On a recent morning, two third-graders from New Hanover County get their teeth cleaned and examined in the dentist's office that's parked next to a dumpster, under a stand of pine trees behind their school. The mobile clinic was at another school the day before.
“Open and close, open and close,” dental hygienist Leslie Houston says, before handing a suction tool to her young patient. "There we go. So you can be in charge of that, right?”
Both students’ eyes are glued to Netflix movies of their choosing. Neither seem to notice the x-ray machines or dental implements crowding the 50-foot trailer.
This is the Miles of Smiles mobile dental clinic. Operated by the New Hanover and Brunswick county health departments, it stops at 19 schools a year to screen and treat low-income children. With proof of Medicaid enrollment, students are seen for free.
The unit, one of a handful around the state, has served nearly 5,000 children since it opened in 2006. For many, climbing aboard means their first visit to a dentist.
“Especially in Brunswick County where it’s a little more rural,” said Zachary Hunter, who is in his tenth year working as a dentist on the mobile clinic in southeastern North Carolina. “It’s so far to go to a dentist over there, because the county’s so big and everything’s so spread out -- a lot of times, we get to see a lot of first-timers.”
The American Dental Association recommends children see a dentist no later than their first birthday. But general dentists, let alone pediatric dentists, are few and far between in rural North Carolina.
That’s because dental practices need a certain number of patients to stay afloat, according to Alec Parker, director of the North Carolina Dental Society.
“So if you look at where the dentists are in this state, they’re mostly where the people are,” Parker said.
Jessica Lee, dean of pediatric dentistry at UNC-Chapel Hill, said most dentists are clustered around the Triangle, Charlotte and Greensboro.
“And then you see some kind of what I call areas that just don’t have any provider,” she said.
Three rural North Carolina counties lack any active dentists, according to the latest statewide data: Hyde, Tyrell, and Camden counties. In more than twenty others, there are two dentists per 10,000 residents, or less.
To make things more difficult, not all dentists accept Medicaid. This puts low-income families living in rural areas in a bind.
“We have kids every day that drive two, three hours to come see us here, at Chapel Hill,” said Lee, “which still shocks me today, being on the faculty 15 years, that they would drive that far to come access care.”
Getting this care matters, Lee said, even for kids who still have their baby teeth.
“I can’t tell you how many times we’ve had parents come in and their quote is, ‘I just didn’t know. I didn’t know that this could happen to my child,’” Lee said. “‘No one told me that it could happen to my child, that my three-year-old could get so many cavities and even get sick from them.’”
Back on the Miles of Smiles bus, hygienist Leslie Houston put the finishing touches on a student’s top teeth.
Earlier in the morning she had seen a five-year-old with two cavities, one of which was infected.
“I mean, we have nurses that are waiting for us to get to the schools to take care of the kids that need work,” she said.
Fortunately, Houston said, annual visits from the dental bus seem to be helping.
“So they’re not in the nurse’s office constantly with a toothache, or problem,” she said. “So that’s big.”
That means kids are spending more time in the classroom, learning -- and hopefully smiling too.