By Krista Woolly

An uninsured young woman came to Community Care Clinic of Rowan recently had to have all her teeth extracted due to tooth decay caused by years without dental care. Free dentures gave her a new lease on life, instilling dreams of becoming a nurse so she could help others.

She’s one of the lucky ones. Inability to pay and other barriers to oral health care force many North Carolinians to needlessly endure tooth decay, gum disease, loss of teeth and pain so acute it sends N.C. residents to the hospital emergency department (ED) for care at a rate twice the national average.

Indeed, the system of providing access to oral health care for our most vulnerable neighbors is broken, and finding ways to fix it is critical not only to improving overall individual and community health but also to fulfilling North Carolina’s health equity goal of ensuring access to quality health care for all.

This is the conclusion of a task force assembled by the North Carolina Institute of Medicine, whose report this spring envisions a future where good oral health is acknowledged as a vital component of overall health and regular dental care becomes as available to the uninsured as regular medical care.

For Community Care Clinic of Rowan and other “safety-net” clinics that provide free health care, including dental care, to our uninsured neighbors, “Transforming Oral Health Care in North Carolina” reaffirms our core belief that all North Carolinians deserve quality health care regardless of ability to pay.

How can the system be transformed? Increasing the number of people who can take advantage of the dental benefits available under Medicaid is a key part of the solution, especially with 450,000 N.C. residents becoming newly eligible for the program with the expansion of Medicaid last December.

But only 40 percent of North Carolina dentists currently serve Medicaid patients — in part due to low reimbursement rates that discourage participation — and many aren’t accepting new enrollees. Further limiting access to oral health care are countywide shortages of dentists in 87 of the state’s 100 counties.

Even if limits on Medicaid can be fixed, the task force wrote, “the state still faces challenges in comprehensive access to high-quality oral health care for all residents” that “extend beyond the abilities of Medicaid” — namely, the estimated 700,000 N.C. adults who remain uninsured post-expansion.

The report identifies 151 “safety-net dental access points” where the uninsured can receive oral health care, including local health departments, federally funded health centers, free and charitable clinics like Community Care Clinic of Rowan and school-based dental hygiene programs.

Many free clinics have prioritized oral health care, opening new dental clinics, expanding existing facilities and adding mobile clinics and transportation services to serve residents in rural areas. But the need is so much greater than the resources currently available.

We need to fix Medicaid and expand the capacity of safety-net providers to provide oral health care. We live in a state where 13 percent of adults haven’t seen a dentist in at least five years, 45 percent of adults over age 18 have had permanent teeth extracted and 21 percent of residents over 65 have lost all of their natural teeth.

Nobody disputes the impact of poor oral health. It can negatively affect conditions including diabetes, pregnancy, cardiac disease, arthritis, stroke and dementia. Beyond physical health issues, it impacts social acceptance, mental health and self-esteem and even employability.

Nobody denies that making preventative oral health care widely available will reduce societal healthcare costs — not just by avoiding expensive surgeries but also by reducing ED visits for non-traumatic dental conditions. The uninsured and Medicaid recipients account for 73 percent of such visits.

Rowan County is fortunate to have a clinic with a robust dental department that has served our community’s uninsured for 24 years, relying heavily on local volunteer dentists who give generously of their time. But in so many communities barriers to oral health care deny our neighbors the chance to live their healthiest, best lives.

The memory of that young woman who left with a bright smile and brighter outlook makes me hopeful we can break those barriers down — for Medicaid beneficiaries as well as the hundreds of thousands of uninsured North Carolinians who rely on free and charitable clinics and other safety-net providers.

Krista Woolly is executive director of the Community Care Clinic of Rowan County and current board chair of the North Carolina Association of Free and Charitable Clinics.