After 10 years, Alaska dental health aides are a big reason to smile

In 2004, four students, including three Alaska Native people, returned to Alaska from New Zealand, where they completed a two-year education program to become the first Dental Health Aide Therapists (DHATs) to practice in the United States. They were ready to change the world -- which to them meant bringing improved dental care to people in Alaska's remote Tribal villages.

They were leaders of a national movement to make everyday dental care more accessible to rural Alaskans. Following Alaska's lead, Minnesota and Maine have passed laws authorizing similar mid-level dental care providers. Fifteen other states are exploring mid-levels providers as options to care, and 90 Tribes have passed eight resolutions in support of the mid-level dental approach.

It all started here, with the Alaska Native Tribal Health Consortium (ANTHC), many partners and advocates in the state and across the nation, and Alaska Native people coming together to develop a community-led solution to a crisis that affects all of our villages and cities.

On June 6, ANTHC celebrates 10 years of DHATs in Alaska and the graduation of another class of DHAT students.

For decades, oral disease has run rampant among our Alaska Native people. We have suffered some of the highest rates of oral disease in the world. Rates of tooth decay among our children were twice the national average.

The Alaska Tribal Health System tried many solutions, including hiring itinerant dentists and training community health workers to provide preventive dental services to children and families. None worked. Temporary dentists did not stay and there was little demand for preventive services. Our people needed treatment for active cavities and infections. Prevention could be addressed acute needs were met.

ANTHC learned about the successful New Zealand program, which began educating and deploying mid-level dental practitioners in the 1920s to provide preventive and routine care in underserved communities. We established a similar initiative, building on the principles of our successful Community Health Aide Program. We sent our first class of students to New Zealand in 2003. Today, nearly 80 percent of DHATs return to their home communities to practice.

DHATs are part of a team led and supervised by a dentist, similar to nurse practitioners and physician assistants working as part of a medical team to expand access to care. They provide preventive care and routine services like fillings and uncomplicated extractions, freeing dentists to treat patients with more complex needs. DHATs work in schools and Head Start programs, teaching children how to take care of their teeth. They visit clinics in remote communities, providing commonly needed oral health services.

Much has changed in 10 years. Our students no longer travel to New Zealand for education. Instead, they study at DHAT Educational Program locations in Anchorage and Bethel.

More important is the change that we see in the mouths of children and adults living in 81 Tribal communities served by DHATs. More than 40,000 rural Alaskans now have regular access to dental care from a DHAT - access and continuity of care that few had before. For the first time, we have "cavity-free" clubs in our elementary schools. This is not just change - it is a dramatic transformation from the days when teenagers graduated from high school with full sets of dentures.

Alaska's DHAT program succeeded beyond expectations, but we must continue to invest in it. DHATs are critical resources, and although they have done so much, we need more of them. Currently, 27 DHATs are practicing across Alaska; soon we will have five new graduates returning to rural Alaska. However, not all of our Tribal villages are served by DHATs. We still have thousands of people in many villages who lack access to regular dental care.

Investing in a DHAT is an investment in the community and in the health of our Alaska Native people. We are proud of our DHATs, from our pioneering first class to our new graduates. Next time you see an Alaska Native child with a beautiful smile, think about the community DHATs working with our families across Alaska.

Andy Teuber is chairman and president of the Alaska Native Tribal Health Consortium.