In the face of pressure from dental associations, the University of Washington turned away last week from a historic opportunity to partner with the Alaska Native Tribal Health Consortium to train Alaska Natives to become dental therapists.
Only weeks ago, the dental and medical school deans sent a letter in full support of the program, and in so doing lived up to the university’s responsibility to advocate for public health. An embarrassed medical school administrator and faculty from the schools of medicine and dentistry had to explain to Alaska Native leaders and the W. K. Kellogg Foundation why the UW failed to follow through on commitments. Washington Gov. Christine Gregoire has been asked to investigate.
Dental therapists provide care in 42 countries throughout the world, including Canada, Britain, Australia and New Zealand. But they are vigorously opposed by the American Dental Association and its societies in Washington and Alaska. Because of that opposition, the program was planned as part of the medical school physician assistant program.
Therapists would serve Alaska villages too small and isolated to attract or support dentists and lessen dependency on the non-Native health care system. A similar community health aide program has provided primary medical care for years. The proposal was supported by major public health organizations in the U.S., and UW President Mark Emmert received calls to support the program.
Alaska Native children suffer pain of tooth decay and other mouth problems much worse than other youngsters with better access to dental care. The dental associations argue that care provided by therapists is substandard. Nevertheless, impartial performance evaluations in Canada have been uniformly favorable, and some have shown therapists are better trained to provide care to children than dentists are. The alternative is itinerant care limited primarily to tooth extractions or no care at all.
Because of ADA opposition, no therapist program has ever been mounted in a U.S. university. When the ANTHC sent indigenous students to the University of Otago in New Zealand for training, the ADA, bankrolled by its rich and powerful members, countered by suing the students. Its local affiliate, the Washington State Dental Association, intimidated university officials by threatening to block donations by their members. In an ironic twist, the ADA changed its position just after the university caved in. Even though UW officials knew congressional lobbyists for the ADA had agreed to legislation in the U.S. House of Representatives that would permit the Alaska project, they refused to change their position.
The dental school dean, Martha Somerman, cut short the debate without ever setting foot in an Alaskan village or sitting down to talk to indigenous leaders. In response to questions, UW Provost Phyllis Wise said the dean had “exhibited exemplary leadership in a complex situation.” The dean was to visit Alaskan villages for the first time in July.
The Seattle P-I accurately described the chronic shortage of dental manpower last year. The situation is mirrored in every state, and ADA opposition to dental therapist programs was the subject of a National Public Radio feature earlier this year. The U.S. Public Health Service, the military, health departments and community clinics and most other safety net programs struggle to recruit dentists. American Indian legislators will meet in July to discuss this development. One can only hope that Emmert will rethink this special interest driven decision.
Peter Milgrom has been a professor of dental public health sciences at the UW since 1974 and is director of the Northwest/Alaska Center to Reduce Oral Health Disparities.