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Supporting Culturally Sensitive Oral Health in Indian Country

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The expanse of land we now know as Massachusetts, Martha’s Vineyard and a small portion of Rhode Island was once home to a healthy, thriving community of thousands of American Indians. The Aquinnah Wampanoag has lived in the area for more than 10,000 years.

Brian Swann, DDS, MPH

“These are the people who greeted the pilgrims,” said Brian Swann, who directs the Robert Wood Johnson Foundation-funded Dental Pipeline National Learning Institute program at the Harvard School of Dental Medicine where he is also a clinical instructor. The National Learning Institute partners with 11 dental schools and is led by the American Dental Education Association and the University of the Pacific Arthur A. Dugoni School of Dentistry. Its primary objective is to increase the enrollment and retention of underrepresented students in dental schools.

There are only approximately 2,000 Wampanoag left and “they suffer greatly from health disparities,” said Swann, who has worked to address the health needs of many underserved populations in the United States and the world.

Poor oral health care has been an issue in American Indian/Alaska Native communities for many years. The most recent study reported that the American Indian/Alaska Native population has the highest dental cary (decay in tooth or bone) rate in the country. The problem is attributed to a number of factors, including a lack of access to providers who understand and are committed to working in American Indian/Alaska Nativecommunities.

“The Wampanoag people have also had horrible experiences with oral health due to poor access to care and living with pain and tooth loss from untreated dental problems,” Swann continued. In the areas where many of the Wampanoag live, there are six private dentists (none of them take insurance) and a hospital-based clinic that often needs to be booked six months in advance. In order to get dental care, they have to consider going off island and that can be costly or mean a missed day at work—critical issues for a population that also has limited financial resources.

National Learning Institute Brings Resources to the Underserved

To address these issues and plant a seed that might produce health care providers dedicated to working in areas where people have great difficulty getting high-quality care, Swann’s National Learning Institute students are seeking to provide oral health care for the Wampanoag.

“The purpose of the relationships we are building through the pipeline program is to give students treatment experiences in diverse communities. Of course there is a hope that as they develop their careers, they will incorporate these types of services into their dental practice,” Swann said.

Working on Martha’s Vineyard in clinics and conducting screenings at pow wows, National Learning Institute students do far more than provide dental care. “We also do surveys to assess the complete health needs of the population, including the need for smoking-cessation programs, screenings for diabetes, and mental health services,” Swann said.

The Massachusetts project is a perfect fit for National Learning Institute students who represent a range of social, cultural, economic, racial and geographic backgrounds. A significant part of the program’s mission is to help prepare a diverse range of dental students to address the often dramatic disparities in oral health that impact medically underserved communities around the country.

Expanding the Pipeline

Even the word Wisconsin comes from that region’s rich, American Indian heritage. The name of the state is taken from an Algonquian word—Wishkonsing. That is what the tribe called the area’s large river. Six tribes, including the Dakota Sioux and the Ojibwe, were the original inhabitants of the state. They were followed by six more tribes, including the Cheyenne and Oneida. Eleven remain and are recognized by the federal government today.

In addition to struggling with the oral health challenges experienced in many American Indian/Alaska Native communities, the Wisconsin tribes have disproportionately high rates of heart disease and diabetes.

“In Wisconsin, the tribes most often live in rural areas and have high cavity rates,” said Sheila Stover, a clinical associate professor of dentistry at Marquette University School of Denistry who runs the National Learning Institute program at Marquette. Her outreach focuses on younger students who have not yet graduated from high school or chosen careers in dentistry. She most often works with the Lac du Flambeau Tribe.

“We conduct oral health education days to introduce young people to dentistry and explain how they can become dentists if they are interested,” Stover said. “I concentrate on the need to diversify the profession—that’s the driving force for me. There is a tremendous gap here when it comes to creating a path to bring these young people into the profession.”

Stover explained that in order make dental school a reality for many teens from American Indian backgrounds you have to reach beyond the students themselves. “In order to ensure that the students have the proper support, you have to bring their parents on board. You have to get community leaders involved. Everyone must understand how a dental education can be funded, how students will handle debt and why it’s worthwhile. We know people do better—in terms of health—when they work with people from their own culture, so that’s our goal.”

Stover and Swann also expressed gratitude for the excellent support and training they received from the NLI sessions held at the University of the Pacific. “They are creating and sharing information on best practices from around the country,” Stover said.

“They were extremely helpful in offering guidance about developing goals and expectations for our project,” Swann added. “The experience was vital—we learned a great deal.”