A proven, Native-pioneered solution to improving dental access

Dr. Donald Warne


November is Native American Heritage Month, a time to celebrate the accomplishments of indigenous peoples in North Dakota and across the country. While there are numerous accomplishments to highlight, I want to focus on one that addresses a problem that significantly impacts many people across our state, including non-Natives: lack of access to dental care.

Across our state, seniors, children, rural residents, American Indians, and those who work in jobs that don’t provide dental coverage are particularly impacted by this lack of access. Nearly half of North Dakota counties have zero dentists or just one. Even in larger counties with more dentists, many parents of children insured by Medicaid are not able to find one who takes Medicaid. In fact, North Dakota is third worst in the nation at providing dental care to Medicaid-enrolled kids, with two-thirds not seeing a dentist in 2015.

It also can take up to six months to see a dentist for those living on reservations. And one in three seniors experience dental problems, the highest of any age group. It’s clear that the residents of North Dakota have difficulty getting needed dental care, but there is a solution.

Dental therapists, similar to physician assistants, allow dentists to expand their care to more patients. While they had been successful around the world for decades, it was tribes in Alaska that brought these dental providers to our country in 2004. The Alaska Native Tribal Health Consortium reports that dental therapists have expanded care to 40,000 Alaska Natives who previously were not able to get regular care.

The Alaska experience represents just the beginning for this proven and innovative solution. Since tribes there moved forward more than a decade ago, other states have followed their lead and adopted dental therapy to allow their dentists to extend their care to more people who need it. This includes Minnesota, where a law passed in 2009 and dental therapists have been practicing since 2011. Maine and Vermont have now followed suit, and tribes in Oregon and Washington have now hired dental therapists.

To provide more background, dental therapists are trained and skilled in routine care like filling cavities, placing temporary crowns, and extracting some very loose and badly diseased baby teeth. This frees up the dentist to do more complex procedures and allows their entire team to treat more patients.

While dental therapists are working successfully in traditional dental offices, they also work outside the office just like some hygienists do here in North Dakota. This could allow dentists to extend their office hours or set up a satellite office in a rural county that doesn’t have any dentists. It could also allow dentists or nonprofit programs to bring care to schools or places where people have difficulty moving, like nursing homes. In short, it allows for bringing care directly to the people who need it.

And it is working. A first-of-its-kind study from the University of Washington used 10 years of patient records to analyze how this has worked for tribes in Alaska. The study found that in just one decade, children and adults in communities with high access to a dental therapist experienced a significant increase in preventive dental care services and far fewer children needed traumatic tooth extractions.

Tribes and all the many others in North Dakota that suffer from lack of access to dental care deserve better. That is why the United Tribes of ND, AARP, free market groups, and many others representing the disabled, medical providers, rural residents, and others all support allowing dental therapists to work in North Dakota. In honor of Native American Heritage Month, I hope we will all join together to support a proven, Native-pioneered solution that will improve lives across our state.

Warne is chairman

of the NDSU Department

of Public Health