Dr. Josh Rose is not just a second generation resident of Pamlico County. He’s also a second generation Pamlico dentist, following in his father’s footsteps.

Rose and his wife, Rebecca, run Rose & Rose, DDS, the only private dental practice in the county. 

On a sunny Friday in February, the office just off state Highway 55 is closed for lunch. Dr. Rose sticks out a hand and introduces himself with a firm shake. Having overheard his lunch order, I remind myself to make the most of this break in his packed schedule.

Josh Rose is at ease telling his family story. ”I grew up here,” he said. “This county is very special to my family.” 

His father, Dr. Vernon Rose, grew up fishing and hunting in Roanoke, Virginia. Vernon had been recruited out of dental school to several places on the East Coast but his priority was finding somewhere to be outside, doing the things he loved. 

When he saw the mouth of the Bay River on the cover of a 1972 Carolina sports magazine featuring a story on drum fishing, he made his decision. He would build a dental practice here, in Pamlico County. And he would fish. The possibility that there might not be enough people to make a sustainable practice did not concern him. “He was coming by faith,” Josh Rose said. 

Josh’s brother, Jason, who also goes by Dr. Rose, operates the Coastal Pet Clinic across the street. The brothers grew up watching their dad, witnessing his career success, fishing off the Dawson’s Creek bridge, surrounded by nature. They both went to Pamlico High School. 

“My brother and I … we were trying to find things that would bring us back” to the county, Josh Rose said. “What can I do? I was on an ortho surgery track. … Then I switched during my junior year and got into dental school at UNC-Chapel Hill.” 

While there, he met his wife. They graduated in 2002 and came to Pamlico to join his dad.

Rose, who identifies as a husband, father, fisherman, birder, animal lover, horticulturist and volunteer board member, can talk endlessly about the best parts of the county. 

“We do not have a through-road,” he said “We are a destination.”  He describes the paths of migratory waterfowl and the sightings of bald eagles. They were rare when he was growing up, but are now a near daily occurrence. The natural features of this area are amazing, he said.

This begs the question: Why then are there not more health care professionals attracted to the area?

Most people coming out of dental school would not want to set up shop here, Rose said. He calls it a social issue. “My brother and I … and my wife, we were not looking for nightlife; we were looking for a settled life,” he said. 

He brings up another barrier. “Young people want all the frills and perks of a corporate dental practice: a set salary … a job where they don’t have to do it all,” he said.

Rose described his office’s recent expansion. There is a new ramp, more storage, another hygiene room — an extra 500 square feet in all. Dr. Brian Smith, who has provided orthodontic care in the county since 2010, offers appointments in the newly renovated office next door. 

Rose & Rose is not accepting new patients at this time, but with more hygienists, they can offer more appointments for their current clients. “Hygiene is a great career, very flexible,” he said. “We have an amazing staff.” 

After adding space and expanding the team, the office is starting to catch up with the backlog of routine and preventative care. “Our six month recalls had gone up to eight months, then nine,” he said. ”We could use another dentist in the county.”

Rose and his wife book appointments a year in advance, making personal planning complicated. “There is an impact on lifestyle,” he said. 

When the unexpected happens, such as January’s epic snowstorm, the respite of a day off is short lived. The work does not go away; it just shifts. “We were off Monday and Tuesday, worked Wednesday (usually a day with no patients) and we are still trying to put people back in,” he said. “We triage. What’s hurting? What’s infected? You want to take care of your patients.”

Rose suggests that dental professionals who have already done their time in corporate practice, the ones who are married and looking for a peaceful environment to raise their kids, might be open to running a practice in a rural community. 

Maybe they are looking for something more than the grind of a quota and craving a real connection with their patients. ”I see what our medical professionals are dealing with,” he said. “I hate it for them, spending 15 minutes with a patient, the whole time staring at a computer.” 

He feels lucky to be in dentistry and in private practice. “I like the fact that my wife and I can go somewhere and I know people and can talk to them outside the office,” he said. “It’s not all about doing dentistry; it’s about loving your patients and your community. I don’t want to see that lost in my profession.”

I went back to see Rose a week later, again on a sunny Friday, taking another slice of his lunch hour. We sat in comfortable chairs in the calm and inviting reception area. “I’m here today for the harder questions,” I said.

I wanted to know where all the other people go, the ones Rose & Rose cannot afford to treat even if they could fit them in — the children and adults without the means, and often with the most dire needs. 

Most of Pamlico has a 40% poverty rate. There are drug issues. Smoking and vaping is rampant. Tooth decay, left untreated, can lead to chipped teeth, missing teeth and potentially to more serious metabolic issues. Bad bacteria in the mouth has been linked to heart disease.

Rose lauds the work of Contentnea Health, less than a mile down Highway 55, noting its mission of providing comprehensive primary care and support services for underserved populations. 

The big blue banner that appeared recently in front of Contentnea’s tidy brick building is hard to miss. I pulled into the freshly paved lot and managed to catch Tanya Muse after all the patients had gone, just before the doors closed for the week.

Muse, practice manager for Contentnea, started 14 years ago when it was Greene County Health. She is a longtime resident of Pamlico County, living here for over 25 years. Muse said she loves being part of this community and part of a team that has long provided quality medical and dental care. 

Until last October, when Dr. Victoria Crane joined, Contentnea did not have a full-time dentist. They had been able to offer appointments with dentists rotating in from other offices. Today, Muse says, it welcomes new patients, both children and adults, four days a week. It accepts Medicaid, and as a Federally Qualified Health Center, is able to offer a sliding fee schedule for the uninsured.

Medicaid mandates full dental coverage, including routine and preventative care, for children under age 21. This care is critical for low-income children who may not be brushing their teeth regularly, if at all. It gets trickier for kids whose oral health has been persistently neglected. 

Children by the age of 8 or 9, and sometimes even younger, can suffer so much tooth decay that sedation and surgery are required to address their problems. Sometimes, sedation is the only way to get through even straightforward procedures if a child is fearful or has behavioral issues. The closest option these young patients have are pediatric dentists in New Bern. 

Medicaid does not mandate adult dental care. However, North Carolina’s Medicaid does offer some coverage, including dentures and emergency services such as extractions, but not routine or preventive services. 

For adults who do not qualify for Medicaid and are no longer covered by private insurance, paying for teeth cleaning once or twice a year is a good investment, Rose said. It can prevent bigger problems, or at least catch them early enough to avoid more expensive bills. 

This is especially important in Pamlico County, where Rose describes a different demographic, one that didn’t exist when his father started practicing. “We are getting a much healthier population in older ages than when we started 25 years ago,” Rose said. “It used to be rare to see someone in their late 80s or early 90s. Now it’s a daily occurrence.”

“Teeth are very important,” he said. “You can live longer with good, healthy teeth.”

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