July 01, 2006
Saturday

WASHINGTON -- The American Dental Association has softened its once-vehement opposition to an Alaska Native health program that sends specially trained health aides to drill and extract teeth in Alaska villages, where severe tooth decay is epidemic.

"We still believe that patients are best served by a licensed dentist," said William Prentice, lobbyist for the ADA in Washington. "But we're trying to do everything we can to try to respond to the tribes' concerns on getting dental care in frontier Alaska."

The national dental organization is now backing a federal bill that says Alaska dental health aides, if they consult with a dentist on certain types of cases, can perform work the ADA had previously insisted must be done only be dentists.

"This is somewhat of a breakthrough," said Dr. Mark Kelso, dental director at the Nome, Alaska-based Norton Sound Health Corporation. He oversees two dental health aides who are being dispatched to Savoonga and Unalakleet, Bering Sea villages of about 700 people.

Rural Alaska, like most of rural America, lacks dentists. Dentists visit some Alaska villages only once a year. Many villages don't have fluorinated water or a tradition that emphasizes brushing. And soda pop is ubiquitous. The rate of tooth decay among Natives is more than twice the national rate, and a greater percentage of Native adults have lost all their teeth. Sixty percent of Native children 5 and under have severe dental decay, according to research the ADA cites.

In response, Native and federal health organizations launched the dental health aide program in 2003. It is an offshoot of Alaska's community health aide program that the Indian Health Service started in the early 1960s.

The ADA, however, has been insisting that non-dentists should not be allowed to perform any irreversible procedures, like pulling or drilling teeth, citing concerns about the quality of patient care. In January, the ADA sued the Alaska Native Tribal Health Consortium and eight dental therapists for performing services the association says violate state dental licensing laws.

As recently as last week the ADA was hoping Rep. Don Young, R-Alaska, would insert an amendment to an Indian health bill to prohibit dental health aides from performing irreversible procedures.

"The ADA has received assurances from Rep. Young that he will seek to amend the bill to include language that ensures that no dental health aide is certified under the program to perform treatment of dental caries, pulpotomies or extractions of teeth," one of the organization's lobbyists wrote in a Washington update posted on its Web site on June 20.

But in Washington, it ain't over until it's over. The next day, after negotiations between the two sides, Young had the bill amended in the House Resources Committee to say that health aides can do "pulpal therapy" - root canals, according to the lobbyists - and extractions, but only if a consulting dentist agrees it's a medical emergency that pain relief can't resolve. The bill does not address fillings, nor does it define "medical emergency." Consultation is required only for adult teeth.

Young said he was happy the two sides were able to reach a compromise.

"The (dental health aides) will continue their important role in rural Alaska and perform specific dental procedures to help alleviate the dental crisis in our great state," he said in a written statement June 21. The bill has to go to other committees before it hits the House floor.

The ADA and Native health leaders say they are happy, too.

"It is some additional restriction, but it does not undermine the vitality of the program," said attorney Myra Munson, who lobbies for the Native health corporations.

The ADA is emphasizing the restriction, saying on its web site that the compromise bill would "prohibit" the health aides from performing pulpal therapy and extractions without consultation with a licensed dentist.

"It hopefully will limit the times that a dental health aide will have to perform one of these services just to medical emergencies," said Prentice, the ADA lobbyist.

The organization will continue to press its lawsuit, he said, to reinforce the importance of state licensing laws.

"We believe very strongly in state oversight in healthcare," he said.

Kelso, the Nome dental director, said the Young amendment in the House bill wouldn't change current practices much. The health aides consult with dentists on serious or questionable cases all the time, he said. They would never do a root canal, he said, although they do some of the initial work. The main effect of the bill, as far as he could see, is that a dental health aide would have to call a dentist even when the need for an extraction is completely obvious.

Both Prentice and Kelso, however, said the conflict over the outer limits of dental health aide work has put too much emphasis on drilling and extractions. They say they're more enthusiastic about the preventative work the aides deliver - fluoride treatments, sealants, education.

"We didn't want them to be the village tooth pullers," Kelso said. "We wanted (them) to be maintaining teeth for a lifetime."

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