ADA president testifies on Indian oral health care

Dec. 3, 2009
Dr. Ronald Tankersley testified Dec. 3, 2009, before the Senate Indian Affairs Committee on expanding dental care in Indian country.

WASHINGTON, D.C.--American Dental Association President Dr. Ronald Tankersley testified Dec. 3, 2009, before the Senate Indian Affairs Committee on expanding dental care in Indian country.

Here is a transcript of the testimony Dr. Tankersley delivered:

Mr. Chairman and Members of the Committee:

I am Dr. Ron Tankersley, president of the American Dental Association (ADA), which represents 157,000 dentists around the country. I am a practicing oral and maxillofacial surgeon from Newport News, Virginia.

Let me begin by thanking you for your efforts to reauthorize the Indian Health Care Improvement Act, which contains so many important provisions to improve the health of American Indians and Alaska Natives. Enactment is long overdue.

I have been asked to appear before you to discuss our position on whether to expand the new dental health aide therapist position, currently being tested in frontier Alaska, into other areas of the country.

You know from our previous committee testimony that the ADA does not support delegating surgical procedures to those without the comprehensive education of dentists. So, we are opposed to Congress expanding the Alaska therapist model.

To us, it's not a matter of whether similar providers exist in other countries. The U.S. has higher educational requirements than many other countries. Currently in this country, surgical services are not delegated to any healthcare providers with just two years of post-high-school training. Even nurse practitioners, with six years of education and training, are not given surgical privileges.

The real question is whether establishing such a position, with the attending challenges of recruiting, educating, training, supervising, and regulating such providers, is the best solution for improving access to oral health care in tribal areas.

Furthermore, we believe that recent events make expanding that model even less necessary than in the past. Specifically, the drastic shortage of dentists in the Indian Health Service is finally being addressed--this year alone there will be 70 additional dentists providing care in tribal areas. With one more year of similar recruiting success, the shortage of dentists in the IHS could be eliminated. No other action could have a more significant impact upon increasing access to surgical oral healthcare in tribal areas with profound need.

The ADA has played a critical role in this success, working with the IHS to create and fund a dental summer extern program and lobbying to increase student loan repayments for dentists hired by the Service or tribes. Last year, over 300 dental students applied for 150 openings in the extern program. This year, the ADA successfully advocated for increased funding to double the number of summer dental externs in 2010. We believe that this will lead to more young dentists choosing to work in tribal areas, reducing even further the need to look for other models to provide surgical dental care.

That said, we agree with many others that innovations in the dental team could help increase access to dental services in underserved areas, including tribal lands. For example, the expanded function dental assistant model has been used with great success by the U.S. military. We also strongly support the creation of new innovative dental workforce models that parallel that of medical community health aides. The ADA is currently funding and pilot testing one such model, the Community Dental Health Coordinator (CDHC).

Our initial classes of CDHCs will work in rural, urban and tribal areas. These allied dental personnel come from the underserved communities in which they will work. They are trained to provide community-focused oral health promotion, prevention, and coordination of dental care. And, importantly for this discussion, the CDHC program will be independently evaluated during the pilot phase before the program is replicated in other areas.

We all agree that American Indians and Native Alaskans deserve access to the same oral health care as the rest of the population. Accordingly, the ADA asks Congress to focus on eliminating dentist shortages and supporting workforce innovations that increase efficiency and focus on prevention while still ensuring that people who need surgical care still receive that care from fully trained dentists.

Thank you.

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