Issue 09
Winter 2021
Tribal Oral Health Newsletter
The Latest News on Oral Health from across Indian Country

In Your Inbox Every Quarter!
NIHB PHPP Director
Message from NIHB's New Public Health Policy and Programs Director!

Greetings and Happy New Year, 

Thank you all for taking the time to read the National Indian Health Board’s (NIHB) Tribal Oral Health Newsletter – it is truly labor of love to assemble all of this information. The purpose of this newsletter is to tell the stories of resilience, innovation, and determination taking place in oral health across Indian Country. NIHB remains committed in advancing Dental Health Aid Therapist (DHAT) Programs and improving Tribal oral health care outcomes. This is a shared journey that all of Indian Country walks in together and NIHB is proud to highlight the successes and lessons learned through quarterly newsletters. 

Oral health, much like Tribal public health, suffers from a lack of adequate resources necessary to properly address the disparities seen across Indian Country. This fact makes newsletters, such as this one, vital to amplifying current oral health resources developed by Tribes for Tribes. If your Tribe or Tribal organization would like to submit information to be included in the next NIHB Oral Health Newsletter, please reach out to Brett Weber at BWeber@nihb.org or Casey Long at CLong@nihb.org.  

Warmest Regards, 
Tyler M. Dougherty, MPH, CPH
Director of Public Health Policy and Programs
In This Issue
Tribal Dental Therapy News
- DHAT Students in Alaska Begin Second Year
- Oral Health in Tribal Communities with Medicaid

Updates from Capitol Hill and the Administration
- IHS and Tribes Continue CHAP Expansion Work in 2021
- New Administration Presents New Opportunities for Dental Therapy

The Latest in State Legislatures
- Oral Health in Michigan
- Florida Dental Therapy Bill Now Includes Tribes

Funding Opportunities and Resources
- American Academy of Pediatrics Graphic
- 2021 Continuing Dental Education Catalog for Dental Therapy
- Dental Therapy Toolkit
- Dental Portal
As the COVID-19 pandemic continues, normal oral health care services have been disrupted nationwide. Join the National Partnership for Dental Therapy in advocating for a solution to unmet oral health needs! The Partnership is co-chaired by the National Indian Health Board, Community Catalyst, and the National Coalition of Dentists for Health Equity.

Dental therapists are an invaluable resource to our oral health provider teams. Click here to learn how dental therapists can improve oral health in Tribal communities!

Click here for more information on how your Tribe or organization can endorse dental therapy!
Tribal Dental Therapy News
DHAT Students in Alaska Begin Second Year
On January 11, 2021, current students at the Alaska Dental Therapy Education Program began the second year of their curriculum. In the midst of the COVID-19 pandemic, program administrators have worked to ensure the year proceeds as normal and that the students’ learning experiences are not disrupted. Following a brief stint of online learning due to a localized COVID-19 outbreak, the program’s five students are able to conduct the full scope of clinical work in Bethel. The clinic in Bethel is available to the Dental Health Aide Therapist (DHAT) students through a partnership between Ilisagvik College and the Yukon-Kuskokwim Health Corporation.
 
The program graduated three students in August 2020, but was not able to accept a new cohort of first-year students because of the pandemic. As the five second-year students work and learn in the Bethel clinic, they will expand their patient interaction skills and fine tune their technique. 

The education program, headed by Dr. Sarah Shoffstall-Cone, is tentatively scheduled to accept first year students again in June 2021 and is planning to provide spots for out-of-state students. Click here to learn more about the program. 
Oral Health in Tribal Communities with Medicaid
By: Kristen Bitsuie, National Indian Health Board
Oral health is a huge part of overall health, especially in children and young adults ages 0-20. In the United States dental care in children is the most common unmet treatment in children. Tribal communities are no exception to this, in many instances Tribal communities even have more unmet dental health issues than other parts of the country. This is due to lower-incomes and less access to necessary resources. Currently, each state in America is required to provide access to dental coverage to children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). Specifically, through Medicaid every child enrolled is entitled to dental services, however depending on your state, a referral may be required to a dentist from a primary care doctor. This information is very important for Tribal communities because these programs could ultimately save Tribal youth from several series dental diseases such as Early Childhood Caries (ECC), which can start as soon as an infant’s tooth begins to grow in. ECC is described as the decay of teeth in children ages 6 and under. Other diseases can also stem from the lack of proper dental care and in most cases can be fatal.

One way Medicaid and the CHIP have succeeded in combating this issue is through “Early and Periodic Screening, Diagnostic and Treatment (EPSDT).” In many instances it is imperative that signs of tooth decay or other fatal diseases be diagnosed and treated early on before the infection has a chance to spread to other parts of the body. This benefit provides services, such as dental screenings, to children under age 21. Specifically, under this benefit children and young adults should receive and are eligible for services to relieve pain and infection, restore teeth, and overall dental health maintenance. The state, through Medicaid programs, is required to inform eligible individuals that these EPSDT services are available to them in order to mitigate future healthcare problems that can arise in children and young adults.

From the January 14, 2021 release of 2019 population estimates from the 5-year American Community Survey, 2015-2019, the average uninsured rate for American Indians and Alaska Natives Under 21 years old is roughly 7.4%. That 7.4% of the American Indian and Alaska Native youth population is at risk to several health disparities, many of which can be caused solely by the lack of dental and oral care attention. It is critical that American Indian and Alaska Native youth enroll in health insurance today and keep up with preventive measures to ensure their oral healthcare remains in good condition. Through the help of these programs the lives of American Indian and Alaska Native youth can be saved for a brighter future tomorrow.

Use NIHB'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!
Join NIHB's
Monthly
Tribal Dental
Therapy
Call!
Third Thursday of Every Month

2:00 PM Eastern

800-220-9875

Passcode:
28379700#
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 and Tribes Continue CHAP Expansion Work in 2021
At the December 10, 2020, meeting of the Community Health Aide Program (CHAP) Tribal Advisory Group (TAG) the Tribal members made substantial progress in the work to establish CHAP infrastructure in Tribal communities outside Alaska. The TAG elected a new Tribal chairperson, Mae-Gilene Begay, the Community Health Representative Program Manager from Navajo Nation. The TAG also provided recommendations for how the Indian Health Service should allocate the $5 million appropriated by Congress in Fiscal Year 2020 for CHAP expansion. The TAG’s recommendations were:
 
  • $1 million to IHS Headquarters to establish national CHAP infrastructure 
  • $2.5 million total to the Portland, Alaska, and Billings Areas to support the Areas with CHAP infrastructure ready to operate 
  • $1.5 million total to the remaining nine Areas to establish Area CHAP infrastructure 

The CHAP TAG also recommended that if one of the nine Areas did not utilize its portion, the money be reallocated to the remaining eight Areas, and that none of the funding be distributed via competitive grants.
  
The CHAP TAG is planning on meeting regularly in 2021, possibly as often as monthly. Click here to learn more about CHAP TAG.  

Biden Task Force Supports Dental Therapy
Before Joe Biden was elected President of the United States and sworn into office, his campaign partnered with Senator Bernie Sanders to create a task force to highlight how the Biden Administration would improve health care throughout the country. You can find more about the task force recommendations here.  

The task force document makes clear the inequities that live within the United States, especially in health care. The task force is supportive of investing in community health centers and rural health clinics by increasing support for dental care and expanding the number of dental professionals. There is a desire to increase dental therapists, who would provide access to preventive and primary health care to Americans in rural and low-income metropolitan areas. With the new administration, dental therapy remains in a strong position to improve oral health outcomes throughout Tribal communities.
Oral Health Champion's Corner
This issue’s Oral Health Champion is Trisha Patton, a Dental Health Aide Therapist Instructor Practitioner with the Alaska Dental Therapy Education Program. Trisha became a Dental Health Aide Therapist, or DHAT, in 2011 as part of the fourth cohort of students graduating from the Alaska Dental Therapy Education Program. For the next four years, Trisha provided restorative, preventative, and emergent care services to six Alaska Native communities in the Yukon Kuskokwim Delta. One of those communities was home to her husband’s family, and she connected with many of her patients to get them more comfortable seeking oral health care. She also worked with local educators to set up a school brushing program so that all students in her communities had exposure to oral hygiene. 

In her current role, Trisha observes DHATs in-training during their clinical hours in Bethel and provides feedback. Trisha also leads the infection control course and co-leads a professionalism class for the students. Over the past year, Trisha helped create protocols for the program’s operations during the COVID-19 pandemic. 

Coming from the Alaska Native community of Napakiak, Trisha says her favorite part of her work is when she is able to provide a treatment plan to a community member in her Native language. 

Thanks for all you do to keep Indian Country smiling, Trisha! 
The Latest from State Legislatures
Oral Health in Michigan
It has nearly been two years since Gov. Rick Snyder signed legislation to enact Public Act 463 of 2018 in Michigan, but progress has been made as Michigan is moving forward with a path to license dental therapists. One of the greatest challenges over the last year has been COVID-19, but the draft licensing rules were approved by the Board of Dentistry on November 12, 2020.  

On another note, the dental therapy journey in Michigan has moved forward, again, by Rep. Jason Sheppard’s legislation, House Bill 5827. This legislation was needed to address a single health issue that could not be clarified through the rules language. Ultimately, HB 5827 allows required hours of clinical practice to be supervised by a dentist licensed in the state where the education program is in, not limiting it to a Michigan dentist as previous statute had done. This is ideal for students who want to attend school out of state while Michigan works to refine their educational program. Governor Whitmer signed the bill into law on New Year's Eve. 

To find more about dental therapy in Michigan, click here.
Florida Dental Therapy Bill Now Includes Tribes
Florida State Senator Jeff Brandes has introduced a dental therapy bill for the 2021 legislative session, building off a similar bill he introduced in the 2019 session. Senate Bill 604 would license dental therapists to practice in the state. Similar to the 2019 legislation, SB 604 requires dental therapists to graduate from a program accredited by the Commission on Dental Accreditation (CODA) and does not require dental therapists to have a dental hygiene license. Currently, the only CODA-accredited dental therapy program is housed by Ilisagvik College in Alaska.

While the bill enumerates the practice settings where dental therapists can operate, such as schools, nursing homes, dental health professional shortage areas, and others, the 2021 bill differs from the 2019 version in an important way: explicitly including facilities operated by the Indian Health Service (IHS) or a Tribe as a practice setting for dental therapists. While most Tribal facilities may be covered by other categories such as Federally Qualified Health Centers, facilities in dental provider shortage areas, or facilities with a predominantly underserved population, these categories may not capture every Tribal clinic. By explicitly including Tribal and IHS facilities, the bill will ensure Florida’s two Tribes are able to take full advantage should the bill become law.
 
NIHB will continue to update partners about the status of this and other state dental therapy legislation. For an overview of this legislation, click here.
Funding Opportunities & Resources
American Academy of Pediatrics
The American Academy of Pediatrics has created a new graphic and 30-second snippet to demonstrate tooth brushing technique in a language free format. This graphic and video was created for families with limited English; but the information explains the using the appropriate amount of toothpaste, motions for each portion of the mouth, and bushing both day and night. The video can be found here, and it is a perfect resource for individuals working with children and families.
2021 Continuing Dental Education Catalog from the Indian Health Service
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.

While in person opportunities are currently unavailable, several online opportunities exist.

Click here to view the catalog of 2021 courses.
Dental Therapy Toolkit
The W.K. Kellogg foundation has developed the Dental Therapy Toolkit and is a resource for advocates and partners. This resource spotlights the work of dental therapists and emphasizes how they promote economic development through job creation and business growth, and how they increase the access of care by being an addition to the dental care team. The toolkit can be found here. 
IHS Dental Portal
The IHS Dental Portal contains resources including reports and data on Tribal oral health.

The IHS gathered data as part of the 2010, 2014, 2015, and 2016-2017 Oral Health Surveys.

To view the draft IHS Division of Oral Health Strategic Plan for 2018-2017, click here.
910 Pennsylvania Avenue, SE
Washington, DC 20003
Main Phone: 202-507-4070
Fax: 202-507-4071