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Indian country dental aide expansion: Yea or nay?

WASHINGTON – As visions of sugarplums dance in some heads, tribal communities are pondering methods for expanding dental health care in Indian country.

At a Dec. 3 hearing of the Senate Committee on Indian Affairs, tribal health experts testified on a specific orthodontic topic – whether a new dental aide therapist position currently being tested in Alaska Native communities should be expanded to other regions.

Ronald Tankersley, president of the American Dental Association, testified that the organization does not support delegating surgical dental procedures to those without the comprehensive education of dentists, so the organization opposes Congress expanding the Alaska therapist model.

“To us, it’s not a matter of whether similar providers exist in other countries,” Tankersley said.

“The United States has higher educational requirements than many other countries. Currently in this country, surgical services are not delegated to any health care providers with just two years of post-high school training.”

Tankersley testified that recent events make expanding that model even less necessary than in the past.

Specifically, he said, the drastic shortage of dentists in the IHS is being addressed. This year alone, he estimated there will be 70 additional dentists providing care in tribal areas.

“With one more year of similar recruiting success, the shortage of dentists in the IHS could be eliminated. No other action could have a more significant impact upon increasing access to surgical oral health care in tribal areas with profound need,” Tankersley said.

While opposed to the Alaska therapist model, Tankersley said the ADA is supportive of innovations in the dental arena to increase access to dental services in underserved tribal areas.

The ADA is asking Congress to focus on eliminating dentist shortages and supporting workforce innovations that increase efficiency and focus on prevention, while still ensuring that people who need surgical care receive that care from fully trained dentists.

Evangelyn Dotomain, president of the Alaska Native Health Board, took a different view.

She testified that it’s exciting to see that other parts of the United States are looking at incorporating a dental mid-level model, such as the one being tested in Alaska.

“The Alaska Native Health Board believes that dental therapists can be extremely helpful in combating dental disease and increase the level of oral health throughout Indian country and the nation.”

She called the use of dental therapists an innovative solution to the inadequate numbers of licensed dentists practicing in underserved areas, not just in rural Alaska.

Patricia Tarren, a staff pediatric dentist at Hennepin County Medical Center in Minneapolis, also testified in support of expanding dental health therapy in Indian country.

She supports an amendment by Sen. Al Franken, D-Minn., to remove a restriction in legislation offered by Sen. Byron Dorgan, D-N.D., which limits further expansion of dental therapists on Indian lands and prevents IHS from providing or covering dental therapist services.

Tarren said that given the successful introduction of the Alaska dental therapists, tribes in other states should be allowed to evaluate the data when published and determine for themselves whether to utilize them, rather than being denied by federal legislation.

“For the benefit of all members of society, the mark of a true medical professional is to advance the science of the profession.

“We should therefore be open to the possibility of different models of allied dental professionals, just as our medical colleagues have done with nurse practitioners and physician assistants, for example.”

Dorgan responded that Native Americans should be provided access to high-quality dental health treatment as a basic treaty right. He did not say whether he would consider dropping his restriction.

Franken took issue with Tankersley’s proposition that 70 more dentists in Indian country will address the problem. He continued to push his amendment.