On the Swinomish Reservation in Washington’s Skagit Valley, one full-time dentist serves 3,000 patients. While it’s an improvement from years past when a rotating list of dentists would visit the tribe, it’s still not enough to treat the high number of people with rotting teeth. Tribal leaders are calling the current situation a “health crisis.”
To manage it, they’ve borrowed an idea from the Alaska Native community and hired a paraprofessional known as a dental health aide therapist at the tribe’s clinic. In the second part of our series “Confronting Dental Decay in Indian Country,” we explain the role of a dental therapist.
As tribal member Aurelia Bailey told us, the dental care she received while growing up on the Swinomish Reservation felt “aggressive” at times.
“You know, the minute I get in that chair, I almost have flashbacks,” she said
Bailey only goes to the dentist now if she absolutely has to, and even then, she needs to be sedated. Tribal Chairman Brian Cladoosby says her situation isn’t a unique one.
“There is still a reluctancy for tribal members, even today, even though they know the dental staff, because of that trauma, that generational, that historical trauma, to go in for a six-month cleaning,” he said. “That is still, believe it or not, still a struggle for us.”
It might not help that the wait time at the clinic can be anywhere from three weeks to almost two months. That backlog spurred Cladoosby and other leaders into action trying to find a way to get patients in faster and still provide quality care.
Enter Daniel Kennedy: a trained dental health aide therapist. He has been working on the Swinomish Reservation since January.
“My main goal is to really convince parents and their children to come in and call the clinic their home — their dental home,” Kennedy said.
Dental Boot Camp
Kennedy graduated from Alaska’s dental therapy program, which grew out of a lack of access to dental care in far-flung villages around the state. It’s actually modeled after similar training in New Zealand, which is one of about 50 countries that uses dental therapists. Kennedy’s education started with one year of classroom time in Anchorage.
“The University of Washington sent their professors up to teach us. These are the professors that had been doing this for 20, 30 years,” he said.
Then he moved up to a small Yupik village in northwest Alaska called Bethel. He was there for a year treating patients in an actual clinic. Kennedy was under the direct supervision of a dentist while putting 46 procedures, starting at prevention and teeth cleaning, and ending at extractions, to use.
“We’d start at eight in the morning and get done at six at night, Monday through Friday,” Kennedy said. “So, I’d call it dental boot camp, really.”
He saw first-hand the difference his efforts were making.
“A grandma came in very pessimistic about the program," remembered Kennedy. "So I saw her. I did the complete examination, cleaned her teeth and did a filling within a two-hour period. And she was so amazed, she brought her daughter in. And I did the same thing. And she was so amazed, that she brought her kids in. She was so amazed so she brought her kids in. So I followed, roughly, five generations.”
After graduating, Kennedy returned to his hometown of Klawock, which is a small Alaska Native village in the southeast part of the state. He says being from the community made it easier for his family and friends to willingly go into the dental clinic for treatment. Kennedy worked side-by-side with a dentist for six years before moving to Western Washington.
“When Daniel first got here, I’m like ‘I hope he’s good. I hope he’s really good.’ Because I didn’t know,” Dr. Rachael Hogan said. She’s the lone dentist at the Swinomish clinic. “As I’m watching him and I’m looking at his fillings and his extractions, he’s excellent. His clinical work is excellent.”
As Kennedy’s supervisor, Hogan checks in and approves all the work he does. At least until he gets past a sort-of probationary period, then his role changes slightly.
“He’ll be able to work just under general supervision. So I don’t have to be in the clinic. I just need to be able to be contacted. If someone comes in as a walk-in and needs an extraction then they can call me. I can look at the x-ray. We can have a conversation about it before,” Hogan said. “Those days are coming and that will be really nice as well. That means I can take a day off.”
Hogan says she’s relieved Kennedy’s work has been so good. But, frankly, she was a little surprised. Especially given what she’d heard about dental therapists from professional organizations such as the American Dental Association.
“Definitely there had been bad press poured down to me from the A.D.A. The information I was getting was pretty negative, so I just stayed away from it,” she said.
Dental therapists aren’t popular in the U.S. In fact, a more fitting word would be controversial. The American Dental Association actually sued the state of Alaska to shut down its training program. They lost. But they were able to get language into the updated Indian Health Care Improvement Act that effectively banned all lower 48 tribes from hiring dental therapists.
So how did the Swinomish pull it off? Well, the tribe’s a sovereign nation and they have grant funding. Other groups such as the Concerned Dentists of Washington State and the Washington State Dental Association also have come out against the paraprofessional and its uses in this state. We’ll learn more about that opposition in our next story.
Becoming A Team
Inside the walls of the clinic, though, the staff isn’t letting the controversy get in the way of their work.
“We’re sliding into our groove,” Laura Kasayuli said. She’s been working in dentistry for about 30 years. The last dozen she’s spent at Swinomish as the tribe’s dental hygienist. “He’s working a lot with children. And that lets me focus on the teens.”
Kasayuli says if each of them can find their own niche, then the clinic’s staff can follow through with their goal of raising a generation of kids with zero cavities, good habits and no fear of sitting in the dentist chair.