When Valerie Davidson was a kid in Aniak, she would wait in line once a year to see the dentist. Being last in line was the worst because that meant she had to listen to the other children's screams. It also meant the dentist would be splattered with blood by the time he got to her.
When the dentist only shows up once a year, everybody's teeth are in really bad shape and most of what the dentist does involves blood.
Davidson and other Natives told their stories of rural dentistry woes Friday at a ceremony celebrating Alaska's dental health aide therapist program. The program is the first of its kind in the United States and is meant to address chronic dental problems in the Bush.
Four students who have completed the first year of the program will return to their villages after a second year, trained and certified to do more than a dental hygienist but not as much as the dentists who are so rarely available in remote communities.
The creation of dental therapists stirred up national controversy when it was first proposed several years ago. The Alaska Dental Society and the American Dental Association sued the state and the Alaska Native Tribal Health Consortium last year, saying the aides would not be qualified to drill and pull teeth. In July, after a year of bitter litigation and a state Superior Court judge's ruling in favor of the program, the dental associations settled the suit.
There are currently 10 practicing dental health aides in Alaska villages. The first of them began their jobs three years ago, said Dr. Ron Nagel, dental consultant for the consortium and a leader behind the program. All were trained in New Zealand because no American dental school would admit them until this year, when the University of Washington agreed to sponsor a program to be taught in Alaska.
Dental health aides are not new. "It just hadn't happened in the U.S.," Nagel said.
Fifty-two countries had dental health aide programs before the U.S., Nagel said.
About 100,000 people live in rural Alaska. Most villages see visiting dentists only once or twice a year. And the tooth decay rate for Alaska Natives is more than double the national average, according to state figures.
The effects of bad oral health go beyond losing teeth, said Dr. Mary Williard, clinical site director at the consortium and a dentist who saw first hand the problems in the Bush during nine years spent working in Bethel and outlying villages.
"There are people who don't even smile out there because they are embarrassed," she said Friday.
Tooth loss and decay affect a person's self-esteem. They lead to other health problems. Toothaches prevent children from going to school. Rotten teeth or no teeth can affect a person's ability to get a job if they move to Anchorage, she said.
There just aren't enough dentists willing to serve the Bush, Williard said. She would work 13-hour days for a week straight in a village but still she'd have to turn people away because she didn't have time to see them.
"I had to say no to people who really needed it," she said.
But more importantly, parachuting into a village once or twice a year doesn't address the real need, which is education and preventive dentistry, she said.
For Danielle Boston, one of the four aides currently in training, her motivator was the "baby bottle decay" she saw in her village, Chistochina. The village has about 100 people and is on the road system 40 miles from Glennallen. The 25-year-old said it would take villagers months to get a dentist appointment in Glennallen or Anchorage. People often didn't bother seeing a dentist until it was too late, she said.
That the training is now offered in Alaska was a deciding factor for her, she said. The consortium said it expects more applicants now that aides do not have to move to New Zealand for two years.
The dental therapists perform cleanings, routine fillings and simple extractions. They cannot prescribe medicines. They are in daily contact with dentists. And their focus is primarily prevention, Williard said.
For people like former Aniak resident Davidson, who is a director at the consortium, she is hoping dental health aides mean children will no longer have to endure the pain and fear of infrequent dental care.
Find Megan Holland online at adn.com/contact/mholland or call 257-4343.
