Innovative Program Brings Dental Care to Underserved Alaskans

Ten years ago, the American Dental Association unsuccessfully sued to get the Alaska Native Tribal Health Consortium to halt its Alaska Dental Health Therapist (DHAT) program. Now the program has won a national award for its innovative approach to providing Alaska Natives with dental care. And the idea is expanding to other states.

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The head of the Dental Health Aide Therapist program, Dr. Mary Williard, accepted the Indian Health Service’s Director’s award last week [May 20] on behalf of the team she says has changed dental health in Alaska:

“Forty thousand people now have access to direct patient care by a dental provider living in their community, where there probably wasn’t ever one that lived in these smaller communities before. So it’s new access.”

The Alaska Native Tribal Health Consortium launched the dental health therapist program ten years ago because tribal health organizations across the state were continually recruiting but always short of dentists. And Alaska Native children had cavity rates 2.5 times higher than kids in the Lower 48.

Dental therapists get two years training, including a hands-on practicum. They can do fillings, extract baby teeth, and apply fluoride treatments and sealants. Williard says they also focus on patient education:

“One of the DHAT, Aurora Johnson, reported that in a school where she typically saw eight or so kids with with no cavities out of the sixty in the school, this year she had 34 with no cavities. That’s a huge increase and exactly what we’re looking for. Our Alaska Native children around the state can and should be cavity free.”

Williard says the regional hub providers say they’re now seeing fewer emergency flights from the villages that have dental therapists, who catch problems early.

“Especially in the model in Alaska, which is the model that we think is frankly the best model that should be exported to other parts of the country.”

Al Yee is a senior project adviser for Community Catalyst, a national consumer health advocacy organization. He says Minnesota and Maine have adopted legislation authorizing dental therapists to provide care. And New Mexico and Vermont have pushed legislation through one house in their legislatures. Yee says organizations in some 15 other states are working to launch pilot projects as a first step toward authorization of dental therapists. Yee says one of the selling points is better dental care:

“People just may not have access to dentists because for instance they may not have insurance or they may have medicaid in their particular geography there may be not a lot of providers that take Medicaid patients. So it’s more than just the geographic distance of highly rural areas like obviously in Alaska, there are access issues even in the cities as well.”

The dental therapists work under the supervision of a dentist and do some of the general services of dentists—freeing them up for more complex cases . Yee says dental therapists are also cost effective.

“Because they generally get paid less than a dentist, they can really be a cost effective member of the team.”

The American Dental Association has attacked the program since it began, saying therapists are not qualified to do fillings and extractions.

However, supporters says several studies have shown dental therapists provide quality care equal to or exceeding that of dentists. The ADA has fought the authorization of dental therapists in several other states. Minnesota and Maine legislatures have approved the program, and some 15 other states are developing legislation or pilot projects.