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Rural Health Information Hub

Healthy Smiles: Early Childhood Dental Outreach

  • Need: To decrease the number of children entering kindergarten with untreated tooth decay in the rural Appalachian counties of Rutherford, Polk, and McDowell in western North Carolina.
  • Intervention: A program to give children a dental home that included screenings, targeted outreach, and restorative services.
  • Results: An overall decrease within the service area of children entering kindergarten with sub-par oral health.


Promising (About evidence-level criteria)


In the service area of rural Rutherford, Polk, and McDowell counties, almost 25% of children entered kindergarten with untreated tooth decay, according to 2013-2014 data reported by the North Carolina Oral Health Section, a subdivision of the North Carolina Division of Public Health.

Partnership for Children of the Foothills logo Led by the Partnership for Children of the Foothills, the Healthy Smiles Project comprised 16 members representing nine agencies in the three-county service area. The consortium organizations involved in Healthy Smiles included:

  • N.C. Oral Health Section
  • Rutherford County Schools
  • Polk County Public Schools
  • McDowell County Schools
  • Rutherford Polk McDowell Health District
  • Rutherford Regional Health System
  • Collins Dental Center
  • Mission Children's Hospital
  • YMCA of Western North Carolina

The Healthy Smiles Project utilized the Dental Home model strategy supported by the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA). The program focused on the concept of identifying and establishing young children with dental homes as an oral health prevention strategy. Healthy Smiles was based on three evidence-based AAPD and ADA strategies for dental health. These included dental screenings and exams, information about proper care of the child's teeth and gums, and follow-up treatment when dental issues were found during screenings/exams.

This program received support from a 2012-2015 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant. Healthy Smiles ended on April 30, 2016.

Services offered

  • Dental screenings for preschool children
  • Targeted outreach and education for young children aged 0-5, their parents and childcare providers, and expecting parents
  • Restorative dental services and follow-up care
  • Gas vouchers if needed for transportation to dental appointments
  • Medicaid enrollment
  • Dental subsidies if no insurance was available and child was found eligible
  • Dental puppet show


  • 3% decrease of Rutherford County children entering kindergarten with untreated tooth decay
  • 3% decrease of Polk County children entering kindergarten with untreated tooth decay
  • 1% decrease of McDowell County children entering kindergarten with untreated tooth decay


The main challenge for the Healthy Smiles Project was reduced staffing due to unforeseen health/life issues. However, the devoted staff of dental hygienists from the North Carolina Oral Health Section gave a generous amount of their time (in-kind) to assure that screenings continued in the three-county area. Thus, the program was able to continue to meet its goals and objectives.


  • In-kind and volunteer support to reduce the cost of a similar program
  • Strong leadership to hold staff together and keep goals on track

Contact Information

Barry Gold, Executive Director
Partnership for Children of the Foothills

Children and youth
Oral health
Wellness, health promotion, and disease prevention

States served
North Carolina

Date added
October 14, 2015

Date updated or reviewed
November 1, 2022

Suggested citation: Rural Health Information Hub, 2022. Healthy Smiles: Early Childhood Dental Outreach [online]. Rural Health Information Hub. Available at: [Accessed 7 June 2023]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.