Tribal Oral Health Newsletter
Issue 14
Spring 2022
The Latest Quarterly News on Oral Health from Across Indian Country
Tribal Dental Therapy News
Dental Therapy Training Program Serving Tribes Hiring Faculty in Washington State
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.
What is the Status of Dental Therapy in My State?
Use the National Indian Health Board'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!
Third Thursday of Every Month

2:00 PM Eastern

To be added to the invitation list,
contact Brett Weber, Program Manager, Public Health Policy and Programs at [email protected]
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 Congressional Justification Includes $20 Million Request for the Community Health Aide Program
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.
Advocates Call for Alternate Dental Providers Funding in 2023
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.

Oral Health Champion's Corner
This issue’s Oral Health Champion is Jessica Rickert, DDS, Prairie Band Potawatomi Nation!

Dr. Rickert is the first American Indian/Alaska Native (AI/AN) woman to become a licensed dentist. Her journey was not a direct one, however. She knew at age 12 that she wanted to serve people as a medical provider, but it wasn’t until she entered college at the University of Michigan that dentistry as a professional began to appeal to her.

Upon entering dental school, Jessica found herself in a class with only five other women in a class of 142, educated by a nearly all white male faculty. She remembers times when she felt discouraged by the lack of support for minority students, and while her family supported her every step of the way, her parents never went to college and could not offer practical guidance.

Since her time in training, Dr. Rickert has seen improvement in how public universities engage with AI/AN students and how dental schools recruit Black, Indigenous, and other people of color to become dentists, especially at the University of Michigan. Dr. Rickert sees her role as a guide for the next generation of AI/AN dentists, having mentored AI/AN dental students at institutions such as the University of Michigan and the University of Buffalo.

In her 40 years of private practice, Dr. Rickert worked to build patient trust, and through the Anishinaabe Dental Outreach program, she is able to provide oral health education to Native communities in Northern Michigan, interacting with everyone from expectant mothers to elders about excellent oral health as the basis for excellent physical health.

As a leader in the Society of American Indian Dentists (SAID), Dr. Rickert envisions a support network for Native dental students that continues to advance their dental careers and supports AI/AN dentists in leadership positions. She is excited about SAID’s next conference, where SAID members and others interested in Native oral health will gather from June 22-25 in New Mexico. Students interested in exploring a dental career can click this link

Thanks for all you do to keep Indian Country smiling, Jessica!
The Latest from State Legislatures
Colorado Legislature Considers Dental Therapy Bill in First for State
Dental therapy legislation has been introduced in the Colorado legislature for the first time. The bill would establish a statewide licensing process for dental therapists, focused providers who specialize in routine preventive and basic restorative care. These providers fill a critical gap in patient care, and Tribes that employ dental therapists have seen significant decreases in appointment wait times and significant increases in oral health services offered to their communities.

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.

Wisconsin Legislature Passes EFDA Bill, Holds Back on Dental Therapy For Now
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.

Maryland Expands State Medicaid Program to Include Dental Benefits for Adult Enrollees
Beginning January 1, 2023, Maryland is nearly set to become the latest of 34 states that offers adults enrolled in its Medicaid program coverage for dental services. Under legislation passed with significant bipartisan support, adults with an annual income at or below 133 percent of the federal poverty level will be eligible for diagnostic, preventive, restorative, and periodontal services.

While federal requirements ensure every child enrolled in Medicaid has dental coverage, each state determines whether adults enrolled in Medicaid receive dental benefits. Like other services in Medicaid, dental coverage is paid for by both federal and state funds, with the federal percentage varying state to state.

The legislature budgeted $26.9 million in Fiscal Year 2023 funding, which will be matched by $49.4 million in federal funding, to cover the expansion.

While Governor Hogan has not yet signed the legislation, the expansion was announced as part of a package of agreed upon spending items between the Governor and legislative leaders. 
Funding Opportunities and Resources
Medicaid Adult Dental Benefits: Improving Access for Tribal Populations
Community Catalyst, in collaboration with the National Indian Health Board, the Southern Plains Tribal Health Board, and Native American Connections created a policy brief explaining how a standard dental benefit for adult Medicaid enrollees would improve Tribal health. Read the brief here.
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 entitled “Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response.” Read more here.
Indian Country ECHO: CHAP Learning Collaborative
The Community Health Aide Program (CHAP) ECHO Learning Collaborative is designed to bridge the gap between traditional practices and modern standards of care through bringing together several types of practitioners, including Dental Health Aide Therapists (DHATs), Behavioral Health Aides and Practitioners (BHA/Ps), and Community Health Aides and Practitioners (CHA/Ps). Sessions are open to all, but advanced registration is recommended. Sign up here!
2022 IHS Continuing Dental Education Catalog
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. View the 2022 course catalog here.
National Indian Health Board | | (202) 507-4070
Visit the NIHB COVID-19 Tribal Resource Center at: 
To reach the NIHB COVID-19 Response Team, contact: [email protected]
For media inquiries, contact Janee Andrews at [email protected]