Grant expands dental school’s program for oral health care to pre-K, Head Start
Mallory Jones held out her arms as her 6-year-old daughter bounced through the door of the East Carolina University School of Dental Medicine’s Pediatric Clinic.
Jones smiled as her daughter, who had just received dental care during the school’s Give Kids a Smile event in Ross Hall, flew into her arms and grinned.
Hygienist Rachel Stewart takes X-rays of Hunter Brown’s teeth as part of his dental care visit through the School-Based Oral Health Prevention Programs. (Photo by Rhett Butler)
Jones, a mother of four whose family resides in Jones County, had heard about the event because her daughter is enrolled in the dental school’s School-Based Oral Health Prevention Programs. As a student at Trenton Elementary School, she receives dental care and education from Rachel Stewart, ECU dental hygienist and case manager of the School-Based Oral Health Prevention Programs as well as third year dental students and faculty.
“I received a letter home saying there was going to be a dentist on site doing teeth cleanings and checkups on the kiddos, and I was all about that,” Jones said of her oldest daughter. “Then I received a note home saying that she had started getting a few cavities and needed to get that taken care of. We were very hesitant, but Rachel was with us every step of the way. She squashed all of our concerns and fears and told us what to expect. I’m so thankful for this, for having ECU there saying, ‘We’ve got you.’”
Launched in Bertie County in 2019 through a $400,000 Duke Endowment grant secured by Dr. Wanda Wright RN, DDS, MS, MSD, the program expanded to Jones County in 2023 with an additional $465,000 grant jointly funded by the Duke Endowment and the Blue Cross Blue Shield of North Carolina Foundation. The program places ECU hygienists, like Stewart and Gina Hamilton RDH, CDHC in rural, underserved school districts to provide preventive oral health care and education to children. Services include, but are not limited to, dental exams, X-rays, cleanings, fluoride varnish application and dental sealants to all public school children, kindergarten through high school.
Now, thanks to a grant from the BlueCross BlueShield of North Carolina Foundation, Jones’ three younger children and other pediatric patients could receive care through these and similar programs across the state — the initiative has expanded to include dozens of Head Start and NC-PreK centers in the Carolinas. The School-Based Oral Health Initiative, which previously worked solely with school-age children, will now also serve preschoolers ages 3-5.
“As of 2023, nearly 20% of kindergarteners in North Carolina already have untreated cavities,” Stewart said. “This statistic alone demonstrates that it is crucial we reach children and families with both oral health services and education well before they enter kindergarten. Ensuring children receive oral health care services and education at the earliest age possible is the best way to prevent problems before they start.”
ECU’s School of Dental Medicine is one of eight grantees that are part of the first cohort in North Carolina. ECU has not only implemented two programs, but faculty and staff, Dr. Vanessa Pardi DDS, MS, PhD, Dr. Mark Moss DDS, MS, PhD, and Anna Pollard MBA, RDH offer technical assistance to other programs across the state. Others in the cohort include public health departments, federally qualified health centers and community health centers.
ECU’s portion of the Head Start and pre-K expansion grant is a total of $204,000 awarded over three years.
Stewart: Service through leadership
Part of the East Carolina University School of Dental Medicine’s mission is to prepare graduates and residents who are not only dentists, but also dentist leaders who serve their communities through the profession.
The school’s faculty and staff take that mission to heart as well.
Rachel Stewart, MPH-D, RDH, dental hygienist and case manager of the School-Based Oral Health Prevention Programs, provides oral health care to schoolchildren in eastern North Carolina — and takes on state leadership roles in her field.
Stewart serves as president-elect of the N.C. Dental Hygienists’ Association, in part because the landscape of dental hygiene is constantly evolving, she said. She helps share vital information related to oral health with dental professionals and the public.
Stewart is also currently serving as the N.C. dental hygienist liaison for Head Start, helping connect parents, caregivers and young children with oral health care information and resources.
“Providing oral health resources to children and families very early in life is crucial to improving and maintaining optimal oral health and overall health,” she said.
Stewart is also a member of the Collaborative Acceleration Team within the N.C. Oral Health Collaborative. In this role, she learns about legislative decisions that impact oral health care for North Carolinians and gives a voice to dental hygienists and school-based oral health programs.
“As individuals and as a community, it is imperative we remain aware of changes that can impact us as professionals, as well as changes that can impact our programs and patients,” Stewart said. “It is also important for us to serve as influential leaders, using our experience and expertise to guide changes that will best protect the practice of dentistry, while also providing safe and accessible oral health care to the residents of North Carolina.”
Pollocksville Elementary School student Shy’Zaria Brown prepares for a dental checkup as part of the School-Based Oral Health Prevention Programs. (Photo by Rachel Stewart)
“This expansion provides the unique and exciting opportunity to open new pathways to care and prevent oral health problems before they have a chance to take hold,” said Daijah Davis, director of Oral Health at the BlueCross BlueShield of North Carolina Foundation, which is supporting the effort alongside the BlueCross BlueShield of South Carolina Foundation and The Duke Endowment. “Many dental programs have shared that by the time they see children in kindergarten, it is often too late to prevent dental disease, as many have already begun experiencing decay. Bringing preventive care into the early care and education setting can play a vital role in stopping decay before it begins.”
Head Start centers, which help low-income children develop skills and prepare for school, are well positioned to educate and engage families in preventive care. Organizers of the School-Based Oral Health Initiative plan to expand to more than 80 Head Start centers — 40 or more in the Carolinas. The first cohort will be in regions where elementary school clinics are already running, like ECU’s in Jones and Bertie counties.
The Jones County program is jointly funded by the BlueCross BlueShield of North Carolina Foundation and the Duke Endowment; in addition to planning funding, the school received a $400,000 implementation grant in late 2022. For the past three years, the Delta Dental Foundation has provided a $5,000 grant to offset the cost of care for uninsured children. The Bertie program is now self-sustaining through insurance reimbursements, while Jones County’s is still grant-funded.
Costs are also significantly reduced by using teledentistry, through which hygienists in the schools can connect with dentists on campus to discuss and diagnose cases. During their visits, Stewart and Hamilton (hygienist at the Bertie County site) perform imaging and clinical documentation, and use teledentistry to consult with Dr. Vanessa Pardi and Dr. Michael Webb. The dentists review cases, provide diagnosis and offer treatment recommendations. Additional direction and supervision of the programs are provided by Dr. Wanda Wright.
Since 2019, more than 1,500 children have received oral health care services in Bertie and Jones counties, with more than 22,000 procedures completed in 11 sites. During the 2024-25 school year, about 700 patients received care through the program.
Stewart and Hamilton see 8 to 10 patients a day, on average, and will also care for the additional patients added through the grant.
“The grant will allow us to focus on getting those children enrolled,” Stewart said. “The earlier the better, to catch cavities earlier, but also to reduce dental anxiety.”
Joseph Noble, principal of Trenton Elementary School, said the program and the grant expansion will have a lasting impact not only on students’ smiles, but also their confidence and overall health.
“I am tremendously proud of our partnership with ECU’s dental school,” he said. “They have had a significant impact on the health and happiness of our students, many of whom would not receive any dental care without them. Our students enjoy visiting Mrs. Stewart, and they get first-class dental care without leaving the school’s building.”
Belen, a student at Pollocksville Elementary School in Jones County, was enrolled in the program during kindergarten. Stewart recommended that Belen’s mother bring her younger daughter, Lee, for an assessment when she was 3 years old.
“Mom speaks only Spanish, so we coordinated with the school’s translator, Debra Alamanza, so we could see Lee before she even entered school,” Stewart said. “We were concerned that she may need care and did not have access.”
Lee is now in pre-K and fully enrolled in the School-Based Oral Health Prevention Program.
“Both girls are doing great and have healthy teeth,” Stewart said. “They both love participating in the program.”
Stewart has presented details about the program on a statewide level to increase awareness to pre-K and Head Start administrators. One of her goals is to work with them to educate parents, who must sign consent forms before their child can receive screenings or dental care.
“We wrote into the grant equipment and supply purchases, of course,” she said, “but we also put in for more educational information for both the children and families, as well as administrators and people that are in charge of the programs, so we can get buy-in from the higher-ups.”
Grant funds can be used to support staff time, infrastructure, materials, community engagement, training opportunities and other program needs. The funds may also be used to provide training and partnership resources to Head Start and state pre-K sites.
“We have been so gratified to work with such strong partners over the years on this project,” said Stacy Warren, associate director in The Duke Endowment’s Health Care program area. “We are looking forward to working with our partners and Head Start leaders to bring vitally important oral health care to preschool-age children.”
The BlueCross and BlueShield of North Carolina Foundation and the BlueCross BlueShield of South Carolina Foundation are independent licensees of the Blue Cross Blue Shield Association.
Based in Charlotte and established in 1924 by industrialist and philanthropist James B. Duke, The Duke Endowment is a private foundation that strengthens communities in North Carolina and South Carolina by nurturing children, promoting health, educating minds and enriching spirits. Since its founding, it has awarded more than $5 billion in grants. The endowment shares a name with Duke University and Duke Energy, but they are separate organizations.