Village lessons on the dental access crisis: Alaska’s program a potential model for the lower 48
In late August, I found myself in a small conference room in a sub-regional clinic (SRC) in St. Mary’s, Alaska, a village of 549 Yup’ik residents, listening to Bernadette Charles describe how she is working to meet the village’s oral health needs. Not only was her passion for preventing disease and serving her community admirable, her presence in this small village offers policy professionals a promising approach on how to expand dental care to rural and underserved communities.
Oral health is essential to overall health, yet nearly 50 million Americans lack access to a dentist for routine oral health care. There are 4,000 federally designated dental professional shortage areas in the U.S. Nearly 9,700 new dental practitioners are needed to overcome our nation’s dental care shortage. Therefore many communities around the country struggle to attract and retain dental providers. However, St. Mary’s and other Alaska Native communities are leading the way in developing a robust workforce by training providers from their own communities – a potential model for communities across the country that are grappling with a shortage of dental care.
Charles, an Alaska Native who is St. Mary’s first full-time dental provider in almost a decade, is not a dentist but rather a dental therapist, an alternative provider who extends the reach of dentists by providing basic preventive and restorative care under the general supervision of dentists in locations where dentists are not located.
Dental therapists, first deployed in New Zealand in the 1920s, have a long history of providing dental care in community-based settings in 54 countries throughout the world. However, Charles is one of only thirteen dental therapists practicing in the United States.
Charles was trained as part of a program established by the Alaska Native Tribal Health Consortium (ANTHC) to address the longstanding challenges of maintaining an adequate dentist workforce in harsh, rural Alaska.
The impact Charles and her colleagues are making in reducing barriers to care in underserved Alaska is undeniable – dental therapists are now serving nearly 20,000 people in communities that previously did not have dental care providers.
While the success of the practice of dental therapy was evident during my recent trip and is well-established internationally, concerns about the quality of care have been repeatedly raised by those opposing this model. As their major argument against the dental therapist model, organized dentistry claims dental therapists provide lower-quality care, and have expressed safety concerns.
To address any questions regarding the quality of care provided by dental therapists and to document the model’s potential, RTI International of Research Triangle Park, NC conducted an independent evaluation of the Alaskan dental therapy program. W.K. Kellogg Foundation, the Rasmuson Foundation and the Bethel Community Services Foundation funded the evaluation.
The RTI evaluation released today found that dental therapists with two years of intensive training provide safe, competent, appropriate dental care. Other findings include:
— 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 (at remote locations).
— They are successfully treating cavities and helping to relieve pain for people who often had to wait months or travel hours to seek treatment.
— Patients were very satisfied with the care they received.
— They are well-accepted in tribal villages.
The study of the Alaska program adds to research of programs that have been in place for decades that shows preventive and basic dental repair services provided by dental therapists are safe, high quality, acceptable to the public, and cost-effective.
While the study provides evidence of the efficacy of dental therapists in Alaska, I saw firsthand the impact Bernadette Charles had on her village. She brought regular dental care to St. Mary’s as well as three other villages — Mountain Village (where she grew up), Pilot Station, and Pitka’s Point — all areas in remote Alaska that previously had no care. Before dental therapists like Charles were able to work with their supervising dentists to extend care to remote, rural communities, residents depended on an annual visit from a dentist and irregular itinerant care, or they had to round up residents to fly hundreds of miles to the nearest dental care facility.
Before dental therapists, dental care for Alaskan natives was inefficient and costly. The addition of dental therapists to the dental team meant professionals who received rigorous training in providing a specific set of preventive and basic services, including cleaning, filling and routine extractions could work in the community to prevent disease and treat patients to the highest level of their training. Dental therapists allowed dentists like Dr.Dezbaa Damon, who supervises Bernadette Charles, to maximize their training and treat only the highest need patients, thereby extending their reach and improving access to care for thousands of Alaska Natives.
In Alaska, the addition of dental therapists to the dental team has improved the state’s ability to deliver quality, coordinated, and cost-effective care. As we struggle to address dental workforce shortages and improve the delivery of care in the lower 48, we could learn a lot from Alaska.
— David Jordan, Director of the Dental Access Project