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Dental association eases rules in Alaska program

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ANCHORAGE, Alaska (AP) – The American Dental Association is softening its opposition to a program that allows dental health aides in Alaska Native villages to extract teeth, perform surgery and other services usually provided by licensed dentists.

“We still believe that patients are best served by a licensed dentist,” said William Prentice, a lobbyist for the association. “But we’re trying to do everything we can to try to respond to the tribes’ concerns on getting dental care in frontier Alaska.”

The ADA is now backing a federal bill that says Alaska dental health aides can perform work if they consult with a dentist on certain types of cases. The association previously insisted such work must be done by dentists.

“This is somewhat of a breakthrough,” said Dr. Mark Kelso, dental director at the Nome-based Norton Sound Health Corp. Kelso oversees two dental health aides who are being dispatched to the Bering Sea villages of Savoonga and Unalakleet.

Dental health care is rare in rural Alaska. Some villages are visited by a dentist only once a year.

The rate of tooth decay among Alaska Natives is more than twice the national rate. According to research cited by the ADA, 60 percent of Native children 5 and younger have severe dental decay.

The dental health aide program – launched in 2003 by Native and federal health organizations – is an offshoot of Alaska’s community health aide program that the IHS started in the early 1960s.

The ADA had previously said nondentists should not be allowed to perform any irreversible procedures, like drilling or pulling teeth, citing concerns about the quality of patient care.

The association sued the Alaska Native Tribal Health Consortium and eight dental therapists in January for performing services the ADA says violate state dental licensing laws.

The association had hoped Rep. Don Young, R-Alaska, would insert an amendment to an American Indian health bill to prohibit dental health aides from performing irreversible procedures. But after negotiations between the two sides, Young had the bill amended in the House Resources Committee to say that health aides can do “pulpal therapy” and extractions, but only if a consulting dentist agrees it’s a medical emergency that pain relief can’t resolve.

The bill does not address fillings or define “medical emergency.” Consultation would be required only for adult teeth.

The bill must go to other committees before it hits the House floor.

The ADA and Native health leaders said they are happy with the bill.

“It is some additional restriction, but it does not undermine the vitality of the program,” said attorney Myra Munson, who lobbies for the Native health corporations.

The ADA is emphasizing the restriction.

“It hopefully will limit the times that a dental health aide will have to perform one of these services just to medical emergencies,” said Prentice.

The organization will continue its lawsuit to reinforce the importance of state licensing laws. “We believe very strongly in state oversight in health care,” Prentice said.

Kelso said the amendment in the House bill wouldn’t change current practices much. The health aides consult with dentists on serious or questionable cases and they would never do a root canal, although they do some of the initial work, he said.