- Just ahead on Black Issues Forum, when we talk about health disparities in the black community, we rarely start with oral health, but maybe we should.

From preventable diseases to emergency room visits and generational habits to generational wealth, what's really happening behind our smile?

We talk about access, consequences, representation, and the pipeline for future doctors.

Coming up next, stay with us.

- Quality public television is made possible through the financial contributions of viewers like you, who invite you to join them in supporting PBSNC.

(upbeat music) ♪ - Welcome to Black Issues Forum, I'm Kenia Thompson.

When we talk about health disparities in the black community, we often focus on heart disease, diabetes, maternal health, but there's another area that quietly impacts all of them, our oral health.

From access to dental care, preventative treatment, and representation in the profession itself, we're digging deeper into what's happening behind the smile and why it's more important than we think.

Joining me to talk teeth are Dr.

Natalie Erskine, owner of Diadem Family Dental, and Dr.

Davia Nicholson, owner of Complete Smiles of Hillsborough and adjunct faculty member at UNC's School of Dentistry, where she also works in admissions.

Welcome to you both.

- Good morning.

- Thank you so much.

- Yes, so I'm gonna be transparent.

Dr.

Erskine, I was sitting in your chair, and yes, she is my dentist, and I said, "Ooh, this will be a great conversation to have on the show."

Because why?

We don't really talk a lot, at least I'll say, I avoid the dentist like a plague, sorry, love you.

But it's a fear that many people do have, right?

And so let's think about when we think dentist, sometimes people think cosmetic, they may think cleaning, but what is it about our dental oral care that's truly foundationally important to our bodies?

- I think a lot of times patients forget that their teeth are connected to the rest of their body, right?

The oral mouth is important because it is entryway for your GI system, respiratory system, a lot of things are passing through there.

Additionally, there's studies that show that gum health is also tied to heart health, and increased rate of heart disease, and also for pregnant patients.

The mother can pass bacteria down to the baby in utero.

So a lot of OBGYNs are often trying to motivate those patients to make sure they're going to the dentist while they're pregnant, so that's very important.

- It's so connected, and you just don't think about that in our day to day.

Dr.

Nicholson, state of oral health equity survey study shows that black adults, 52%, reported having lost one or more permanent adult tooth to decay or gum disease.

So what are some of those contributing factors that are causing folks to lose permanent teeth to gum disease or decay?

- A lot of it stems, and we'll probably say this many times today, access to care.

If you don't have a dentist available to you, or you don't know how and when to seek one out, it'll lead to tooth loss.

The presence of dental pain is a tough thing to deal with day to day.

We know that people lose sleep over it.

You lose hours of work, especially for our children, can miss time out of school.

So if we can do anything to provide that care, let people have the knowledge they need to know when and how to complete dental visits, knowledge of what they can do for themselves to make their oral condition better, that'll stop a lot of these things.

- One thing I learned recently, 'cause my doctor needed to go to the orthodontist, but when we were at the dentist and they recommended braces, they said, "Oh, we don't do that here."

So tell us the difference between orthodontics and dental work like dentistry.

- So your general dentist is gonna be there to help you with your preventative measures to make sure you're keeping things clean.

Orthodontist is gonna be there to help move teeth.

So they're moving teeth for functional reasons.

Maybe there's crowding.

Maybe there's aesthetic concerns.

Crowding often involves that.

Also spacing.

Sometimes people don't like spacing in certain areas, so they get braces to remedy that.

So pretty much the orthodontist is just a dentist that helps with moving teeth.

Once that is completed, then they'll bring you back to your general dentist to get work done.

But it's very important for patients to remember when they are seeing the orthodontist, they need to still see the general dentist every six months.

And also keep your oral hygiene up 'cause orthodontist will take your braces off if you are not keeping your teeth clean.

- That's one thing I've learned, right?

They actually won't see my daughter if it's been six months or more that she hasn't had a cleaning, which is good, it's healthy.

I'm grateful.

I've never experienced a cavity.

Hopefully you won't find one anytime soon.

But Dr.

Nicholson, what is a cavity?

And how do we get there?

What are the consequences of having a cavity?

- A cavity is essentially a hole in the tooth.

There are bacteria that we all have in our mouth.

Some have more than others.

And if we feed those bacteria the things that they really like, they start working.

And they can cause bad things to happen on our teeth, like cavities.

So I guess maybe that is what I have because-- - I thought my tooth just cracked, but it was in so much pain that she just took it out and we were done.

But anyway, I digress.

Research shows that in many black households, going to the dentist isn't always routine.

A lot of times it's just need based or necessity when we have a crisis that's going on in our mouths.

Why has preventative care historically been inconsistent within our communities?

And to you both, but I'll start here.

- Primarily it's whatever in the household is stressed.

So if we have in our formative years parents that are stressing the importance of not only telling us to brush our teeth, but making sure that it's actually getting done, that's usually a big aid in that.

And also just sort of understanding you don't have to have dental insurance to go to the dentist.

There's a lot of options that a lot of practices have that are there for patients that don't have insurance, but can try to relieve some of that financial burden for the patients.

- You bring up a point about insurance.

Not all health insurance is covered dental work, right?

So does that play an impact in the disparities that we're seeing?

And how do people navigate around not having dental insurance?

- It definitely can.

But getting people to have the knowledge that just because you don't have dental insurance doesn't mean dentistry has to be inaccessible to you.

We don't care if you have dental insurance or not.

We want you to come in, we will treat you.

There are other, even different plans that many dentists have in-house to make things accessible and cut costs so it doesn't feel so daunting.

So you don't need dental insurance every time.

We have many things that are available.

Even community health centers are available to people.

And there you can work on a sliding scale or a sliding fee so they take into account household income, how many people are in the home.

So things are very accessible.

They can be.

- So I hear to ask for a plan too.

I think some people are afraid to even try to go 'cause they don't know if it's an option.

- Very true, very true.

We kind of get hesitant if we don't see something just readily available.

So we have to advocate for ourselves.

One big thing that we talk about in dentistry, especially on boards of health and things like that are advocacy and teaching people to advocate for themselves.

Ask for what you need.

There are many things available and even the private practice dentist wants to give back and make those things accessible to everyone.

- What are some barriers that are happening that prevent or that keep folks from going in for preventative care year to year?

- So primarily insurance again.

A lot of patients are just not sure if they can use it or if they have the benefits.

So it's one, knowing your coverage, knowing that you also don't have to have it to begin with.

And there's also a little bit of issue right now in dentistry as far as availability to get cleanings.

It's a lot of backlog from COVID onward.

People moving in the area that are trying to get into offices as well.

So availability of appointments can be difficult for a lot of patients just getting in, even if they are finally ready.

A lot of times you'll call and there'll be months out.

- We think about rural areas.

Part of that access is I guess what you're referring to there.

Are we seeing dental offices in rural areas?

Are they having to travel further out for those services?

- Many people do have to travel further in rural areas for basic services.

Think about general dentistry.

There are more general dentists than specialists.

But if you're looking for a specialist, you may have to go some places, several counties over to see a pediatric dentist or surgeon, a periodontist.

So having more dentists in the workforce will help that eventually.

That is our hope.

- Yeah.

So you also work at UNC's, sorry, dental school.

And you work with students all the time in admissions.

How are the numbers when you take a look at representation in the field of black students entering this space?

What does that look like?

- So in my role with the admissions committee, I'm able to see many students from their application to matriculation.

And it's an exciting, exciting thing to see.

But we could definitely use more applicants, more black applicants specifically.

We want to have our workforce look like the population that we serve.

Right now in North Carolina, we do have more black dentists than the national average.

We have about 9% of dentists in North Carolina who are black, but still doesn't match the population.

Nationally, we're only 4%.

So getting more of us out there, getting the education, knowing that this is a field that's accessible to you, that welcomes you and wants you, that's one of the goals.

- Is it just a lack of knowledge for students?

Or do they think, well, because I don't see much of myself in this space, like what do you think it is?

- It can be.

And I could say that may have been a definite thing some years ago, but now thanks to social media, we're out there.

- You're out there.

- Especially in areas like this, in Durham, Raleigh, Charlotte, you see more of us being influencers and showing what young dentists really can look like.

We see, especially women in dentistry.

Now we have had some of the first dental school classes that have more women than men this last cycle.

And that's a huge shift where more black people, a little more colorful now than the past.

And we know this is something that we can do, but it starts with seeing it.

I've still met many people.

My hometown is a small town in North Carolina, and we have very few black dentists there.

Thankfully, my dentist, I was able to see them and I knew this is something I could do from the time I was a small child, that was available to me.

But there's still people who have never gone to a medical black dentist.

- Well, Dr.

Erskine, do you work with students at all?

Or do you find students reaching out to you and having questions about the industry?

- They do reach out, oftentimes by email.

I don't work directly with them, so not particularly.

- Well, one thing that I've noticed with the both of you is that you own your own practices.

And I think that is a kind of a way to pipeline into entrepreneurship.

Maybe share a little bit about your journey on how you acquired your office and what was that like?

- So I started my practice March of 2021.

Dr.

Larry Howells had opened the office in 1974.

So it's in the Old Farm area in Durham.

And so he more or less held my hand through the process of learning how to open the practice.

And then from there, it's just been a learning experience.

It's been great as far as being able to be an entrepreneur 'cause you do get to set your own hours.

Sometimes you're working the job, sometimes the job's working you, just like every entrepreneur feels.

But it's good because, for example, I've had two children since I opened the office.

So it allowed me to have that time to step back, focus on them, and then get back to seeing patients.

It's been great.

- Yeah, you wanna share your experience?

- Sure, I had a similar experience in purchasing a practice from a retiring dentist.

I purchased just last year, so March of 2025.

Thank you.

We'll come up on a year next month.

Well, in March this year, we had a similar experience in just putting ourselves out there and you think you do all the preparation.

You read the books, you take the classes, but until you're in it, you don't know fully what to expect, but it's been a good journey.

- And what I hear too is both of you had a level of mentorship, which is always important in any career, right?

But especially one where we aren't maybe seeing ourselves as much.

Dr.

Nicholson, what's the emotional toll?

We shared the stat earlier that 52% of adults find themselves losing a permanent tooth.

That can be hard.

I mean, what is that emotional impact that oral health has on us mentally?

- It's incredible.

The first thing that most people see on you is your smile.

And if you're not confident in your smile, you don't like how it looks, it makes you hide away.

There are people who won't go out of the house because they don't like how their smile looks.

So we end up being sometimes the therapist, the friend, the mentor to try to push people to increase their home care, change their habits, and helping them to rebuild their smile, rebuild their confidence.

- Dr.

Oskine, if someone does come in that has socially just been ostracizing themselves because of missing teeth, what are some solutions that you may present?

- Oftentimes we'll discuss maybe getting a bridge.

Sometimes we'll talk about getting implants done.

Sometimes partials and dentures might be a good option for those patients as well.

Just really all depends on what they're trying to accomplish and we just try to tailor fit a plan best for them.

- Now, I'm gonna talk about this.

It may be, you know, we don't talk about it, but oftentimes it's something that speaks louder than words is bad breath.

What are some of those contributing factors of bad breath and how do we prevent that?

Let's go to you, Dr.

Nicholson.

- So the most obvious thing is oral care.

How you take care of your teeth.

What are your habits?

Are you brushing?

Big things there.

Are you flossing?

Many people brush, but that floss isn't getting there.

So are you doing just those two basic things?

That goes a long way.

Diet is another contributor.

If we have a lot of foods in our diet that lead to those odors, we will eventually smell them, but brushing floss, it takes care of it.

- I've watched people do that tongue scraper thing.

How important is that?

- That's good too, 'cause if you're not brushing your tongue then that can lead to bad breath as well.

- Okay, and then fronts and tooth gems and all of that.

- They're all pretty.

- They are pretty.

- But take care of the foundation.

- That's right.

- That is the goal.

I like tooth gems.

I have some of my team members who have them.

- Yeah, I like them too.

- I'll put it, I have a front.

I have a grill for Halloween.

We have some great labs in the area, but the foundation has to be taken care of first before anything else.

- Indeed.

So let's talk about that foundation.

Let's talk about how do we brush.

So mechanical toothbrushes, the old school toothbrushes, the water pick, how do we actually do it and how many times?

- Yeah, so angling that brush at a 45 degree angle is really gonna be the best thing.

I know if we think about TV, we see them going.

- Straight across.

- But you wanna get at that angle 'cause that really allows you to reach all the way back.

You wanna move in a circular motion.

But truthfully, you don't have to have an electric toothbrush.

There's a lot of patients that come in, I'm sure you see this as well, they brush their teeth just fine.

They don't need an electric toothbrush and there's nothing there when you're going to actually try to clean their teeth.

So electric toothbrushes just make it easier.

But it's not a requirement.

So if you don't really wanna think too much in it, you just sorta wanna let the brush do the work, get an electric toothbrush.

But the biggest-- - Do you find that patients may get a little lazy in brushing their teeth with an electric toothbrush?

- No, not necessarily.

- 'Cause it does the work for you.

- It does a lot of the work for you and a lot of times there's apps now that people have connected to their toothbrush.

So it'll let you know, am I brushing too hard?

Am I getting everywhere?

- Really?

- Yeah.

- Wow.

- And it gives you a timer.

It's pretty fancy.

- Now flossing, that's a thing that I've never really been good at, but I know it's a necessity.

So what does flossing look like?

We have to go through each and every-- - Absolutely.

We use a method called C-shaped flossing.

It's hugging the tooth with the floss and sliding up and down.

In commercials you see the shimmy motion with the floss.

That's really just gonna irritate your gum.

We see gum bleeding, that makes us stop 'cause we don't wanna see that.

So if you use a C-shaped motion, sliding up and down, hugging the side of every tooth, that'll get them very clean and you're off to a good start.

- I've always had a question about this.

I see a lot of videos on social media about tonsil stones.

Is that connected to oral health as well?

- It's not necessarily connected, but oftentimes we will see patients, like when we tell you to open, you'll see those tonsil stones in there.

But it can cause you to have bad breath.

So sometimes people will, if they can handle it, will go in and pick it out for them or try to use the water.

- And then another question about how we brush and all that.

Toothpaste, I use a sensitive one because my teeth are sensitive.

Are there ones we should stay away from?

I remember when my kids were younger, the ones with the little, oh, I forget, like the strips kind of things inside of 'em.

- Kind of sparkly.

- Yeah, what should we use?

- It's perfectly fine to try different things to see what's the best fit for you.

Some people think some flavors are a little harsh, so you don't have to have one with very strong mint flavors.

I do like toothpaste with fluoride.

That is a huge thing that's in the news a lot today because of not wanting fluoride in water, but fluoride is extremely beneficial for us.

So using a fluoridated toothpaste.

There are some toothpastes that have high fluoride concentrations that can be prescribed for people who have very high cavity or decay risk.

You can talk to your dental professional and they can see if that's something good for you, but fluoride, for sure.

- Before we leave our viewers with some tips, you also offer a unique service at your office dealing with CPAP machines.

And I guess I've heard that those machines can be a little cumbersome, but you provide a different solution.

Tell us a little bit about that.

- So we provide something called an oral appliance.

It's pretty much a device that you can use that moves your lower jaw forward, so you have space in your upper airway to breathe at night.

So a lot of times people aren't a fan of CPAPs just because the straps can make it difficult for them to breathe or be comfortable.

Sometimes if you have claustrophobic issues, it can be too much for you to get comfortable while sleeping.

So it's just another option a lot of patients aren't aware of because they'll try the CPAP and then they won't be comfortable and then they just will do nothing to remedy their sleep apnea needs.

- All right, last two questions.

I'll give you adults, I'll give you kids.

What are some non-negotiables as we age with our teeth that we need to be aware of?

- Your maintenance and knowing that your oral health contributes to all sorts of conditions in the body.

The inflammation that we find in conditions like diabetes, heart disease, even Alzheimer's disease can be linked to the mouth.

So if we cut down on inflammation there, we can cut down on it throughout the body.

So think about your dental health, your oral health as part of your systemic health.

We want healthy, happy bodies.

Starts with the mouth.

- Now for parents, obviously they're the ones taking the kids to the dentist.

You've got that one kid that's like, "I don't want our guys to go to the dentist."

How do we deal with that?

What are some things we should know about preventative care for them?

- So the biggest thing is we know that for kids going to the dentist for the first time, it can be overwhelming.

So we don't want parents to feel like they shouldn't go 'cause they're concerned their kid might be nervous.

We understand that.

We pretty much will talk with the parent, talk with the child, just try to get them more comfortable.

But every time a child comes to the dentist, they get more and more comfortable.

So you really wanna bring children as soon as they have teeth.

The first appointment's probably gonna be fast because they might be a little anxious.

But there's a lot of shows out right now that show kids how to go to the dentist.

So having them watch that prior to their appointment would be good.

And having the parents be excited to go.

And they can even try on some of their teddy bears, things of that sort.

But it's very important for kids to go to the dentist because dental ailments are one of the top reasons children are out of school, even starting as soon as kindergarten.

So it's really something that we wanna encourage parents to take time to make sure that the kids are going to the dentist.

- Now if we have a viewer who's watching who says, "I just hate going to the dentist.

"They're anxious about the dentist."

What are some tips when you sit in that chair to kinda help calm you down?

What would you recommend?

- So when we have dental treatment done, headphones are welcome.

You can bring headphones.

I always provide sunglasses so the lights aren't too bright.

We try to make it as calming of an experience as possible.

It's stressful.

We know you have strangers around you.

We hope to not be strangers for long.

But it's just one of those facts.

So we want you to do what you need to have a calm, relaxing environment.

And we have both built teams around us that are very calming, very welcoming to people so we can ease some of that anxiety.

- And we had talked about it in the green room, but find a provider that you trust, that you've learned to come to trust.

I think that that's a big piece of it too.

Well thank you both.

I think my teeth will be a lot better as a result of this conversation.

Hopefully viewers have found this informative.

Dr.

Erskine, Dr.

Nicholson, thank you both so much.

- Thank you.

- Thank you for having us.

- And I thank you for watching.

If you want more content like this, we invite you to engage with us on Instagram using the hashtag #blackissuesform.

You can also find our full episodes on pbsnc.org/blackissuesform and on the PBS video app.

I'm Kenia Thompson, I'll see you next time.

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