Expert panel: Dental therapy can help undo racism in oral health care

  | By Laura Brannon
Expert panel: Dental therapy can help undo racism in oral health care

As the COVID-19 pandemic exposed, racial disparities and inequities in our health system run deep. When it comes to dental health, people of color and those with low incomes face the steepest hurdles to getting care. In recent years, nearly 60 million people lived in a community without enough dental providers. This shortage most hurts Black, Indigenous and other people of color, as well as people struggling to make ends meet.

Dental therapy is an effective policy to close such gaps and start undoing racism in dental care. The National Partnership for Dental Therapy and Washington’s Statewide Poverty Action Network recently hosted a webinar that explored this topic. Panelists discussed how several aspects of dental therapy promote oral health equity, including the profession’s model of delivering care; its goal to develop a workforce from the local community; and its accessible training.

The webinar featured a wide range of experts on the issue, including:

After generations of trauma, dental therapy delivers better results

Valerie Nurr’araaluk Davidson, of ANTHC, addressed how dental therapy has improved the oral health of Alaska’s Indigenous communities. She shared what it was like for the dental care system to neglect the remote, 250-person village where she grew up. A dentist would visit for a few days every year or two and spend all his time pulling teeth. When people lined up outside the clinic, she recalled, “we would literally hear the screams of our relatives behind that door.” Even today, her older brother “cannot get basic dental care, not even a cleaning, without being completely sedated because that was… an incredibly traumatic experience.”

Decades later, Alaska’s tribal leaders adopted dental therapy in response to the persistent lack of access to regular dental care for their communities. As Marcy Bowers, of SPAN, remarked, “in the U.S., tribes have been on the cutting edge of this issue.” Almost two decades ago, they brought dental therapy back from New Zealand and established the profession in Alaska. Dental therapists are highly skilled and come from the community they serve. By providing “training and care close to home, in a language and a culture that the people that we are serving come from,” it promotes trust among providers and patients.

Data proves this approach leads to better health. Today, Ms. Davidson shared more children are cavity-free in communities with dental therapists. And “over 40,000 Alaskans in rural communities have access to regular dental care.” Dental therapy also means jobs for communities, benefitting local economies.

Dental therapy can be an anti-racist policy

Dashni Sathasivam, of HES, defined terms that panelists used throughout the conversation. She explained that health equity means “everyone has a fair and just opportunity to attain their optimal health” regardless of any social factors, like race, disability or socio-economic status. She emphasized that racial equity is “central to health equity.” A racist policy is “any measure that produces or sustains racial inequity between racial groups.”

She described how, if enacted with intention, dental therapy can be an anti-racist policy given its approach to centering people who have faced disproportionate harm and its focus on uprooting racism in the dental system. This includes who provides care and how it’s delivered. Dental therapy policies can target, she explained, “systemic racism by trying to increase workforce diversity and representation.” She continued that the model aims to “increase access to quality dental care among communities of color, those who have really been left out of the current delivery care system.”

Dental therapy advances equity in the oral health workforce

Dr. Eleanor Fleming, of Meharry Medical College, shared insights on racial inequities in dental education and the oral health professions, and how dental therapy can help reduce the harm. She walked through how barriers to becoming a dental provider are due to “opportunity gaps.” Often Black, Indigenous and other students of color do not get the resources they need throughout public school to prepare for an academic future that includes dental school.

And many may not recognize oral health as a viable career path. As a Black dental professional, Dr. Fleming noted, “let's be honest. What comes to mind when I say “dentist?” Nine times out of 10, it's not going to be me.” She also highlighted hurdles that Black students can confront when they do apply to dental school. The dental professions and its academic institutions are not immune to unconscious bias. Racism can lead to hiring discrimination, for example, against Black women who wear natural hair like her.

But, she asserted, “these disparities are not inevitable.” Dental therapy can interrupt inequity by diversifying the dental workforce. Its professional education is more accessible to lower income students than is training to become a dentist — but is no less rigorous.

Tera Bianchi of Community Catalyst reminded participants that dental therapy education standards are set by the American Dental Association’s Commission on Dental Accreditation, which oversees all U.S. dental education programs. The standards mandate a minimum of three academic years of training, but gives colleges the flexibility to adapt the training to the needs of their community. For instance, Iḷisaġvik College in Alaska offers the program on a year-round basis, meaning their students complete six semesters of education in two calendar years. This decreases the cost of education for the student and allows them to get into the workforce sooner. Other colleges may choose to create advanced standing pathways that allow dental hygienists and dental assistants to become dually-trained is less time. Regardless of their pathway to the profession, panelists affirmed that dental therapists are trained to a high standard and provide effective care.

Bringing dental therapy to more communities

As Ms. Davidson reflected on bringing dental therapy to Alaska, our local solution to our local problem really is a problem that exists everywhere.” Whether you’re in Seattle, Washington or Washington, D.C., she continued, if you can’t access timely, affordable care, “you might as well be in one of our remote villages.”

With an accessible path to high-quality education, and a focus on building a representative workforce, dental therapy can reduce the harm of oral health policies tied to racism and economic inequality. By investing in this profession in more communities, policymakers can advance racial justice and equity in oral health care.