Kids growing up without cavities: Examining the practice of dental therapy on Tribal lands
On August 25, the Washington State Dental Therapy Task Force gathered to examine the current practice of dental therapy on Tribal lands. Task force members heard from a range of speakers including researchers, practitioners, and Tribal members.
Brian Cladoosby, former Chairman of the Swinomish Tribe, explained the fight to bring dental therapists to his community. Inspired by the success of the Alaskan dental therapy program, he was determined to bring the practice to members of the Swinomish Indian Tribal Community, many of whom lacked vital access to oral health care providers. But there were many barriers preventing dental therapists from serving the sovereign nation: Even though dental therapists had been practicing in the U.S. since 2005, Tribes in individual states were required to work with their state legislators to authorize the practice on Tribal lands. After working to pass legislation statewide, and then specifically on tribal lands, Tribes in Washington were successful in securing passage of SB 5079 in 2017. There are now dental therapists practicing in five Tribal communities, most of whom were recruited from and are members of their Tribe.
Dr. Rachael Hogan, Dental Director of the Swinomish Dental Clinic, has seen firsthand the positive impact that dental therapists can make. Since adding two dental therapists to the team, she has seen both decreased wait time for appointments and increased access to care. As dental therapists are taking on many routine and preventative procedures, Dr. Hogan and Dr. Dailey, the clinic’s other dentist, can spend more time on more complex procedures and have even started an implant program. Finally, she noted that the clinic has been able to increase community outreach by 100%, which probably accounts for the amazing feedback they receive from patients, many of whom are excited to have members of their own community providing care.
“Not only have I gotten so much love and support back from the community, the patients love receiving treatment from one of their own members... I have also noticed how many of our youth now have aspiring dental jobs as their big sister, cousin or aunty is doing. And that of course gives me fuel to make me want to be the best I can not only in being myself but also as my role in being a provider.”
- Angela M. Johnson, Dental therapist
In her position as Native Dental Therapy Initiative Director at Northwest Portland Area Indian Health Board, Dr. Miranda Davis has worked with several dental clinics across Washington to integrate dental therapists into their practices. She echoed Dr. Hogan’s sentiments about the positive impacts dental therapists make for their colleagues and the patients they serve. Dr. Davis also explained the training and supervision that dental therapists go through in order to provide high quality care. All of the dental therapists in Washington received education at the Alaska Dental Therapy Education Program—the only dental therapy education program in the U.S. accredited by the Commission on Dental Education—as well as 400 hours of direct supervision in their home clinics to receive a license. Furthermore, every two years they are required to undergo 80 additional hours of direct supervision for license renewal. Several Tribes in Washington have built dental licensing boards to not only license their dental therapists, but other dental providers working for the Tribe.
The positive effects that Dr. Hogan and Dr. Davis have observed in Washington state mirror peer-reviewed published research on dental therapy in Alaska’s Yukon Kuskokwim Delta. Dr. Donald Chi, a board-certified pediatric dentist and Professor of Oral Health Sciences at the University of Washington, presented findings from a 2017 study showing that communities with increased dental therapy treatment days saw improved health outcomes for patients, particularly children. In the communities in which dental therapists were practicing, more adults and children received preventive care, fewer children under age 3 had extractions of the front four teeth, and fewer children suffered from cavities.
The scientific research and firsthand experiences presented to the Task Force prove that dental therapy is already having a remarkably positive effect in Tribal communities. It’s time our legislators let these dedicated and qualified providers make an impact in communities across the state. If you’d like to share your thoughts about dental therapy, or your oral health experience with the Task Force, please do so here: bit.ly/WhatsYourDentalStory
For more information on Dental Therapy on tribal lands please visit: https://www.tchpp.org/about-dental-therapy