LILLINGTON, N.C. — Many North Carolinians are living in a dental desert where access to health care is limited, affordability of regular preventive care and cleanings is a strain, and too few dentists exist.
“In Northampton County, I didn’t know we had a dentist in the county when I was growing up. There was one — located on the opposite side of the county. Rural health care isn’t just about the lack of dentists, it’s also about access to care and access to care in a reasonable amount of time and distance,” said Ernest Garner.
Garner grew up in Garysburg, N.C., a small rural community that boasts a little more than 1,000 residents. He moved from his home town for a career in finance and engineering before realizing just where he could serve the most. At the age of 46 he is finishing his fourth and final year at the East Carolina University School of Dental Medicine and he is helping bridge the gap in communities just like the one he grew up in.
“There is an opportunity to serve patients in these areas where there is limited access to care,” he said. “It’s part of the school’s mission and our own personal missions.”
The American Dental Association reports in April 2016, there are a total of 210,030 dentists nationwide with 5,319 in North Carolina. While North Carolina is the fifth fastest-growing state with a population of more than 10 million, it ranks 47th in the nation in dentists per capita. Twenty-seven out of the state’s 100 counties are served by two dentists or fewer per 10,000 people and one-third of the dentists practicing today are 55 years or older.
ECU is striving to educate the next generation of dentists with the focus on primary care for underserved areas. Fourth-year dental students like Garner are offered a unique experience to spend six months of their final year serving patients through the school’s eight established Community Service Learning Centers (CSLC) and living in those communities where health care is needed the most.
“This is more than fillings, extractions, root canals, and dentures. You can’t fill and drill your way into better oral health. We must help change some of the social determinants of health in people’s lives. As our students become practitioners, it’s not just about the dental procedures and preventions. It’s about what’s going on in these communities,” said Dr. Gregory Chadwick, the school’s dean.
“Do they have naturally fluoridated water? What’s the economy like? Do they have jobs? Do they have availability to foods that are nutritious? Or is the nearest grocery store where they can get fresh vegetables 20 miles away and they are going where they can get candy bars and sodas? We have to change some of these things if we are truly going to alter and improve the oral health of the people of North Carolina,” he added. “Understanding these living conditions, help our students understand why they are seeing the cases they do.”
CSLC’s are in Ahoskie, Brunswick County, Davidson County, Elizabeth City, Lillington, Robeson County, Spruce Pine, and Sylva. Patients of all ages are welcome, Medicaid plans are accepted, and the costs of services are generally two-thirds lower than regular patient fees.
“In each of these clinics, we are seeing patients with great need. It’s not just one little thing, some patients, who are adults, have never been to the dentist, said Jennifer Rominger, 24, of Advance, who has spent eight weeks at each of the clinics in Elizabeth City, Davidson County, and now, Lillington. “We’re seeing varying populations. In Lillington, we meet a lot of farm workers, in Davidson County most patients were self-paying where as in Elizabeth City, those were mainly Medicaid patients.”
Across the state, the clinics serve 35,313 patients with one patient from 98 of the state’s 100 counties. Each of the CSLC’s provides an economic impact over more than $1 million per site, per year.
Garner will tell you a combination of varying case types walk through the doors of the clinics. Factors such as affordability, lack of dental education, distrust of medical professionals, anxieties associated with the stigma that dentists only pull teeth, and minority populations without access to care are a few the reasons a gap in rural healthcare exists.
“There is the opportunity for our dental school to provide the dentists to take care of those populations. For who is the most likely to practice there? Somebody from that county who has relatives and family there,” said Chadwick.
It’s one of the reasons the school only accepts in-state students with an emphasis on students who wish to return to practice in rural communities. Out of 100 counties in the state, students hail from 74 of those. The School of Dental Medicine will graduate it’s third class of students in May.
Chadwick added, “We educate leaders who happen to be dentists; that leadership is essential as we as look at how we as a profession can improve rural health for the people of North Carolina.”