Millions of people throughout Arizona face significant challenges when it comes to accessing dental care and treatment of dental disease. Nowhere in Arizona is need more acute than on the American Indian reservations. There is a proven model using mid-level dental providers that can increase access to affordable, quality oral health care. However, the opposition from organized dentistry is fierce.
Arizona is home to 22 individual sovereign tribal nations with 394,196 tribal members living on and off reservations. Our tribal nations have grappled for decades with a shortage of dentists willing to work for the Indian Health Service (IHS) and tribal facilities. Despite research showing that dental health is an integral part of an individual’s overall long-term health, Arizona’s current dental care delivery model fails to address chronic oral health provider shortages, geographic isolation and the long-distance travel to access specialty care. In some areas, basic oral health-care services are not available locally. Because of this, 76 percent of American Indian children in Arizona have experienced tooth decay by age 5. This is an urgent need that can be eased with the help of dental therapists.
Dental therapists are mid-level dental providers who have been delivering innovative and locally accessible dental care under the supervision of dentists around the world since the 1920s. These providers are well-trained in routine procedures such as oral exams, filling cavities, stainless-steel crowns on primary teeth and, in limited cases, extractions. This gives dentists the ability to concentrate on the most complex needs of their patients. Dental therapists are also able to work outside the dental office, in rural and remote areas, bringing care directly to the people who need it.
The Alaska Native Tribal Health Consortium (ANTHC) first introduced dental therapists to the U.S. in 2004. Since then, dental therapists have expanded care to 40,000 Alaska Natives in 81 previously underserved communities. But the consortium’s success didn’t come easily — they first had to fend off a lawsuit from the American Dental Association and the Alaska Dental Association. Tribes in Oregon and Washington have also stopped allowing organized dentistry to dictate their dental systems, and are taking steps to implement this native solution to increase access to dental care for their own members.
Nationally, the Indian Health Care Improvement Act (IHCIA) establishes the IHS Community Health Aide Program (CHAP) in the lower 48 states. To the detriment of tribes, in 2010, the American Dental Association lobbied for, and won, an amendment restricting tribes’ use of dental therapists and now requires that each state first authorize the use of any mid-level dental health provider service. Therefore, for these services to be provided in tribal communities in our state, Arizona statues must be amended.
Tribes in Arizona deserve the right to utilize dental therapy amid other solutions and preventive measures to address persisting oral health challenges. Unfortunately, organized dentistry’s position remains one that will continue to restrict access to care and disregard the urgent needs of all Arizonans. At a recent hearing on this issue with Arizona legislators, the Arizona Dental Association absurdly claimed that our state does not have an access issue. So long as this misinformation continues, our people we will continue to face limited access and high-cost dental care. In fact, it is the Dental Association’s continued apathy toward the pain and suffering of our people that I find most hurtful and offensive.
The Inter Tribal Association of Arizona (ITAA) believes dental therapy is an effective model to address dental care needs for people of all ages. We will continue to work with the Office of the Governor, the Arizona state Legislature, the Arizona American Indian Oral Health Initiative, the Arizona Advisory Council on Indian Health Care and other important stakeholders to pursue legislation to address oral health care improvements, not just for our people, but for all of Arizona.
The Hon. Chester Antone is a council member for the Tohono O’odham Nation and vice chairman for the Arizona American Indian Oral Health Initiative. He wrote this guest opinion as a representative of the Inter Tribal Association of Arizona.