Issue 06
Spring 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
- COVID-19 Pandemic Disrupts Oral Health Care Delivery
- Lummi Nation Shows How Tribes Can Benefit from Teledentistry during Pandemic

Updates from Capitol Hill and the Administration
- Federal Government Creates Position Description for Dental Health Aide Therapists
- CHAP Interim Policy Nears Completion

The Latest in State Legislatures
- Hawaii Legislature Considers Dental Therapy and Other Oral Health Solutions
- Deadline for Public Comments on Dental Therapy Law Passes in Michigan

Funding Opportunities and Resources
- National Indian Health Board COVID-19 Tribal Resource Center
- 2020 Continuing Dental Ed Catalog
- Oral Health Care Tips for Caregivers
- IHS Dental Portal
April is National Oral 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. Click here to learn how dental therapists can improve oral health in Tribal communities!

Click here for more information on how to join the Partnership!
Tribal Dental Therapy News
COVID-19 Pandemic Disrupts Oral Health Care Delivery
As the COVID-19 pandemic disrupts normal life across the nation, Tribal and non-Tribal oral health providers have made adjustments to help stop the spread of the virus. In many cases, these adjustments have resulted in patients postponing elective and routine care. Additionally, many places where dental therapists are best suited to offer care, such as schools and community centers, are closed. As of April 30, most dental clinics within the Indian health system, including those run by the Indian Health Service, Tribes, and Urban Indian health organizations, had implemented the following recommendations.

  • The Centers for Disease Control and Prevention (CDC) is recommending clinics postpone routine dental services due to the risk in spreading the virus between patients and dentists.

  • The Occupational Health & Safety Administration has guidance for workplaces. OSHA is recommending that providers conducting dental procedures likely to generate aerosols use personal respirators. OSHA also categorizes oral health providers as very high exposure risk for COVID-19.

Dentists may have success in patient engagement by offering teledentistry services, which can also help determine if a patient urgently needs care.

It is also expected that once patients are able to access dental services like normal again, pent up demand may lead to longer than usual wait times between making an appointment and being seen. At that point, dental clinics may want to assign staff--such as dental hygienists and dental therapists--to work as efficiently as possible within their scopes of practice, and may want to work with their patients to reduce appointment no-shows.

National Indian Health Board has created a COVID-19 Tribal Resource Center to provide Tribes with updates, resources, guidance, and other materials to protect the health and safety of their communities. You can access the Center here.
Lummi Nation Shows How Tribes Can Benefit from Teledentistry during Pandemic                
By Dr. Miranda Davis, Northwest Portland Area Indian Health Board

When dental clinics in the Northwest began limiting patient visits due to COVID-19 in early March, the Lummi Tribal Health Center (LTHC) innovated quickly. Within days, community members were able to receive a visit from their dental and medical providers in the comfort and safety of their own homes, whether or not they have internet access or experience with technology. Here’s how.

When a patient calls LTHC, a receptionist determines whether they would benefit from a telehealth visit. If so, the needed support is determined. For a teledentistry visit, a staff member (“runner”) drives to the patient’s home and delivers a bin to the patient’s doorstep with the relevant technology: a portable WiFi system, an iPad, and an iPhone that connects to an intraoral camera. A dental assistant talks the patient through use of the technology over the phone prior to the appointment and instructions are e-mailed to the patient. When the visit is completed, the patient leaves the equipment on the doorstep for the runner to retrieve and sanitize. A sanitizing system is set up in the back of the runner’s vehicle.

The LTHC Dental team is also bringing direct care to patient homes. Kits are pre-prepared for various home care needs. Kits include such items as denture adhesive, oral hygiene items, silver diamine fluoride, and temporary filling material. Runners also bring certain commonly needed prescription medications so that the patient is likely to receive what they need immediately during the teledentistry appointment.

In addition to responding to the community’s urgent dental needs, the dental team is proactively providing teledentistry appointments for routine oral hygiene visits with dental therapists and hygienists. This keeps patients involved in care when they can’t physically visit the clinic, and allows providers to identify and intervene early when problems arise.

Lummi dental director Dr. Jessica Dubek congratulates her team on quickly innovating and working together to bring this important care to the community, with special thanks to Drs. Jessica Hudson and John Todorovich for initiating the teledentistry program. Dr. Dubek notes that with uncertain times ahead and many patients having difficulty with transportation or fears about returning to the clinic, their teledentistry program will likely continue even after the COVID-19 crisis resolves. “We are doing all we can to continue to serve our community, and we’re finding that community members really value this service. I think in the future more patients would appreciate receiving a professional dental evaluation from the comfort and safety of their own homes.”  
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
Tribal Dental
Third Thursday of Every Month

2:00 PM Eastern


Updates from Capitol Hill and the Administration
Federal Government Creates Position Description for Dental Health Aide Therapists
In February 2020, the Indian Health Service (IHS) gained a new tool to expand the use of mid-level oral health providers in its facilities: a federal position description for Dental Health Aide Therapists (DHATs). This resource is necessary because the federal government needs a position description in place before it can hire for any positions. This positive development came after considerable pressure and advocacy from Tribes, particularly those in the Pacific Northwest.

This is a technical but important development. The position description only applies to the federal government, but Tribes and Urban Indian organizations can copy it and hire their own DHATs outside of CHAP. Importantly, the position description is within the 640 series of federal workers—meaning that there is no requirement for a bachelor’s degree. This crucial point expands the accessibility of the position to populations that have not historically benefitted from institutions of higher education, such as American Indians and Alaska Natives.

As IHS finalizes a policy to expand the Community Health Aide Program (CHAP) to Tribes outside Alaska, it will be able to utilize DHATs in its facilities, in accordance with the Indian Health Care Improvement Act. That law allowed DHATs to work under CHAP, but only if the state the Tribe or IHS facility is in allows it. While the position description will not be able to remove this inappropriate barrier, it does mean that IHS will be able use CHAP to employ DHATs in facilities located in states that have already approved dental therapy, expanding oral health access to more Tribes and allowing these providers to expand on their success.
CHAP Interim Policy Nears Completion
On February 21, 2020, the Community Health Aide Program Tribal Advisory Group (CHAP TAG) met to discuss the status of the draft interim policy that would expand CHAP--and the providers who provide medical, behavioral, and oral health services--to Tribes outside Alaska.

The Indian Health Service (IHS) and CHAP TAG have been working on the policy for more than two years, and Tribal consultation over the draft interim policy generated 37 letters from Tribes and 260 comments on various issues.

Consultation resulted in several clarifications in the policy language, including allowing Tribes to implement CHAP through amendments to their self-governance agreements and stating that, while federal law prohibits IHS from using a dental therapist to fill a vacant dentist position, Tribes are not subject to this requirement with dental therapists employed through CHAP.

It is not clear when the interim policy will take effect, and the COVID-19 has substantially delayed additional progress on CHAP expansion. Once the policy is in place, IHS Area offices will be able to work with Tribes to establish Area Certification Boards to certify CHAP providers and get them working in Indian Country.
Oral Health Champion's Corner
This issue’s Oral Health Champion is Rochelle Ferry, a dental therapist serving the Port Gamble S’Klallam Tribe!

Rochelle—“Roz” to her patients--has worked as a dental therapist since she graduated from New Zealand’s dental therapy program in 2006, first in Alaska Native villages and now at the Port Gamble S’Klallam Tribe in Washington State. She has been interested in dentistry ever since she lost her front tooth in an accident as a teenager.
Working under the supervision of the Tribe’s dentist, Dr. Bloch, Roz gets the opportunity to spend time with children and elders in their space which, often times, lacks the pressures found in a formal dental setting. Twice a year children from the youth center visit the dental clinic, and Ferry enjoys watching their eyes light up when they learn something new! She finds that when they visit the clinic later they are less fearful of a dental exam.

With the current pandemic, Roz has not had the opportunity to visit elders and children in their homes, schools, or gathering places like she normally would. She is the only full time dental employee at Port Gamble S'Klallam and one of the Tribe’s only dental health care providers seeing patients on an emergency basis, an invaluable service during the pandemic.

Thanks for all you do to keep Indian Country smiling, Roz!
The Latest from State Legislatures
Hawaii Legislature Considers Dental Therapy and Other Oral Health Solutions
In the 2020 session, a dental therapy bill was introduced in Hawaii’s legislature for the first time since 2014. House Bill 1806 applies statewide, allowing dental therapists to practice under the supervision of a dentist. The bill has been referred to several committees within the House of Representatives, which may result in a longer than typical legislative consideration process. The Hawaii legislature is currently recessed in response to the COVID-19 pandemic.

For a summary of the bill’s impact in the state, click here.

While National Indian Health Board is an intertribal non-profit serving all federally recognized Tribes, our work does not include the Native Hawaiian community. While the federal government treats Native Hawaiians as a distinct group, it does not recognize the group as an Indian Tribe. However, many of the factors that make dental therapy a success in Alaska, such as a provider shortage and isolated communities, are present in Hawaii as well. NIHB is monitoring the bill’s progress and will continue to do so once the legislature reconvenes.

The legislature is also considering a bill to restore adult dental benefits to the state's Medicaid program, which would benefit nearly 350,000 people throughout the state at a cost of around $7 million. Slightly different versions of that bill have passed the state House of Representatives and the state Senate, and further action is likely once the legislature reconvenes. This is a legislative priority for Papa Ola Lokahi, a nonprofit health organization serving Native Hawaiians.
Deadline for Public Comments on Dental Therapy Law Passes in Michigan
In 2018, Michigan became the first state to pass an Alaska-model dental therapy bill statewide. As NIHB has documented previously, this law will carry enormous benefit to the state’s Tribes, many of which actively engaged with state lawmakers to enact the bill.

In 2019, the Michigan Board of Dentistry and the Department of Licensing and Regulatory Affairs drafted rules implementing the new law. Those draft rules were released for public comment, and NIHB created a template comment for Tribes to submit to the state. While the rules were overall favorable to Tribes and rural communities, there were a few provisions that could be strengthened to the benefit of Tribes.

The deadline for comment submission from across the state passed on March 27, and now the Michigan Board of Dentistry will finalize the rules based on feedback from the public. Once the rules are in place, dental therapists will be able to practice in dental clinics across the state of Michigan.
Funding Opportunities & Resources
NIHB COVID-19 Tribal Resource Center
The National Indian Health Board has launched a Resource Center for Tribes to address the global COVID-19 pandemic. Included are community health information, COVID-19 one pagers, and advocacy tools.

Click here to visit the Reource Center!
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.
910 Pennsylvania Avenue, SE
Washington, DC 20003
Main Phone: 202-507-4070
Fax: 202-507-4071