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Study supports tribal dental therapists

WASHINGTON – While some lawmakers have expressed skepticism toward dental therapists providing oral hygiene services to tribal patients for fear of subpar care, new research suggests several benefits.

This month, the first major independent evaluation of U.S. dental therapists with a special focus on tribal programming was released. It was conducted by RTI International of Research Triangle Park, N.C., and funded by the W.K. Kellogg Foundation, the Rasmuson Foundation, and the Bethel Community Services Foundation of Alaska.

A major finding was that a dental health aide therapist program, which largely serves Alaska Natives, has helped expand the reach of dentists, providing needed care to thousands who can’t currently access it. With no dental programs – the current status quo in some remote tribal communities – many Indian citizens are likely to suffer poorer health outcomes than the general population.

In Alaska, dental therapists have been providing preventive and basic dental care to families in remote Alaska Native villages since 2006.

The study offered several positive findings specifically about the program, including that dental therapists are technically competent to perform the procedures within their scope of work and are doing so safely and appropriately; they are consistently working under the general supervision of dentists; and they are successfully treating cavities and helping to relieve pain for people who often had to wait months or travel hours to seek treatment.

At the same time, patients tend to be satisfied with the care they received, and the program has been well-accepted in tribal villages.

Some health practitioners have been anxiously awaiting the research, given that some health officials, mainly the American Dental Association, have weighed in against the widespread support of tribal dental therapist programs, suggesting they are inferior.

At a December Senate Committee on Indian Affairs hearing, Ronald Tankersley, ADA president, testified that the organization does not support delegating surgical dental procedures to those without the comprehensive education of dentists.

The organization has opposed Congress expanding the Alaska therapist model, and has suggested that the drastic shortage of dentists in the IHS system is being addressed.

“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.”

Meanwhile, some Indian health organizations, including the Alaska Native Health Board, have supported the programs, saying they can be an important tool against a serious epidemic. The new research supports this conclusion, health officials said.

Sen. Byron Dorgan, D-N.D., SCIA chairman, has sided with the ADA, supporting legislation that limits expansion of dental therapists on Indian lands and prevents IHS from providing or covering dental therapist services.

Dorgan believes Native Americans should be provided access to high-quality dental health treatment as a basic treaty right – and that IHS should be facilitating it.

But tribal health officials have said IHS continues to have problems addressing Indian dental health needs.

The study confirmed the seriousness of the situation, reporting that tooth decay rates among American Indian and Alaska Native children are five times the national average for children from 2 to 4 years old. In Alaska, more than 60 percent of children aged 2 to 5 have untreated cavities.

Several health officials now say in the absence of alternatives, tribal dental therapist programs should be looked at as an option to serve other Indian country areas that don’t currently have access to strong services. Federal funding to support such programs has been urged.

“These findings clearly indicate to me that alternative providers such as dental therapists can successfully provide good, quality dental care in areas where people can’t gain access to dentists,” said Sterling K. Speirn, the W.K. Kellogg Foundation’s president and chief executive officer. “Other states and tribal areas should explore the dental therapist model as a way to expand the reach of dentists, and in the process, help millions of people get the dental care they so desperately need.”

The researchers also said that as dental therapists continue to reduce oral disease that is prevalent in Alaska, they can focus more on preventive services. Along those lines, the study found that dental therapists who live in the villages where they provide care can promote prevention and reinforce educational messages to improve oral health outcomes with children and families. In addition, school support for preventive efforts was stronger in villages where dental therapists lived.

Jerry Drake, executive director of the Bethel Community Services Foundation, said the findings of the evaluation are “critically important” to the people of Alaska.

“The information provided in this evaluation confirms that dental therapists are working well under general supervision of the dentists. And I am confident dental therapists can begin to make greater inroads with their care,” said Mary Williard, clinical director of the Dental Health Aide Therapist training program in Alaska. “A necessary priority has been to reduce the number of Alaskans who are in pain from untreated dental disease and we are now in a better position to increase education about the long-term benefits of preventive oral health care.”

A copy of the full report and videos of the Alaska dental therapist program are available online.