Issue 01
Winter 2019
Tribal Oral Health Newsletter
The Latest News on Oral Health from across Indian Country

In Your Inbox Every Quarter!
In This Issue
Tribal Dental Therapy News
Washington Tribes Show Success of Dental Therapy
North Dakota Tribes Pass Dental Therapy Resolutions
Oregon Dental Therapist Becomes Pillar of Her Community

Updates from Capitol Hill and the Administration
Congress Enacts Action for Dental Health Act
Cardin Introduces Bill to Add Dental Benefit to Medicare
Administration Releases Report on Choices in Health Care Delivery

The Latest in State Legislatures
Michigan Joins Growing Number of Dental Therapy States
Idaho Tribes Lead the Way for Oral Health Access
Bill Defeated in North Dakota, but Progress Still Clear

Funding Opportunities and Resources
Oral Health Workforce Development
Medicaid Resources
IHS Dental Externships
IHS Dental Portal
National Indian Health Board and Community Catalyst Launch the

The partnership will provide resources to allies and advocates for dental therapy in Tribes and communities nationwide!

Click here for more on this new partnership!
Tribal Dental Therapy News
Washington Tribes Show Success of Dental Therapy
Tribes in Washington were the first to bring dental therapy to the Lower 48. First, Swinomish hired its own dental therapist in January 2016, licensing the provider with its own dental board. Then, Tribes advocated successfully at the state capitol to bring dental therapy to Tribes statewide. Now, multiple Tribes have hired or are planning to hire dental therapists.

Port Gamble S'klallam Tribe was the first Tribe to hire a Dental Therapist after Washington State passed the dental therapy law. Since that time, the Tribe's wait time between making the appointment and being seen has been almost completely eliminated! Some Tribes without access to dental therapy have told the National Indian Health Board that wait times can exceed six months!

As for Swinomish, the over three years of work the dental therapist has given the Tribe have resulted in fantastic outcomes! The total number of patients seen by the Tribe's oral health care team has increased by 20%! Because the dental therapist is seeing so many patients with easily treatable issues, the Tribe’s dentists are able to focus on more complicated procedures: 50% more crown, bridge, and partials have been performed since 2016!

The evidence shows that dental therapy is working in Tribal communities, and that all Tribes should have the oral health care access promised them.
North Dakota Tribes Pass Dental Therapy Resolutions
North Dakota is one of the states where Tribes have long been advocating for dental therapy legislation (see "Bill Defeated in North Dakota, but Progress Still Clear" below). As lawmakers considered the merits of the legislation, Tribes spent 2018 taking action themselves.

Each of the five Tribes in North Dakota has passed a resolution within the pat year endorsing dental therapy as a solution to Indian Country's unmet oral health needs.

This unified voice is crucial as Tribes assert their sovereignty in oral health care delivery. Thanks to these resolutions, North Dakota lawmakers can be sure that the Tribal position on dental therapy is clear moving forward.
Oregon Dental Therapist Becomes Pillar of Her Community
Naomi Petrie is proud to work for her Tribe. Since July 2017, Naomi has worked for the Confederated Tribes of Coos, Lower Umqua, and Siuslaw Indians as a dental therapist.

Naomi was part of the first wave of dental therapy students from the Pacific Northwest to study under the Alaska Dental Therapy Education Program. She spent her first year in a classroom in Anchorage learning the didactic aspect of oral health. Her second year, Naomi lived in Bethel, a hub community on the Yukon-Kuskokwim Delta. During that year, she worked in the clinic every day and traveled to nearby villages twice. "We spent our time in the villages focusing on the children and getting them familiar with us as dental providers. I mostly did sealants," Naomi says. She credits her time in these communities with inspiring her to focus on her own Tribe's youth as a dental therapist.

Naomi long wanted to serve her Tribe through health care. She grew up on the Tribe's land and always participated in community activities. The local community college has a nursing program, and Naomi considered becoming a nurse. However, the Tribe's health director recommended she look into Alaska's dental therapy education program. After doing some research, Naomi decided that this was the best way she could serve her people.

When Naomi began working for her Tribe, her head dentist, Dr. Sarah Rogers, oversaw her work directly for a period of time. This preceptorship time is designed to ensure both Naomi and Dr. Rogers were comfortable with the dental therapist's scope of practice. Naomi finished her preceptorship in October 2018 and is now treating members of the community under general supervision.

Naomi sees her own patients now, and she collaborates with the Tribe's Head Start program to ensure the youth have sealants and the early oral health care they need. Naomi loves placing sealants, because it is usually the first oral health care procedure the children see and she gets to form a bond with them."One bad experience in a dentist's chair can stay with someone for life. I want to lower their anxiety and make them comfortable," she says.

The Tribe is not resting on its laurels. Another dental therapist is in her preceptorship, and the dental clinic is exploring mobile unit options to bring services to community members where they are. The dentist is able to spend more time with patients and do more complex procedures now that Naomi is taking the patients with the easiest need.

In reflecting on her career path, Naomi says, "I want to set a good example for the children in my community. I have had kids come up to me and tell me they want to be a dental therapist, and that makes it all worth it."
Use NIHB's state legislative tracker to learn more about dental therapy legislation in your state and how you can help make access to oral health care a reality for the Tribes!
Join NIHB's
Second Thursday of Every Month

1:00 PM Eastern


Updates from Capitol Hill and the Administration
Congress Enacts Action for Dental Health Act
One of the last acts passed by the 115th Congress was the bipartisan Action for Dental Health Act of 2018. The bill was sponsored by Reps. Robin Kelly (D-IL) and Mike Simpson (R-ID) in the House and by Cory Booker (D-NJ) in the Senate.

The legislation authorizes the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) to enter into grants, contracts, or cooperative agreements with state, Tribal, and local governments for initiatives around oral health improvement and oral health education. These efforts would focus on underserved populations, including American Indians and Alaska Natives.

The bill also strengthens HRSA's "Grants to States to Support Oral Health Workforce Activities" to allow states to use funding for innovative oral health delivery models for underserved populations and well as strategies to reduce emergency room dental care.

Dental therapy has a strong track record of addressing both of these issues, and while this grant is limited to states, the funding can help build a national dental therapy infrastructure, which will benefit Tribes.
Cardin Introduces Bill to Add Dental Benefit to Medicare
Senator Ben Cardin (D-MD), has introduced S. 22, the Medicare Dental Benefit Act of 2019, which would include dental coverage under Medicare Part B.

American Indians and Alaska Natives disproportionately suffer from oral health disparities. In 1999, IHS found that an astounding 98% of all American Indian and Alaska Native elders (aged 55 and over) had lost at least one tooth to trauma or untreated decay and 21% had no remaining natural teeth. While a followup survey in 2016 showed positive trends, it is clear that Tribal elders are going without the oral health care they need.

Medicare provides health coverage for 49 million Americans aged 65 and older as well as almost 9 million Americans living with disabilities. Overall, over 650,000 AI/ANs receive health coverage through the program. Yet Medicare does not offer any coverage for non-medical oral health services.

When Senator Cardin introduced the bill, he said, "Good oral health is essential to overall health, but quality oral care can be expensive – essentially out of reach – for too many people in Maryland and around the nation."

Click here to for the legislative text of the Medicare Dental Benefit Act of 2019.
Administration Releases Report on Choices in Health Care Delivery
On December 3, 2018, the Department of Health and Human Services (HHS) released a report conducted with the Departments of Labor and Treasury on increasing choice in health care delivery.

The report follows an Executive Order signed by President Trump, which ordered Cabinet secretaries to, "facilitate the development and operation of a health care system that provides high-quality care at affordable prices for the American people by promoting choice and competition."

The report included dental therapy as one way to increase choice, stating, "Emerging healthcare occupations, such as dental therapy, can increase access and drive down costs for consumers, while still ensuring safe care." The report also recommended states study how dental therapists can increase access and reduce costs.

Click here to read the full report.
Oral Health Champion's Corner
This issue's Oral Health Champion is Rachael Hogan, DDS, at the Swinomish Indian Tribal Community!

Dr. Hogan has been the Dental Director at Swinomish since 2015. Mentoring and taking on externs yearly, she actively engages minorities in the dental profession and encourages dental students to consider public health dentistry as a career.

Rachael has long championed dental therapy. She has worked alongside a dental therapist since 2016, helping lead the effort to address the oral health crisis in Indian County!

Thanks for all you do to keep Indian Country smiling, Dr. Hogan!
The Latest from State Legislatures
Michigan Joins Growing Number of Dental Therapy States
On December 28, 2018, Michigan Governor Rick Snyder signed into law SB 541 , which would allow dental therapists to practice in the state of Michigan. Tribes in the state have expressed eagerness to add these providers to their oral health care team.
The new law had been considered by the legislature for several years. It received an initial vote in the state Senate in October 2017, but languished in a state House committee. Thanks to the efforts of advocates, Tribal and non-Tribal, the bill received enough support in the House to pass in December 2018.
The new law allows dental therapists to apply for licenses with the state and practice within the scope of their license at hospitals, Federally Qualified Health Centers, Tribal clinics, Urban Indian Health facilities, and other settings within the state. The bill take effect immediately, but the state still must finalize rules, such as Medicaid reimbursement rates for services performed by a dental therapist.
Governor Snyder signed the bill into law shortly before leaving office. The new Governor, Gretchen Whitmer, will oversee the law's implementation. The new law follows education standards developed by the Commission on Dental Accreditation (CODA): Dental therapists working in Michigan will not have to obtain dental hygiene licenses, nor is there a degree requirement set in the statute. By following the CODA standards, the law allows Tribes in Michigan to replicate Alaska's successful  dental therapy model without adding in any unnecessary barriers. For more information on Michigan's dental therapy law, click here .
Idaho Tribes Lead the Way for Oral Health Access
For the first time, the Idaho legislature has a bill pending that would authorize dental therapists to practice statewide. Seeing the success of Tribes in other states in the Pacific Northwest are having with dental therapy, Tribes in Idaho are leading the effort to pass S. 1062.

The sponsor of the legislation is the Chairman of the Senate Health and Welfare Committee, Lee Heider, and the early support of a powerful lawmaker is a good sign for the legislation’s prospects. The Idaho legislature is expected to adjourn for 2019 on March 25, so advocates are working tirelessly to see this bill through the legislative process!

Click here for a summary on Idaho's dental therapy legislation.
Bill Defeated in North Dakota, but Progress Still Clear
On February 13, 2019, the North Dakota House of Representatives defeated legislation that would have authorized dental therapists statewide. The margin in the House was 31 yes votes to 62 no votes. While this vote is disappointing, it does show growing understanding of oral health issues in the state. In 2015, a less comprehensive dental therapy bill was defeated in the Senate with 6 yes votes to 40 no votes.

In North Dakota's 2019 legislative session, H.B. 1426 would have followed on Michigan's recent success by allowing dentists to hire dental therapists in certain settings, including Tribally run health facilities.

The bill was referred to the House Human Services Committee, where it received a hearing on January 21, 2019. Several Tribal leaders spoke in favor of the legislation, pointing to the need for more providers in their communities. A bipartisan committee vote advanced the bill to the House floor, where it was defeated.

The National Indian Health Board and the National Congress of American Indians wrote a letter to the Chairman of the House Human Services Committee detailing how dental therapy could help North Dakota's Tribes.

Click here for a summary of how North Dakota's 2019 legislation would have impacted Tribes. The legislature can again consider dental therapy legislation in 2021.
Funding Opportunities & Resources
Oral Health Workforce Development
In 2014, Health Resources and Services Administration (HRSA) awarded $1.6 million to Vermont Technical College to develop its dental therapy education program through its Grants to States to Support Oral Health Workforce Activities. While this specific grant is limited to states and state entities, HRSA encourages States to " work with tribal entities to facilitate greater consultation and coordination between state and tribal governments." Interested Tribes may be able to come to an arrangement with their states to secure funding for dental therapy education programs at their Tribal colleges and universities.

This grant was reauthorized by the Action for Dental Health Act, signed into law in December 2018 (see above article, "Congress Enacts Action for Dental Health Act" ).
Medicaid Resources
Medicaid dental benefits vary by state.
The Center for Health Care Strategies, Inc. has a fact sheet providing an overview of Medicaid adult dental coverage by state here.

You can also learn more about Medicaid dental health coverage by visiting the Medicaid website.
IHS Dental Externships
Indian Health Service Dental Externships provide an opportunity for dental students to gain professional experience, as well as to determine whether a career with the Indian Health Service (IHS) Division of Oral Health or a position at a specific IHS or Tribal site would be a career path of interest.

Externships are available for dental students between their third and fourth years of school within the months of May through September.
IHS Dental Portal
The IHS Dental Portal contains resources including reports and data on Tribal oral health.

The IHS gathered data as part of the 2010, 2014, 2015, and 2016-2017 Oral Health Surveys.

To view the draft IHS Division of Oral Health Strategic Plan for 2018-2017, click here.
910 Pennsylvania Avenue, SE
Washington, DC 20003
Main Phone: 202-507-4070
Fax: 202-507-4071