A Law Backing Tribal Sovereignty Is Answer to Expanding Oral Health

Mark Trahant

The challenge in health care can be boiled down to two ideas: Improve the quality and cut the costs.

It’s a fact that the U.S. spends too much, both private and government money, on health care, nearly 18 percent of all goods and services. The good news is that cost has been slowing, partly because of the economy, and most partly because the Affordable Care Act.

But this is just a first step. We have a long way to go. The reason is the country’s demographics: We have smaller population of young people, a huge baby boom generation, and people are living longer. Add this all up and the numbers are not sustainable by any metric. So math, not politics, ought to determine the route forward and that means looking for innovation to make health care less expensive. So when something comes along that does just that, you would think that it would be worth a celebration. But that’s not how change works.

As I have written before, the Alaska Native Tribal Health Consortium’s Dental Health Therapist Program is such a model. The Alaska program trains young people to practice mid-level dentistry, something that’s common around the world. This program expands access, improves quality, health, and is less expensive. It’s backed up by rigorous studies, that show mid-level providers offer “safe, competent and affordable care.”

Mark Trahant

So where is the celebration? Well, that will have to wait until the fight is over.

Washington state is considering legislation that would expand mid-level providers and the Washington State Dental Association is opposed saying that “midlevel providers will not make dental care more affordable, how dental residencies are a superior alternative, and how dentists in private practice are reimbursed 25 cents on the dollar for adult Medicaid patients.”

There is an interesting history here. The dental association in Alaska, and nationally, had long opposed the creation of the mid-level providers or Dental Health Therapists, and even sued to try and stop the program. Only now dental associations sort of praise the program, saying that it might be “appropriate” because of Alaska’s remote locations. The dental trade groups just don’t want that program to expand again.

One of the reasons why the Washington legislature is considering changing the law is that some tribes in the state are keen on a mid-level provider as one way to make it easier for tribal members to get better dental care.


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denturist2th's picture
Submitted by denturist2th on
The dental workforce issues are more relevant than ever. Specifically, the need for change in ADAs existing ill-fated & outdated polices currently in place on workforce issues regarding denturists. We need denturists; providing removable oral prostheses care and referral services, freeing up dental chairtime for children, emergencies, and restorative care. The needed action of progressive and innovative dental workforce models includes denturists, dental therapists, dental health aide therapists, and independent practices and boards for dental hygienists for better public health service. As the debate continues over the indispensability of dental therapists I’m reminded of the rhetoric similarities by ADA and its opposition to the use of denturists back in the late 70’s and early 80’s. Unlike ADA’s claim regarding the lack of working models showing the success of dental therapists or dental health aide therapists, there are several evidence based working models associated with six U.S. states along with all Canadian Providences showing the success of the denturist profession and its ability to work, leaving no logical reason why denturists shouldn't be providing denture and referral services for Americans across our nation. The dental therapist concept has been a military concept and working model in branches of the U.S. military, providing oral health services to large numbers of recruits and military personnel (patients), especially when there were fewer dentists. Open the flood gates of oral healthcare providers for all Americans across our nation, through more affordable and alternative delivery methods and models. Denturists are trained, educated, and ready to serve. Gary W. Vollan L.D. State Coordinator, Wyoming State Denturist Association, www.wysda.org https://twitter.com/denturist2th