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LETTER |
Dyan Campbell is with the Maternal-Infant Services Network, Inc, of Sullivan, Orange, and Ulster Counties, Central Valley, New York. Howard F. Pollick is with the Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco. Kathy M. Lituri is with the Department of Health Policy and Health Services Research, Boston University School of Dental Medicine, Boston, Mass. Alice M. Horowitz is with the National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md. John Brown is with the Department of Community Dentistry, University of Texas Health Science Center, San Antonio. Julie Ann Janssen is with the Division of Oral Health, Illinois Department of Public Health, Springfield. Karen Yoder is with the Division of Community Dentistry, Indiana University School of Dentistry, Indianapolis. Raul I. Garcia is with the Department of Health Policy and Health Services Research, Boston University School of Dental Medicine, Boston. Amos Deinard is with the Department of Pediatrics, University of Minnesota, Minneapolis. Sheranita Hemphill is with Sinclair Community College, Dayton, Ohio. Magda A. de la Torre is with the Department of Dental Hygiene, School of Allied Health Sciences, University of Texas Health Science Center, San Antonio. Buddhi Shrestha is with the Rochester/New York State Oral Health Coalition and the New York State Oral Health Technical Assistance Center, Rochester Primary Care Network, Rochester, NY. Clemencia M. Vargas is with the Department of Health Promotion and Policy, University of Maryland Dental School, Baltimore, Md. All authors are also with the American Public Health Association Oral Health Section.
Correspondence: Requests for reprints should be sent to Howard F. Pollick, Clinical Professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, 707 Parnassus Avenue, D-3212, San Francisco, CA 94143-0758 (e-mail: howard.pollick{at}ucsf.edu).
The article by Sekiguchi et a1.1 has provoked controversy around the acceptability of dental health aide therapists (DHATs) who are trained to provide diagnostic and dental treatment services in Alaskan Tribal health programs.
To deal with extensive unmet dental needs, DHATs have been trained under a federal program to deliver year-round care, under the general supervision of a dentist, in their remote villages, where it is difficult to recruit dentists.2 However, Sekiguchi et al.1 disagree with this initiative stating that dentists are the only personnel qualified to provide these services and that DHATs cannot be effective substitutes. They provide no evidence for their opinion.
In contrast, Nash3,4 has proposed that use of DHATs is an acceptable and valid means to address current unmet treatment needs, especially among young children, and not just in Alaskan villages. Double-blind studies comparing Canadian dental therapists with federal dentists demonstrated equivalent quality of dental restorations. Currently, there are some 42 countries with some variant of a dental therapist, including New Zealand, Australia, China (Hong Kong), Singapore, Thailand, Malaysia, Great Britain, and Canada.2
There has been a lack of dentists willing to work in these communities for years. Most dentists prefer to work in more economically viable communities. One of the constructive responses by the American Dental Association has been to ask Congress to fund a loan forgiveness program for dentists willing to work in the Indian Health Service where there are positions currently vacant.5
The Alaska Board of Dental Examiners has informed the State Attorney General that in the opinion of the Board, currently trained DHATs are practicing dentistry illegally. However, the Board has no jurisdiction, because the therapists are working in tribal programs outside the purview of state law.6,7 Ultimately, the tribes will decide which way to go.8
The leadership of the Oral Health Section of the American Public Health Association believes that the rural Alaska Natives will be best served by the DHATs and endorses the program as a practical and innovative response to address the extensive oral health needs of these communities.
References
1. Sekiguchi E, Guay AH, Brown LJ, Spangler TJ Jr. Improving the oral health of Alaska natives. Am J Public Health. 2005;95:769–773.
2. Alaska Dental Health Aide Program. Available at: http://www.phs-dental.org/depac/newfile50.html. Accessed July 6, 2005.
3. Nash DA. Developing a pediatric oral health therapist to help address oral health disparities among children. J Dent Educ. 2004;68:8–22.[Abstract]
4. Nash DA, Nagel RJ. Confronting oral health disparities among American Indian/Alaska native children: the pediatric oral Health therapist. Am J Public Health. 2005;95:1325–1329.
5. Palmer C. IHS recruitment dilemma. ADA backs loan repayment as key to filling vacancies. ADA News. Available at: http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1357. Accessed July 6, 2005.
6. Garvin J. Controversy in Alaska. Are dental therapists the answer to Alaska Natives’ caries crisis? Available at: http://www.agd.org/library/2005/april/garvin.asp. Accessed July 6, 2005.
7. Lyle PR Sr. State Licensure of Federal Dental Health Aides. File 663-05-0152. September 8, 2005. Available at: http://notes4.state.ak.us/pn/pubnotic.nsf/0/7dd55e5de43af6b58925707e007fceb8/$FILE/663-05-0152+Dental+Health+Aides.pdf. Accessed on October 12, 2005.
8. ADA News February 17, 2005 Available at: http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1265. Accessed July 6, 2005.
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