Transforming systems to advance oral health in North Carolina


Reflect on & celebrate a decade of partnership and commitment to accessible and equitable oral health

Oral health is an often overlooked and underfunded facet of public health and individual wellness. While poor oral health has the potential to affect us all, there are certain members of our communities who encounter more challenges in accessing timely and high-quality dental care. This includes children from low-income backgrounds, older adults (aged 65 and above), racial and ethnic minorities, pregnant women, individuals with special healthcare needs, and those residing in rural or remote areas.

The kicker is that although dental issues can largely be prevented and treated, they often are not. Untreated tooth decay (dental caries) and periodontal diseases result in unnecessary discomfort, infections, and tooth loss. Additionally, these ailments contribute to a diminished quality of life and unfavorable health outcomes and share common risk factors with conditions like diabetes, heart disease, and adverse reproductive/birth outcomes.

Ensuring equitable access to quality, affordable oral health services requires intentional investments.

Since 2009, The Blue Cross NC Foundation invested nearly $10M in nearly 80 organizations in North Carolina, seeking to cultivate cross-sector and community partnerships to spur systemic changes that improve the oral health of all people.

This evaluation was commissioned by the Blue Cross and Blue Shield of North Carolina Foundation; however, its contents do not necessarily represent the views of the Foundation.

This site shares learnings from a 2023 retrospective evaluation (conducted by Intention 2 Impact, Inc.) of the Blue Cross and Blue Shield of North Carolina Foundation (Blue Cross NC Foundation)’s Oral Health portfolio.

These findings seek to highlight the impactful collaboration between the Blue Cross NC Foundation and an array of cross-sector community partners, share lessons learned from a decade of grantmaking, and provide inspiration for the road ahead.

Whether a community advocate, oral health provider, health professional, educator, public servant, funder, or simply an oral health enthusiast, the evaluation team hopes these findings stimulate continued conversations about the importance of quality, affordable oral health services in the progression towards improved health for all.

Over the past decade, North Carolina’s standing compared to other states and Washington D.C. has increased both in terms of dentists per capita (46 dentists in 2009 to 55 dentists in 2021 per 100,000 individuals) and policies that promote access to preventive and other services provided by dental hygienists. Significant progress has been made to advance oral health policies, strengthen the oral health care safety net, increase access to care, and bolster coordination & partnership across partners in the state.

But there is still more work to be done. While dentists per capita have grown, most of this growth occurred in 5 counties (Durham, Guilford, Mecklenburg, Pitt, and Wake) that have historically been well-supplied with healthcare workforce. Sixty percent of NC’s population residing in the remaining 95 counties gained only 20% of the dental workforce during this period of growth.

Communities are also struggling to stay free of dental diseases. In 2019-2020, 15 % of kindergarteners had untreated tooth decay, and more than half the kindergarteners experienced some tooth decay, a fully preventable disease. Disparities by race/ ethnicity and rurality of residence are also significant, with tooth decay prevalence among White children being 30% and 52% among Hispanic/Latino children. Furthermore, nearly half (48%) of the Medicaid-eligible children ages 1-20 years had not received a preventive dental service in the past year.

Adults in NC are struggling, too. In a convenience sample of pregnant women screened in 2016, one in three were found to have untreated tooth decay. Recent data shows that only a little over half of the adults (56%) in NC have access to dental insurance, and nearly half the adults (46%) 18 years and older have had one or more teeth extracted due to tooth decay.

With continued investments by funders and engaged partnerships between various actors in the ecosystem, further improvements in the oral health of North Carolinians are possible and necessary.

  1. U.S. Dentist Demographic Dashboard, American Dental Association.
  2. NC’s Dentist Workforce Continues to Grow, But Mostly in 5 Counties, The Cecil G. Sheps Center for Health Services Research, University of North Carolina
  3. North Carolina Oral Health Improvement Plan, 2020-2025, North Carolina Public Health

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The insights and learnings generated from this 10-year retrospective evaluation of the Blue Cross and Blue Shield of North Carolina Foundation’s oral health portfolio would not have been possible without the candid reflections and voluntary participation of various oral health grantee partners and leaders across North Carolina. Thank you for your steadfast commitment and dedication to the oral health and overall well-being of communities across NC.

This retrospective portfolio evaluation and learning process, and the production of this web report was conducted by Intention 2 Impact, Inc., including Dr. Nina Sabarre, Dr. Kathleen Doll, Dr. Sahiti Bhaskara, Blake Beckmann, and Chris Lysy.

This process was supported by the Blue Cross NC Foundation’s Oral Health Program Director, Daijah Davis, Vice President of Program and Strategy, Katie Eyes, Director of Evaluation & Learning, Sarah Smith, and Learning and Evaluation Officer, Chelsey Hurt.

Blue Cross and Blue Shield of North Carolina Foundation is an independent licensee of the Blue Cross and Blue Shield Association (BCBSA) ® Registered Marks of the BCBSA.

During the grantmaking period considered in this evaluation (2009-2022), grants were made to the following organizations.

The following peer funders were instrumental in catalyzing oral health progress in NC: