CARY, N.C. -- The State Board of Dental Examiners on Thursday is expected to approve a new rule that would loosen restrictions on dental hygienists, allowing them to deliver preventive care to patients without a dentist's oversight.

Supporters of the change -- including the director of the North Carolina Oral Health Collaborative, Dr. Zachary Brian -- say currently, hygienists cannot administer fluoride treatments or dental sealants used to prevent tooth decay, until a dentist has clinically assessed a patient.

Brian notes that few low-income children in the state are regularly visiting a dentist's office.

"They're still working under the direction of a dentist, but the dentist would not be onsite with them, although he or she could choose to do that," he explains. "But what this is really aimed at doing is allowing hygienists to go into a high-needs setting such as a school or a nursing facility, assess a patient, and then deliver preventive oral health services."

In North Carolina, more than 38% of children entering kindergarten have already experienced tooth decay, according to the state Department of Health and Humans Services.

Brian adds, these rates almost double in some racial, rural and low-income communities.

Brian points out that tooth decay and disease in young populations can affect academic performance and well-being.

"We lose about 51 million school hours every year across the U.S., due to unmet oral health needs," he states. "If a child is in constant pain, it's very difficult for he or she to you know, concentrate on studies, and be present and learn."

Brian also urges parents to take a child's complaints about mouth pain seriously.

"Kids are typically pretty resilient and pain-tolerate," he states. "So, if a child is coming and saying they have tooth pain, they really have pain. So, there are a lot of downstream implications of not having those oral health needs met earlier on."

In 2016, North Carolina completed its first oral health assessment of pregnant women, and found less than half of the more than 450 women surveyed reported having dental insurance.

The high cost of dental treatment was the single most common reason mothers-to-be gave for skipping dental visits.


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January's cold temperatures in Missouri and across the nation can pose risks for those with heart conditions.

The American Heart Association has tips on staying heart-healthy in winter - including dressing warmly to reduce strain on your heart, and avoiding overexertion during activities like shoveling snow.

St. Louis Physician, Dr. Ravi Johar, is a board member of the American Heart Association. He said snow shoveling is a leading cause of winter heart problems, especially for men in their 50s and 60s.

He stressed that cold weather constricts blood vessels, increasing the heart's demand for more blood during exertion.

"So you have a combination of the body needing more blood to the heart and getting less flow through it because of the cold weather," said Johar, "and that unfortunately can lead to a heart attack - and it's one of the most common times that you do see a heart attacks occurring, is at that time of the year."

Other winter tips from the American Heart Association include eating balanced meals with fruits, vegetables, lean proteins, and whole grains - and limiting alcohol because it can make you feel warmer than you are, raising the risk of hypothermia.

While it may be very comforting to enjoy a hot cup of cocoa or apple cider in the winter, heart health experts warn these drinks are often loaded with sugar - which can be dangerous for the heart if you drink too much.

Dr. Johar added that exercising in winter can be very beneficial.

"Exercise at any time of the year will increase your immunity," said Johar. "So during cold and flu season, having a little bit better immunity is always beneficial. You do need to make sure you have enough fluids, you need to stay hydrated even though you don't feel quite as thirsty cause you're not sweating as much, it's real important to make sure you stay hydrated."

The American Heart Association emphasizes that people should pay attention to symptoms like chest discomfort, dizziness, or unusual fatigue, and seek medical help if needed.

Advocates for patients are calling on UCHealth to end its practice of filing lawsuits over unpaid bills, after a 9News report found that the state's largest healthcare provider has sued more of its patients than has any other major provider.

Dana Kennedy, co-executive director of the Center for Health Progress, said the vast majority of patients are not trying to get out of paying their bills.

She said many patients taken to court would have qualified for financial assistance.

"In an emergency, you may end up at a UCHealth hospital," said Kennedy. "And the last thing that you want to worry about is if you are going to be getting sued. You want to be able to focus on your own health and healing."

A spokesperson for UCHealth - which recorded nearly $840 million in 2023 profits - said lawsuits are only filed as a last resort when patients don't pay, and are necessary to remain financially sustainable.

Not all health providers turn to lawsuits.

In response to similar complaints, lawmakers in Maryland recently passed a measure requiring hospitals to pay back low-income patients they sued who would have qualified for free care.

Erin Ostlie-Madden is a physician assistant and volunteers with Care Not Courts, a campaign to end medical debt lawsuits.

She said the practice hurts people already struggling financially, just because they sought medical care.

"They have to take time off of work, which can additionally harm them financially," said Ostlie-Madden. "They might need to hire a lawyer. If the lawsuit goes through, they can have their wages garnished."

State lawmakers have passed protections to ensure that patients can access financial assistance.

But Kennedy said, as anyone who has tried to navigate hospital websites and telephone systems knows, they don't always make it easy.

"They are required by law to provide community benefit," said Kennedy. "And the practice of suing people in communities does not support the health and healing of patients, it really causes more harm to all of us in Colorado."




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Oregon's largest health care strike, including the state's first doctors' strike, is set to begin this Friday if a settlement cannot be reached.

The Oregon Nurses Association delivered a 10-day notice of an open-ended strike to Providence Health and Services in Oregon last week, accusing it of dangerous levels of understaffing, neglecting patient care and offering inadequate pay and benefits.

Dr. Charlie Saltalamacchia, an OB/GYN physician at Providence Women's Clinic, said in labor and delivery there is no cap on the number of patients, leading to unsafe conditions.

"We can sometimes have patients that we're responsible for in excess of 30 during a shift," Saltalamacchia observed. "There can be multiple emergencies happening at the same time with no limits. "

Without a deal, nearly 5,000 nurses, doctors and other providers will walk off the job at all eight Oregon Providence hospitals and six clinics starting this Friday. CEO Jennifer Burrows wrote in a statement Providence offered double-digit pay raises for nurses and accused the union of refusing to compromise. The union countered they are being stonewalled.

Saltalamacchia noted providers often stay longer than their shifts and are asking for pay and working conditions comparable to other hospitals.

"These health care workers have worked for so many years at great personal expense and cost to provide excellent patient care," Saltalamacchia emphasized. "These requests are just really reasonable."

Providence is a nonprofit operating 51 hospitals in seven states. It merged with California's St. Joseph system in 2016.

Jay Formick, a registered nurse at Providence Willamette Falls Medical Center, said the merger marked a turning point.

"They went from being companions or partners in the process of negotiating a contract to becoming hard and fast opponents," Formick contended.

Providence initially refused to negotiate during the 10-day strike notice, prompting the nurses association to file an unfair labor practice charge. Providence has since said in a statement it will resume talks with union doctors and urged them not to strike, citing the difficulty of replacing them compared with nurses.