Access and provider shortages
Building a stronger future: supporting AI/AN dental students
By: Tamana (Bunny) Begay, DDS, Supervising Clinical Director, Gallup Indian Medical Center and External Advisor, Delta Dental’s Driving Greater Diversity in the Oral Health Workforce Campaign
The oral health of many American Indian and Alaskan Native (AI/AN) communities heavily relies on the Indian Health Service, tribal clinics, or urban centers. These centers, often located in rural areas across the United States, face significant challenges in providing adequate oral health care.
In rural centers, finding dentists to provide the necessary care required to maintain overall health can be challenging. The more remote the location, the larger the barrier is in the recruitment, hiring, and retention of providers. If a dentist is not available for long periods of time, community members may have to wait, requiring dental care to be postponed, often leading to tooth loss.
Clinics in urban areas have the potential to be fully staffed; however, access can still be an issue, as the number of community members wanting to get care or to establish a dental home exceeds the availability of providers.
These long-standing issues have made many community members accustomed to episodic care and have only sought care when in critical or emergent need. For these reasons, some communities have decided this is unacceptable and have looked to their community members to fill the void.
Image provided by the Society of American Indian Dentists
Oral and overall health
A patient’s oral health is an integral component of their overall health. When one’s oral health suffers, this can exacerbate other health and social concerns. For example, in both men and women, the prevalence of diagnosed diabetes was highest among AI/AN adults (13.6-16%).1 Furthermore, those with diabetes frequently have problems with their teeth and gums, especially when they have poor glycemic control. The higher the blood glucose, the greater the risk of developing periodontal disease. AI/AN individuals with diabetes have two to three times more advanced periodontal disease than people who do not have diabetes.2
Pediatric patients suffering from dental pain miss school and have difficulty eating the types of hard, crunchy foods we encourage. Attending school with both pain and hunger makes it difficult to concentrate fully, leading to poor educational outcomes.
Challenges and overcoming barriers
According to a study by the National Indian Health Board, there is one dentist to 2,800 people in Indian Country compared to one to 1,500 people nationally. In knowing some of this, it is imperative that we look at what resources are currently available to help Indian communities thrive.
As mentioned, recruiting dental providers has been and continues to be challenging. AI/AN students pursuing a career in dentistry find the road increasingly difficult, especially with the cost of both undergraduate and graduate schools. Potential barriers include having to move and adapt to a new environment, finding or creating new support systems, overcoming the feeling of isolation, balancing coursework, or even navigating a pathway to applying to dental school. Many students may have to start their college education at a tribal or community college to catch up academically to succeed in an undergraduate program, which may also be a financial decision.
The financial stress of making ends meet is very real. There are often demands from family and extended family to help with matters at home, whether attending a ceremony or helping financially. The Indian Health Service provides scholarships for both undergraduate and graduate studies, but it is highly competitive; therefore, not all students are able to benefit from the program.
Addressing the provider pipeline
To help mitigate some of the challenges of AI/AN pre-dental students are facing the Society of American Indian Dentists (SAID), with funding supported by the Delta Dental Oral Health Diversity Fund, has developed numerous support programs. While we know from the American Dental Education Association that the number of AI/AN students has decreased over the last decade, SAID has seen an increase in student membership numbers.
Student members are provided with a number of programs, such as pre-admissions workshops, mock interviews, scholarships to prepare for or take the Dental Admissions Test, and formal mentorship. Mentorship has been vital to the development and growth in numbers of AI/AN dentists and other oral health care providers. Seeing someone from a similar background able to reach their goals of becoming a provider is reassuring. Having someone you can ask questions of, or get encouragement from who understands where you are coming from and where you want to go is important. Especially from a cultural lens, which is why the SAID has been instrumental in leading the way.
A brighter future
Although small, AI/AN represents only 0.2% of active dentists in the country, and we foresee growth in the future. The Society of American Indian Dentists (SAID) will celebrate its 35th anniversary in 2025, three decades of a small community of providers working hard by mentoring future generations. By being part of and giving back to Indian Country, many of the oral health issues we see today will be the past, as we have a positive outlook on our future.
1CDC- National Diabetes Statistics Report, May 2024
2IHS- SPDI fact sheets 2023