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From NPR News this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MELISSA BLOCK, host:

And I'm Melissa Block. The American Dental Association filed suit this week to stop a program that provides dental care in rural Alaska. It involves what is known as dental therapists. They provide cleanings and also fill cavities and pull teeth.

Alaska's the only state that allows dental therapists to work legally and the ADA says the more complicated procedures should be reserved for dentists. Alaska's Public Radio Network's Annie Feidt reports.

ANNIE FEIDT reporting:

The Indian Health Service launched Alaska's dental therapy program more than a year ago. The federal agency allows the therapists to treat Alaska natives. But the American Dental Association thinks they should be subject to state licensing laws like dentists. Jim Toll is executive director of the Alaska Dental Society which signed on to the lawsuit and echoes the concerns of the ADA. He says the therapists are practicing dentistry illegally.

Mr. JIM TOLL (Executive Director, Alaska Dental Society): When we learned that there were training people taking people with essentially only a high school education. Sending them out of the country, and they were coming back and doing irreversible surgical procedures, we said wait. That's not good and it's not safe.

FEIDT: There are no dental therapy training programs in the United States. So Alaska's dental therapists study in New Zealand instead, where therapists have been working since the early 1920s. Dental therapists practice in other countries too, like Canada and Australia. But Alaska's therapists are the first to treat patients in the U.S. There are currently eight working in rural Alaska with four more in training. They're allowed to perform simple fillings and extractions. But Jim Toll says even minor procedures can lead to serious complications.

Mr. TOLL: I have yet to meet a dentist who would tell you that there's any such thing as a simple extraction until it's over. Dentists are trained to deal with all of the anomalies once they get in there and start doing that, to recognize to know how to respond and compensate.

FEIDT: At a clinic in Bethel in western Alaska, 10 dentists serve a region the size of Washington State.

Unidentified Woman: A little tiny sweep, and then brush down.

FEIDT: Most patients aren't on the road system so even a minor problem requires a long and expensive plane trip. The Bethel Clinic is trying to entice six more dentists to join their team with compensation packages of almost $180,000 a year. But the positions have been open for six years. Dentist Mary Willard says therapists are beginning to fill the need.

Ms. MARY WILLARD (Dentist): We have a whole waiting room full of people with tooth aches basically and we tend to treat our patients on a as-need basis sometimes because we're so short of staff. That's not really the most efficient way to do dentistry.

FEIDT: Kids in rural Alaska suffer from tooth decay at two-and-a-half times the national average. Lillian Magilten (ph) is a dental therapist who just began practicing in Tuksuk Bay, a small village on the Baring Sea.

Ms. LILLIAN MAGILTAN (Dental Therapist): When I was in Christ's Church, the dental therapist, my host dental therapist, Esreket (ph). She's like oh, look at all these bombed out teeth. You know and I'd look over her shoulder and then they'd come up, and then you come back to Alaska and it's like, man, those bombed out teeth are nothing compared to what I'm seeing today.

FEIDT: The tribal organization that oversees the program is hopeful the therapists will win the right to continue practicing. Legal Affairs Director Valerie Davidson says a lot is at stake.

Ms. VALERIE DAVIDSON (Legal Affairs Director): I think it will be a significant loss. Right now the dental health therapists are providing a service in many villages in which they have no other access to dental care. The dentists aren't there.

FEIDT: There are pockets of dentist shortages in inner cities and rural areas across the country. And supporters of Alaska's program think it could work in the rest of the United States. The American Dental Association has taken that part of the battle to Congress. A bill making its way through the Senate will prevent Alaska's program from expanding beyond the state.

For NPR News in Anchorage, I'm Annie Feidt.

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