Issue 08
Autumn 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
- Alaska Dental Therapy Education Program Receives Accreditation
- National Indian Health Board Funding Tribes and Tribal Organizations to Expand Dental Therapy in Indian Country
- Arizona Strong Teeth, Strong Kid Campaign Works to Educate Tribal Youth

Updates from Capitol Hill and the Administration
- IHS Announces Tribal Consultation on FY 2020 CHAP Expansion Funding, Continuing Agency Work to Expand CHAP
- Area Indian Health Boards Work to Fill IHS CHAP Tribal Advisory Group Vacancies
- As Presidential Campaign Heats Up, Dental Therapy Gains Bipartisan Support

The Latest in State Legislatures
- Michigan Publishes Second Draft of Proposed Dental Therapy Rules
- Concluding Years-long Rulemaking Process, Maine Sees First Dental Therapist on East Coast

Funding Opportunities and Resources
- NIHB Fact Sheet on Tribal Oral Health during COVID-19 Pandemic
- CDC Resources on Oral Health Services during COVID-19 Pandemic
- 2020 Continuing Dental Education Catalog from the Indian Health Service
- State by State Factsheets on Medicare Oral Health Coverage
As the COVID-19 pandemic continues, normal oral health care services have been disrupted nationwide. Join the National Partnership for Dental Therapy in advocating for a solution to unmet oral health needs! The Partnership is co-chaired by the National Indian Health Board, Community Catalyst, and the National Coalition of Dentists for Health Equity.

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 your Tribe or organization can endorse dental therapy!
Tribal Dental Therapy News
Alaska Dental Therapy Education Program Receives Accreditation
The Commission on Dental Accreditation (CODA) has awarded accreditation to the Alaska Dental Therapy Education Program. The program, operated by Iḷisaġvik College with support from the Alaska Native Tribal Health Consortium, is the first dental therapy education program to receive CODA accreditation in the country.

CODA is the national body recognized by the United States Department of Education to accredit oral health provider education programs, including dental and dental hygiene programs. In 2015, CODA approved standards for dental therapy education programs.

Accreditation for the program in Alaska comes after years of work educating oral health providers, most of whom are Alaska Native, to provide quality care to over 40,000 people in Tribal communities throughout Alaska. CODA conducted a site visit of the program in March 2020.

When the accreditation award announcement was made public, National Indian Health Board (NIHB) Chief Executive Officer Stacy A. Bohlen said, "NIHB is pleased that the Alaska Dental Therapy Education Program has received accreditation from the Commission on Dental Accreditation. This program has for years educated Native oral health providers who are building paths to accessing oral health care and providing high quality care in their own Tribal communities. Accreditation validates the groundbreaking and life changing success this program continues to provide. Through NIHB’s Tribal Oral Health Initiative and the National Partnership for Dental Therapy, we will continue our work to support Tribes across the country that are bringing or want to bring dental therapy to their communities. NIHB sends our sincere congratulations to the faculty, staff, and students whose work made today possible.”

Dental therapists have worked under the Community Health Aide Program (CHAP) in Alaska since 2004. As IHS expands CHAP to Tribes outside Alaska, the newly accredited education program will continue to train dental therapists to work in IHS, Tribal, and other settings in the 13 states with dental therapy laws. Several of these states require that dental therapists graduate from accredited programs. This accreditation award for the Alaska program brings these communities one step closer to equitable oral health access.
National Indian Health Board Funding Tribes and Tribal Organizations to Expand Dental Therapy in Indian Country
As the National Indian Health Board (NIHB) expands the reach and scope of the Tribal Oral Health Initiative, NIHB is pleased to announce that the organization is funding several entities across Indian Country to help support the utilization of dental therapy throughout Indian Country. This project is possible thanks to the support of the W. K. Kellogg Foundation. With the Indian Health Service expanding the Community Health Aide Program (see "IHS Announces Tribal Consultation on FY 2020 CHAP Expansion Funding, Continuing Agency Work to Expand CHAP" below), the time is now to double down on dental therapy’s success in Alaska and the Pacific Northwest! Dental therapists are an integral part of the solution for Indian Country’s oral health challenges. NIHB will fund these entities to help develop a Tribal dental therapy workforce, build out dental clinics’ capacity to incorporate dental therapists into the existing oral health team, and continue to educate Tribes across the country on dental therapy’s record of success. The entities NIHB is funding for this work include:

  • Swinomish Indian Tribal Community
  • Southwestern Indian Polytechnic Institute
  • Intertribal Council of Arizona
  • Northwest Portland Area Indian Health Board
  • Southern Plains Tribal Health Board

Please join NIHB in congratulating these awardees as they work to bring oral health access to their communities. NIHB is proud to support and amplify their work!
Arizona Strong Teeth, Strong Kid Campaign Works to Educate Tribal Youth
By Corey Hempstreet, Arizona Advisory Council on Indian Health Care

Strong Teeth, Strong Kid (STSK) is an oral health campaign that highlights the importance of dental S-milestones for ALL children ages 1-5 by educating parents and caregivers. Good oral health is an integral part of children’s health and development. American Indian/Alaskan Native children, ages 1-5, have the highest rate of tooth decay in the United States. To address this oral health crisis, Native American Connections, Arizona Advisory Council on Indian Health Care, Totem Concepts, and other oral health partners throughout Arizona have teamed up to create positive change.

Strong Teeth, Strong Kid campaign’s mascot, Toby the Tooth is a muscular molar that teaches the importance of dental S-milestones. Along with Toby the Tooth, is his friend, Community Health Representative (CHR) Pam who emphasizes the importance of your overall health. Through health-related messaging, Toby the Tooth and CHR Pam are dedicated to improve oral and overall health outcomes.
To access resources for parents or caregivers such as, activity sheets for children, factsheets, list of Arizona IHS/Tribal Dental clinics, and more, please visit the Strong Teeth, Strong Kid website:

The campaign has also created a fact sheet, poster, and crossword activity sheet. We can stop cavities together!

For more information, please email: [email protected]
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

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NIHB COVID-19 Tribal Resource Center
The National Indian Health Board has developed a Resource Center for Tribes during the COVID-19 pandemic.

Publications include funding opportunities, community health tools, webinars, and other resources to assist Tribal leaders and public health professionals.
Updates from Capitol Hill and the Administration
IHS Announces Tribal Consultation on FY 2020 CHAP Expansion Funding, Continuing Agency Work to Expand CHAP
Tribes have an opportunity to engage in consultation on how the agency should spend the $5 million Congress allocated in Fiscal Year 2020 to support CHAP expansion.

Click here to read the Dear Tribal Leader Letter from September 21, 2020 initiating consultation. Comments are due via email November 23, 2020 to [email protected] with the Subject line: “National CHAP Expansion Funding.”

The letter identified four activities that the funding could support:
  • Exploring how available funding can be used to support Tribes and Federal facilities positioned to begin operating a CHAP;
  • Supporting the development of National and Area Certification Boards to certify CHAP providers;
  • Investing in training for CHAP providers; and
  • Continuing community education on the value and integration of the CHAP into Tribal and Federal programs.

IHS also hosted a learning series on CHAP expansion, providing Tribes with detailed information on the new CHAP expansion interim policy, the scope of work for CHAP providers, and how CHAP and Community Health Representatives can complement each other’s work in Tribal communities.

Recordings of each learning series can be found here.
Area Indian Health Boards Work to Fill IHS CHAP Tribal Advisory Group Vacancies
In 2018, the Indian Health Service (IHS) chartered the Community Health Aide Program Tribal Advisory Group (CHAP TAG) to ensure Tribal perspectives were included as the draft interim policy for CHAP expansion was being formulated. CHAP currently provides frontline medical, behavioral, and dental health care services to Alaska Native communities, and the agency is expanding the successful program to Tribes across the country.

Earlier this year, IHS published the draft interim policy for CHAP expansion. However, much work remains. IHS and Area Indian Health Boards will work together to create the infrastructure for CHAP implementation, including Area Certification Boards, which certify CHAP providers, and Academic Review Committees, which review training standards for CHAP providers. To ensure Tribes have a voice in this continuing work, the CHAP TAG may seek to modify its original charter, which only included the work to craft the draft interim policy. However, several current vacancies on CHAP TAG will make the group less effective. For CHAP TAG to continue, Area Indian Health Boards (AIHBs) and Tribes in the following Areas are encouraged to put forward Tribal nominations to serve on the TAG:

  • Albuquerque Area (Primary & Alternate)
  • Bemidji Area (Alternate)
  • Tucson Area (Alternate)

AIHBs and Tribes in these Areas should work with their Area IHS offices to fill the vacancies on CHAP TAG. Additionally, the Direct Service Tribes Advisory Committee’s (DSTAC’s) seats on the TAG is currently vacant. That post can be filled by a member of DSTAC through the IHS Headquarters Office of Direct Service and Contracting Tribes.

The CHAP TAG roster can be viewed here.
As Presidential Campaign Heats Up, Dental Therapy Gains Bipartisan Support             
Dental therapy has long been an issue that appealed to both conservatives and progressives, Republicans and Democrats. Dental therapy offers a market-oriented solution to lack of access to oral health care in marginalized communities. With the 2020 presidential election in just a few days, the major party candidates, President Donald Trump and former Vice President Biden, have each criticized the other’s health policy proposals.

In this environment, it may be surprising to learn that the candidates are able to find any common ground. But they have done just that with dental therapy!

In July, the Biden-Sanders Unity Task Force—formed to find common ground between Vice President Biden’s campaign as well as that of Senator Bernie Sanders, who had run against Mr. Biden in the Democratic primary—released a series of policy recommendations. According to the document, “Democrats will support policies that increase the number of primary care practitioners, registered nurses, dentists, and dental therapists, especially in rural and low-income metropolitan areas, so it’s easier for every American to access preventive and primary health care.”

This follows a 2018 policy report on choice and competition in the health care sector from the Trump Administration detailing extensive support for dental therapy. The Republican president’s report said, “Emerging healthcare occupations, such as dental therapy, can increase access and drive down costs for consumers, while still ensuring safe care. States should be particularly wary of undue statutory and regulatory impediments to the development of such new occupations.”

Additionally, in state after state, lawmakers of both major parties have introduced, supported, and voted for dental therapy licensing legislation. It’s clear that dental therapy’s record of success in Tribal and other communities is appealing to policymakers across the political spectrum.
Oral Health Champion's Corner
This issue’s Oral Health Champion is Dr. Eldon Bloch, a dentist serving the Port Gamble S’Klallam Tribe in Washington State!

Following a 30-year career in the Navy, Dr. Bloch has worked at Port Gamble for the past 8 years and has at times found himself to be the Tribe’s only full-time oral health care provider. Occasionally supervising part-time hygienists and working alongside part-time dentists, Dr. Bloch worked tirelessly to provide a range of services to his patients: fillings, extractions, crowns, bridges, and denture work. He remembers going to the local Head Start to screen the children for dental problems.

While he worked at the small, 4-chair Tribal dental clinic, Dr. Bloch began supervising Rochelle Ferry, a newly certified Dental Health Aide Therapist, or DHAT. He worked closely with Roz, overseeing her work until he became confident of her abilities. At the onset of the COVID-19 pandemic, Eldon found himself relying on Roz more and more as the Tribe’s dental clinic had to close, and then reopen for emergency cases only. He and Roz rotated days in the clinic to avoid possible exposure to the virus, with Roz consulting him remotely to develop patient treatment plans. He says that having her on the team makes his job easy.

Dr. Bloch loves working at Port Gamble, and is particularly fond of the community relationships he has made during his time there. Eldon looks forward to the planned 2021 opening of the Tribe’s new combined medical and dental facility, which will offer more space for him and Roz to see additional patients.

Thanks for all you do to keep Indian Country smiling, Eldon!
The Latest from State Legislatures
Michigan Publishes Second Draft of Proposed Dental Therapy Rules
Michigan is widely regarded as a success story in the broader dental therapy movement. In 2018, the state legislature passed a dental therapy bill that allows dental therapists to practice in settings across the state and follows the standards for dental therapy education approved by the Commission on Dental Accreditation.

As Michigan wraps up the work writing the rules and regulations on dental therapy implementation in the state, it is clear that Michigan Tribes and other underserved communities will have the tools they need to implement this law successfully and fill in the gaps of the current state oral health delivery system.

On September 18, 2020, the state Department of Licensing and Regulatory Affairs held a public hearing on the second draft of rules written after public comments on the first draft. The second draft addressed issues of portability, which impacts dental therapists licensed or certified in other jurisdictions who want to practice in Michigan. In particular, Accreditation for the Alaska program was particularly helpful with ensuring that Dental Health Aide Therapists certified by the Alaska program have a pathway to licensure in Michigan.

Final rules have not yet been published by the state, but are expected in the near future.
Concluding Years Long Rulemaking Process, Maine Sees First Dental Therapist on East Coast
Six years after a dental therapy law passed in Maine, Claire Roesler has become the first practicing dental therapist in the state, and anywhere on the East Coast. Roesler will be working at Penobscot Community Health Care in Bangor, Maine and she will be working on preventive and routine care with the existing oral health team there.

Maine’s dental therapy law was signed into law in 2014. The statute provides dental therapists with an established licensing process, allows DTs to practice within an oral health team in various environments (including hospitals, clinics, and public health facilities, among others). Under the law, dental therapists can supervise up to three dental assistants and two hygienist. The state spent several years drafting rules implementing the law, a process that concluded earlier this year.

While dental therapists have been practicing in the United States for over 15 years, they are more prevalent in Western and Midwestern states. Roesler will be joining a clinic that focuses on increasing access to critical health care to underserved populations in the state. Although Maine’s law is not specific to the inclusion of Tribes, Maine is home to four American Indian Tribes that will be able to employ dental therapists if their health care facilities fall under the allowed practice settings. For more information on Maine’s dental therapy law, click here

Having a dental therapist practicing on the East Coast shows that the workforce model meets the needs of diverse communities across the country. Welcome to the East Coast, Claire Roesler!
Funding Opportunities & Resources
NIHB Fact Sheet on Tribal Oral Health During COVID
The National Indian Health Board (NIHB) has created a fact sheet on dental services during the COVID-19 pandemic. This fact sheet is part of a larger body of work created by NIHB to assist Tribes and American Indian/Alaska Native populations navigate the pandemic.

Click here to visit NIHB’s Tribal COVID-19 Resource 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.

While in person opportunities are currently unavailable, several online opportunities exist.

Click here to view the catalog of 2020 courses.
CDC Resources on Oral Health Services During COVID-19 Pandemic
The Centers for Disease Control and Prevention (CDC) has published several fact sheets, guidance documents, and other resources related to providing and accessing safe oral health care services during the COVID-19 pandemic.

These documents are entitles “Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response.”

Click here for more.
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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