Dental disease can have negative and lasting effects on overall health and quality of life. The Institute of Medicine of the National Academy of Sciences reported last year that close to 5 million children in the United States did not receive needed care in 2008 because of costs. Increasing use of dental care has been selected by the U.S. Department of Health and Human Services as one of a small number of national leading health indicators, designating it as a national priority. Innovative initiatives have been undertaken in North Carolina to promote oral health, and there have been improvements in the state. For example, both the use of dental services among children and their oral health status are improving. Yet persistent and difficult challenges remain, such as ensuring an adequate workforce for the future, improving oral health literacy, maintaining existing programs, and resolving disparities in oral health and lifetime access to preventive and treatment services for all North Carolinians. This issue brief reviews some oral health initiatives and their outcomes--with a focus on youth. Commentaries in the policy forum also focus on access to oral health care; assessing, educating, and building the dental workforce; new practice models and trends; insurance innovation; and patients with special needs.