Tribal Oral Health Newsletter
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The Latest News on Oral Health from across Indian Country
In Your Inbox Every Quarter!
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In This Issue
Tribal Dental Therapy News
--Fort Peck Tribes Declare Oral Health State of Emergency
--NIHB Funding Tribes for DHAT Work
--Dental Therapy Program Returning to Saskatchewan Indigenous Communities
Updates from Capitol Hill
and the Administration
--Dental Demonstration Program Appropriations Update
--CHAP Expansion Funding Announced by IHS
--Indian Health Service Congressional Justification Outlines Agency's Dental Priorities for 2022
--Congress Considers Dental Benefits For Medicare
The Latest in
State Legislatures
--Oregon Legislature Passes Statewide Dental Therapy
--Maine Expands Dental Benefits
Funding Opportunities
and Resources
--Everything You Need to Know about Dental Therapy
--CHAP Learning Collaborative
--CDC Resources on Oral Health Services During COVID-19 Pandemic
--2021 Continuing Dental Education Catalog from the Indian Health Service
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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!
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Want to Learn More About
How Dental Therapy
Benefits Tribes?
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Tribal Dental Therapy News
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Fort Peck Tribes Declare Oral Health State of Emergency
The Tribe conducted a community health assessment in 2016 found that 1 in 3 high school students had not received dental care in over a year, and that the Tribe's population to dentist ratio was 43% higher than the national average, indicating a shortage of dentists.
The Tribe is hopeful that the declaration will lead to an increase in funding for much needed dental staff across the reservation.
The National Indian Health Board hosted a series of roundtables at the Tribe in 2019. Many participants noted that wait times for dental appointments can be over six months and that many patients are referred to Billings for complex dental care, which requires a nine-hour roundtrip drive. Click here to read more about the roundtables.
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NIHB Funding Tribes for DHAT Work
The National Indian Health Board is proud to announce the 2021-2022 recipients of the Tribal Oral Health Initiative’s dental therapy in Indian Country funding opportunity. These Tribes and Tribal organizations will work on projects related to dental therapy, including implementing the innovative workforce model in Tribal dental clinics, recruiting community members to look at a dental therapy career, and educating Tribes and other stakeholders on the benefits dental therapy can bring to underserved communities. This year’s recipients are:
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Dental Therapy Program Returning to Saskatchewan Indigenous Communities
A partnership between indigenous communities and universities in Saskatchewan aims to begin training dental therapists in the Canadian province by March 2022. Like American Indians/Alaska Natives in the United States, indigenous peoples in Saskatchewan suffer from poor oral health outcomes stemming in large part from historical trauma, alienation from traditional foods, and a shortage of dental providers. First Nations leaders in the province are working to ensure dental therapists are the reliable, culturally competent, and effective solution to oral health needs in their communities. In the 1970s and 80s, dental therapists trained and worked in the province, but funding cuts eliminated the education program, and there has been no dental therapy education program in Canada since 2011. More information on dental therapy in Canada can be found here.
This new pilot project in Saskatchewan is the latest example of indigenous communities benefitting from dental therapy’s flexible, accessible workforce model. While National Indian Health Board serves only federally recognized Tribes in the United States, this development is another example of indigenous communities working to improve their own oral health care and will serve as a positive example to Tribes in the U.S. looking to do the same.
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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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Join NIHB's
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Tribal Dental
Therapy
Meeting!
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NIHB COVID-19 Tribal Resource Center
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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.
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Updates from Capitol Hill and the Administration
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Dental Demonstration Program Appropriations Update
In 2010, Congress created the Alternative Dental Health Care Provider Demonstration Project to allow states and Tribes to bring innovative oral health care workforce models to their communities. This $60 million program would have allowed Tribes selected by the program to incorporate providers such as dental therapists into their oral health care teams. However, every year since the program’s creation, congressional appropriators have included language in the annual spending bill to block funding for the program. This year, however, the House Labor and Health & Human Services Appropriations subcommittee did not include the language blocking funding in its legislation, which passed the House of Representatives as part of a minibus on July 29, 2021. There are still many things that must happen, including the Senate legislation being released, before advocates can claim victory. However, the House not including the ban on funding in its legislation is an unprecedented step and a very promising sign for Tribes’ ability to benefit from the Alternative Dental Health Care Provider Demonstration Project.
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CHAP Expansion Funding Announced by IHS
The Indian Health Service (IHS) has worked to expand the Community Health Aide Program (CHAP) to Tribes outside of Alaska for several years. CHAP provides medical, behavioral, and dental services to Tribes in Alaska where the Western health care model has struggled to provide care. CHAP providers often come from the communities they serve, and the success of the program in Alaska led IHS to begin expanding CHAP to Tribes nationwide in 2016.
However, funding the expansion has been easier said than done. For the past two years, IHS has asked Congress for $25 million to expand CHAP, and Congress has only funded $5 million for each year, for $10 million total. In an April 28, 2021 Dear Tribal Leader Letter, IHS announced that it was combining the two years’ funding into one pool to support Tribes and Tribal organizations plan for and implement expansion. IHS will award three $1 million grants to build out existing CHAP infrastructure and nine grants of $520,000 to support CHAP planning and assessment. Funds will be obligated by September 30, 2021.
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Indian Health Service Congressional Justification Outlines Agency's Dental Priorities for 2022
Each year, the Indian Health Service (IHS), like every federal agency, publishes a Congressional Justification, outlining the priorities of the agency and recommending budget appropriations to Congress. For Fiscal Year (FY) 2022, IHS is asking Congress to fund the agency’s dental line item at $287.3 million, an increase over FY 2021’s enacted funding level of $214.7 million. The Congressional Justification also requests $25 million in FY 2022 for expansion throughout Indian Country of the Community Health Aide Program, which provides medical, behavioral, and dental health services in Alaska Native communities. This funding would support the development of training centers for these providers at Tribal Colleges and Universities. IHS also plans to continue the Tribal Assessment and Planning Grants and the Tribal Planning and Implementation Grants to support Tribes and Area Indian Health Boards that are in various stages of preparation for CHAP expansion.
IHS found that the 2.6 million dental services performed in the Indian health system in FY 2020 represented a 36% decrease from the previous year—this is a quantifiable impact of the COVID-19 pandemic’s disruption of the Indian health system as dental clinics closed for several months to all but emergency care.
Among the agency’s priorities for dental health is to increase the number of American Indian/Alaska Native children with dental sealants and topical fluoride application to increase access to dental care across all age ranges. Evaluation data from the IHS Early Childhood Caries Collaborative, in operation from 2009 to 2017, shows that sealants increased by 65% and fluoride varnish application increased by 68.2% for children younger than six. From 2010-2019, IHS reports that childhood caries decreased by 5% across the Indian health system and untreated decay in children under six decreased by 14%, the first decrease in this area reported documented by IHS.
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Congress Considers Dental Benefit for Medicare
Currently, Medicare covers only emergency oral health care services. Recently, however, prominent members of Congress have indicated interest in expanding the program to cover regular and preventative dental care. Senate Majority Leader Chuck Schumer (D-NY) announced that the Senate’s $3.5 billion reconciliation package would include a provision expanding Medicare’s coverage to include dental, hearing, and vision care for the program’s 44 million enrollees, including approximately 650,000 American Indian/Alaska Native people. With a closely divided Congress, the expansion of Medicare to include dental and other coverage still faces many hurdles to be enacted.
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Oral Health Champion's Corner
This issue’s Oral Health Champion is Denise Goudelock, a dental hygienist at Puyallup Tribe!
Ms. Goudelock operates the school-based sealant program for Puyallup Tribal Health Authority at the tribal school, and she is active with volunteer activities in the community. She has been a dental hygienist for 33 years, spending 23 of those years with the Tribe.
Denise graduated from the Virginia Commonwealth University in 1988 following an externship at the Pine Ridge Indian Reservation in South Dakota, where she worked to educate community members on the link between commercial tobacco use and dental health. Following her externship, Goudelock became the reservation’s permanent dental hygienist. Following her time at Pine Ridge, she became a commissioned dental hygienist with the U.S. Public Health Service, which led her to Puyallup.
Ms. Goudelock was drawn to dental hygiene as a profession because of its impact on children. Before the COVID-19 pandemic, she would visit the Tribe’s school every week to provide preventative treatment for the students. Denise also helps screen the Tribe’s preschool children and apply fluoride varnish. Understanding the holistic nature of health, Denise assists the Tribe with diabetes, prenatal, and tobacco cessation public health work. She also assisted the tribe with its drive through COVID-19 testing sites.
Denise says her favorite part of her job is protecting, promoting and advancing the health and safety of the people she serves in the community.
Thanks for all you do to keep Indian Country smiling, Denise!
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The Latest from State Legislatures
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Oregon Legislature Passes Statewide Dental Therapy
The Oregon state legislature has passed a bill allowing licensed dental therapists to practice across the state of Oregon, including in the state's Tribal communities. Dental therapists, focused providers who specialize in routine preventative and basic restorative oral health care services, have worked in Oregon as part of a pilot project, including at select Tribal and Urban Indian health organization pilot sites, since February 2016. The new law allows them to practice in Tribal communities and in health settings across the state.
In addition to the Oregon pilot sites, dental therapists are currently working in Minnesota, Maine, Idaho, Washington State, and Alaska, where evidence has shown dental therapists have improved oral health outcomes and increased patient care. Oregon's bill follows the education standards approved by the Commission on Dental Accreditation (CODA). Oregon dental therapists will have to graduate from a CODA-accredited program. There is no degree requirement or hygiene licensure requirement in the legislation.
The new Oregon law also provides authorization for dental therapists working under the Community Health Aide Program (CHAP). The Indian Health Service is working to expand CHAP, which certifies medical, behavioral, and dental health care providers in the Alaska Area, to all of Indian Country. Dental therapists working under CHAP could use that federal certification instead of a state license. Governor Brown signed the bill into law on July 19, 2021.
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Maine Expands Medicaid Dental Benefits
Because each state operates its own Medicaid program, exact levels of coverage can vary. While the federal government requires baseline coverage for state Medicaid coverage, states can choose to go above those baselines or not to. Not every state offers comprehensive oral health care benefits for adult Medicaid enrollees. Maine is one of ten states not to offer comprehensive adult dental coverage, but that is soon to change. In the state budget, signed by Governor Mills on July 1, lawmakers included funding for full dental coverage for the state’s approximately 217,000 enrollees, which includes approximately 7,300 American Indian/Alaska Native people. This benefit will allow Medicaid enrollees in the state to access preventative oral health care, improving oral health and avoiding expensive emergency room dental care.
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Funding Opportunities & Resources
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CDC Resources on Oral Health Services During COVID-19 Pandemic
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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 entitled “Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response.” Click here for more.
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CHAP Learning Collaborative
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Everything You Need to Know About Dental Therapy
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The W.K. Kellogg Foundation has created a comprehensive guide to dental therapy in America, including historical benchmarks, data on the financial impact dental therapists have on the oral health care delivery system, and case studies on the difference dental therapists can make for their patients. Click here to read more.
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2021 Continuing Dental Education Catalog
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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 2021 courses.
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