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UKnowledge > College of Public Health > Journal of Appalachian Health > Vol. 8 () > Iss. 1

 

Corresponding Author

Blaire Mirmow; mirmowb@nychhc.org

Author Affiliations

  1. Blaire Mirmow, DMD, MPH: Dental Public Health Resident, Department of Dentistry/Oral Maxillofacial Surgery, Jacobi Medical Center (Bronx NY); E-mail: mirmowb@nychhc.org; ORCiD: https://orcid.org/0000-0009-0004-8420-4883
  2. Bill Milner, DDS, MPH: President, Access Dental Care (Asheboro NC)
  3. Nadia Laniado, DDS, MPH, MS: Director of Community Dentistry and Population Health, Jacobi Medical Center (Bronx, NY); ORCiD: https://orcid.org/0000-0003-0698-498X

Author Area of Expertise

Blaire Mirmow: dental public health, rural health, oral health inequities

Bill Milner: older adults, special care dentistry, mobile dentistry, long-term community-based services and supports

Nadia Laniado: dental public health, clinical research, community dentistry

Abstract

Introduction: Despite statewide growth, rural communities in Western North Carolina (WNC) face persistent barriers to oral health care driven by chronic dental workforce shortages and systemic geographic disparities. Within this Appalachian region, the dental safety net serves as a vital yet strained support system, struggling with limited financial resources and a lack of provider participation that leaves many underserved populations without essential oral health services.

Purpose: This study aims to explore the experiences of individuals working within the WNC dental safety net to identify barriers and strategies required to strengthen the delivery of oral health care in high-need rural settings.

Methods: Semi-structured interviews were conducted with 17 oral health stakeholders involved in the WNC dental safety-net system between June – August 2024. Interviews explored challenges to meeting community oral health needs and potential solutions. Data were analyzed using thematic analysis.

Results: Three major themes emerged: (1) workforce challenges involving dentists, hygienists, and dental assistants, (2) fragmentation between dental providers and the broader health care system, and (3) financial instability. Proposed solutions corresponding to each theme included streamlined credentialing and expanded allied health training programs to address workforce shortages, skills-based continuing education for public health dentists to reduce specialty referral gaps and fragmentation, and increased Medicaid reimbursement rates paired with coordinated policy advocacy to strengthen financial sustainability across the safety net.

Implications: These findings suggest structural challenges facing rural safety-net programs and highlight opportunities to strengthen their capacity to meet growing community oral health needs.

DOI

https://doi.org/10.13023/jah.0801.04

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Mirmow B, Milner B, Laniado N. Exploring systemic challenges in the Western North Carolina dental safety net: a qualitative analysis. J Appalach Health 2026; 8(1):42-59. DOI: https://doi.org/10.13023/jah.0801.04

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