We Need More Native American Representation in Oral Health Care

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By Rudy Oxendine

May 12, 2023

Considering my personal and professional background, finishing a residency and embarking on a new career as a pediatric dentist in my 40s, at times, feels surreal. I spent the first 14 years of my professional life moving up the ranks as a police officer in Greenville before taking a huge chance on a new path. Completely shifting the lives of my family to pursue a career in dentistry has had its challenges, and yet, been well worth the alteration.    

As I’ve journeyed into and through the profession, one aspect certainly stands out. There is a small network of Native American providers to turn to for support and guidance. There are vast communities of dentists throughout the country that are phenomenal resources. However, having a dentist that shares similar cultures, history, and traditions is a connection that is needed, meaningful, and empowering.    

A recent white paper from the CareQuest Institute for Oral Health, the Society of American Indian Dentists (SAID), and the National Indian Health Board’s (NIHB) Tribal Oral Health Initiative helps explain why. “American Indian and Alaska Native Communities Face a ‘Disproportionate Burden of Oral Disease’: Reversing Inequities Involves Challenges and Opportunities” spotlights that the number of American Indian and Alaska Native (AI/AN) students applying to dental school has decreased dramatically over the past decade, with a record high of 92 in 2006 to record lows within the past 20 years of 16 AI/AN applicants in 2019 and 19 in 2021.  

Understanding the depth of the impact that underrepresentation has on the community is the beginning of major health changes within the Native population. Closing these cultural gaps between the provider and the patient is a small change that may be the key to lasting results. 

A Disproportionate Burden of Oral Disease  

Enrolling in the East Carolina University School of Dental Medicine started as a dream over 13 years ago while working as a police officer and putting myself through college. Still, it was challenging to see myself as a dentist. As a Native American and proud member of the Lumbee Tribe, I knew there were not many people from my background in oral health care.  

It reflects the deep disparities in health care among native populations. AI/AN adults are already twice as likely to have untreated decay compared to the overall US population, while the prevalence of early childhood caries (tooth decay) in AI/AN communities is three times higher than for Caucasian children. Oral health impacts overall health. Adolescents with tooth decay are more likely to miss school and suffer academically. For adults, poor oral health is linked to chronic diseases such as diabetes, heart disease, stroke, and more.  

We — future providers, current providers, policymakers, and educators — have much work to do to turn this around.  

Opening Doors for the Next Generation  

I believe education is as important as access to care, and school-based programs are a great opportunity for providers to educate children. Where I grew up, we did not understand, nor were we taught, basic oral hygiene as kids. For example, we knew we needed to brush our teeth at night, but we didn’t understand that you shouldn’t eat after brushing and before bed. Programs that meet parents and kids where they are can make a difference. 

The report mentioned above also outlines several steps different stakeholders can take to effectively address these disparities, from developing partnerships with AI/AN communities to better understand their needs, to increasing representation of AI/AN individuals and developing pipeline programs for them to enter the dental workforce. 

For me, joining SAID as a student member was an eye-opening experience. For the first time, I was able to see people with similar backgrounds and stories. This engagement has given me something to aspire to in a way I had never experienced before. It reinforced that I do have a path in dentistry.   

Now, as I embark on this new career, I look forward to being that example for the next generation of Native Americans. I look forward to giving back to my community and helping to bolster that network and that support system for future providers.  

To do that, we must be more purposeful in building the programs needed for native communities not only to access oral care but to see that as a viable career path. Some promising work is underway here in North Carolina. For example, Robeson County has started a mobile dentistry program that brings oral health care into underserved communities. We should be doing more outside-the-box outreach programs here in North Carolina and across all underserved communities. We also need to increase and improve school-based programs — which could go beyond oral hygiene tips to include a presence at career days and information about the opportunities for a career in dentistry.  

I’ll always remember being that 12-year-old child visiting a dentist for the first time. At that time, it never would have occurred to me that I could have a future in this industry. I want to make sure that experience is different for the next generation. If representation keeps going in the right direction, improved health outcomes will surely follow. 

Rudy Oxendine is currently completing his final year of pediatric residency at East Carolina University School of Dental Medicine. He is a member of the Lumbee Tribe and a resident of Greenville, North Carolina.