Study Finds Oral Health Outcomes for Alaska Native Communities Served by Dental Therapists Better Than for Those Without

Published August 12, 2017

Where dental therapists practiced, Alaska Native children and families had fewer instances of invasive procedures and more preventive care visits

BETHEL, ALASKA – Children had lower rates of tooth extractions and more preventive care in Alaska Native communities served frequently by Dental Health Aide Therapists (DHATs) than residents in communities not receiving any DHAT services, according to a new study released by the University of Washington.

The study, led by Donald Chi, D.D.S., Ph.D., at the University of Washington and funded by The Pew Charitable Trusts, Rasmuson Foundation and the W.K. Kellogg Foundation, presents an analysis of patients in the Yukon-Kuskokwim Health Corporation (YKHC) from 2006 to 2015. YKHC serves 25,000 Alaska Natives representing 58 federally recognized tribes.

Using patient records and Medicaid claims data, researchers counted the total number of dental therapist treatment days provided in each community. They then compared communities with no dental therapist treatment days to those with the highest number of treatment days and found the following: for children, high exposure to dental therapists was associated with fewer extractions, less use of general anesthesia and more preventive visits.

Adults in these communities with the highest DHAT visit days had fewer extractions and more preventive care visits.

While U.S. studies of dental therapists to date have examined care quality and patient access, this is the first known study to look at long-term outcomes of communities served by dental therapists.

“It’s been more than a decade since tribal communities approached the foundation with their plans for how to improve oral health care for their children,” said La June Montgomery Tabron, president and CEO of the W.K. Kellogg Foundation. “Today, we know these proven, tangible and dramatic shifts in improved access and care for children of color is a game changer as we seek to advance racial equity and tackle health disparities for children of color.”

In the United States, dental therapists were first employed in Alaska in 2005 to serve Alaska Native communities. Dental therapists are highly trained, mid-level providers. They work under the supervision of a dentist and offer routine restorative and preventive services, like dental exams, providing fillings, cleaning teeth, placing sealants, and performing simple tooth extractions. They are a cost-effective way to increase access to critically needed dental care in communities and tribal nations while broadening career pathways to support a robust economy.

“For more than a year, the dental therapist at our Swinomish Dental Clinic has been successfully working as a member of our oral health team,” said Brian Cladoosby, Chairman of the Swinomish Indian Tribal Community. “Just like the mid-level providers in our medical clinic, expanding the dental team with dental health aide therapists and more efficiently utilizing all members of the dental team has shown strong results in Alaska and here at Swinomish.”

Indian Country is leading the way for improving oral health through dental therapists. Following the lead of Alaska’s YKHC, the Swinomish Tribe in Washington hired a dental therapist in 2015. In Oregon, the Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians just welcomed their first Alaska-trained dental therapist in July 2017.

Elsewhere in Indian Country, a 2017 National Indian Health Board oral health survey found that 85 percent of respondents familiar with dental therapy said that they would like their tribal leaders to explore implementing a dental therapy program to address the oral health crisis.

Dental therapists have also been authorized in Minnesota, Maine and Vermont, and they are being considered in Arizona, Kansas, Maryland, Massachusetts, Michigan, New Mexico, North Dakota and Ohio.

“Alaska has proudly put the DHAT program on the national map. It is a model of health care that makes an immediate difference in the lives of people who would otherwise have limited to no access to dental care,” said Diane Kaplan, president and CEO of the Rasmuson Foundation. “This study showcases what we have seen for years, dental health aide therapists are improving the health outcomes of rural Alaskans.”

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