Alaska was the first U.S. state to allow dental therapists – professionals who have certification but who are not dentists — to provide general care for patients’ teeth and mouths. And the Yukon-Kuskokwim Delta, the mostly Yup’ik and highly rural region in western Alaska, was the first in the state where dental therapists were allowed to practice.
Now a newly published study shows positive results from the first decade of that program, operated in a region where residents’ dental health had long suffered because of a dearth of services.
The study, published in the Journal of the American Dental Association, tracks a decade’s worth of dental services provided in the region.
It found a big increase in early intervention, indicating a reduction in the need for more serious treatment like tooth extractions.
From 2006 to 2015, the study found, there was a “substantial” increase in diagnostic and preventive dental care in the region, corresponding to the phase-in of dental therapy practices. There was also an increase, though not as big, in the number of restorative services provided annually.
Preventive services include things like fluoride treatments to strengthen teeth, and restorative programs include fillings, said a study co-author, Dr. Donald Chi of the University of Washington. Chi worked in the past as a traveling pediatric dentist in the Yukon-Kuskokwim region.
The annual numbers of more serious services like surgeries remained constant during 2006 to 2015 period, the study said.
Dentists were providers of over 17,000 of the services tracked during the period, while dental therapists provided only about half as many services, according to the study
But by 2012, dental therapists were providing as many or even more of certain types of services, the study found. Dental therapists and dentists were each providing about the same number of diagnostic and restorative services starting in that year, and by 2012 dental therapists had surpassed dentists in the number of preventive services performed, according to the study.
Through the study period, dentists remained the dominant providers of more complicated services. These services include surgeries and endodontic care, which involves nerves within the teeth; a root canal is an example, Chi said.
At most, there were 17 dentists and 10 dental therapists practicing in the region over the study period, he said.
Chi said the findings give useful information about the effectiveness of dental therapy, which was pioneered in New Zealand. Dental therapy is now allowed in about a dozen U.S. states that followed Alaska’s action, with the intent of increasing basic service in areas with a chronic lack of dental care.
“All eyes are on states where dental therapy is operating and largely working,” Chi said. Eyes are on Alaska in particular, he said. “In terms of long-term data, Alaska’s the state with the longest-running program.”
There are two types of dental therapy models being used in the U.S., the study said. One is the Alaska model, which is restricted to tribal areas. The other requires additional training and a dental hygienist degree, the study said.
The latest study is one in a series that evaluated the performance of dental therapy in Alaska.
The first study, published in 2010, found that Alaska dental therapists provided safe and effective service, contrary to warnings by some organizations about the dangers of non-dentists providing care like cavity fillings.
Chi has been involved in several follow-up studies, including some that were more locally focused. Those studies found several positive trends, especially among children. A study by Chi and his colleagues that was published in 2020, for example, found a strong correlation between dental therapy and a reduction in dental emergencies, especially among children. And a 2018 study correlated dental therapy with a reduction in tooth extractions.
But research by Chi and his colleagues has also identified a chronic problem: There do not seem to be enough dental therapists to meet the demand for services. A 2019 study, for example, found that therapists in the Yukon-Kuskokwim Delta reported “being overworked, stressed and geographically isolated.”
To help alleviate those supply problems, the Alaska Native Tribal Health Consortium has partnered with Utqiagvik-based Ilisagvik College on a three-year academic program in the subject. The classroom portion is in Anchorage, while the on-site clinical work is in Anchorage, Bethel and some outlying villages.
There are currently 28 dental therapists working in Alaska, said Dr. Sarah Shoffstall-Cone, director of the Ilisagvik College program.
In the early years of dental therapy practice in Alaska, students had to go to New Zealand to become trained, she said. Starting in 2007, ANTHC partnered with the University of Washington to do training in Anchorage, she said. The Ilisagvik College partnership began about seven years ago, she said.
Two years ago, the ANTHC program became the first U.S. dental therapy program to be accredited by the American Dental Association’s Commission on Dental Accreditation.
The Alaska model is being followed elsewhere. In Washington state, Skagit Valley College has launched a similar dental therapy education program.
Along with recruitment of new dental therapists, there are other efforts to help residents of the Yukon-Kuskokwim Delta and other rural areas avoid serious dental problems.
Chi is now working on a new research project to try to find ways to reduce consumption of sugary beverages in the Yukon-Kuskokwim region.
Past research has correlated lack of piped water with increased consumption of sugary beverages – and high rates of dental cavities, especially among children.
But even in rural areas that now have dependable water service, “soda and fruit drinks like Tang and Kool-Aid are just really pervasive,” Chi said. “A lot of times, families are accustomed to those sweet drinks.”
Beverage companies play a role, too, by marketing their sugary drinks as healthy, he said.
On that project, Chi has research partners from the Yukon Kuskokwim Health Corp., the University of Alaska Fairbanks and the Oregon Health and Science University.
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