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Last week, the New York Times reported on the dire need to improve health care on Native American Tribal Lands. Unfortunately, one of the major components of overall health and the health care system was overlooked as part of the article – oral health and access to dental care.
Today, Native American Indian children and adults are suffering disproportionally because of lack of access to dental care. Untreated dental decay is two to three times higher among Native Americans than in the general population.
For example, at the Pine Ridge Clinic in South Dakota, children ages three and four attending a Head Start program were recently given screening exams by a dentist near the village of Wounded Knee. Of twenty kids who were screened, 18 of them were found to have severe dental problems that could only be treated in an operating room due to the extent of their dental problems. That means the children had severe decay deep into their teeth that was causing pain, multiple infections and made eating difficult. More than half of each of these children’s teeth were severely decayed because of lack of access to dental professionals and services.
The Indian Health Service dental clinic in Pine Ridge is understaffed, making it impossible to provide care to all the children on the reservation suffering from tooth decay. In short, if children are able to get to the clinic, which is 17 miles away, dentists are so overwhelmed by the demand to provide more serious treatment that they are unable to provide preventive care or treat cavities or decay.
While a shortage of dental professionals is a major problem throughout the country, it is worse on tribal lands. The Indian Health Service (IHS) has a 34 percent vacancy rate for clinical dentists; in some areas, the vacancy rate is 50 percent. In fact, there is only one dentist per 4000 Indians, compared to one dentist per 1700 in the general population.
Fortunately, Alaska has found a solution to this critical need for dental professionals to serve Native American Indians and the general population, who lack access to quality, affordable dental care. There, the Alaska Native Tribal Health Consortium (ANTHC) has added a dental therapist to the dental team to increase access to care.
Dental therapists are home-grown health professionals who serve their own communities. They fill a critical role in the dental partnership by providing complementary services to those dental hygienists and supporting the work of dentists. For nearly 100 years, dental therapists have been providing cleanings, sealants, fillings, and simple extractions to underserved urban and rural populations in countries with advanced dental care systems similar to the U.S., such as Canada, England, and New Zealand.
Before the program was implemented, some residents had access to dentists who only visited once a year. With the support of philanthropic organizations, dental therapists were trained, first in New Zealand and now by the University of Washington’s Medical School, and have returned to provide critical care to Alaskan natives. Now, 11 dental therapists are providing care in nine dental shortage areas to more than 7,000 previously underserved Alaska Natives. By 2012, there will be 32 dental therapists living in and providing culturally competent, high, quality dental care in dental professional shortage areas.
The quality of care offered by the dental therapists is well documented. Research and evidence from other countries where dental therapists have been part of the dental team since the 1920s shows that the preventive and basic dental repair services provided by dental therapists are safe, high quality, acceptable to the public and cost-effective.
Despite the successful use of dental therapists as part of the dental team, the American Dental Association is trying to prevent dental therapists from joining dental teams on tribal lands in the lower 49. Thursday afternoon, ADA President Ron Tankersley testified that Native American Indian people should not receive care from dental therapists.
With 83 million Americans lacking access to dental care, now more than ever, we need to look at ways to improve the system. Dental therapists can benefit everyone, including dentists because they can provide critically important basic treatments to patients and allow dentists to focus on more serious services and surgeries. We need to work together to provide all residents with access to quality, affordable, dental care – the dental therapist model is a proven solution for bringing care to every community.
–David Jordan, Dental Access Project director