Rural patients could get more access to dental care, as dental hygienists can now treat patients in high-need areas without direct supervision, the N.C. Rules Review Commission decided Thursday, Jan. 16.
North Carolina’s rural communities are starved for dental care. Camden, Hyde, and Tyrrell counties haven’t hosted a dentist for the past decade. Almost 60 counties have dental care shortages, according to the N.C. Department of Health and Human Services in 2018. And only 29.7% of dentists accepted patients covered by North Carolina’s Medicaid in 2016.
For residents of Tyrrell County, the closest dentist is a 45-minute drive away, and nearly half of the residents reported losing at least one tooth because of poor oral hygiene.
Dentists say the old rules made that shortage even worse. Hygienists couldn’t travel to high-need areas and treat patients unless accompanied by a dentist.
“The unfortunate fact is that in a lot of areas of our state, there aren’t dentists available to see people. It became an effective bar on people in rural areas with no access to dentists,” said Ben Popkin, a consultant with the Foundation of Health Leadership and Innovation.
Poor dental care takes a toll not only on patients’ health, but also on the state’s fiscal health. Without preventative care, patients can land in the emergency room, which racks up charges but usually does little to treat oral decay.
“I’ve traveled a lot in the state and seen tons of issues in the ERs with dental problems — infections, heart disease, a lot of different things. To improve that, we did a gentlemen’s work today for the poor in the state,” said Rules Review Commissioner Tommy Tucker.
He hopes the new rule will help rural communities and seniors in nursing homes. It frees hygienists to perform basic procedures, such as cleanings, in high-need areas with only a dentist’s standing order instead of the presence of a dentist. It also allows dentists to supervise more than two working hygienists in high-need areas.
“We hope it will be a great opportunity for people who haven’t been seen by a dentist to have a long-term dental home, especially children and the elderly in long-term care facilities,” said Bobby White, N.C. Board of Dental Examiners CEO. “The hygienist can be the original point of content and provide services that are needed immediately, as well as a dental home for more serious services.”
The rule change is expected to kick in this February.
“It’s a few words here and there in the regulation, but it can have a really big impact,” Popkin said. “It could be a great market-based solution that removes a barrier to care.”