Copyright ©2008 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

RACHEL MARTIN, host:

Way out on the edge of the Bering Sea in the most remote parts of Alaska, it's tough to get access to a lot of things, as you can imagine. Sometimes people have to drive for an hour to get to the nearest corner store. Turns out that getting access to a dentist can be even more challenging. Dentists are few and far between in this part of the country.

And the native Alaskans who live in that area are suffering from disproportionately high rates of dental decay and dental loss. To deal with it, communities there have started to train their own so-called "dental therapists" to fill cavities and clean teeth, but the American Dental Association says these people aren't real dentists, and they could end up doing more harm than good.

We read about this in an article. We decided to rip from the headlines of the New York Times. I spoke with Carol Odinzoff of the Alaska Native Tribal Health Consortium. She's the project manager of the community-based program that's training students to become dental therapists. Your program decided that you could address this need by training more dentists, right?

Ms. CAROL ODINZOFF (Project Manager, Dental Health Aide Initiative, Alaska Native Tribal Health Consortium): Well, we're training dental-health aides.

MARTIN: Explain the difference. What is a dental-health aide? And how does that compare to a fully trained dentist?

Ms. ODINZOFF: In about 2000, the Alaska Tribal Health System decided that we were going to have dental-health aides, and since that time we sent some out to get trained in New Zealand, because 42 other countries around the world already have dental-health therapists. We sent ten out who are currently working in our Alaska tribal villages.

MARTIN: So, these are people who receive training to provide services that aren't full-fledged dentistry, but that first level of care. What kinds of procedures are they trained to perform?

Ms. ODINZOFF: We've got dental-health therapists who are trained over a two-year period of time to do drilling, and filling, cleaning, and they do some invasive processes such as pulling teeth in collaboration with their dentist.

In other words, they're not going to just pull a tooth. They're going to work collaboratively with their dentist to make a decision on whether the tooth needs to be pulled. They use a lot of telemedicine, where they'll actually take a picture of the tooth in question, and after they take that picture they can email it to the dentist.

MARTIN: Mm hm.

Ms. ODINZOFF: So they have that collaboration.

MARTIN: And are the dentists in Anchorage, or in city center, or outside of Alaska?

Ms. ODINZOFF: We have four corporations around Alaska currently using dental-health-aide therapists. So, for instance, in the western part of Alaska, there's a town called Bethel where they have a hospital, and a population of 6,000.

In the communities surrounding Bethel, there's 25,000 people in 50 villages. The corporation there, the Yukon-Kuskokwim Health Corporation, has four - three dental-health-aide therapists in those rural communities.

MARTIN: As you mentioned, this kind of care, dental therapists, this is something that, according to the World Health Organization, every major industrialized country in the world, except the United States, is employing this kind of dental therapy in some form. Have you heard of or come across any reports or complaints in other countries about sub-standard practices?

Ms. ODINZOFF: We've done a lot of research, and we've had a lot of help from the educational system around the country. You know, some of the dental schools, some of the academia, and we have not been able to find anywhere in the world where this has not been a successful model of providing dental services in rural communities.

MARTIN: I want to talk a little bit about some of the concerns raised by the American Dental Association. The ADA filed suit in 2006 against a therapist and your organization. It was since - the suit was dropped. But one of the major criticisms of the ADA was that the therapists are not trained adequately, and they're not licensed as professional dentists are, who have an official accreditation. Can you understand that concern? What was your rebuttal to that?

Ms. ODINZOFF: I have less of a concern, because I have seen the community-health-aides program be so successful in providing very good care to people and communities across Alaska. So, I don't have any of the concerns that other people who haven't seen the program that they may have. Scope of practice, I think, was one of the issues that the American Dental Association cited in their lawsuit, and I think on paper that is a good concern.

But given the fact that we are able to train, and we are able to supervise this workforce model, these people - it hasn't proven in any other country to be a concern. And we, to this point, are not having problems with that scope of practice, with the drilling, and the filling, and the exams, and the education. We're not having - we're not seeing problems.

MARTIN: Because the alternative is these people just simply don't get any dental care, correct?

Ms. ODINZOFF: That's correct. If I said to you that you have somebody in your community, and I'm just talking about Alaska's native communities, that we have somebody there that provides those services, that you don't have to wait till you've got one - one really infected mouth, where your gums are all infected, your teeth are all infected, you're going to take better care of your teeth.

MARTIN: How much of this, Carol, is about education? How much of what the dental therapists end up doing is teaching people about preventative dental care?

Ms. ODINZOFF: I think it will get there. The problem right now was what we're seeing is so much active decay, so much active disease, mouth, after mouth, after mouth. We've had five-, and six-, and seven-year-olds with absolutely decayed teeth.

So, where they're having to go to the hospital, go under anesthesia, and get full mouth restorations with full silver-crown caps on their teeth, I had never seen it before I came to Alaska. This problem really grew because Alaskan native kids have two and a half times the amount of decay in their teeth than kids around the country.

MARTIN: What are the criteria for admission into the program, and getting certified?

Ms. ODINZOFF: We're looking for people who are from the bush communities with a desire and a skill set that will allow them to do college-level classes. The first year is mostly didactic, which - they're in the classroom. They do some work on fake teeth. They learn how to drill and fill on plastic models.

The second year, they go out to Bethel, which is, again, 400 miles from the end of the road, to this training center, and they actually see patients. And I have to tell you that they opened the doors in January, and they have not had an empty appointment time.

MARTIN: Plenty of business.

Ms. ODINZOFF: Plenty of business.

MARTIN: Well, Carol, we appreciate you being here. Thanks for walking us through this program, the work that these folks are doing. Carol Odinzoff is the project manager of the Dental Therapy Program run by the Alaskan Native Tribal Health Consortium. Thanks, Carol, very much.

Ms. ODINZOFF: Thank you.

MIKE PESCA, host:

And I, for one, would just like to note that we cover dentistry issues better than any public radio show this side of All Incisors Considered, so a little pat on the back. You know what else we cover? New music, and today is New Music Tuesday with Lizzie Goodman. New music from Madonna, the Roots and this woman, Robyn.

(Soundbite of song "With Every Heartbeat")

ROBYN: (Singing) Maybe we can make it all right. We can make it better sometimes. Maybe we can make it hard to take, yeah.

PESCA: Refer to self if you are in dentistry...

MARTIN: You think? It's going to be all ladies, all the time on New Music Tuesday today if you consider the fact that Beth Givens, she's a lady. She fronts Portishead.

PESCA: She sings about teeth.

MARTIN: She does. Well, no, she doesn't.

PESCA: She uses her teeth in singing.

MARTIN: Teeth, got to get off the teeth.

PESCA: She utilizes them all.

MARTIN: Come back. New Music Tuesday today on the Bryant Park Project from NPR News. Let's have some more Robyn.

(Soundbite of song "With Every Heartbeat")

ROBYN: (Singing) To waste some time. Tell me would it make you happy, baby. We could keep flying for....

Copyright © 2008 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Support comes from: