The ache of lost dental care in NC

ned.barnett@newsobserver.comApril 5, 2014 

There is no shortage of fiascoes and outrages concerning actions taken by Republican legislative leaders and the McCrory administration. But no situation better illustrates their indifference to the needy and their foolish management of state resources than what has happened in a small corner of the Department of Health and Human Services where the N.C. Oral Health Section operates.

Created in 1918 to address pervasive dental problems within a rural state, the Oral Health Section is the oldest dental public health program in the nation and for many years was its finest.

The section provided a network of dental hygienists who monitored the oral health of children in the state by looking into the mouths of virtually every kindergartener and fifth-grader, about 300,000 children.

Identify and educate

The hygienists would identify problems and work to get children, many of whom had never seen a dentist, into a dentist’s office for care of cavities, gum disease and orthodontic problems. The hygienists would also educate parents about their children’s dental issues.

The Oral Health Section coped with budget trims in the past, but it was still providing broad preventive care across the state until last summer. That’s when Republicans in the state Senate scoured the state budget for savings even as they were throwing money at the rich through tax cuts. When they turned to savings at DHHS, a proposal arose to cut $850,000 in oral health funding, a 30 percent reduction.

Fourteen of the state’s 39 public health hygienists and one recently retired hygienist took time off, donned their scrubs and went to the General Assembly to lobby against the cuts.

Their initiative eventually contributed to the firing of Rebecca King, head of the Oral Health Section and a dentist and 35-year state employee. King is appealing her dismissal through the state’s Office of Administrative Hearings.

After the hygienists’ lobbying effort, DHHS officials asked King to provide the names of the hygienists involved. King declined, saying employees were free to do what they wanted on their off time.

Meanwhile, the budget cuts went through and department leaders asked King to draw up plans for how the cuts would be implemented. In a tense meeting with DHHS Secretary Aldona Wos, King outlined three options. Wos apparently was upset with what she called King’s “doomsday” scenarios. King was fired shortly afterward.

To adjust to the cuts, 14 public health hygienist positions were eliminated and the dental examinations of the state’s fifth-graders were ended. About half of the state’s kindergartners also won’t be seen. A sampling of third-graders’ oral health was added to track the general condition of North Carolina’s children’s teeth.

The Oral Health Section will focus on the state’s poorer counties, limiting its coverage to 65 counties. Some counties with higher median incomes but large pockets of poor children have lost all school dental exams.

For a savings of $850,000 the state is sharply curtailing oral health exams that spared thousands of children serious dental problems and saved the state Medicaid program money by heading off emergency medical care for the indigent.

The American Dental Association reported last week that emergency room visits for dental problems cost nearly $3 billion from 2008 through 2010, and most of those seeking care were low-income and without insurance.

High cost of cuts

Dr. Jane Weintraub, dean of the UNC-Chapel Hill School of Dentistry, said cutting the budget for statewide exams of children’s teeth is a costly mistake.

“It’s not going to be savings because these kids are going to end up needing much more dental care,” she said. “They’ll end up in the emergency room where the problem won’t be solved, or they’ll end up in the operating room. The savings are incredibly short-sighted.”

After King’s experience, the state’s remaining dental hygienists know that speaking out about the program’s reductions is a risk. But retired hygienists would discuss what has been lost.

Carol Foster of Yanceyville retired as a public health dental hygienist in 2007 after 35 years with the state. When she started going into schools to examine children’s teeth, she said, “It was nothing to see just bombed out mouths, teeth decayed down to the gums.” By the end of her career she was seeing less decay, progress she attributed in part to the program’s dental monitoring.

“That doesn’t mean it’s a good idea to stop the program because in another 10 years you’re going to be right back where you were,” she said.

‘Rampant disease’

Beverly Bizzell of Southern Pines retired in 2011 after 36 years as a public health dental hygienist. She was among those who went to the legislature to try to stop the cuts.

In her years of examining children’s teeth, Bizzell saw children with “rampant disease,” including teeth decayed to gums, huge abscesses and teeth that looked moss green from never being brushed. She asked one child whether he had brushed his teeth and he said it was his brother’s week to use the toothbrush. Many children didn’t even have a toothbrush, and when it came to their children’s oral health, some parents “either didn’t know or didn’t care.”

“Then you have all these gum issues as a result,” she said. “I saw children with red, inflamed gums. You just touch (their gums) and they just gushed with blood.”

Bizzell said she is “heartsick” about the budget cuts. “The bottom line is you can’t lose a third of your program and think you can have the same kind of services. It’s just impossible,” she said.

It’s mystifying how conservatives can’t see the savings in protecting the dental health of the state’s children. To save $850,000 – an amount already lost many times over in Wos’s boondoggle-plagued department – they are ending dental exams for hundreds of thousands of children. It’s a foolish economy that will cost taxpayers in the end and cause many children unnecessary and enduring pain.

Editorial page editor Ned Barnett can be reached at 919-829-4512, or

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