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Oral Health Costs and Conditions in North Carolina


Oral health care costs are high for citizens of North Carolina, but more so for those who live below the poverty line. The average cost of dental services for children from low-income families was almost three times as much as it was for other children. At one point in time, over two-thirds of all adults over 65 years old had lost all their teeth due to lack of access to proper care and procedures such as dentures or implants which can cost upwards of $4000 on average. Oral health conditions in North Carolina continues to deteriorate because not everyone has the resources necessary to maintain their dental health. North Carolina needs to take action to help its residents improve their oral health by implementing affordable options for receiving dental care. The paper offers solutions to oral health issues faced by North Carolinians.


Based on a study conducted by Prasad and colleagues, in North Carolina, over 1 million adults reported not seeing a dentist within the past year and more than 3 million adults reported having no dental insurance coverage. These statistics demonstrate how many adults do not go to the dentist regularly and lack access to dental care because of cost or lack of insurance coverage. Preventative dental care helps maintain good oral health, but when an adult has untreated tooth decay or gum disease it can lead to serious consequences such as tooth loss, chronic pain or even heart attack (Okunev et al., 88-98). Hence, firsly, education campaign to make sure everyone is aware of the importance of oral health. In North Carolina , it is common for children to go without dental care due to lack of funds or access, which can lead to serious diseases such as gingivitis. Hence, education campaigns are needed to ensure all citizens are aware of the importance of oral health. The Office of Public Health could start by running public service announcements on radio stations, televisions, and through social media platforms like Facebook and Twitter. They could also provide more information on their website, letting people know where they can find help with oral health. Finally, more schools in North Carolina need to provide free dental services for students so that they don’t miss out on an important part of growing up.

In 2018, Governor Roy Cooper announced $1 million would be given to fund Triad and Piedmont areas. However, it was not enough because many school districts already struggle with providing adequate health services. Furthermore, there has been controversy over how many dentists these new clinics will actually employ. For example, according to Raleigh’s WTVD news station only five dentists will work at the Piedmont location while twelve will work at the Triad location (Lancaster). Consequently, this means that some students may not be able to receive necessary dental care even after these new clinics open. As long as there are large gaps in coverage, our state will continue to see challenges surrounding oral health. Raising awareness of the importance of oral health should be another important step towards bettering our state’s condition. Signs can be put up in doctors’ offices encouraging them to mention the importance of taking care of our mouths before anything else and public service announcements can educate viewers on the same topic during commercial breaks.

Over the years, North Carolina dental conditions have slowly worsened since the 1990s. North Carolina residents have seen a gradual rise in the number of cavities, adults ages 30-44 who had missing teeth and those adults ages 45-64 who were diagnosed with periodontal disease. One cause of oral health deterioration is the increasing rate of dental caries among adolescents. According to a 2016 report, 8% of North Carolina adolescents had cavities in at least one permanent molar and 15% had cavities in at least one permanent premolar. In contrast, 5% of adolescents had cavities in at least one permanent molar and 11% had cavities in at least one permanent premolar in 1998 (Burgette et al., 77-83). There are many reasons why dental caries has increased over the years, including more frequent consumption of high sugar foods and drinks, a decrease in the frequency of tooth brushing and an increase in the use of antibiotics. All three reasons have been shown to increase the risk of developing dental caries. Thus, there is need for more dental care providers in North Carolina. Hence, our state needs to invest in more dental clinics and promote preventative dental care instead of waiting for people to come in with toothaches or other health issues. The North Carolina Department of Public Health should create public service announcements to raise awareness of the importance of oral health and inform the public on how they can access dental care services. Additionally, the North Carolina State Board of Dental Examiners should adopt a mandatory continuing education requirement for all practicing dental professionals (Saxen et al., 193-199). This will ensure that they maintain a good level of skill and expertise in order to provide quality dental care. The NCDPH also needs to develop standards and rules to improve the quality of dental health in the state.

Studies show that those who visit the dentist regularly have healthier teeth than those who do not (Hoeksema et al., 2615-2622). Given these findings, making regular dental visits accessible to all North Carolinians is crucial to maintaining good oral health. More North Carolinians deserve the opportunity to take advantage of affordable dental care (Firmino et al., 459-471). Hence, Dental Clinics should be set up in every county. Furthermore, low-income families and senior citizens who are on Medicaid and Medicare, respectively, should be provided with vouchers to cover the cost of getting dental care. Schools across North Carolina should also establish mandatory pre-screenings to determine if students are suffering from any oral health issues. Educating children about the importance of brushing and flossing their teeth twice a day, providing nutrition education to high schoolers, and putting fluoride in public water systems. Moreover, educating children before the age of six about healthy food choices would help promote better oral hygiene habits since children learn best through repetition. Providing nutrition education to high schoolers would be a great idea as well.

Over the years, dental insurance rates in North Carolina have gone up, costing individuals and families a significant amount of money. This is problematic for a variety of reasons, but primarily because the majority of the population does not carry dental insurance. Additionally, dental care is expensive and difficult to come by in rural areas (Willink et al., 2241-2248). Accessibility to dental care should be a fundamental right that no North Carolinian should be denied. Therefore, starting a statewide initiative to provide free dental care to anyone who needs it would address these major concerns and prove beneficial in the long run. Furthermore, it would be beneficial to provide dental care at all of the local health departments as well as community centers. This would allow people to have easier access to this care. Even with these changes in place, there are still more steps that need to be taken in order for North Carolina ‘s oral health costs and conditions to improve. Provision of dental insurance in North Carolina should be made more widely available to those who cannot afford it. This could be done by allowing people on Medicaid and Medicare, respectively, to purchase dental insurance with vouchers that cover the cost of premiums. Furthermore, it would be beneficial to allow dental care providers in North Carolina to accept medical insurance plans from both Blue Cross and Blue Shield of North Carolina as well as Cigna. This would allow for patients to easily sign up for these plans and give them the option of not just one or the other. Patients who wish to continue seeing their current provider can do so while receiving coverage through either BCBSNC or Cigna. In addition, the North Carolina Medical Society should allocate funding to create a dental insurance exchange (Crook et al., 191-194). This would provide a forum for private and public entities to work together in order to provide dental care at the lowest possible cost for North Carolinians. Another idea is to increase the number of dentists and dental hygienists in the state. This would allow people who are qualified, but unable to find work due to economic constraints, the opportunity to receive training and become employed as dentists or dental hygienists.

Since 2013 dental costs in North Carolina have been reported to have increased over 50%. While healthcare in general has seen an increase of 11% between 2011-2013, dental care has seen an even larger rise, going from $2 billion in 2011 to $2.5 billion in 2013. There is also a disparity between rural and urban areas when it comes to availability of dental care; while 90% of urban North Carolinians live within 30 miles of a dentist office, only 64% percent of rural residents can say the same thing (Watson et al., 32-35). The disparity in availability of dental care results in poorer outcomes, too. Rural North Carolinians are found to suffer from worse oral health than their urban counterparts, which creates a vicious cycle: the lack of dental care leads to worse oral health and the worse oral health leads to the inability to work, which makes affording dental care impossible (Harris et al., 167-184). The average person spends two hours per day dealing with gum disease and tooth decay. Hence, there is need for the North Carolina State Legislature to amend the laws regulating dental care. North Carolina should make dental care a priority in its budget, particularly in rural areas. Free or reduced-price dental care should be offered to people who are low income or unemployed. Affordable and accessible dental insurance should be made available to the elderly and disabled. Reallocating funds from specialty programs to ones that are less costly and more beneficial for the citizens of North Carolina is another idea worth considering.


Conclusively, it is evident that oral health costs and conditions in North Carolina are a problem that needs to be addressed. The proposed solution of increasing access to dental care through dental clinics will help to mitigate this issue. However, this is just one part of the puzzle; more research needs to be conducted in order to develop a more comprehensive plan to reduce oral health disparities in North Carolina.

Works Cited

Okunev, Ilya, et al. “The impact of underutilization of preventive dental care by adult Medicaid participants.” Journal of Public Health Dentistry 82.1 (2022): 88-98.

Prasad, Monika, et al. “Integration of oral health into primary health care: A systematic review.” Journal of family medicine and primary care 8.6 (2019): 1838. Prasad, Monika, et al. “Integration of oral health into primary health care: A systematic review.” Journal of family medicine and primary care 8.6 (2019): 1838.

Lancaster, Jennifer Leigh. “A Historical Study of Early Industrial Education Centers in North Carolina.” (2018).

Burgette, Jacqueline M., et al. “Advancing oral health policy through persuasive messaging and effective research measures.” Journal of Public Health Dentistry 81.1 (2021): 77-83.

Firmino, Ramon Targino, et al. “Is parental oral health literacy a predictor of children’s oral health outcomes? Systematic review of the literature.” International journal of paediatric dentistry 28.5 (2018): 459-471.

Hoeksema, A. R., et al. “Health and quality of life differ between community living older people with and without remaining teeth who recently received formal home care: a cross sectional study.” Clinical Oral Investigations 22.7 (2018): 2615-2622.

Willink, Amber, Cathy Schoen, and Karen Davis. “Dental care and Medicare beneficiaries: access gaps, cost burdens, and policy options.” Health Affairs 35.12 (2016): 2241-2248.

Crook, Hannah, et al. “North Carolina’s Health Care Transformation to Value: Progress to Date and Further Steps Needed.” North Carolina Medical Journal 81.3 (2020): 191-194.

Watson, David, Hannah Rutten, and Melanie Yuen. “Trends in Dental Utilization Among Young Children in the United States, 1996-2016.” Pediatric Dentistry 44.1 (2022): 32-35.

Harris, Jenine K., et al. “The double disparity facing rural local health departments.” Annual review of public health 37 (2016): 167-184.

Saxen, Mark A., Douglas E. Peterson, and Michael Mashni. “Point: A 21st-century paradigm for the recognition of dental specialties in the United States: Historical review, lessons learned, looking forward.” The Journal of the American Dental Association 150.3 (2019): 193-199.


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