North Carolina oral health initiative celebrates 25 year anniversary

A North Carolina initiative to decrease childhood tooth decay, which became the blueprint for similar programs nationwide, just turned 25 years old. 

The Into the Mouths of Babes Program allows medical providers to perform preventative oral health treatments — including fluoride applications and check-ups — to children under the age of three and a half insured by N.C. Medicaid. 

Emily Horney, early childhood oral health coordinator for the North Carolina Department of Health and Human Services, said that surprisingly, early childhood tooth decay is the most common chronic disease among children and is five times more prevalent than asthma. 

“[The program's creation] was motivated by the fact that a lot of young children didn't have access to dental care, and because of that, they had really poor oral health,” Ashley Kranz, a senior policy researcher at RAND said. She researched the program while she was a PhD student at UNC.

In the mid-to-late 1990s, dentists in western North Carolina advocated for more dental care in their area. This advocacy resulted in the formation of a grant program called Smart Smiles in 1998, which became Into the Mouths of Babes in 2000. 

After the program began, it underwent an evaluation phase spearheaded by Dr. Richard “Gary” Rozier, a former professor of public heath at UNC, who recently died. 

Dental Officer for N.C. Medicaid Dr. Mark Casey, who worked with Rozier described him as the brains behind the whole operation. 

 “Dr. Rozier through his research and publications and different scientific journals was the voice of our success of our program,” Casey said. 

Rozier’s contributions and the program have had a nationwide impact. The research he conducted was used to prove how impactful Into the Mouths of Babes is, and led to the creation of similar programs throughout the country. 

It wasn't until 2013 — 13 years after North Carolina's program started — that a lot of other states started to adapt similar programs, Kranz said.

“All of this really started in North Carolina, and the evidence was built that supported these recommendations coming out, and so that other states could follow suit and see the benefit that this Into The Mouths of Babes program was doing,” she said.

Rozier’s and other’s evaluations have shown the effectiveness of this program at stopping tooth decay, as the program has helped lower tooth decay rates throughout the state since 2004. 

“The evidence was really showing that this provision of preventive oral health services in the medical office does promote children's oral health and reduce tooth decay,” Kranz said.

Casey also said if a child receives four or more fluoride treatments throughout the course of the program, they experience significantly less dental decay. 

Every quarter, approximately 30,000-35,000 children are treated, Casey said. He said the entire program is incredibly cost effective, considering the low cost of preventative care compared to the cost of treatment. 

Although Into the Mouths of Babes has been successful in preventing tooth decay, Horney said that there is still more work to be done in expanding the program.  

“Access to dental care is still a major challenge in North Carolina, especially for Medicaid beneficiaries, for various reasons, and not all medical providers are participating into this Into The Mouths of Babes Program,” Horney said.

For the program’s next 25 years, Horney said they hope they can continue expanding awareness and visibility for the program, ensuring every child in North Carolina has access to oral health care. 

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