Planning an Oral Health Future
Planning an Oral Health Future
Despite their long-standing contributions in other countries, dental therapists were largely unknown and were certainly not used in the United States until their introduction into a few Alaska Native communities in 2006. Native villagers wanted a regular source of dental care, but over many decades, they have been unable to recruit dentists to serve these small, isolated communities. As a result, they searched for alternatives and settled on the dental health aide therapist (DHAT) concept that was successfully implemented in New Zealand and other countries.
The reaction of organized dentistry was initially to pursue legal means to stop this practice of "illegal dentistry." When that failed, the American Dental Association offered the community dental health coordinator (CDHC) as a preferred alternative. The CDHC has no independent clinical duties but serves as a liaison to help patients overcome obstacles to care, such as transportation and financing. Such a person might be very helpful in addressing some of the barriers to obtaining dental care.
But what if a community has no clinical dental services available? The DHAT in an Alaska Native village lives in the community year-round; he or she provides clinical care and oral health education in schools and promotes health behaviors in the community at large. Critics of the DHAT concept have overlooked the latter role. DHAT trainees are selected from individuals who have a strong desire to return after training to live in their home communities. When they return home, they also serve as role models for others. In essence, we have a local community devising a solution for its problems by adapting a concept studied and widely used with success in other parts of the world. We should be admiring, not assailing, such efforts.
In its 2011 report, the Institute of Medicine commented that:
...[C]ommunity health workers...link community members to systems of care, help to mobilize communities to change the conditions for health, and conduct health education. Community workers seem to be most effective when they are selected from among individuals who are respected and trusted by their communities. In addition to their knowledge of the community's needs, their formal participation in the public health enterprise may also reassure community groups that are wary of government systems or health care providers for political, economic, or other reasons. In general health care, the use of community health workers has been shown to increase utilization of health care services and improve outcomes.
The introduction of the DHAT and CDHC roles into Alaskan villages would seem to be very much in line with this concept.
With the development of dental therapists (DTs) and advanced dental therapists (ADTs), Minnesota has adapted the DHAT concept to address its dentally underserved population. Whether other communities in the United States find the Alaska and Minnesota approaches useful remains to be seen; nonetheless, it is an exciting time as communities begin to explore and implement their own solutions in the absence of adequate professionally driven solutions.
Using More Dental Auxiliary Providers
Despite their long-standing contributions in other countries, dental therapists were largely unknown and were certainly not used in the United States until their introduction into a few Alaska Native communities in 2006. Native villagers wanted a regular source of dental care, but over many decades, they have been unable to recruit dentists to serve these small, isolated communities. As a result, they searched for alternatives and settled on the dental health aide therapist (DHAT) concept that was successfully implemented in New Zealand and other countries.
The reaction of organized dentistry was initially to pursue legal means to stop this practice of "illegal dentistry." When that failed, the American Dental Association offered the community dental health coordinator (CDHC) as a preferred alternative. The CDHC has no independent clinical duties but serves as a liaison to help patients overcome obstacles to care, such as transportation and financing. Such a person might be very helpful in addressing some of the barriers to obtaining dental care.
But what if a community has no clinical dental services available? The DHAT in an Alaska Native village lives in the community year-round; he or she provides clinical care and oral health education in schools and promotes health behaviors in the community at large. Critics of the DHAT concept have overlooked the latter role. DHAT trainees are selected from individuals who have a strong desire to return after training to live in their home communities. When they return home, they also serve as role models for others. In essence, we have a local community devising a solution for its problems by adapting a concept studied and widely used with success in other parts of the world. We should be admiring, not assailing, such efforts.
In its 2011 report, the Institute of Medicine commented that:
...[C]ommunity health workers...link community members to systems of care, help to mobilize communities to change the conditions for health, and conduct health education. Community workers seem to be most effective when they are selected from among individuals who are respected and trusted by their communities. In addition to their knowledge of the community's needs, their formal participation in the public health enterprise may also reassure community groups that are wary of government systems or health care providers for political, economic, or other reasons. In general health care, the use of community health workers has been shown to increase utilization of health care services and improve outcomes.
The introduction of the DHAT and CDHC roles into Alaskan villages would seem to be very much in line with this concept.
With the development of dental therapists (DTs) and advanced dental therapists (ADTs), Minnesota has adapted the DHAT concept to address its dentally underserved population. Whether other communities in the United States find the Alaska and Minnesota approaches useful remains to be seen; nonetheless, it is an exciting time as communities begin to explore and implement their own solutions in the absence of adequate professionally driven solutions.
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