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'Confronting Dental Decay In Indian Country' Part I

Ariel Van Cleave
Staff at the Swinomish Dental Clinic have been delivering baskets to new moms. It's part of their effort to raise a generation of kids with no cavities on the Skagit Valley reservation.


Rotting teeth, a fear of the dentist’s drill, long lines out the clinic door: These challenges are facing the Swinomish Tribe.

For decades, dentists would visit the reservation once a month. And if you ask tribal member Aurelia Bailey what that was like, she says it was “horrific.”

“I hated going to the dentist,” she said.

That common refrain has lead to major oral health problems for many members of the tribe. Leaders on the Skagit Valley Reservation say they have a solution, though: a paraprofessional known as a dental health aide therapist. They’ve been used in Alaska for the last 10 years, though some professional dentists’ groups are against the providers.

The Swinomish is now the only tribe in the lower 48 to have one on staff. The first part of our series, “Confronting Dental Decay in Indian Country,” takes a look at the evolution of dental care at Swinomish through one woman’s story.  

‘It Was Frightening’

Aurelia Bailey is in her 50s now. But she still has clear memories of when she was a kid, sitting in the dentist chair of the single-wide trailer that served as the dental clinic at Swinomish.

There was the time she was five years old, walking home with a black-and-blue face. The dentist, injecting Novocaine into her cheek, had hit a nerve.

Another experience that sticks with her happened a few years later when she went to the clinic because of a cavity in one of her back teeth.

Credit Swinomish Tribal Archive
The Swinomish Dental Clinic 1975-2011

“The visiting dentist that was there, he was so rough and aggressive,” she remembered. “He pried my mouth open and was pinching my cheek. I had the bib on and I was halfway numb. He had the needle in my mouth and I just pushed him out of the way and I took off out the door,” she said.

“I ran home, still with that little blue apron clipped to me. I got home and my dad was so upset with me. He’s like, ‘What are you doing? You’re supposed to be at the dentist.’ And I said, ‘He hurt me. I don’t wanna go back there.’”

Her dad won the argument, so Bailey made her way back to the clinic.

“And the dentist had even talked about restraining me to the chair, like, tying my hands to the armrests. It was frightening. Very frightening,” she said.

Not Unique To The Swinomish

Other members of the Swinomish tribe have their own stories to tell just like Bailey. And she says a lot of the people she grew up with refuse to go to the dentist because of that trauma. At least until they’re overwhelmed by pain. That’s meant more adults have dentures and lack basic skills for maintaining healthy teeth.

“You see people that have teeth that are pretty much rotted all the way out,” she said. “And that’s because they don’t want to go back and fix it,” she said.

The situation at Swinomish isn’t a unique one. According to a recent study by the Pew Charitable Trusts, Native Americans experience the worst oral health of any population in the country; often three and four times higher rates of decay when compared to white people. And part of the reason could lead back to how dental care was delivered.

“For many of the Native kids, I would say, probably all the way to the mid-‘80s, it was a bad experience,” said Bailey.

Part of that “bad experience” has to do with simple supply and demand, with only one dentist for every 3,000 patients.

Credit Ariel Van Cleave / KPLU
The new Swinomish dental clinic

While the tribe has built its own dental facility and care has improved, the demand for treatment is just outpacing the staff’s abilities.

Swinomish leaders decided the clinic needed another pair of hands, so they made a controversial decision and hired a dental therapist; this is a paraprofessional not licensed in the state of Washington.

Dental therapist Daniel Kennedy was trained in Alaska, and was most recently providing treatment to friends and family in his hometown, an Alaskan Native village called Klawock, in the southeast part of that state.

“And they thought that was different,” Kennedy said. “Rather than having someone from down south come up for a week or two and do it quickly and leave.”

He says they were more willing to come in because they knew him.

Now that’s the thing the tribe is banking on: making the clinic feel more like home. But for tribal members like Bailey, she still can’t bring herself to walk inside the building.

“I only go when I absolutely have to. And the last time I went to the dentist was three months ago,” she said.

Bailey landed in the dentist chair after her 18-month-old granddaughter slammed her little head against Bailey’s mouth, fracturing one of her teeth. She finally went to the dentist after three weeks of dealing with the pain to see if the tooth could be saved.

“They had put stints in, and they said that those were supposed to be temporary. And I still haven’t gone to get them filled in and replaced,” said Bailey. “It’s just crazy … I’ve had to get teeth pulled. But I always will look for somewhere where they have laughing gas, or they can put me to sleep, because otherwise I will freak out.”

Ending The Generational Trauma

That level of fear is something Swinomish leaders want to be done with. And getting to tribal members as early as possible to teach good dental habits, compassionately, will be key.

Dental therapist Daniel Kennedy has already been working with preschool-aged kids, showing them how to properly brush and floss.

We’ll learn more about his role as a dental therapist in our next story. Though, Daniel’s work, so far, has many in the tribe, including Aurelia Bailey feeling grateful. She says it might be too late for her, but maybe not for children like her granddaughter.

“I’m hopeful that she can go to the Swinomish clinic, and get the best care possible — in the kindest way possible,” she said.

Ariel first entered a public radio newsroom in 2004 while in school at Bradley University in Peoria, Illinois. It was love at first sight. After graduating from Bradley, she went on to earn a Master's degree in Public Affairs Reporting from the University of Illinois at Springfield. Ariel has lived in Indiana, Ohio and Alaska reporting on everything from salmon spawning to policy issues concerning education. She's been a host, a manager and now rides shotgun with Kirsten Kendrick as the Morning Edition producer at KNKX.