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Tribal dental care access falls short

New Mexico is a culturally rich and diverse state with 22 American Indian tribes, pueblos and nations that exercise sovereignty over their land and people.

Our tribes have exercised these rights since time immemorial and prior to the Spanish, Mexican and United States governments.

Tribes have the inherent right to govern and protect the health and welfare of their citizens, and oral health care should be no different.

There is an oral health care crisis in our New Mexico tribal communities that must be addressed. Many tribes are located in rural areas, and most are in dental provider shortage areas.

Even those living in urban areas have little to no access to dental care.

Dental decay and disease are highly prevalent in the American Indian population. In one New Mexico pueblo, 70 percent of adults suffer from untreated dental decay, and 58 percent of the children live with untreated dental decay.

These children are missing school and suffering needlessly. Adults miss work, and elders cannot eat nutritious foods.

This is needless suffering when a proven solution is readily available.

By utilizing the dental therapist model, all tribal, rural and underserved people throughout the state of New Mexico could benefit from much needed oral health care. The states of Alaska and Minnesota are already using this model, as well as countries around the world.

A dental therapist is a mid-level oral health provider, recruited and trained from the local community they will serve. For my community, dental therapists would mean employment and oral health care that is culturally and linguistically appropriate for our community members.

In our state, this would impact the itinerant nature of care in rural/tribal communities with providers who come and go with no continuity of care.

The Alaska program has resulted in over 40,000 more people in approximately 25 rural Alaska communities having access to dental care for the first time.

In Alaska the people saw a need and they fixed it. We should have the opportunity to do the same thing.

However, the New Mexico Dental Association and the American Dental Association have asserted strong opposition to this viable and proven solution. Not surprising given that the ADA launched a similar negative campaign in Alaska.

In fact, the ADA resorted to underhanded tactics and slipped language into the Affordable Care Act that precludes the use of dental therapists in the lower 48, which has adversely impacted tribal sovereignty, taking away the right of tribes to determine what is best for their own communities.

The NMDA has also made the ludicrous suggestion that to solve our tribal dental crises, the tribes should use “monies from their casino profits” to hire dentists.

Obviously, the NMDA is ignorant of the fact that not all tribes have casinos and have a host of pressing issues that the NMDA cannot even begin to imagine nor understand. This level of arrogance, ignorance and paternalism is surprising in the 21st century.

Dentists are expected to be trusted medical professionals who take care of us and who we look to for sound guidance and advice in meeting our oral health needs. According to the preamble of ADA Principles of Ethics and Code of Professional Conduct, the “[q]ualities of honesty, compassion, kindness, integrity, fairness and charity are part of the ethical education of a dentist…” and “the ethical dentist strives to do that which is right and good.”

The NMDA and the ADA need a refresher on their ethical principles and need to think about the people who are needlessly suffering in our state. The dental therapist legislation is a viable, safe solution to end the suffering and address the oral health care crisis in New Mexico.

Michael Bird is a member of the Kewa/Santo Domingo Pueblo and a past president of the American Public Health Association.

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