Tribal Oral Health Initiative

As the united voice for Tribes in the area of health advocacy, the National Indian Health Board (NIHB) brings together stakeholders including Tribal leaders, Tribal health directors, Area Indian Health Boards, Tribal Epidemiology Centers, and public health leaders to form the Tribal Oral Health Initiative, which explores solutions and develops recommendations to address oral health disparities and lack of access to oral health treatment and prevention services in Indian Country.

Across Indian Country, there is a wide consensus that the current oral health care delivery model is inadequate and has led to significant oral health disparities among American Indians and Alaska Natives (AI/ANs). One solution to Indian Country’s oral health crisis, first implemented by Tribes in Alaska, is dental therapy. Dental therapists are focused oral healthcare providers that offer basic dental treatment, with a special emphasis on preventative and routine care. Similar to physician assistants, dental therapists operate under the general supervision of a dentist. More and more Tribes are interested in dental therapy as they learn about the benefits Alaska Tribes have seen since 2004.

The NIHB’s Tribal Oral Health Initiative is a growing body of work that seeks to educate Tribal leaders on the oral health crisis’s solutions, including dental therapy. The Initiative has created resources for Tribes and their advocates available on this webpage, including a Tribal Dental Therapy 101 Toolkit, research, Tribal leader and Tribal healthcare administrator trainings, a Legislative Tracker comparing dental therapy legislation at the state and national level, and a Tribal Dental Therapy Implementation Guide, designed to help Tribes break down the barriers standing between them and an adequate oral health provider workforce.

Watch this short video to hear from Alaska Native youth in Kake, Alaska on how dental therapy helps their community:





How Does Dental Therapy Work in Indian Country?

Dental therapists have been practicing in Alaska Native communities since 2004. As part of the Community Health Aide Program (CHAP), which provides much needed health services in rural Alaska, dental therapists complete a rigorous two calendar year program, a 400 hour preceptorship under the direct supervision of a dentist, and then begin practicing in communities where the unmet oral health needs are the highest, usually in rural areas. Dental therapists are trained to perform the most common dental procedures with proficiency, which meets a significant proportion of patient need. Because of this, dentists can focus their limited time on the most serious cases, practicing at the top of their scope.

Due to a clause in the Indian Healthcare Improvement Act of 2010, Tribes are unable to adopt dental therapy as part of CHAP unless they receive state approval. However, Tribes interested in dental therapy have options. Swinomish Tribe in Washington State has used its sovereignty to develop its own licensing standards outside of the program. Swinomish has employed a dental therapist since January 2016, which is helping that Tribe meet its oral healthcare needs and is saving the Tribe money. Tribes in Minnesota, Washington, Arizona, and Maine have gained state authorization to hire dental therapists. Two Tribes in Oregon have also begun implementing dental therapy as part of a state pilot program.

NIHB continues to education members of Congress on the need to respect Tribal health sovereignty and not require Tribes to go through their states to receive the health care they need.

Why Dental Therapy is Right for Tribes

Diseases of the mouth and access to oral healthcare are critical issues for many American Indians and Alaska Natives. In fact, American Indians and Alaska Native children ages 2-5 years have an average of 6 decayed teeth, while the same age group in the U.S. population has only one decayed tooth. Furthermore, half of American Indians and Alaska Natives live in what are considered “dental shortage areas.” Often, the current health delivery system under-prioritizes oral healthcare so much that Tribes do not have the resources to even maintain adequate oral health, much less address these disparities.

The dental therapy model is extremely useful for areas with a shortage of oral healthcare providers. These dental shortage areas include many rural reservations. Because dental therapists teamed up with dentists are more cost effective than dentists operating alone, they actually save their programs money!

NIHB offers training to Tribal leaders on the potential that dental therapy offers to Indian Country and how they can implement their own dental therapy programs. On this website, you can see the Tribes, Intertribal organizations, and Area Indian Health Boards that have shown their support for dental therapy. NIHB also offers further resources on the dental therapy model, as you can see below.

Join the movement as Tribes continue to assert sovereignty and develop their own solutions to their people’s oral healthcare needs!

NIHB Contact:

Brett Weber
Congressional Relations Coordinator

National Indian Health Board
910 Pennsylvania Ave, SE
Phone: 202-507-4086
Washington, DC 20003
[email protected]