IMPROVING THE ORAL HEALTH OF ALASKA NATIVES

The article by Sekiguchi et a1.1 has provoked controversy around the acceptability of dental health aide therapists (DHATs) who are trained to provide diagnostic and dental treatment services in Alaskan Tribal health programs.

To deal with extensive unmet dental needs, DHATs have been trained under a federal program to deliver year-round care, under the general supervision of a dentist, in their remote villages, where it is difficult to recruit dentists.2 However, Sekiguchi et al.1 disagree with this initiative stating that dentists are the only personnel qualified to provide these services and that DHATs cannot be effective substitutes. They provide no evidence for their opinion.

In contrast, Nash3^,4 has proposed that use of DHATs is an acceptable and valid means to address current unmet treatment needs, especially among young children, and not just in Alaskan villages. Double-blind studies comparing Canadian dental therapists with federal dentists demonstrated equivalent quality of dental restorations. Currently, there are some 42 countries with some variant of a dental therapist, including New Zealand, Australia, China (Hong Kong), Singapore, Thailand, Malaysia, Great Britain, and Canada.2

There has been a lack of dentists willing to work in these communities for years. Most dentists prefer to work in more economically viable communities. One of the constructive responses by the American Dental Association has been to ask Congress to fund a loan forgiveness program for dentists willing to work in the Indian Health Service where there are positions currently vacant.5

The Alaska Board of Dental Examiners has informed the State Attorney General that in the opinion of the Board, currently trained DHATs are practicing dentistry illegally. However, the Board has no jurisdiction, because the therapists are working in tribal programs outside the purview of state law.6^,7 Ultimately, the tribes will decide which way to go.8

The leadership of the Oral Health Section of the American Public Health Association believes that the rural Alaska Natives will be best served by the DHATs and endorses the program as a practical and innovative response to address the extensive oral health needs of these communities.