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Oregon Approves Coos Bay Tribes to Integrate Mid-Level Native Dental Therapists

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A project that will train and employ Native Americans to perform basic oral health in their own Coos Bay-area communities has been approved by the Oregon Health Authority (OHA).

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The mid-level providers will deliver dental care to populations with the highest oral disease rates. American Indians and Alaska Natives are disproportionately affected by lack of oral health care and have the highest rates of cavities and gum disease in the world.

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The Coquille Tribe and the Confederated Tribes of Coos, Lower Umpqua, and Siuslaw Indians received the approval for the pilot project on February 9. The pilot will operate under an Oregon law approved in 2011 that promotes innovative and data-driven improvements to the state’s oral health system.

The mid- level dental providers will be integrated into the tribal health care systems. Called dental health aide therapists (DHATs), the providers will expand quality yet cost-effective and culturall competent care. They can perform preventive care and routine restorative duties, such as filling cavities. Similar to physician assistants, they focus on a limited number of prevalent and much-needed procedures, and they complete a rigorous educational program to do so. They work under the supervision of a dentist and are re- certified every two years.

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“Our intent is to increase access to care for our tribal members. The rates of untreated tooth decay are four times higher nationally for native preschool-aged children compared to their non-native peers, and those numbers are reflected here as well. That is unacceptable. We need to turn those numbers around, and this a step in the right direction,” Mark Ingersoll, chairman of the Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians, said.

The Coos Bay, Oregon-based Dental Clinic is owned by the Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians and recognized as an Indian Health Services (IHS) Dental Clinic.

Their dental clinic cares largely for their own members, as well as members of other Tribes within the give-county service area. With one full time dentist at the clinic, the need for more providers is acute. The tribe plans to hire an experienced DHAT this year to start providing services and has sent one of their members to the two-year Alaska DHAT Education program.

The Coquille Tribe is also recruiting a student from their community to receive DHAT training. “This model of care really focuses on quality and the continuity of care that comes from training and hiring members of our own community. We know they are far more likely to stay here and be a part of our health care system, unlike the itinerant dentist model that is common in the Indian Health Service system,” Brenda Meade, Tribal Chairperson of the Coquille Indian Tribe said. The tribe is newly establishing an oral heath component as part of their health care services. “We are building from the ground up and having a DHAT as part of the team means we can serve more people with better care at lower costs. It just makes sense.”

The pilot would replicate what Alaska Natives did more than a decade ago by educating and hiring these providers to help their dentists extend care to more people. The Alaska Native Tribal Health Consortium (ANTHC) reported in 2014 that their dental health aide therapists program has brought jobs to tribal communities in Alaska, economic growth to participating clinics and cost savings to patients that used to travel hundreds of miles to see a dentist for urgent, and costly care.

The two tribes are partnering for the pilot with the Northwest Portland Area Indian Health Board (NPAIHB), an organization that supports health promotion and disease prevention for the 43 federally- recognized Tribes of Oregon, Washington and Idaho. “We know that many Oregonians struggle to get the dental care they need. But American Indians are among those who suffer the greatest oral health disparities because of access to care. That is why we are excited to bring a proven, innovative solution to Tribes in this state, and at the same time demonstrate the benefits of this provider to all those in need,” Joe Finkbonner, NPAIHB’s Executive Director said.

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