Making A Difference Through Collaboration
Two partners work together to improve the oral health of American Indians.
Michael Monopoli, DMD, MPH, MS | Herminia Frias
Across the country, great strides have been made in improving oral healthcare. As providers, stakeholders, and leaders in our communities, we are responsible for ensuring that everyone has the same opportunity for access to quality dental care that focuses on individual needs. For American Indians, particularly those in tribal areas, the oral health gap is substantial and deeply felt. According to the Indian Health Service, almost half of 6- to 9-year-old American Indian and Alaska Native children suffer from untreated tooth decay, compared to 17% of 6- to 9-year-old children in the general population.
Why do American Indians often experience poor oral health, and how can we effectively address this engrained disparity? At the Arizona American Indian Oral Health Initiative (AAIOHI) and DentaQuest Foundation, our experience on the front lines and as a driver of this conversation has shown that it’s a complex issue requiring a multifaceted approach. As a coalition and a foundation, we are tasked with one of the most important responsibilities in addressing this oral health inequity—bringing the right people to the table, including tribal representatives, oral health providers, the community, and others, to have a meaningful dialogue that inspires action.
Through these collaborative efforts, including last year’s Arizona Tribal Oral Health Legislative Forum (hosted by AAIOHI and the Advisory Council on Indian Health Care with support and funding from DentaQuest Foundation), we can identify challenges and potential solutions that are targeted and community-informed. One area of improvement discussed at the forum was the dental workforce. Many tribal communities are in rural areas, which can make accessing oral healthcare difficult. In 2014, the Center for Native American Youth reported that more than 2.4 million American Indians/Alaska Natives lived in counties with dental care shortages.
To address this challenge from within, we must support the development of dental health professionals in tribal communities. Not only does this help create a more diverse provider base, it builds trust because the practitioner understands the tribe’s values and has experienced firsthand the need to improve oral health.
For example, the San Carlos Apache Tribe is beginning this development early by partnering with Pathways Into Health to pique fifth grade students’ interest in healthcare, including dentistry. Thus, when preparing for college, these students have already been exposed to the profession. Another potential solution is facilitating scholarships to help remove some of the financial barriers to training.
While developing this skillset is an important long-term effort, a key short-term need is attracting providers to serve tribal communities, thus increasing the healthcare network. Then, new delivery models such as teledentistry can further improve access by expanding the reach of these providers. Through all of these solutions, we can increase the likelihood that American Indian patients have access to a regular provider—a “dental home”—for ongoing, continuous care, not just treatment of immediate problems.
Finding the right provider is only one piece of this puzzle. As AAIOHI has seen through its work with the tribes, some have a tainted view of oral healthcare from past negative experiences. To assuage these fears and build trust, we must ensure that American Indians, like any other population, are receiving continuity of care that is culturally competent and incorporates new, innovative methods of treating diseases like caries. This includes increasing access to and prioritizing preventive and restorative care when appropriate.
Raising awareness about the importance of oral health and the existence of this disparity is the first step in turning the tide of inequity experienced by American Indians. Through our respective forums and circles of influence, we have the opportunity and responsibility to make systems-level changes to improve and facilitate oral healthcare for those who need it most.
About the Organizations
AAIOHI works with tribes, urban Indian communities, the oral health delivery system, and stakeholders to manage and sustain a tribally-driven, statewide oral health coalition. DentaQuest Foundation is the leading US philanthropy focused solely on oral health. AAIOHI is a grantee within DentaQuest Foundation’s Oral Health 2020 network, a group of partners committed to working collaboratively at the national, state, and community levels to eradicate dental disease in children, as well as improve lifelong oral health.
About the Authors
Michael Monopoli, DMD, MPH, MS, is the vice president of foundation programs at DentaQuest Foundation.
Herminia Frias is the project coordinator for AAIOHI.