Dental therapy education programs are growing across the country, including one in Washington State that will train many of the Dental Health Aide Therapists (DHATs) working for Tribes in the state. The dex-xayebus (the Lushootseed word means “Place of Smiles” and is pronounced dah-hi-ya-buus) Dental Therapy Education Program located in Mt. Vernon, Washington is currently recruiting for two main program coordinator positions ahead of its anticipated opening later this year.

1) Dental Therapy Clinical Coordinator Faculty

The Clinical Coordinator position is responsible for developing, planning, organizing, directing, and integrating the clinical training and applicable community outreach activities. This position provides didactic and clinical oral health instructions to Dental Therapy students. The Clinical Coordinator Faculty will perform clinical services for patients as well as clinical supervision of Dental Therapy trainees at SVC, clinical site facilities, and during the community rotations.

2) Dental Therapy Education Coordinator Faculty

The Education Coordinator Faculty is responsible for curriculum cultivation and assuring course content is meeting and/or exceeding industry standard. This position is responsible for managing all supporting course content materials such as selecting specific training modules and textbooks. The Education Coordinator Faculty provides training of new instructional methods and topics to faculty and adjunct instructors as required.

Click here to view the job postings here. The postings will remain open until filled.

Each year, all federal agencies publish a Congressional Justification that details its funding requests to Congress for the upcoming Fiscal Year (FY). The Indian Health Service’s (IHS) FY 2023 Congressional Justification has an overall budget request of $9.3 billion for the agency to meet the health needs of 2.7 million American Indians and Alaska Natives. The 2023 Congressional Justification also includes, for the first time ever, a request to put IHS’s budget under mandatory funding, a long sought goal that would ensure IHS’s budget is not subject to government shutdowns or appropriations politics.

Included in IHS’s request to Congress is $20 million to expand the Community Health Aide Program (CHAP) to Tribes outside Alaska. CHAP provides certification to community members to provide frontline medical, behavioral, and dental health services in Native Alaska communities. Dental Health Aide Therapists (DHATs) in the Tribal health system work under this program. In 2010, Congress granted IHS the authority to expand CHAP to Tribes nationwide, which IHS began in 2016. Due to funding limitations, IHS has not completed the expansion and Tribes in different Service Areas have had varying levels of expansion work completed. In 2021, IHS funded grants for a small number of Tribes to assess and plan for CHAP expansion, and a separate grant for Tribes to implement CHAP expansion.

In 2020 and 2021, Congress appropriated only $5 million in annual CHAP expansion funding, far below the needed level. IHS’s $20 million request for 2023 funding represents a substantial increase to “training, certifying, and hiring of health aides, as well as national program management activities.”

Congress is not required to enact the funding levels requested or even base their appropriations levels on the agency’s request. It will not be known how much funding is available for CHAP expansion until Congress release appropriations bills in late spring and early summer.

The COVID-19 pandemic exacerbated a significant dental health workforce shortage. These shortages only intensify the existing barriers to access to dental care. Dental care is out of reach for many Americans, especially American Indians and Alaska Natives. Almost 62 million Americans live in areas without dental providers.

To expand the number and types of oral health providers across the country, the Health Resources and Services Administration (HRSA) can provide alternative dental health provider workforce grants to states and Tribes. However, Congress has included language defunding this program in its annual appropriations bills. While advocates were successful in removing this language in initial 2022 bills, the omnibus package that funded the government through the end of Fiscal Year (FY) 2022 ultimately included the prohibition on funding the program.

The National Indian Health Board (NIHB), along with 90 other health organizations, sent a letter to House and Senate leadership urging them to eliminate this funding ban in FY 2023 and fully fund the alternative dental health care provider demonstration grant program. Fully funding the program would allow states and Tribes to employ the dental providers, including dental therapists, and reduce dental shortages. Lifting the ban and fully funding this grant program would accelerate the implementation of dental therapists and more importantly address the provider shortage and increase access to oral health care.

Read the letter to the Senate here and the letter to the House of Representatives here.

The Colorado legislation is based off the standards created by the Commission on Dental Accreditation (CODA) and allows a dental therapist to work under the indirect supervision of a dentist for most procedures, meaning the dentist approves the treatment plan and is available for consultation if needed.

The last day of the 2022 legislative session in Colorado is May 11, leaving not much time for the legislature to pass the bill. However, S. B. 22-219 is sponsored by the Senate Majority Leader and has already been referred out of the Senate Health & Human Services Committee.

National Indian Health Board’s summary of the Colorado legislation is available here.

As the National Indian Health Board previously reported, the Wisconsin legislature considered different oral health workforce models to reduce unmet dental health need throughout the state, including in the state’s Tribal communities. Despite a unanimous vote in the state senate in support of dental therapy, ultimately, the legislature adopted a bill bringing Expanded Function Dental Auxiliaries (EFDA) to the state instead of dental therapists.

EFDAs are Dental Assistants trained to take on additional services. The scope of practice for an EFDA includes preventative oral health services like the application of sealants, impressions, temporizations, packing cord, removal of sutures and cement from crowns. To become an EFDA, a Dental Assistant in Wisconsin must obtain 70 hours of classroom instruction followed by 3000-practicing hours under a dentist before becoming certified as an EFDA.

In contrast, a dental therapist completes a two-calendar year program and does not need to be a Dental Assistant prior to entering the Dental Health Aide Therapy program. A dental therapist’s scope of practice includes community based oral health care with routine preventative and basic restorative care.

The new Wisconsin law places many requirements on the education and certification process to become an EFDA that would take longer to see improvements in oral health. Although EFDAs are helpful, they are not nearly as impactful as dental therapists. Tribes in Wisconsin support dental therapy because the provider’s scope of practice meets a higher percentage of patient need. A dental therapist’s education includes culturally specific components, which would provide culturally competent oral health care. This improves the level of comfort patients feel with providers and would improve oral health care to the Tribe’s population.

Advocates in the state are still supportive of dental therapy to provide restorative care to underserved communities and are hopeful the legislature will pass a dental therapy bill next year.

Click here to read the Wisconsin Legislature’s EFDA law.

Click here to read NIHB’s summary of the Wisconsin dental therapy bill.