In Alaska, Dental Therapists Seen as Helping to Improve Oral Health

Dental therapists working in the Yukon-Kuskokwim (YK) Delta region in southwestern Alaska are helping to prevent oral health disease and improve quality of life, according to a new study that examines the views of dental providers and native community members. 

The study, published in the Journal of Community Dentistry and Oral Epidemiology on Aug. 29, was based on interviews with 125 residents with varying exposure to dental therapists as well as 16 health care providers working in that region. Conducted by a research team based at the University of Washington, this qualitative study follows up on an earlier analysis of 10 years of patient dental records of the YK Health Corporation, the nonprofit tribal organization that serves as the principal health care provider for delta residents.

The Alaska Native Tribal Health Consortium introduced dental therapists to Alaska’s tribal communities in 2004. The new providers were authorized in compliance with federal law and were the first such workers in the nation. Dental therapists, who provide routine preventive and restorative services, have been part of the tribal dental workforce in the YK Delta area since 2006.

The earlier research, published in 2018 in the Journal of Public Health Dentistry, found that children and adults had lower rates of tooth extractions and more preventive care in YK communities served routinely by dental therapists than those in communities with no care by the midlevel providers. YKHC serves about 25,000 people from 58 federally recognized tribes.

Among the new study’s key findings:

• Providers said they see fewer patients with “large cavities” and more children with no cavities since the arrival of dental therapists. They noted that such improvements seemed tied to the expanded access to care allowed by that change.
• They also reported reductions in the prevalence and severity of oral health disease among those living in communities where dental therapists provided care.
• Community members noted that native residents were becoming more knowledgeable about their oral health needs and said that dental therapists had helped prevent disease and improve quality of life.
• Throughout the delta, residents noted chronic unmet dental needs, but those reports came more frequently from those living in areas with no dental therapists.

In these qualitative findings, providers highlighted the benefits of adding dental therapists to the roster of caregivers. “The care I was providing when I’d go out on a village trip changed,” said one dentist. “Most of our patients before [dental therapists] … needed fillings and extractions. Now when I go out to a community with a [dental therapist], you know they’ve got the fillings and extractions under control.”

That means the dentists can focus on more complicated treatments, the practitioner said. “There are patients that need crowns and bridges, dentures, higher-level services that wouldn’t have been in the realm of what we were doing before because I would have had to do [the less complicated] fillings [and] extractions.”

A mother in a community visited frequently by dental therapists described the high level of care her 7-year-old daughter has received. “From the time she had her first tooth come out, we went to the dental therapist every six months, and every three months for fluoride treatments. And to this day she doesn’t have cavities or fillings.”

The researchers interviewed nine dentists, three dental therapists, three dental hygienists, and one physician assistant. They talked with 125 community members, who were divided into three categories according to the number of days they had access to dental therapists: 39 came from communities with no exposure to the midlevel caregivers, 48 from those with medium exposure, and 38 from those with high exposure.

The interviews with providers and residents also revealed areas for improvement, most notably the continuing unmet dental needs among adults, as well as problems retaining dental therapists in isolated tribal areas. Care for adults tends to be limited to emergency treatment because Alaska’s Medicaid program enforces an annual dollar cap for nonemergency care for patients 18 and older, an issue aggravated by the reality that not enough dentists and dental therapists serve the area to address the need. Providers reported problems retaining dental therapists, including not always being able to station them in their home communities, lack of social support, a heavy travel schedule, and lack of child care.   

In sum, interviewees said that residents of areas served by dental therapists have better access to community-based preventive programs and dental care than those in places with no access.  

“These improvements are encouraging, particularly when considering the relatively short duration of Alaska’s dental therapy program and the small number of dental therapists in practice,” wrote the study’s authors, led by Donald L. Chi, DDS, an associate professor at the University of Washington School of Dentistry.

They recommend further research on how dental therapist practice patterns change over time, on strategies to address how prevention gaps can be filled, and on ways to retain dental therapists.

Funding for the research came in part from The Pew Charitable Trusts, the W.K. Kellogg Foundation, and the Rasmuson Foundation.

Jane Koppelman directs the research portfolio for The Pew Charitable Trusts’ dental campaign.