.
Esther Lee, a third-year student, said it’s important for the event to be a “one of a kind” dental visit that might lead to more regular care for children — and perhaps even the parents and caregivers who bring them. The goal is for them to come back to the dental school or look for a provider closer to home for routine cleanings and screenings.
As a child, Lee had to travel to another state to go to the dentist.
Her parents are Korean immigrants who put their trust in an uncle’s care who spoke Korean and was in Atlanta, about a four-hour drive from their Charlotte home. Paying it forward through events such as Give Kids A Smile Day buoys her spirits.
“It’s my favorite day of the year,” Lee said.
Closing the coverage gap
The dental students, faculty and state health officials noted the need to improve access to care for children from low-income families.
The North Carolina Medicaid dental program covers a wide range of care — from cleanings, screenings and other preventative services to fillings, tooth restoration, denture fittings, periodontal care and some oral surgeries.
After years of resistance, the Republican-led General Assembly finally agreed to expand Medicaid benefits to more low-income workers, creating a new access point to oral health care for underserved children.
“Our recent expansion of Medicaid has helped expand access to oral health care for thousands of our fellow North Carolinians across the state,” Kansangra said.
A major sticking point, though, is that only about 45 percent of North Carolina’s dentists accept Medicaid patients. Many of those providers, though, are not accepting new Medicaid beneficiaries.
Dentists say that the Medicaid reimbursement rate for their care has remained the same for the past 15 years, which has contributed to the access issue. A task force and other oral health advocates have been looking into the issue and may present recommendations for change this year.
Meanwhile, oral health care providers keep stressing the importance of classifying dental and periodontal services as crucial.
“Good oral health in childhood is a critical component to overall health and well-being,” Kelly Kimple, senior medical director for health promotion in the NCDHHS Division of Public Health, said in a statement that announced February as National Children’s Dental Health Month. “By supporting proper dental care for our young ones, we can prevent lasting impacts to help them lead healthier lifestyles in the future.”
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It seems vital to attract more people into dental hygiene work also. Perhaps some incentives like tuition reimbursement might help. In our area the shortage is very serious and limits the options for quality dental care.