Improving Oral Health

The Duke Endowment seeks to improve the oral health delivery system throughout North Carolina and South Carolina to ensure every adult and child has access to essential dental services.


Millions of adults and children do not receive essential oral health services each year. Profound oral health disparities exist due to poor access and the inability to afford care. As a result, untreated dental needs consistently rank as one of the highest causes of avoidable emergency department utilization in hospitals. 

Poor oral health can result in lower quality of life and poor health outcomes. It can negatively impact self-esteem, employability and the ability to learn. Tooth decay is also the single most common chronic childhood disease, resulting in 51 million hours of school missed each year. 

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Our Objective

We seek to improve the oral health delivery system throughout North Carolina and South Carolina to ensure every adult and child has access to essential dental services. We know that oral health is directly correlated to overall health, therefore, to ensure optimal health, access to quality oral health services needs to be a core component of health care.

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What We Fund 

The Endowment has three primary strategies to improve access to quality oral health services for vulnerable populations:

1. Expand School-based Oral Health Programs
Dental disease is 100 percent preventable and preventive measures such as fluoride varnish and sealants significantly improve the oral health of children. Providing vulnerable children with school-based access to oral health education, prevention and treatment helps ensure they are healthy, pain free and ready to learn. While school-based oral health programs have proven to be effective, widespread replication has not been achieved. The Endowment is partnering with the BlueCross BlueShield of North Carolina and BlueCross BlueShield of South Carolina foundations to proliferate school-based oral health programs throughout both states. The Endowment uses content experts and technical assistance teams to provide ongoing support to school-based oral health programs to ensure that they are clinically sound and achieve long-term sustainability. 

2. Support the Demonstration and Advancement of Medical-dental Integration Models
As the correlation between oral health and chronic diseases such as diabetes becomes more evident, new models of care designed to integrate dental and medical services are being considered. The Duke Endowment is working with partners to develop and implement models of medical-dental integration to demonstrate the clinical effectiveness and cost savings achieved by providing dental therapies. 

3. Advocate for Evidence-informed Oral Health Policy Changes
The Endowment believes that in order to improve the oral health delivery system for vulnerable populations, we need to support advocacy, policy and regulation improvements as well as programming. The Endowment has provided funding to support the North Carolina Oral Health Collaborative (NCOHC). NCOHC has been instrumental in raising awareness related to oral health inequalities, educating key stakeholders on solutions and advancing policies and regulation changes to improve oral health delivery system for all Carolinians.

School-based Oral Health Programs

The Duke Endowment’s oral health initiative seeks to support system reform and policy change; to promote prevention by expanding school-based oral health services; and to support oral health integration.


pdf – March 15, 2022

Oral Health in America

This report highlights the most promising new approaches for improving oral health and for ensuring that all Americans enjoy its benefits. Finally,

March 15, 2021

Advancing Oral Health in North Carolina

We are taking steps forward to improve the oral health of North Carolinians, and change doesn’t happen without diverse stakeholder engagement. Meet some of the tireless advocates who have contributed decades of their leadership to help get us where we are today.

pdf – March 15, 2021

Community-Academic Partnership to Improve the Oral Health of Underserved Schoolchildren in Rural North Carolina

Dental care is is the most common chronic illness for children. Caries can reduce the quality of life, cause missed classroom hours, and decrease cognition. Strategies to improve children’s oral health must be evidence-based, developed, and implemented in consultation with communities.

pdf – March 15, 2021

A Technical Assistance Curriculum for Expanding Sustainable School-Based Oral Health Programs in the Carolinas’ Dental Safety Net

School-based oral health programs (SBOHPs) provide opportunities to address oral health inequities by providing convenient access points for care. No published guidelines on SBOHP implementation existed. Our work describes how philanthropic, public, and academic organizations partnered to support dental safety net providers with designing comprehensive SBOHPs in North and South Carolina.

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