We need dental health aides

When I first arrived in Barrow in 1972, dentistry was an “almost there” service.  One dentist, usually paying off a government loan by working in an underserved rural area, handled the whole North Slope.  What this meant in reality was that dental care in villages outside of Barrow was pretty much non-existent and dental care in Barrow consisted of the fill it or pull it variety.

I’d never seen the results of poor dental hygiene until I saw my first almost toothless 20 year old. I had no idea what baby bottle mouth was until I saw the first child whose baby teeth were already rotten.  I thought everyone had a mother standing over them making them brush every night just like I thought everyone had a sink with clean running water to stand over.

Improving dental health in remote villages has been a painful and not very successful battle for a long time.  If I were asked why I thought this was true, a few immediate and obvious causes come to mind. 

A diet that changed in one generation from no sugar to loads of sugar is one of the more blatant culprits.  Babies like sugar and when I first got to Barrow, it was routine for moms to put Kayro syrup in their baby’s bottle to make the powdered milk more palatable. It was also standard to let the baby fall asleep sucking on that bottle.

Then there was the common practice of using sugar to pacify a rambunctious child.  It was not unusual to see a mother walking through the store with two or three kids and each of them had a candy bar in one hand and a sugared pop in the other.  Even when their teeth were already so full of cavities that they visibly flinched when biting and chewing, they still put it in their mouths.

Of course, when you have a cavity and there is only a dentist in your village twice a year, that cavity is likely to be a major problem by the time it’s seen. What could have been a filling if treated immediately, now becomes a pulled tooth because the dentists didn’t do lengthy, multiple visit procedures such as root canals or caps.

When I became director of the borough’s health department in the late 1970s, one of the first programs we contracted from Indian Health Service was the dental program. The idea was to supplement the program with borough monies to get more dentists on the Slope.

We were almost successful. There was a point in time when we were actually able to send dentists to villages along with technicians who could make impressions and put in new teeth in one week.  Our dentists worked long days and the techs often sat up all night making and baking new teeth.

But still the frustration mounted as the dentist would wait for 500 cases of soda to be offloaded from the plane he was taking back to Barrow.  Each one of those sodas represented a defeat for all his hard work.

It was never easy to recruit dentists to the bush – not even to the North Slope where we offered extremely competitive wages as well as federal student loan debt forgiveness.  And we never seemed to be able to get past immediate treatment needs so education and prevention always lagged.

I can understand why the new dental program being tried in some bush areas using dental aides might threaten the Alaska Dental Association. I imagine when the community health aide program was first proposed for remote villages that medical personnel had the same concerns.

But without health aides, physical health in remote villages would be non-existent. Without dental aides, dental care, prevention and education will continue to be practically non-existent.

The health aide program has proven that you can train people to act under the supervision of physicians and provide good quality health care in remote locations.  I think the dental aides deserve a chance to prove the same thing.  Unless, that is, the dental society has some secret stash of dentists hidden somewhere in the state who are clamoring to practice in a remote region of Alaska.

Like it or not, these aides are the best chance a lot of people in the bush will ever have to make it to 21 with a smile they don’t have to hide behind their hand. I say best of luck to them.