Alaska’s Efforts on Rural Dental Care Paying Off

ICTMN Staff
12/27/10

ANCHORAGE, Alaska (AP) – ?Alaska’s efforts to deliver prompt, affordable dental care to its rural residents is gaining ground here, and providing a model for other states.

The Dental Health Aide Therapy program, started in 2006 in Alaska, is the first of its kind in the United States. An independent evaluation of the program, conducted over two years and released in November, confirmed that dental therapists at work in five Alaska communities are providing safe, competent, appropriate dental care to children and adults.

Nearly 50 million Americans lack affordable dental care. Nationwide, states are seeking ways to improve access to dental care and exploring alternatives such as dental therapists. Based on the Alaska study, the W.K. Kellogg Foundation, which funded Alaska’s program, announced a $16 million initiative in November to fund similar programs in Kansas, New Mexico, Ohio, Vermont and Washington.

“It’s so exciting to see this positive feedback,” said Fiona Brosnan, public relations manager for the Alaska Native Tribal Health Consortium, which runs the Alaska program. “People are looking at our program and seeing that it’s working. We’re leading the country.”

The recent study conducted by RTI International of Research Triangle Park in North Carolina was funded by the W.K. Kellogg Foundation, and Alaska’s Rasmuson Foundation and Bethel Community Services Foundation.

It evaluated the work of dental therapists in five unnamed Alaska communities, and polled hundreds of patients who received procedures on how dental therapists performed.

Therapists were directly observed placing sealants on children’s teeth to prevent cavities, preparing composite and amalgam fillings, placing stainless steel crowns, and giving oral health instruction to patients. Examination standards used to assess clinical competency for board certification of U.S. dental school graduates were used to assess their work.

Key findings of the evaluation indicated:

  • Dental therapists are technically competent to perform the procedures within their scope of work and are doing so safely and appropriately.
  • They are consistently working under the general supervision of dentists.
  • They are successfully treating cavities and helping to relieve pain for people who often had to wait months or travel hours to seek treatment.
  • Patients were very satisfied with the care they received.
  • Dental therapists were well-accepted in tribal villages.

“The information provided in this evaluation confirms that dental therapists are working well under general supervision of the dentists,” said Mary Williard, clinical director of Alaska’s training program.

An estimated 85,000 Alaska Natives live in remote villages accessible only by air or water. In most of these tiny villages, a dentist is available only one week a year. Frequently, only the most urgent cases are seen.

The RTI evaluation surveyed 405 Alaska Natives, and found that more than half of all children have untreated dental decay, as do 60 percent of adolescents and 77 percent of adults.

About 25 percent of the dentist positions in tribal health organizations statewide are unfilled, and the dental therapist program is helping to fill that gap.

There are currently 14 practicing dental therapists in Alaska serving 25,000 potential patients in communities from Unalakleet to the Aleutian chain and the Panhandle. That number is poised to double.

Five therapists are currently completing preceptorships (three months or 400 hours of practical experience and training) under the supervision of a professional dentist. Seven new students graduated Dec. 10 from the two-year intensive training program and are ready to begin their preceptorships.
That’s about half the number needed, Brosnan said.

“The optimal number of therapists would be 50 to 60 practicing around rural Alaska. We are evaluating the program right now to figure out where to go in the future.”

Since the 1960s, dental care for rural Alaska Natives has been provided primarily by itinerant dentists employed by (or under contract to) the IHS or tribal organizations.

In 2003, ANTHC, in collaboration with tribal health organizations statewide, began the Alaska Dental Health Aide Initiative. Its goals are to reduce the number of Alaskans in pain from untreated dental disease and educate on the long-term benefits of preventive oral health care, like brushing and flossing.
Alaska’s program was modeled after one in New Zealand that started in 1921 and has been adopted by many countries worldwide. Alaska’s first 10 dental therapists were trained in New Zealand.

In 2006, the Kellogg Foundation helped fund the DENTEX Training Center in Anchorage, which partners with the University of Washington School of Medicine’s Physician Assistant Training Program in Seattle.

Students spend the first year of the two-year certification program in Anchorage, and their second year at the Yuut Training Facility in Bethel. They complete their preceptorships under the guidance of a regional dental chief from an Alaska Native tribal health organization.

“That dentist decides when the student is ready to be certified and go out to the village on their own,” Brosnan said. “Once they’re out there, they still work under the supervision of a dentist.”

The goal is to bring eight to 10 students a year into the training program, Brosnan said.

Candidates must be high school graduates, but they do not need to be Alaska Native. They must be sponsored by an Alaska Native regional health organization when they apply, however, Brosnan said.
The sponsoring regional health organization pays for their two years of education, and the dental therapist commits to a minimum four years of service to pay their loan back upon completion of the program.
“So the students themselves don’t pay the tuition, but it is part of the loan agreement when they’re accepted into the program,” Brosnan said.

Organizations that employ certified dental therapists are Yukon Kuskokwim Health Corporation, Southeast Alaska Regional Health Corp., Maniilaaq Assoc. (Kotzebue), Norton Sound Health Corporation and Bristol Bay Area Health Corp.

Once dental therapists are certified, they become employees of the regional corporation and work in a variety of settings including subregional clinics and remote villages in the area.

The five students now completing their preceptorships are employed by the Aleutian Pribilof Islands Association, Tanana Chiefs Conference in the Interior, Bristol Bay Area Health Corp., and Yukon Kuskokwim Health Corporation.

Dental therapists treat patients who are eligible through IHS, but some regional health corporations have contracts that allow them to see non-Alaska Native patients who need care, Brosnan said.

“It varies by community.”

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