3.2.2 Case 5: Improved Oral Health for Tribal Communities - Alaska, USA Another well-documented model of oral healthcare in underserved communities is that of Alaska, where the majority of the native population lives in remote villages accessible only by airplane, boat or snow mobile. Due to a chronic shortage of dentists and a high prevalence of dental disease, with 62% of children ages 2 to 5 having untreated caries, the unmet need for dental services was one of the highest in the USA. To address this need, the Alaska Native Tribal Health Consortium, with the support of the Indian Health Service, in 2003 sent six Alaskans to be trained in dental therapy at the University of Otago, New Zealand’s national dental school. They returned to Alaska to start practicing in rural areas. Initially, the innovation was opposed by the American Dental Association on the grounds that the practice was illegal. Eventually, the Association agreed to join forces to improve the oral health of Alaskans. An independent evaluation of the program has concluded that the dental therapists met all the quality standards and were well-received by the communities they served. There are currently 11 therapists trained in New Zealand, who practice under the general supervision of the dentists and perform cleanings, restorations and uncomplicated extractions (Wetterhall et al. 2010).
3.2.3 Case 6: Improved Oral Health for Vulnerable Populations USA 33
Experiments with the innovative oral health workforce models in the USA also include the community dental health coordinator (CDHC), which started as a pilot program in several US states in 2012. CDHC is a new program implemented by ADA to increase access, especially for underserved people. ADA defines CDHC as “a new team member who serves as a conduit between underserved communities and dentists.” CDHCs are described as community health workers with dental skills focusing on education and prevention. CDHCs main responsibility is to provide oral health education and disease prevention in the communities which they serve; they also act as a link between patients and dentists when care is needed. CDHCs are recruited from the communities they serve, in contrast to the advanced dental health therapists in Minnesota, who are mostly drawn from the existing dental hygiene workforce. The CDHCs are required to complete 1872 hours of instruction followed by an internship. The curriculum incorporates biomedical, dental and clinical sciences. The students are taught to provide patient education and routine preventive services and help patients navigate health care system. The CDHCs focus on community outreach and improving access to oral health for underserved populations in their respective populations, such as children, high-risk groups (HIV/AIDS patients, diabetes patients, perinatal patients, low-income groups and senior citizens). Apart from community outreach, the CDHC’s scope of work includes patient navigation, education, and preventive services such as fluoride varnish (ADA 2014). Even though the program is new, so far the results have been encouraging. It has been shown that introducing the CDHC had a significant positive impact on access to oral health care. Forty-three percent of CDHCs were shown to use this initiative for
