Issue 05
Winter 2020
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
- NIHB Applauds First Dental Therapists at National Convening hosted by Community Catalyst
- Supplemental University of Washington Study Shows Further Impact of Dental Therapy in Alaska
- “Tooth Whisperer” Celebrates Four Years as First Tribal Dental Therapist Outside of Alaska

Updates from Capitol Hill and the Administration
- House Passes Legislation Creating Medicare Dental Benefit
- Congress Funds IHS’s Dental Line Item at $210 Million for 2020

The Latest in State Legislatures
- Wisconsin Dental Therapy Bill Continues Steady Progress with Tribal Support
- Florida Legislature Rejuvenates Dental Therapy Discussion

Funding Opportunities and Resources
- Native American Pre-Dental Student Gateway Program
- 2020 Continuing Dental Ed Catalog
- Oral Health Care Tips for Caregivers
- IHS Dental Portal
February is National Children's Dental Health Month! Please join the The National Indian Health Board and the National Partnership for Dental Therapy in observing this important time!

Dental therapists are an invaluable resource to our oral health provider teams, and many focus on serving young patients. Click here to learn how dental therapists can improve children's oral health!

Click here for more information on how to join the Partnership!
Tribal Dental Therapy News
NIHB Applauds First Dental Therapists at National Convening hosted by Community Catalyst
As part of Community Catalyst's National Convening on Dental Therapy, the National Partnership for Dental Therapy presented Leadership Awards to honor the courage of the first group of dental therapists to practice in the United States. These four dental therapists each embody the theme of the convening held on November 18-19, 2019: “Courage. Leadership. Community.”

Robert Curtis, Stephanie Wood, Conan Murat, and Lillian McGilton each worked as part of the first group of dental therapists serving Alaska Native communities at a time when the future of the profession was far less guaranteed than it is today. The awards to these four courageous individuals were presented by Dr. Mary Williard, Director of the Alaska Native Tribal Health Consortium’s Dental Health Aide Therapist Educational Program as well as the Honorable Valerie Davidson, the former Lieutenant Governor of Alaska.

The National Indian Health Board extends its sincerest thanks, appreciation, and congratulations to these four individuals for their work in restoring the oral health of Native Alaskans.     

To learn more about the National Partnership for Dental Therapy, visit .
Supplemental University of Washington Study Shows Further Impact of Dental Therapy in Alaska            
A new study released by the University of Washington offers qualitative data on the difference dental therapists are making in Alaska Native communities. The study supplements a 2017 study that used quantitative data to analyses the health benefits to communities served by dental therapists. For more information on that study, click here .

The 2019 supplement interviewed sixteen providers and 125 community residents from six Alaska Native communities in the Yukon-Kuskokwim Delta, where dental therapists have worked since 2006. The study examined dental therapy’s impact in communities with high and medium exposure to dental therapists contrasted to those not currently served by dental therapists.
Key findings from the study include:

  • Study participants were overwhelmingly satisfied with the care provided by dental therapists and felt especially comfortable receiving oral health care from DHATs with similar cultural backgrounds.
  • Community members felt that oral health care and oral disease prevention were becoming more widespread since the time dental therapists first began working.
  • Dental therapists were particularly effective at addressing children’s oral health needs, but many adults still have unmet need.
  • Health outcomes could improve further with additional resources to increase dental therapist recruitment and retention.

The 2019 supplemental study shows further evidence of dental therapy’s positive impact. Study participants pointed to expanded access to oral health care, increased knowledge about oral health practices, and strong community bonds with the dental therapists. These key changes in Alaska Native communities’ oral health show dental therapy’s potential to restore Indian Country’s oral health.

To access the study, click here .
“Tooth Whisperer” Celebrates Four Years as First Tribal Dental Therapist Outside of Alaska
Dan Kennedy thinks of himself as the Tooth Whisperer whenever he gets a nervous child calm and willing to have him examine their teeth. He tells them, “I am going to talk to your teeth and figure out what’s causing your mouth to hurt.” In January 2016, Dan began seeing patients at the Swinomish Indian Tribal Community in Washington State as their dental therapist. In that role over the past four years, Mr. Kennedy has provided preventative and routine restorative oral health services to the community. He has a special affinity to providing care to children, many of whom are scared of the dentist.

This isn’t a new phenomenon for Dan Kennedy, who originally worked as a dental assistant with the Southeast Alaska Regional Health Corporation. His own son was not comfortable with his pediatric dentist and resisted being examined and cared for. When Dan probed why his son was uncomfortable, his son said that he didn’t know the den tist, and he’d feel better if someone like his dad could take his pain away. That experience inspired Dan to go to school to become a dental therapist in Alaska, where he studied with experienced faculty as part of one of the first dental therapy classes. Once he had completed a 400-hour preceptorship seeing patients in his hometown in 2009, he worked as a full dental therapist in Alaska and now in Washington State.

Since moving to Swinomish, Mr. Kennedy has striven to ensure the Tribal youth understand the importance of oral health and how the Tribe’s oral health provider team can help them take care of their mouths. He has seen over 300 children, developing rapports with them and “whispering” to their teeth to get them more comfortable seeking dental care.

Dan sees the proof of his success in the Tribe’s response. In addition to more people receiving care, and wait times decreasing from nearly three months to under one month, the Tribe has recruited two community members, Sarah and Asiah, to become dental therapists. With a larger dental provider team, Dan looks forward to restoring the next generation’s oral health in Swinomish, and hopes that all Tribes will have the same opportunity.
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!
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Updates from Capitol Hill and the Administration
House Passes Legislation Creating Medicare Dental Benefit
The United States House of Representatives has passed legislation that would create a dental benefit under Medicare, meaning enrollees would gain coverage for outpatient oral health care without needing to obtain supplemental insurance. Currently, Medicare only covers dental services that are deemed medically necessary in inpatient facilities. On December 12, 2019, the House voted 230-192 to add dental and vision benefits to Medicare as part of a package aimed at lowering the cost of prescription drugs.

Medicare currently covers approximately 450,000 American Indians/Alaska Natives (AI/ANs) over the age of 65 and another 200,000 AI/ANs living with disabilities. For more information on how Medicare interacts with the Indian health system, click here.

While legislation adding a dental benefit to Medicare beneficiaries faces steep odds in the current Senate, its advancement through one chamber of Congress is a significant victory.
Congress Funds IHS’s Dental Line Item at $210 Million for 2020
On December 20, 2019, President Trump signed the Fiscal Year 2020 appropriations legislation funding the Indian Health Service (IHS) through September 30, 2020. This act is the final step in a nearly year-long process to secure annual funding for the agency. In March 2019, the Administration released its Budget Request to Congress for Fiscal Year 2020. Congress then spent several months drafting and considering appropriations legislation for the year. This process took such time that two stop-gap Continuing Resolutions had to be passed to ensure the government was funded and to avoid a government shutdown.

Overall, Congress appropriated $6.05 billion to the agency for the current year, including $210,590,000 for the dental line item. These figures are a 4.2% increase for IHS and a 2.9% increase for the dental line item over Fiscal Year 2019’s appropriation. The dental line item provides for IHS’s ability to provide oral health care services to the agency’s beneficiaries, funding over 3.8 million dental services each year. According to the 2020 Congressional Justification published by the agency, the line item “supports preventive care, basic care, and emergency care, with approximately 90 percent of services covering basic and emergency care. Basic services are prioritized over more complex rehabilitative care such as root canals, crowns and bridges, dentures, and surgical extractions. The demand for dental treatment remains high due to high dental caries rate in American Indian and Alaska Native (AI/AN) children; however, a continuing emphasis on community oral health promotion and disease prevention is essential to impact long-term improvement of the oral health of AI/AN people.”

The appropriation for Fiscal Year 2020 also included $5 million for IHS to expand the Community Health Aide Program (CHAP) to Tribes outside Alaska. CHAP offers medical, behavioral, and oral health providers to Tribal communities.

For further information on the 2020 appropriation to the Indian Health Service, click here.
Oral Health Champion's Corner
This issue’s Oral Health Champion is Mellie Burns, RDH, PDHC, Children’s Dental Program Manager for the Eastern Band of the Cherokee Indians (EBCI), where she has worked for 11 years after a career in private practice.

Ms. Burns has spent the entirety of her career with EBCI promoting dental health and providing dental prevention services for children at Tribal daycare centers, the Dora Reed Head Start Center and Cherokee Elementary School. She provides age appropriate classroom education, dental screenings, and fluoride varnish applications for children in each of the above mentioned settings. 

Additionally, Ms. Burns provides case management services for children identified with urgent dental needs to ensure this vulnerable population is receiving the dental care they need. Ultimately, her goal is to ensure the population she serves achieves and maintains the program’s vision of “Happy, Healthy Smiles.”

Thanks for all you do to keep Indian Country smiling, Mellie!
The Latest from State Legislatures
Wisconsin Dental Therapy Bill Continues Steady Progress with Tribal Support 
The Wisconsin General Assembly is continuing its consideration of Senate Bill 89 and its companion Assembly Bill 81 to allow the state to license dental therapists throughout the state. Tribes have been at the forefront of the effort to pass the legislation, particularly Oneida Nation. That Tribe supported the bill in part due to high wait times for Tribal members to see a dentist, an average of six months between making an appointment and being seen!

The Wisconsin Senate Committee on Health and Human Services held a hearing in August, and the Assembly Committee on Medicaid Reform and Oversight followed suit on December 18, 2019. A number of dental therapy proponents spoke in support of the legislation at the hearing and pointed out that the bill would have a positive impact on the state’s Tribes.

Click here to watch a recording of the hearing.

The bill is still in committee in both the House and Assembly. Lawmakers are considering adding amendments to require dental therapists to see a minimum number of Medicaid patients. Overall, the bill would give Tribes the ability to replicate many of the positive oral health outcomes that Alaska Native communities have seen since dental therapists began working there in 2004.
Florida Legislature Rejuvenates Dental Therapy Discussion
Dental therapy is not a new topic for Florida lawmakers. In 2018, legislation to bring the oral health care provider to the Sunshine State died in committee. As the 2020 legislative session begins warming up, dental therapy is back on the agenda.

Senate Bill 152 would authorize dental therapy in Florida and allow the state’s two Tribes, the Seminole Tribes and the Miccosukee Tribe, to replicate the success that Alaska Native communities and Tribes in the Pacific Northwest have seen with dental therapy. Tribes there have used dental therapists to effectively address dental provider shortages. This problem is particularly acute in Florida, where 63 out of 67 counties have a shortage of dentists, according to Floridians for Dental Access. Additionally, dentists in Florida have the lowest participation rate in Medicaid of any state (just 18%), meaning that over 60% of the state’s children enrolled in Medicaid do not see a dentist every year.

Advocates in the state had their first Day of Action on January 29, urging state lawmakers to enact the legislation. Should Florida authorize dental therapy, it will be the largest state yet to have done so.
Funding Opportunities & Resources
Native American Pre-Dental Student Gateway Program

The Seneca Nation Health System and the University at Buffalo School of Dental Medicine have developed a ‘Gateway to Dentistry’ internship program for Native American undergraduate students considering application to Dental School. 

Click here for more information!

June 22-26, 2020
2020 Continuing Dental Education Catalog from the Indian Health Service
The Indian Health Service Division of Oral Health offers several webinars and in person trainings for Continuing Dental Education for dentists, dental hygienists, and dental assistants year round. Click here to view the catalog of 2020 courses.
Oral Health Care Tips for Caregivers

The NIH National Institute of Dental and Craniofacial Research developed a series of fact sheets for caregivers who help someone brush, floss, or visit the dentist.

Suggestions range from ways to help elders find low-cost dental care to how to make holding a toothbrush easier.

Click here to view the fact sheets!
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.
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