Dental care in Alaska’s remote villages

When I moved to Barrow in 1972, the only dental care available over the entire 88,000 square miles of the North Slope was one Indian Health Service dentist who, quite frankly, was paying back a scholarship obligation and had less than great dedication to improving oral health there. So routine dental care consisted of filling and pulling. And often it was the patient doing the pulling because no dentist showed up in some villages for months or years on end.

I took advantage of the lack of dental services to avoid ever seeing a dentist. I thought I was in heaven.  Then the borough took over the dental contract from Indian Health Service and I hired a dentist to come to Barrow to set up a real practice. The next thing I knew, he had me in a dental chair and from somewhere above the bright light shining in my face as he did an exam I heard him say, “You have the oral hygiene of Genghis Khan.” After that I went to the dentist a lot more often and eventually managed to not end up with dentures before I was 30.

But a lot of North Slope residents weren’t so lucky. They didn’t have teeth and they didn’t have dentures. Their teeth had fallen out or been pulled and not replaced. People younger than me looked decades older because they were toothless. So one of the first things we did when the dental program got organized was to hold denture clinics in Barrow. I can’t begin to describe what it was like to see these young Inupiat enter the dental clinic as toothless old people and emerge with a set of gleaming teeth and a wide smile, finally looking as young as they really were.

Yet dental care is still, in many respects, the unwanted stepchild of health care in the Bush.

Decades ago the Community Health Aide program was instituted to bring basic health care and health screenings to populations that would otherwise not see medical care from one year to the next. Questions raised about the competency of minimally trained people to handle medical care in isolated settings were resolved with each passing year as these amazing men and women proved their ability to make informed decisions on care and to seek help the minute they sensed they were entering difficult waters.

Given that success, I am unable to fathom why the Alaska Dental Society and American Dental Associations are taking any position on the Dental Health Aide program other than one of support and encouragement, coupled with offers to oversee and help develop a safe and effective curriculum. It’s not as though these dental aides are taking money or patients from dentists because, quite frankly, I haven’t seen any stampede of dentists wanting to set up practices in remote Alaskan villages.

What I find even more disturbing is the lack of information about what, if anything, the Alaska Dental Society or the American Dental Association has done to improve dental care and increase the presence of dentists in villages during the years this program has been operational. It seems as though the only time they say anything, it’s because they are objecting to the program.  They come across as the dental version of the Party of No.

We have heard loud and clear what they’re against. The question is what are they for? What are they doing to advance care and alleviate the suffering in villages where there is no dentist? Because anyone who has ever had a toothache knows that even 24 hours of pain can greatly diminish the quality of your life and cause you to want to take a pliers to the offending tooth.

The Dental Health Aide program is still new. Like the Community Health Aide program before it, it will need constant tweaking to keep current and safe. But also like the Community Health Aide program before it, it has the potential to greatly improve the quality of life in Alaska’s most remote villages.

Until the dentists in this state come up with a better way to get this care to remote locations on a regular and timely basis, they should stop complaining and start helping make this program even better and safer. It’s the right thing to do.