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Smile! Swinomish Tribe to Deliver 21st-Century Dental Care

The Swinomish Tribal Community is planning for a future with better healthcare for its members by training a Dental Health Aide Therapist.

Swinomish tribal members and their neighbors can look forward to better oral health in the near future.

The tribe has sent Aiyanna Gruzman to Alaska to train as a mid-level dental care provider. She will return in 2017 prepared to evaluate patients’ oral health status, give fluoride treatments, fill cavities, apply sealants and perform simple extractions. Her contributions will free up time for the tribe’s one full-time dentist, Dr. Rachael Hogan, to help patients who need more complex procedures.

Gruzman will also be able to provide patients—kids and adults alike—with the information they need to maintain their oral health and prevent the pain, suffering, missed school and work and sometimes life-threatening consequences of inadequate dental care.

In announcing the DHAT (Dental Health Aide Therapists) initiative on the reservation at NCAI’s mid-year conference in June, Swinomish Tribal Chairman Brian Cladoosby said, “We cannot have healthy communities without access to reliable, high quality and culturally competent dental care. We must break the cycle of poor oral health, and while it may take a generation, we must start now.”

The tribe took over the responsibility of providing dental care in 1995/96 from the Indian Health Service, replacing the run-down modular trailer that served as the dentist’s office on the reservation and replacing it with a state-of-the-art facility funded largely by the tribe itself. The tribe has been subsidizing operation of the dental clinic since 1995.

The trailer where IHS provided dental care on the Swinomish reservation.

“The tribe went for decades with a contract dentist who came to the reservation once or twice a month. He could only treat the most critical patients, those with the most complex needs, and never got to the others. Mostly he pulled teeth,” says John Stephens, Haida descent, programs administrator for the tribe. Prevention and education, the keys to achieving oral health, were impossible under those conditions.

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Before signing on to the DHAT concept, the tribe did a three-year analysis of procedural codes and found that about half the procedures required among its clientele were ones that DHAT’s were trained to perform. Research showed that DHATs performed those services as well (or better, in the case of patient education) than did dentists.

Dr. Hogan said, “When I learned the tribe was interested in hiring a mid-level dental provider as a means to improve the oral health of their community, I began to research the program. My first concern was, is it safe? The DHAT program has been operating in Alaska for over 10 years and now provides care to more than 40,000 people. The program has been closely monitored and the statistical evidence clearly proves it to be a safe, effective method to meet dental needs of underserved populations.”

Stephens says the tribe will be the first in the lower 48 to use licensed DHATs under a tribal regulatory system. Not only will DHATs be able to improve dental health on the reservation, they will provide culturally competent care and help build a workforce on the reservations, says Stephens.

The Swinomish dental clinic serves 1,400 IHS Swinomish clients, but has about 3,000 active patients, since it serves American Indians from other tribes in the area.

The new dental facility built by the tribe under self-governance.

“The effort launched by the Swinomish today can and should be duplicated by tribes all across the country to better ensure that their members receive the dental care they need. We stand hand in hand with the Swinomish today,” said Jacqueline Johnson Pata, executive director of NCAI, when the program was announced.

The Swinomish Tribe is working with the Northwest Portland Area Indian Health Board and the W.K. Kellogg Foundation and Pew Charitable Trusts to bring new and innovative dental resources into the Pacific Northwest. “The integration of dental mid-level practitioners and modernization of our dental facility equals 21st century delivery model,” says Stephens.