State Update

State Spotlight: North Carolina

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North Carolina Statistics:

  • Population in 2012: 9.7 million.
  • The state is naturally divided into three areas: the Appalachian Mountains, the Middle or Piedmont Plateau, and the Coast. The largest city is Charlotte, N.C., with an estimated population in 2012 of 775,202.
  • Median household income: $46,291 (U.S. median household income is $52,762).
  • Approximately 4,800 practicing dentists are located in North Carolina, and the state has two dental schools.
  • Approximately 28% of North Carolinians have no teeth by age 65 (U.S. average is 25%).
  • In 2011, North Carolina moved from a C to a D grade on the Pew Center’s National Oral Health Report Card in part due to the share of dentists’ median retail fees reimbursed by Medicaid falling below the national average.

Program Highlight: The Carolina Dental Home Program began as a pilot program in 2006 with a grant funded by the Health Resources and Services Administration (HRSA), within the U.S. Department of Health and Human Services (HHS). The overall goal of the pilot program was to expand access to dental services for children who are 0-3 years of age and enrolled in Medicaid. Specifically, the Carolina Dental Home is a partnership with local pediatricians, family physicians, and dentists. The local pediatricians and family physicians identify children who are 0-3 years old and at high risk for tooth decay before checking their teeth and risk factors during a well-child visit. If needed, the children are then referred to a dentist.

Services Offered: One of the key objectives of the pilot program was to develop a tool and set of guidelines for medical providers to use to make risk-based dental referrals. After reviewing the available risk assessment and referral guidelines, an initial Priority Oral Risk Assessment and Referral Tool (PORRT) was developed. The PORRT consists of six questions that the physician asks the parent, each related to the following subjects: oral hygiene (fluoride exposure toothpaste and drinking water), diet (bottle use, snacks, and beverages), and history of family dental problems; as well as four clinical indicators from the oral evaluation: non-cavitated lesions, cavitated lesions, enamel hypoplasia, and visible plaque. There is a weighted scoring system to derive an overall score for the 10 items. This tool is designed to provide a priority of referral to a general or pediatric dentist, or to remain in the medical office for preventive care based on the overall score.

The aim of the PORRT is to coordinate the care of young children between the physician and the dental provider. Children under three years of age with obvious dental diseases are referred to a pediatric dentist for treatment. Those children with non-cavitated lesions, or those who are at high risk but without disease, are referred to a general dentist for preventive care and frequent evaluation. Those at low risk remain under the care of physicians but can be referred to a general dentist once they reach three years of age. According to the North Carolina Department of Health and Human Services, “although the dental visit at one year old is an ideal goal, it is not possible to provide a publicly-insured child with a dental home by that age.”

Residents Served: Although the HRSA funding ended in 2010, and the state did not have the resources to formally continue the pilot program, medical offices in North Carolina continue to complete the PORRT and refer children at high risk for tooth decay to local dentists. From 2006 to 2010, approximately 5,800 PORRT forms were completed by physicians in the Carolina Dental Home Program.