Dental care elusive
Woman’s quest for dentures proves arduous

Reservation dental clinics, such as the Thoreau Health and Dental Clinic are often trailers. — © 2008 Gallup Independent / Brian Leddy

Copyright © 2008
Gallup Independent
By Kevin Killough
Staff writer

GALLUP — Linda Spenser lives in a small cluster of homes about 10 miles north of Gallup. Her mobile home is dwarfed by a school bus, whose bright yellow paint makes it stand out next to the dull aluminum siding of her home. A rooster crows beneath a trampoline in her front yard as she explains her struggle over the past year to get dentures.

“I don’t know what I’m going to do,” she says.

Like many people, Spenser can’t afford private dentists, who charge thousands for extraction and dentures. On her meager salary as a school bus driver, Spenser had to get her dental work done through Indian Health Services, which struggles to provide as many services as possible on a limited budget.

Spenser was able to get the bottom teeth removed about a year ago. Due in part to the limited times she can schedule appointments with a dentist, she’s been unable to get the top teeth done. And IHS will be charging her $449 for the dentures, which she can’t afford. For the past year, she’s been living on soft foods like pasta and mashed potatoes.

“I look at these people eating steaks, and I wish I had the teeth to eat that,” she says.

Spenser is only 48 years old. By the time she had her bottom teeth removed a year ago, she says, they had already taken many of them out. Like with many indigenous people, she couldn’t afford regular cleanings and other preventative care. As such, rates of tooth decay and periodontal disease are quite high in the area.

Alaska had a similar problem amongst its Native people, whose rates of tooth decay were some three times the national average. In some cases, Alaskan Natives live in villages so remote that they are accessible only by plane or snowmobile. Not only were few dentists willing to work in such remote areas, the populations had trouble affording their prices.

The Alaskan Tribal Native Health Consortium decided to try an approach that works well in Canada, England, and 44 other countries. Tribal members went to two-year dental therapist programs in New Zealand where they learned to do cleanings, fill cavities, and pull teeth. Dental therapists can provide many preventative care procedures that may reduce tooth decay and prevent people from needing dentures at the young age of 48. And they can provide such services at one-half to one-third the price of dentists.

Dental therapists working in Alaska have been successful bringing down the rate of tooth decay in the area, but the American Dental Association nearly shut down the program because, the organization claims, only licensed dentists should perform “irreversible procedures” such as filling cavities and pulling teeth. To become a licensed dentist a person must obtain an undergraduate degree, a doctorate of dental medicine and pass a statewide exam.

Fortunately, after a yearlong battle, Alaska’s Superior Court ruled in favor of the tribes.

While the ADA maintains that it’s just protecting the quality of dental care, many are accusing the organization of trying to shut out cheap competition, which would put preventative dental care in the hands of many who go without any dental services at all. The organization did not return requests for comment to this story, but the efforts of its Washington branch led the University of Washington to withdraw its support from the Alaskan consortium and kill a planned dental therapist tract at its dental school.

According to the Seattle Post-Intelligencer, the ADA “intimidated university officials by threatening to block donations by its members.”

Dr. Michael Cadieux, a dentist with IHS, says that the dental problems amongst indigenous Navajos are not for a lack of dedication and skill on the part of the dentists that work for IHS.

“I’ve worked with some of the finest dentists in my career here,” he says.

Navajo IHS focuses on basic levels of services, which are those procedures most likely to prevent more serious problems down the line. These include routine exams and X-rays, dental sealants, fluoridation, and pain relief. They also try to focus on children, diabetics, and other populations most at risk.

Jenny Notah, spokeswoman for the Navajo IHS says that this model allows them to have the best effect possible with their resources.

“The Navajo area IHS is committed to providing the highest level of care possible,” she says.

There are ongoing talks amongst dental and other health professionals about finding ways to increase access to services. Cadieux is active as a community representative for dental professionals and travels to conferences where dental therapists and other strategies are discussed.

“We are having open conversations with the ADA,” he says.

Until then, they continue to work with what they have. Cadieux says he believes that the services available are still reaching a good portion of the Navajo nation. He says one of the biggest challenges is recruitment, but they’re turnover rate is so low that positions stay filled.

“The best retention factor is if we can get them to work with us, they usually stay,” he says.