Dr. Sharon Nicholson Harrell, D.D.S., director of FirstHealth's Dental Health Services, views the entire community as a patient.

With a master's degree in public health, she was charged with launching a dental-care program through FirstHealth's five-county service area to reach those least able to obtain dental care.

When FirstHealth opened its first Dental Care Center in Southern Pines in 1998, Harrell and her staff saw the dire need for public dental care immediately and up close.

"When we first opened, there was a little boy who walked in with tears streaming down his cheeks, and his face was swollen out to here," says Harrell, indicating the child's distended cheek. "He was nervous and in pain. The boy had an abscess in his upper molar."

Dental treatment isn't always easy to find.

North Carolina faces one of the most severe shortages of dentists of any state, ranking 47th in the U.S. in terms of dentist-to-population ratio. As of 2004, North Carolina had 4.2 dentists per 10,000.

There is even greater disparity between metropolitan and rural areas: 4.8 dentists per 10,000 population in urban areas compared to just 3.1 dentists per 10,000 people in rural areas.

Some would quickly lay the blame for this failing at public health's door. Others, like Harrell, see the solution in public-private partnerships.

"School nurses were the people who brought it to FirstHealth's attention years ago," she says. "They identified dental health as being the No. 1 health issue among schoolchildren."

It was FirstHealth's CEO, Charles Frock, who navigated the relatively uncharted waters of adding dental care to the health-care organization's services.

"He saw the need and took the very bold move of bringing dental care under the auspices of hospital care," says Harrell.

At the time, Harrell was working as the Dental Director of the Cumberland County Health Department in Fayetteville.

"I guess I was chosen to lead the charge," she says, although she also credits Lisa Hartsock, the former director of community health at the time, as being the "grand collaborator."

Part-time clinics subsequently opened in Troy and Raeford. Nearly 10 years later, the three facilities have served more than 16,000 children, extending services to those underserved in Hoke, Montgomery, Richmond, Scotland, and Lee counties, as well.

'So Kind'

The Dental Center is staffed with four dentists, 13 full-time staffers and several part-time dentists and auxiliary employees. Southern Pines' office is open six days. Troy is open three days, and Raeford is open two days a week.

At first, most of the patients treated were emergency cases with high stress levels. In fact, as many as 70 percent of the patients the office saw in the first year had either never seen a dentist or had not seen a dentist within the past year.

Treating patients under such stress levels took its toll on Harrell and her staff. They were left wondering if they'd ever ease children into less stressful, more routine dental care.

However, more and more of FirstHealth Dental Care Center's patients come in for routine, preventive treatment.

"We still have emergencies, but we don't have as many," she says. "It's a scary prospect for them at first. They're nervous and scared, but we try our best to make them comfortable."

Carthage resident Georgia Bean has been bringing her granddaughters, Monica and Rachel Campbell and Kylie Bean, to FirstHealth Dental Care for 10 years.

When 14-year-old Rachel suffered an abscess last year, Harrell made every effort to accommodate her.

"Dr. Harrell was so kind to me about Rachel when she had that abscess," says Bean. "It was a Saturday night and Rachel needed a root canal. I called Dr. Harrell and she answered. She even came to the office Sunday morning and arranged for Rachel to go to the hospital for IVs, and she got the appointment for the doctor in Fayetteville to do the root canal."

Bean has also taken all three girls to the Dental Health Center for routine checkups and cleanings. Before that, she was traveling to Fayetteville for the same service.

"I don't know what I would have done without Dr. Harrell's help. She's an outstanding person, and the office always tries to make it convenient for me."

The little boy who was treated almost 10 years ago now comes in to comfort his nieces and nephews when they're being treated.

"He's become an advocate," says Harrell.

And that's her greatest reward.

"I've always had a desire to work with the underserved population, to try and make things better for them," she says. "It's been so fulfilling. I go to bed at night feeling I've helped someone. It's instant gratification, and we all get our satisfaction knowing we've provided a service. We're all committed to this."

Harrell and her staff aren't the only professionals dedicated to treating the underserved. Through Smart Start, Dr. Yvette Stokes reserves her Fridays to take children who require oral surgery into the operating room for treatment under anesthesia. Other dentists in the area with private practices come into the dental center on Fridays and Saturdays.

"They receive a wage, but the reward far outweighs it," says Harrell. "They could be out doing something else, but they come in here."

Serves as a Model

Dental-assisting students from Montgomery Community College train at the center, as do students from Pinkney Academy.

FirstHealth is the first program in the state that works with pediatric dental students rotating through its offices.

"They get a firsthand look at a real office environment," says Harrell. "This helps students get a taste for dentistry and introduces them to the notion of doing their part because we're a public health facility based on a private practice model."

During more than 14 years in dentistry, Harrell has mentored some 50 new or aspiring dentists, dental hygienists and dental assistants.

"Of course, I want to educate students about excellence in clinical dentistry," she says, "but I want more than only clinical training for my students. I want them to understand the challenges that many patients face in obtaining dental care, such as lack of transportation, or inability to take off work to get to the dentist. Parents want to get good treatment for their children, but sometimes they just can't find it."

For her work, The American Dental Association's Committee on the New Dentist recognized Harrell with its Golden Apple Outstanding Leadership in Mentoring Award for her work with young dental health professionals. FirstHealth of the Carolinas, with the endorsement of the North Carolina Dental Society, nominated Dr. Harrell for the award, which was presented during the committee's awards luncheon in Boston.

"We're not an island unto ourselves, but a model for other practices," says Harrell.

The clinic has served as an example for several startup programs nationwide.

"Dr. Harrell has distinguished herself professionally in many ways," says Frock. "She has been nationally recognized for the way she mentors young dental health professionals. She is recognized throughout North Carolina for her public health approach to dental care for the underserved, and she is known by her patients and her colleagues as a completely caring, compassionate, and accessible caregiver."

Mary Griffin can be reached at 693-2482 or at mgriffin@thepilot.com9