Lawsuit Puts Alaska Native Dental Care at Risk

The American Dental Association (ADA) and Alaska Dental Society (ADS) have filed a lawsuit against the Alaska Native Tribal Health Consortium (ANTHC) to prohibit dental therapists from providing dental services in rural villages, claiming that the therapists are unqualified to perform such "irreversible" procedures as drilling and tooth extraction.

"We cannot and will not stand by while non-dentists perform irreversible dental surgery on Alaska Natives and others, procedures that other Americans receive only from fully trained, licensed dentists who operate under the safety and accountability standards set by state dental boards," the ADA said in a press release.

The ADA says that it will drop the lawsuit if the dental therapists immediately cease to perform irreversible dental surgery.

Alaska Native leaders defend their use of dental therapists, however. Among Alaska Native children in particular, tooth decay and other serious dental problems occur at more than twice the national rate because of a lack of dental education and accessible dental care in remote, native communities.

According to a July 2005 report by the Alaska Native Health Board, "For the 85,000 Alaska Natives who live in the 200 villages without road access, the only time dental services are available is when a dentist flies in to conduct a dental clinic." This means that if Natives did not have access to dental therapists, they would probably go without any care, according to the Anchorage Daily News.

Andrea Gusty, a reporter for KVTA-Anchorage, and herself an Alaska Native, stressed in a recent phone interview that lack of education is just as serious a problem. She has often witnessed Natives filling up their baby’s bottles with juice and coke, instead of milk.

"They [Alaska Natives] are not taught from an early age how to take care of themselves," Gusty said.

Gusty said that in the past, rural public schools used to bring in health care professionals to educate students about basic wellness and hygiene issues, as these students did not have regular access to dentists or hospitals.

Due to recent funding shortages, however, this type of education in self-care is no longer available. As a result, dental problems such as minor cavities are not given attention and often worsen.

While dental therapists receive fewer hours of training than the average American dental student, they are specifically trained on select procedures, such as drilling and extraction.

According to the Yukon-Kuskokwim Health Corporation (YKHC) in Bethel, Alaska, dental therapists receive two years of training in a foreign dental school, with about 760 hours of their education occurring in a clinic environment.

Upon graduation, they spend between four months to one year training under the supervision of dentists before they receive their certification to work. While practicing in the bush, all of the dental therapists regularly report to dentists in main cities to ensure that the procedures are performed safely and correctly.

Gusty has found that many in the Native community believe the impetus for the lawsuit is not the ADA’s safety concern, but rather the ADA’s concern that dental therapists may detract from their business.

"They [dental therapists] help so many people in rural areas, and the public doesn’t see how small these villages are and how desperately they’re needed," Gusty said.

Paul Sherry and Valerie Davidson of the ANTHC have a slightly different perspective on the pending lawsuit. In a recent phone interview, they concurred that the ADA’s concern is about safety, but they believe that Alaska’s dental therapists are indeed taking the necessary precautionary measures when performing dental procedures.

Although Alaska is the only US state to allow the practice of dental therapy, such therapists provide dental care in 42 countries around the world. Sherry says that there is no evidence that the pre-existing care of the dental therapists practicing in countries such as Canada, Australia, and New Zealand is unsafe.

Sherry and Davidson also point to a 2005 assessment that revealed dental therapists were giving the highest standards of care to their patients.

The ANTHC remains confident about the lawsuit. Says Sherry: "We are federally authorized to be doing this and we believe the quality issue will be decided in our favor. We have no reason to believe that in the end we won’t prevail."

Within the next 10–15 years, the ANTHC hopes to see the number of dental therapists in the state increase from eight to 50.

The ADA envisions a different future, however. The ADA and ADS have jointly proposed an alternative plan to improve Alaska Natives’ oral health, which includes placing a dental health aid in every village to provide educational and preventive services, creating local training programs for dental auxiliaries so that Alaska Natives need not leave the state for training, and securing full funding to enable the Indian Health Service to fill its vacant dental positions.

Whether this alternative will be realized remains to be seen. Gusty, for one, finds the proposal more optimistic than realistic. "It’s a good idea, but we hear good ideas every day," Gusty said.

"To make it work they’d have to follow through with this, and that’s easier said than done. To really improve the dental care for Natives, they [the ADA and ANTHC] need to work together."