By: Jean Johnson for Dental1
Native American residents in rural Alaska are caught between a rock and a hard place. Not only do children have dental decay rates 2.5 times higher than the national average, trained dentists and dental hygienists are scarce in their area.
|What’s at Issue|
| Things to ponder about dental care in rural areas:|
Is the community one that will attract qualified dentists and hygienists?
What types of procedures might be better done in larger urban areas?
When is it appropriate to get a second opinion from a dentist who specializes in one of the many new subfields of dentistry?
How can a patient and their family determine if the care they are receiving in a rural area is adequate and not jeopardizing their dental health over the longer term?
In response, the Alaska Native Tribal Health Consortium has done what it considers to be the next best thing to having enough licensed dental practitioners – it hired dental health aid therapists trained in New Zealand programs to provide basic care including cleaning, filling cavities and extracting teeth.
The American Dental Association (ADA), however, has gone on record with its position that the Native Health Consortium is courting serious trouble. In early February 2006, the ADA sued the Alaska Native Health Consortium in Superior Court. The move came only after considerable wrangling.
The program began a year ago, and so far Alaska is the only state to allow dental therapists in the door. There are eight dental therapists currently practicing in Alaska with four more prospective therapists presently training in New Zealand.
Still, the program came under fire from lawmakers throughout the mainland states almost immediately. Senator Tom Coburn (R, Okla.), for example, tried to regulate what dental therapists were allowed to do by proposing an amendment to limit procedures to those that could not cause “irreversible harm.” But the Senate Indian Affairs Committee rejected the Coburn measure in October 2005.
A Native Perspective
“Basically there are not enough dentists and dental hygienists in the entire state of Alaska to deal with the Native population, even in urban area of Anchorage,” said member of the Lakota Sioux Tribe, Jeanne Eder, Ph.D. and professor of history at the University of Alaska Anchorage.
“I cannot get my teeth cleaned at the Alaska Native hospital because the wait is phenomenal. It’s easier for me to pay and go to a private dental hygienist. Even though they have a whole floor devoted to precautionary dental health there, they don’t have enough help to keep up,” said Eder.
Eder also noted that when she needed a root canal, she had to go through a lengthy process in the Native health system. “It’s packed, and that’s just for urban Alaska,” she said.
Jim Towle, executive director of the Alaska Dental Society – which signed onto the ADA lawsuit – clearly thinks the shortage should be addressed in other ways rather than letting dental therapists take over duties generally relegated to the purview of dental professionals.
But Eder points out that attracting more qualified people to Alaska’s hinterland is hardly going to happen any time soon.
“Our national image is poor because people in the lower 48 don’t understand the distance and size of Alaska,” she said. “If you superimpose the state on a map of the continental United States you’ll quickly see that Alaska is one-fifth the size.
“Then you look at Native villages along the coastline or up along the Arctic Circle like Kozsebue, and you can see that for residents living there, coming into Anchorage or even Fairbanks is like going from South Dakota to Alabama!”
Eder also explains that remote little bergs like Kozsebue are too isolated for the majority of dentists and hygienists to even consider relocation.
“These are places with grocery stores so small they could fit in your house,” said Eder. “So what dentist wants to go live there? And those places are the hub of a larger area where people have to travel 30 and 40 miles by four wheeler, boat or dog sled to get to town. Yes, there are usually small clinics there, but they don’t have the staff.”
Even though at first glance this seems like a vicious circle, Eder adds that from what she has seen, the Alaska Native Tribal Health Consortium is working to promote dental health education in the schools. Posters are up warning against the effects of soda pop and candy, and children are taught about how to brush and the importance of flossing.
So what is Professor Eder’s answer?
Eder suggests that the ADA explore some type of traveling dental service such as aircraft to take qualified personnel out to the main village hubs. Until then, dental therapists might just be the answer. Certainly they are better than letting people suffer needlessly, says Eder.