Overcoming Barriers to Dental Care One Kid at a Time

As a way to meet dental care needs of American Indian and Alaska Native children, some tribes are turning to dental health aide therapists to provide basic services.

Dental treatment remains the single most unmet healthcare need in the U.S., according to a 2015 survey, with nearly half of adults reporting that they are not able to afford the dental care they need.

In 2105, the Indian Health Service reported that American Indian and Alaska Native preschool children have the highest level of tooth decay of any group in the U.S., more than four times higher than white non-Hispanic children. More than 1 in 3 American Indian and Alaska Native children between the ages of 1 and 5 years old has untreated decay.

Cost, lack of access to dental providers, and, according to Dr. Rachael Hogan, dental director for the Swinomish Indian Tribal Community, fear, keep people from getting the dental care they need.

One highly-effective solution was pioneered by the Alaska Native Tribal Health Consortium. Midlevel dental therapists—highly trained professionals qualified to provide preventive and routine dental care, such as applying fluoride treatments and sealants, filling cavities, and performing simple extractions—can provide care at a cost far lower than having dentists perform those services.

A new survey finds the use of dental therapists has strong support in the U.S., where lobbying efforts by professional dental organizations have largely prevented their licensing. Eighty percent of the voters surveyed said they were in favor of permitting dental therapists, a move that so far has been made by only three states besides Alaska—Minnesota, Maine and Vermont—and by tribes in Washington and Oregon.

The Swinomish Indian Tribal Community, in partnership with Northwest Portland Area Indian Health Board, was the first tribe in the lower 48 to employ a dental health aide therapist for basic oral health services. “We cannot stand by any longer and allow Native people to continue to suffer tooth decay at a rate three times the national average,” said Tribal Chairman Brian Cladoosby in a news release.

A year ago, Daniel Kennedy, Alaska Native, joined the tribe’s dental team as a dental therapist. He not only provides services but he has become a part of the community, spending at least one day a week with kids in the tribe’s daycare and Head Start programs, which has tremendous benefits. Not only do the children learn how to brush their teeth and floss, “the kids see Daniel all the time, so they are totally comfortable and trusting when they come into the clinic for exams, treatments and cleanings,” Hogan said. A new generation will not experience the fear of dentists that so often keeps their parents and grandparents away, she said.

Kennedy’s participation has also helped cut the wait time for an appointment from 8 weeks down to 3 or 4 weeks. In July, Hogan said, the two dentists in the practice will be able to start doing crowns and bridges for clients. “We can get through treatment plans a lot faster now. Once the dental decay is under control we can begin restorative work,” she said.

And the tribe is planning to send one of its own tribal members for training as a DHAT this spring, she said.

In Oregon, several tribes have launched a pilot program, also in conjunction with the Northwest Portland Area Indian Health Board, to train dental therapists within the Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians and the Coquille Tribe of Southern Oregon.