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6/9/15 - Innovative program brings dental care to underserved Alaskans

“Alaska is, frankly, the best model that should be exported to other parts of the country."

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 that 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.

The head of the Dental Health Aide Therapist (DHAT) training program, Dr. Mary Williard, accepted the Indian Health Service Director’s award May 29 on behalf of the team she said 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,” said Williard.

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 sealants. Williard said they also focus on patient education, describing the experience of a dental therapist working in Northwest Alaska.

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

“Alaska is, frankly, the best model that should be exported to other parts of the country,” said Al Yee, a senior project adviser for Community Catalyst, a national consumer health advocacy organization.

Yee said 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 said organizations in some 15 other states are working to launch pilot projects as a first step toward authorization of dental therapists. Yee said one of the selling points is better dental care for more people.

“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,” said Yee. “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.”

Yee said dental therapists are also cost effective. And, he said, because they live in the communities they serve, they provide culturally appropriate care in villages.

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

However, supporters said the therapists work within a narrow scope, and several studies have shown they provide quality care equal to or exceeding that of dentists. The ADA has fought the authorization of dental therapists in several other states.