One of my passions as a dentist is improving oral health to under served populations. Close to 50 million Americans live in dental health shortage areas– regions of the country that are designated as dental health professional shortage areas by the U.S Department of Human Services’ Health Resources and Services Administration. The Pew Center estimates than 17 million poor children go without dental care each year.
However, the problem is much worse for American Indians living on the reservations in this country. As a member of the Cherokee Nation of Oklahoma, this issue is very important to me. While most of the patients I see at Sage have quite easy access to regular dental care, the situation is totally different for indigenous populations.
This August, I will be a keynote speaker at the 2014 International Indigenous Oral Health Conference in Adelaide, Australia. For the past four years, I have been a member of the national leadership team for the Oral Health Project sponsored by the W. K. Kellogg Foundation and I am currently the Associate Director for the Center for Native Oral Health Research at the University of Colorado, Anschutz Medical Campus. In this work, my colleagues and I strive to improve access to oral health for people living in rural areas, inners cities and reservation communities.
At this conference, I will be presenting our models of dental service delivery for Indigenous populations. The conference overall will be exploring the challenges we and other researchers have experienced in conducting oral health research among Indigenous groups. It will also look at the number of issues that are related to taking the results of this research and translating it into effective public policy and what some of the successes have been.
Oral Health Disparities among the American Indian Population
To be blunt, oral disease is rampant for American Indians on reservations, and access to dental care is beyond deficient. For example, 90 percent of the residents of the Pine Ridge Indian Reservation showed signs of active decay, a rate three times that typically found in the United States.
- Results from Indian Health Service Oral Health Surveys show early childhood caries continues to increase.
- Children (ages 2-5) are 3+ times more likely to have untreated decay (68% vs 19%)
- Adults have significantly more periodontal disease
- Nearly 25% of adults over 65 are completely edentulous.(Without teeth)
A very large percentage of the residents I have evaluated at the reservation suffer daily from wrenching dental pain and yet they face huge barriers to getting routine care. A severe shortage of dentists willing to practice in isolated areas has left many Americans, including American Indians, with ongoing dental problems that threaten their overall health.
I was at the Pine Ridge Reservation this week, where I am involved in both research and treatment of the residents. There are 30,000 people living in an area roughly the size of Connecticut and there are only ten dentists there to serve the whole area. So, most residents wait for many months just to get an appointment and, sadly, quite of few of the children in the study had never seen a dentist before.
Is there a solution?
There is a very good way to increase the dental workforce in these areas and that is allowing dental therapists to pick up the slack. Dental therapists provide basic preventive and restorative treatments that would go a long way to address the need.
Minnesota became the first state to establish licensing of dental therapists with the main purpose being to provide dental health services to underserved populations. Alaska followed and they have been able to reach 35,000 people who didn’t have access to care before. As of April 2014, the state Senate of Maine approved the use of dental therapists. Vermont, New Mexico, Kansas and Washington are other states considering dental therapists. There is a recent article in USA Today explaining this expansion and the very unfortunate reality that the American Dental Association is strongly fighting the efforts.
Dental therapists have been a part of the dental health scene in many other countries as well. An extensive review of how well this is working was conducted by the Kellogg Foundation. The report reviewed dental therapists in 54 countries, including the United States, Canada, New Zealand, Australia and the Netherlands.The report found that the public perspective of dental therapists was positive, there was no evidence of compromises to children’s safety or quality of care and that “the profession of dentistry should support adding dental therapists to the oral health care team.”
As I said, this is an area I am passionate about and needs a lot of public education, so I am pleased to be a part of this upcoming conference. It won’t be bad to have a nice trip to Australia as well!