ECU seeks a dental school

Greenville school cites lack of rural practices

East Carolina University wants to establish a dental school in Greenville to ease the state's chronic shortage of dentists in rural and under-served areas, but more North Carolina dentists are against the new school than for it.

Some say dentists in the state -- most of whom trained at UNC-Chapel Hill's School of Dentistry -- may not want to see an upstart challenge their alma mater for students, faculty and scarce state resources.

There also appears to be a more practical reason for the lack of enthusiasm: A new dental school would eventually pump as many as 50 new dentists a year into the existing market, creating competition for patients and, over time, making it harder to earn a good living.

Dr. Rex Card, a Raleigh dentist who is president of the N.C. Dental Society, said when he started practicing in the early 1980s, North Carolina and many states had an oversupply of dentists. Many did not have enough patients and left the state, he said.

Card said some dental society members are concerned a new ECU dental program could bring back those conditions, even though it wouldn't admit its first class until 2010 or 2011, under the most optimistic timeline.

"For the first few years it might be a good thing," said Card. "But after that we might be producing too many."

ECU submitted its proposed dental curriculum this month to the 16-campus University of North Carolina system for consideration, and the Board of Governors could vote to approve the new program at its Nov. 10 meeting.

The dental society, whose members include more than 80 percent of the state's licensed dentists, has not taken an official position against the ECU dental school. But a survey of society members found that half oppose it, Card said. Another 25 percent support the ECU program and the rest are undecided.

It isn't the only proposal being considered to address the state's dental access problems.

A plan developed jointly by leaders at UNC's dental school and ECU calls for increasing the class size at UNC from 80 to 100, in addition to building the ECU dental school. The dental society is in favor of expanding UNC.

There's little argument that residents of the state's poor and rural areas have a difficult time getting dental care. Ann Lamm, 64, can't remember the last time she had her teeth examined, cleaned or otherwise tended, but it has been years. She can't afford a dentist and none work at the free health clinic in the Halifax County town of Roanoke Rapids where she gets medical care.

"I need my teeth looked after just like anyone else," Lamm said, noting that older people who don't qualify for Medicaid or who aren't old enough for Medicare are especially vulnerable. Children, too, have had trouble getting care.

An advocacy group sued the state in 2000, claiming the state didn't reimburse dentists adequately for Medicaid patients, creating a scarcity of services that hurt thousands of poor children. The state Medicaid program raised payments 30 percent for the 60 most common dental procedures, but still only one in four private dentists actively treat Medicaid patients today.

A change in state law that took effect in January 2003 made it easier for out-of-state dentists to set up practice in North Carolina, but there is no evidence that the more than 200 dentists who have come under the new provision are settling where they are most needed.

The number of safety-net dental clinics -- including public health dental clinics and free clinics -- has nearly tripled across North Carolina since 1998, but about 80 percent of Medicaid patients get care from private dentists, according to Medicaid data.