Dental Health Aide Therapist or DHAT programs were pioneered in the U.S. by the Alaska Native tribes in the early 2000s. Today the Swinomish Tribe in Washington also has a DHAT program and in Oregon, the Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians welcomed their first Dental Health Aide Therapist in July.
Tooth decay affects 43 percent of American Indian/Alaska Native children, according to a 2014 study by the Pew Charitable Trusts. Untreated tooth decay in children can lead to pain, eating problems, sleep disturbances, hospitalization, systemic infection, school absences and low self-esteem. Dental Health Aide Therapists are trained to fill cavities, clean teeth and administer fluoride treatments that help prevent tooth decay.
DHATs go into schools, day cares and Head Start programs to work directly with children, educating them on good dental hygiene practices such as brushing and flossing. Working within the schools means that DHATs are able to serve all children in the community, not just those who get to dental clinics.
DHATs are usually members of the communities they serve and are thus able to provide culturally competent dental care. “We’re so proud to have Bonnie [Johnson] as a DHAT worker. She’s a Native like us. She understands the needs of the people,” said Norma Shorty, a community health aide worker in Emmonak, Alaska, in a video sponsored by the W.K. Kellogg Foundation, one of the backers of Dental Health Aide Therapist programs.
* Since children see their DHATs in school, on the street and in the grocery store, they are less likely to fear their oral care provider than perhaps their parents and grandparents are. “The kids see DHAT Daniel [Kennedy] all the time, so they are totally comfortable and trusting when they come into the clinic for exams, treatments and cleanings,” Rachael Hogan, dental director for the Swinomish Indian Tribal Community, told ICMN.
In remote communities, DHATs go where the children are and set up temporary treatment facilities, instead of parents having to find and pay for transportation to a dental clinic, which could be hundreds of miles away. “We are so happy that we have the therapist here so we don’t have to travel for that purpose anymore,” said Gina McKindy, a resident of Aniak, Alaska, in another Kellogg video. “Healthy teeth are so important for my kids. I just don’t see how it would be without the program.”
DHATs receive two years of rigorous training in the procedures they will perform. They are trained to the same level as dentists, but learn fewer procedures, making their education less expensive than training dentists and putting more practitioners in the field faster. One in three AI/AN children has unmet dental care needs, in part because there are not enough dentists to serve them. More DHATs mean more kids get care.
The first independent study of the Alaska Dental Health Aide Therapist program in 2010 found that mid-level practitioners were “practicing safely and provided competent patient care within their scopes of practice” and that patients reported a high level of satisfaction with the care they received.
In communities with access to DHATs, fewer children under age 3 had their front four teeth extracted and more children received preventive care, which included an exam, fluoride treatment, or both, according to a new study by Donald L. Chi at the University of Washington School of Dentistry, who looked at dental services the Yukon Kuskokwim Delta in Alaska.