“That’s When Things Started to Change”

By Lowell Dempsey, January 31, 2016

I grew up just outside of Washington, DC, where there were at least five dentist offices within 20 minutes of my house. To travel any farther would have seemed ridiculous.

But nearly five years ago, I learned just how privileged I was to have dental care so nearby and accessible. I had just started work on the W.K. Kellogg Foundation’s dental access project, where I learned that the situation was dire for much of the nation, particularly for people in low-income, tribal and rural communities. Now, I have heard far too many stories of children and families traveling hours for care, and adults wrenching out their own teeth because of unbearable pain.

Statistics show how pervasive this problem is. Close to 50 million children and families live in areas that don’t have enough dentists. More than half of kids on Medicaid can’t find a dentist who will treat them. According to the Institute of Medicine, our current system of dental care doesn’t work for a third of the country, and for children of color and Native Americans, it’s even worse.

But for every great societal challenge, there is a moment when we look back and say, “That’s when things started to change.”

For our nation’s oral health crisis, that moment is now.

On January 4, 2016, the Swinomish Indian Tribal Community in Washington State took the historic step of exercising its sovereignty as a tribal nation to deploy a dental therapist in the community to bring preventive and routine care to tribal members in need of it.

In Washington, American Indian and Alaska Native kids suffer rampant tooth decay at rates three times the national average. The Swinomish community only has one dentist available to treat its 3,000 patients. The tribe, like other communities in Indian Country, has tried for years to add dental therapists to help with the patient load. But attempts to authorize dental therapists in Washington have failed repeatedly because of political opposition from organized dentistry.

The Swinomish tribe’s courageous step is the rallying cry of “Enough!”

Now is the time for tribes and supporters to reject the status quo of poor oral health, and to join a movement that brings dental care to people where they need it most: in their communities.

Things are changing as others in and around Washington follow in the Swinomish community’s footsteps. Here are recent signs of progress:

  1. An investigative Seattle Times article highlighted organized dentistry’s tactics opposing efforts to bring dental therapists to Washington.
  2. The Seattle Times editorial board stood in favor of dental therapists, and called on state lawmakers to license them in Washington.
  3. Washington State Sen. John McCoy openly called on lawmakers to allow native communities to recruit dental therapists.
  4. In Oregon, two other tribes, Confederated Tribes of Coos, Lower Umpqua & Siuslaw and Coquille Indian Tribes, applied for dental therapy pilots that are expected to receive approval.

Indian Country is at the helm of this progress, just as they have been in other states. Since dental therapists began practicing in Alaska a decade ago, for example, more than 45,000 Alaska Natives have gained access to dental care. And it’s paying off: tribes are beginning to see the first generation of cavity-free children.

I have been inspired to witness all of this unfold, to watch a desire for good oral health become a shared value, to follow along as communities like Swinomish courageously take action to achieve it, and to see that the tipping point for access to oral health is, finally, here.

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