Dental Health Professional Shortage Areas Extend Into Almost Every North Carolina County

SEPT. 14, 2020

CARY — Ninety-eight of North Carolina’s 100 counties have now been designated as Dental Health Professional Shortage Areas (Dental HPSAs), according to new data released by Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (DHHS). 

HRSA’s 2020 update represents a 32.4 percent increase from 2019 Dental HPSA designations, which classified 74 North Carolina counties as dental HPSAs. Now, Stokes and Orange counties are the only two without Dental HPSA designations, and both counties are currently under review. 

“The new data show a dramatic yet unfortunately unsurprising disparity in access to basic oral health care in North Carolina,” said Dr. Zachary Brian, director of the North Carolina Oral Health Collaborative (NCOHC), a program of the Foundation for Health Leadership & Innovation (FHLI). 

Counties are designated as Dental HPSAs when there are not enough oral health professionals to meet communities’ needs. Dental HPSAs may be geographic, population, or facility-based, and all or part of a county may be designated. Among the new Dental HPSA designees are Wake and Buncombe counties, two of North Carolina’s counties with larger urban populations. 

“The data additionally underscore the idea that even in urban areas, access to oral health care is not available to all,” said Brian. “Just because you live around the corner from a dentist doesn’t mean you have access to care.” 

In addition to the number of dental professionals in a particular area, income, insurance coverage disparities, transportation insecurities, and a maldistribution of dentists across North Carolina’s counties, among other factors, all contribute to the overall lack of access to essential oral health care services.

NCOHC, which works to increase equity in oral health care, believes that effective policy reform will play an important role in increasing access amidst the growing shortage of oral health professionals in relation to North Carolina’s expanding population. In June 2020, NCOHC released a policy brief outlining opportunities at the state level and providing a road map to workforce and payment modifications that could help increase access to care for underrepresented and underserved North Carolinians. 

A close up of a map

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HRSA’s map of Dental HPSAs in North Carolina. 
Any county with a score greater than 1 is considered a shortage area.

Additional Information

  • HPSA designations can cover an entire county or a part of a county. For example, the dental HPSA designation for Wake County only covers the eastern part of the county, and while Mecklenburg County as a whole is not a dental HPSA, Charlotte is. 
  • HPSA reviews such as the ones currently happening for Stokes and Orange Counties are typically performed when the Office of Rural Health receives a request to do so. In early 2020, the Oral Health Section of the North Carolina Department of Health and Human Services requested review of all undesignated counties, which triggered the increase in dental HPSAs. 


About FHLI’s North Carolina Oral Health Collaborative 

The North Carolina Oral Health Collaborative works to advance systems change, improving the overall health and well-being of all North Carolinians by increasing access and equity to oral health care. NCOHC seeks to influence policy at a statewide level, and through collaboration, listening, and knowledge-sharing, NCOHC works to provide maximum impact in achieving optimal oral health care for all North Carolina communities.

For more information, contact: 
Marni Schribman, Director of Communications & Public Relations

In May, Suzanne Martin joined the Foundation as the Director of Outreach and Engagement for the NC Oral Health Collaborative (NCOHC). In her position, she strives to achieve oral health equity for all North Carolinians through network building and systems change with stakeholder groups statewide.  She will oversee the implementation of a comprehensive communications campaign that will include: broad dissemination of the Portrait of Oral Health, Innovations Bank, NC Oral Health Agenda, and culturally appropriate health messages.  With extensive experience in program management, evaluation, and nonprofit administration, Suzanne brings both knowledge and passion for affecting greater change in oral health across NC.  We asked Suzanne a few questions to get to know her better.

Q: Where are you from and how did you end up in North Carolina?

I’m originally from Shreveport, Louisiana, but spent most of my early life in Smyrna, Georgia. After finishing high school, my dad got a job promotion so I moved with him to Raleigh, North Carolina and have stayed ever since.

Q: What drew you to the Foundation?

When I first came across The Foundation and NCOHC, I appreciated their commitment to public health equity.  I also loved the idea that I would get to work with people who are as passionate as me about providing meaningful service to strengthen our communities across NC.

Q: What types of organizations have you worked for in the past?

Prior to joining the NCOHC, I worked for several different types of organizations. Most recently I worked for the American Cancer Society as the program manager for National Human Papilloma Virus (HPV) Vaccination Roundtable.  Prior to that, I have experience working in non-profit administration for organizations like HopeLine, Inc. (a crisis and suicide prevention nonprofit) and Stop Hunger Now (an international food aid nonprofit) and in higher education, as a social work instructor, an academic advisor and an equal opportunity and diversity trainer for North Carolina State University.

Q: What are you most excited for in this position?

I am most excited about the opportunity to use all of my skills and abilities to strengthen and grow the NCOHC’s network as well as advocate for systematic change to meet the oral health needs for all North Carolinians.

Q: What do you like to do for fun/in your free time?

I enjoy gardening, co-leading my daughter’s girl scout troop, lifting weights, and crocheting.

Zulayka Santiago, Director of the North Carolina Oral Health Collaborative recently spoke at the Institute for Emerging Issues (IEI) panel about health in childhood. The panel, which took place at NC State University, was a part of IEI’s kidoNomiCs kickoff Tuesday. It was moderated by Kathy Higgins, president of the Blue Cross and Blue Shield of North Carolina Foundation and vice president of BCBSNC Corporate Affairs.

Along with Zulayka, the panel included the following guests:

  • Michelle Hughesexecutive director, NC Child
  • Jamie Kilpatrick, associate manager, Public Consulting Group
  • David Reesepresident and CEO, East Durham Children’s Initiative

While discussion surrounded overall childhood health, Zulayka weighed in on the oral health sector. She discussed the importance of oral health care at a young age, noting that tooth decay is the most common chronic disease of early childhood,  and is two to three times more common than asthma or obesity. She also touched on the importance of health equity.

To view the full panel discussion, see below:



ZulaykaWe are thrilled to announce that Zulayka Santiago, Director of the North Carolina Oral Health Collaborative, was recently selected as an inaugural fellow for the Leaders for Health Equity Fellowship program. The fellowship, offered by George Washington University’s Health Workforce Institute, honors health sector professionals with a commitment to health equity and demonstrated leadership potential. Zulayka was selected as one of 16 fellows from a competitive group of applicants from all over the United States and other countries.

The year-long program will begin in January, and is designed to provide fellows with the necessary skills and experience to identify disparities, combat inequities, strengthen individual leadership, and build a network of like-minded leaders from a wide array of institutions. In addition to online meetings and training, fellows will convene in-person a total of three times, with initial and final meetings in Washington D.C., and a mid-year convening in Rwin Kwavu, Rwanda.

With a career and passion centered around oral health, Zulayka will focus her fellowship on exploring health workforce options to increase access to oral health care and reduce oral health disparities.

[box] “I am delighted and honored to be a part of this phenomenal group of people. I look forward to deepening my knowledge about the intersections of health equity and particularly excited about gaining a global perspective to generating solutions to these complex problems.” [/box]

For more information about the Leaders for Health Equity Fellowship program, click here.

Over the past month, the NC Oral Health Collaborative has been hard at work organizing two separate events designed to address oral health disparities, access issues, and opportunities for improvement in North Carolina. Both events were a great success and helped the Collaborative move forward with their vision of achieving oral health for all North Carolinians.

image011First, on September 23, academics, providers, practitioners and community advocates gathered in Cary, NC for the 2016 NC Oral Health Summit. Overall, the Summit was designed for attendees to gain a common understanding of:

1.) current oral health disparities/inequities and access issues in NC,
2.) the work that has occurred thus far to address these problems in NC and,
3.) systems-level solutions that are proving successful in NC and other states.

Throughout the day, various speakers helped attendees better understand the breadth and scope of the problem and offered some inspiration for the road ahead. The keynote speaker, Dr. Bob Russell, encouraged dentists to move from being the ‘hands’ of the operation to the ‘head’ of the operation by exploring workforce models that could increase capacity for care.

The day concluded with the group diving into a draft version of the NC Oral Health Agenda. Through the collective wisdom of the group, the Collaborative was able to gather some great feedback that will help them strengthen and refine what is put forth as legislative priorities in 2017.

img_1299Then, on October 7, the Collaborative held an educational program in Raleigh, NC called Exploring Teledentistry as a Vehicle for Addressing Oral Health Access Issues. The program addressed major forces impacting the oral health industry and the potential use of telehealth to expand the reach of dental practices in North Carolina.

Attendees represented both private practice and public health, and varied from academic dentists and hygienists to funders to non-profit health care administrators. Additionally, continuing education credits were provided to interested participants through WakeAHEC.

The event began with Dr. Paul Glassman, a Professor of Dental Practice at the University of the Pacific San Francisco, describing the current state of the health care system and how its consistently poor health outcomes drive the need for new and innovative methods of delivering health care. He then described the Virtual Dental Home model, which has been used in California to increase access to oral health care for the underserved by providing services in the community where people live, work and play.


After that, various panelists shared their diverse experiences in the use of telehealth and discussed some of the opportunities and challenges to implementing teledentistry here in NC, which led to a great discussion.


Overall, hosting these gatherings was important to the work of the Collaborative as it seemed to draw several new stakeholders to the conversation of oral health disparities and improving access to care. Much gratitude to Zulayka Santiago, Rhonda Stephens, and Emily Bernson for all their hard work!

Hospital emergency room entrance outsideIf you’ve ever experienced a toothache, you understand that this kind of pain impacts much more than your mouth. The nerve endings inside the gums are sensitive, and the pain can last for a day, or for years. A toothache can have a negative impact on your overall well-being. Without regular dental care, a preventable oral health issue can escalate into unbearably painful and dangerous complications. Recent research has indicated possible associations between chronic oral infections and diabetes, heart and lung disease, stroke, and even low birth weight or premature births.

But for many people, making an appointment to see the dentist isn’t easy. Seeing the dentist might be too expensive, too far away, or otherwise inaccessible. While some basic services are covered by Medicaid in North Carolina, many other states have cut or eliminated adult dental benefits for Medicaid programs. Furthermore, finding a dentist locally that accepts Medicaid is challenging.  Additionally, fewer employers are offering dental insurance, and often times, dental benefits cover very little of the overall costs of dental care. Consequently, the emergency department may be the first (and only) choice for treatment for painful oral health issues, and as a result, the number of people using the emergency department with gum disease, cavities or abscesses has almost doubled in just the ten years from 2000 to 2010.

White pills spilling onto tableThe main problem with this increase is that the emergency department it isn’t the best place to treat long-term oral health problems. Emergency departments lack the staff and training to provide solutions other than treatment for the pain, leading to over half of patients being sent home with a prescription for an opioid, even if they don’t need it. Evidently, an increasing over-prescription of opioids from emergency rooms has become clear, as shown by the 10% increase in emergency room visits resulting in opioid prescriptions between 2001 to 2010. This increase has prompted the National Institutes of Health (NIH), for the first time, to begin funding various research projects that will help shed light on how this rise in opioid prescriptions from emergency rooms’ is contributing to the continuing abuse of these narcotics in the United States.

Recently, it was estimated that 5 to 23 percent of all prescription opioid doses dispensed are used non-medically, and one study shows that two-thirds of emergency room visits involving overdoses are due to prescription drugs. With that being said, ensuring safe methods of prescribing opioids across all medical settings is important to preventing patients, especially the young and vulnerable, from developing or maintaining an addiction. While the solution to this growing problem is not simple, it is one the North Carolina Oral Health Collaborative is working to solve.

The North Carolina Oral Health Collaborative works to resolve these types of issues by addressing oral health disparities that drive people to the emergency department in the first place. Zulayka Santiago, the Collaborative’ s Director says that, “although these issues are complex requiring systems and policy changes, we are clear that the best solutions are those that harness the brilliance of many.” It is essential that solutions to these problems are rooted in and informed by those individuals who grapple with these realities on a daily basis with evidence-based scientifically sound methods. To that end, the NCOHC is partnering with individuals and organizational representatives who have a vested interest in ensuring all North Carolinians enjoy good oral health.”  To learn more about the NCOHC’s work, please visit:

NC Oral Health Collaborative Logo

Oral health disparity affects all age groups, but is particularly difficult for the elderly. The complications of frail and failing teeth are compounded by the inability to access care. Insurance coverage for oral health is spotty, and Medicare, the public insurance available to the elderly, does not cover oral health.intense_med_equip

Many of our aging community members, especially vulnerable and underserved populations, did not grow up with the benefit of water fluoridation, and 25 percent of adults aged 60 are missing many of their original teeth. Besides the painful side effects of oral health issues, missing or weak teeth affect nutrition, as older adults choose softer and potentially less nutritious foods. Twenty-three percent of the elderly population in the U.S. also suffer from gum disease, which is more common in disadvantaged populations.

In North Carolina, we are fortunate to have caring organizations working to collaborate on solutions to the problem of oral health disparity among the elderly. One of these organizations is Access Dental Care, a dentist office on wheels. Access Dental is a non-profit organization that travels to long-term care facilities to meet the needs of elderly patients.
Zulayka Santiago Portrait

Zulayka Santiago, director of the NC Oral Health Collaborative, reflected on the experience of a day with Access Dental:

“As a newcomer to the world of oral health, I had heard great things about the work of Access Dental Care.  Given that words so often fall short in communicating the impact, it was important for me to witness their work in real time. I met them at Rex Health and Rehabilitation in Apex, a new site for them.  It was a cloudy Monday morning, but what I witnessed that day would brighten most any day.

I met the van in the parking lot and helped them unload all of their equipment.  In just a few minutes a full dental office set up in one of the dining areas!  The ease and flow of process signaled to me that those three individuals had performed this routine many times.  Providing dental care to individuals who are frail, elderly or who have intellectual or developmental disabilities is not easy (to state the obvious).  My brief time with Access Dental Care definitely affirmed this fact.  But more importantly, what the experience illuminated for me was that this type of work requires a certain strength of character and commitment to ensure that each patient receives the care they need with compassion and a lightness of heart.

Dr. Bill Milner (dentist), Betsy White (dental hygienist) and Rhonda Little (dental assistant) made a big impression on me that day.  As we work to ensure access to optimal oral health for all North Carolinians, it is essential to celebrate the models that are working well and doing a good job of reaching the most vulnerable.  I applaud and am inspired by the work of Access Dental Care. I am grateful to have such strong partners within the NC Oral Health Collaborative.”

The Foundation, through the expertise of the NC Oral Health Collaborative, acts as a convener for oral health disparity issues in the state. We work with partners like Access Dental Care to develop strategies and action plans to improve the oral health status of all North Carolinians. For more information on the Oral Health Collaborative, click here.

To learn more about Access Dental Care, visit

ZulaykaThe North Carolina Oral Health Collaborative brings together partners across the state to address oral health gaps. Zulayka Santiago joined our team as director in August. Her vast nonprofit experience includes working in the public, private, philanthropic, nonprofit and cooperative sectors. To learn more, we asked her some questions about her life’s work and her interest in oral health:

What attracted you to the Oral Health Collaborative?
My career thus far has had some interesting twists and turns.  Yet themes that are consistent throughout are a commitment to social justice, equity and community building.  All you have to do is scratch the surface to understand that there are strong intersections between oral health and health equity.  The people most directly impacted by the disparities in oral health are the same folks that are experiencing very similar health disparities in other areas: working class or poor people of color, our elders, folks in rural areas and people with intellectual and developmental disabilities. It is simultaneously heartbreaking and inspiring to know that dental caries remains the number one chronic disease of childhood, even though it is entirely preventable.  This is part of the work of the NCOHC is to highlight the ‘entirely preventable’ aspect of this astounding fact and to work together to implement solutions.

Where were you before accepting this position?
I had been an independent consultant for almost 3 years immediately before starting this position.  Prior to that I had taken a year to focus on being a full-time mother to my newborn daughter, and prior to that I had a brief, but significant role as a Program Officer in Health Disparities with the NC Health and Wellness Trust Fund.

How does your background in social justice and equity connect to the NCOHC?
There are many reasons why inequities in oral health exist including: lack of health literacy, limited English proficiency, cultural, societal and economic barriers.  Part of these inequities are also linked to the workforce issues facing healthcare as a whole.  Regardless of geography, socioeconomic background, race, ethnicity, age or mental/physical ability, it is tremendously important to ensure that all North Carolinians have access to good dental care, provided by someone they trust, in a timely and compassionate manner.

I think part of my role will be to find a way to help create space for and elevate the voices of the folks most directly impacted by these issues.  I am all too familiar with ‘outsiders’ flocking into marginalized communities and dictating how and why things should be done.  It is important that the work we lay out for this collaborative be relevant, respectful and considerate of the folks who have to grapple with these issues at a community level.

What are your hopes for the position?
I am a strong believer in the power of the collective.  This type of transformative work requires us to work across difference of silos, sectors, political ideology, etc. towards goals that will benefit all of North Carolina.  There is great potential in this work.  Potential for dramatic change within our lifetime and that is very exciting to me. My hope is that we can build upon the wonderful work that has already been done and develop a comprehensive plan of action that will bring to life NCOHC’s mission of reducing oral health disparities and promoting improved oral health for all North Carolinians.

In your experience, what’s been the best strategy for successful collaboration in the non-profit world?
Building authentic and trusting relationships.  Relationships are the key to so many things, and definitely for successful collaborations.  Focusing first on the vision, mission and values that bring us together and then laying out a roadmap with some clear goals and outcomes that benefits our individual organizations and pushes the work of the collaborative forward.  There is already an incredibly powerful, dedicated, and well-connected group of folks that make up the collaborative.  Now it’s just a matter of keeping them engaged and figuring out the best way to harness their brilliance towards achieving our collective goals.

mariaOn April 14th 2014, Maria Isabel Rego (Bel) launched OHEALL (Oral Health Equity for All) in Winston Salem, NC. OHEALL’s vision revolves around a world of oral health equity for all and its mission is to provide community members and leaders with oral health equity specific community organization tools, resources, and information.

Bel was involved in health equity community outreach and research at the Maya Angelou Center for Health Equity from 2009 until 2013, when she was accepted to East Carolina University’s graduate school. In January of 2014, Bel also completed a one-year social entrepreneurship and civic leadership training at Mobilize, a nonprofit organization in Washington D.C., and this past summer she received her M.A. in Health Education and Promotion from East Carolina University.

As part of her M.A. degree, Bel completed a graduate internship at the NCFAHP under Jacqueline Brown’s guidance at the NC Oral Health Collaborative (NCOHC).  During this experience, she helped the NCOHC curate resources for their website, implement the beginning of a social media presence on Facebook and Twitter, and she provided support for the NCOHC’s endeavors in oral health policies and oral health literacy. Besides being off and running with OHEALL, Bel also plans to attend dental school in the near future.

If you would like to learn more about OHEALL, visit their website: