Exploring Systemic Challenges in the Western North Carolina Dental Safety Net: A Qualitative Analysis

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.