The American Dental Association (ADA) really, really does not like Alaska’s Dental Health Aide Therapist program. The Association is sponsoring some very disturbing, negative, scare-tactic television ads to generate political pressure against this program–part of the Indian Health Care Improvement Act–which is currently up for reauthorization. The following is a press release from the ADA:

WASHINGTON, July 15 /U.S. Newswire/ — American Dental Association (ADA) President-elect Robert Brandjord, DDS, yesterday urged a Senate committee to reject a plan that would allow therapists with as little as 18 months of training to perform surgical procedures on American Indians and Alaska Natives, as proposed in the Indian Health Care Improvement Act (S. 1057).

     “This is second-class care,” he said. “It is unsafe, unfair and unneeded. It is an admission that those who been entrusted to provide care have essentially given up.”

     The ADA supports training community-based dental aides to provide patient education and preventive services to people in remote villages, Dr. Brandjord added, but absolutely cannot support any plan that would let inadequately trained individuals perform such irreversible surgical procedures as extracting teeth, drilling cavities and performing pulpotomies (which are similar to root canals).

     Dr. Brandjord, an oral surgeon, pointed out that even extracting a tooth can have serious, even life-threatening complications. Therapists, he said, “are not prepared to routinely perform these procedures safely.”

     For a copy of the ADA position paper on Alaska’s Dental Health Aide Therapist (DHAT) program, contact Richard Green 202-236-9990 or Fred Peterson 312-440-2806.

     And now for another view regarding this critical public policy, and public health, issue. The following extended quote is from the testimony by Rachel A. Joseph, Co-Chairperson of the National Steering Committee for the Reauthorization of the Indian Health Care Improvement Act, before a Joint Hearing of the Senate Committees on Indian Affairs and Health, Education, Labor, and Pensions, July 14, 2005.

Alaska Dental Health Aide Program (DHA) – A Local Solution to a Crisis

     Alaska has a severe shortage of dentists. Imagine your child has an unbearably painful toothache and the dentist comes to your community just once a year. In fact, the only ways in or out of your village is by boat or airplane; and, the airfare is several hundred dollars. Tribal and IHS dentists make the care of children’s teeth their first priority; thus, an adult may not get an appointment during the dentist’s annual visit. This is reality for approximately 85,000 Alaska Natives in rural Alaska.

     Alaska Natives are fighting an epidemic of dental decay and have implemented the Alaska Dental Health Aide (DHA) program as an effective means of fighting these conditions. DHAs are needed to address shocking rates of oral disease in Alaska; for example, Alaska Natives suffer rates of dental caries 2.5 times the national rate; one-third of rural Alaska school children miss school because of dental pain; one quarter of the children report covering their laughter or smiles because of the way their teeth look….

     The DHA Program is a local solution to a critical problem and consists of a specialty practice area focused on prevention, relief of pain and infection, and basic restorative services. Dental Health Aides and Therapists provide sorely needed access and continuity of dental care in rural Alaska. The DHA program is authorized under section 121 of the Indian Health Care Improvement Act (IHCIA), 25 U.S.C. § 1616l.

     The American Dental Association has been advocating for the removal of this authorization, arguing that DHAs do not have the training necessary to perform within their scope of practice. It is important to note that DHAs must meet rigorous requirements, which includes training that requires hands-on practice under a dentist’s supervision; continuous education; federal certification; and, ongoing performance evaluations. DHA therapists receive two years, or 2,400 hours, of classroom training and clinical experience. They spend about 760 hours in a clinic treating children. While in college, they perform more clinical procedures than the average graduate of American dental schools experience.

     While DHAs are new to the United States, New Zealand has a 75-year history of success in using dental health paraprofessionals. The World Health Organization shows that dental health aide/therapists now work in 42 countries, including Great Britain and Canada. After Canada started its program, the ratio of teeth pulled to teeth fixed dropped from over 50 percent to less than 10 percent. A study of the Canadian effort compared the work of dental therapists and dentists and found that the quality of restorations by therapists equal that of the dentists.

     Significantly, organizations with a profound interest in public health, but no profit motive, support the DHA program. Some of these include the Indian Health Service, under Director Dr. Charles Grim, who is a dentist; the Alaska Department of Health and Social Services, whose Commissioner, Joel Gilbertson, said [DHA] “holds great promise for addressing the profound dental problems of rural Alaskans, and we applaud Congress for giving the program a chance to demonstrate its potential for success” and the American Association of Public Health Dentistry.

     America has seen this kind of resistance to mid-level health practitioners and physician extenders for many years. For example, chiropractors fought for more than a decade to provide patient care, unfettered, within their scope of practice, despite vociferous objections by the American Medical Association. That conflict was decided in favor of the chiropractic profession in the Supreme Court decision on Wilk, et. Al .v. AMA. Nurse Anesthetists, Osteopathic Physicians, occupational therapists, physical therapists and other health professions have fought, and continue to fight, battles similar to the one the DHAs now face. Today, mid-level medical personnel have proven to be an effective, cost efficient and important part of the health care team. We support the DHAs as part of a health care team. (a full transcript of this testimony is available)

     Dental Health Aides and Therapists–good public policy, or bad public policy. What is your take on it?


Lawrence D. Weiss Ph.D., M.S.
Alaska Center for Public Policy

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