Alaska’s Dental Health Aide Therapist (DHAT) program graduated five on Friday, bringing to 32 the number of midlevel dental providers available to serve in tribal communities throughout the state. The DHAT program, now in its 10th year, makes dental care accessible to more than 40,000 Alaska Natives in rural areas where before 87 percent of 4- and 5-year–olds and 91 percent of 12- to 15-year-olds suffered with tooth decay.
The five graduates received certificates showing that they have successfully completed the two-year DHAT training program. Their next move will be 400 hours of practice under the direct supervision of a dentist with a sponsoring tribal health organization. Then they will be certified as DHATs and can practice more independently in remote locations, although close supervision continues through their careers.
DHATs are trained to perform oral exams, clean teeth, fill cavities, do simple extractions and, most important, provide preventive care, such as fluoride treatments and sealants, and education about oral health.
In the first year that DHATs are available in their communities, they mostly treat infections and perform extractions as they begin to make inroads into the results of years of limited or no dental services. "After about a year," says Mary Willard, DDS, educational program director for the Alaska Native Tribal Health Consortium (ANTHC), "they begin seeing patients on a regular basis and take out fewer teeth," as the emphasis on prevention and maintenance begins to pay off. DHATs typically provide 1,200 patient visits a year and 700 of those are for preventive services. "That's where we'll win the battle," says Willard. She estimates that rural Alaska needs a total of 60 to 70 DHATs.
The DHAT program also means "the way our dentists practice is changing a bit. They can now do implants and dentures and other procedures. Before this, people didn't have access to dentures because dentists did not have the time," since they were constantly swamped with problems that needed immediate attention, she says. "So we're also improving the quality of care that is available. The model allows dentists to practice more efficiently."
And it provides dental care at less cost. A DHAT earns about half what a dentist does, but clinics can bill out their services at the same rate as they do dentists' services, explains Willard. A 2013 report from Community Catalyst found that midlevel dental providers cost less than 30 cents for each dollar of revenue they bring in, making it a cost-effective solution for Alaska's tribal health organizations.
Those organizations do a lot of the recruiting for the program. "When they want a DHAT they will find someone," says Willard. In exchange for the training they receive, students are required to serve as DHATs for four years. Nearly 80 percent of DHATs return to their home regions to practice. The program has an 81 percent retention rate.
Shannon Hardy is a 2011 graduate of the Alaska DHAT program. She had to leave her husband and five children, ages 18 months to nine years, in Fort Yukon for six months at the beginning of her training because the family could not find housing in Anchorage. She says the program was "like dental boot camp. We had training from 8 to 5 in Anchorage and we had homework till 11 at night, so it was pretty intense. The second year you still have a lot of homework but it seems to get a little bit easier when everything clicks together."
But, she says, "it was so worth it. Now I get to go home and work on the people that I really care about, to help them with their dental health. It's amazing and I love it."
Hardy and Willard both are convinced that this program could expand to the lower 48 where access to dental care is by no means assured, especially not to lower-income and rural populations. The Pew Charitable Trusts finds that nationally 60 percent of children have tooth decay, writing, "Dental care is the single greatest unmet need for health services among children."
The DHAT model is a proven cost-effective way of providing high-quality dental care to underserved populations. This concept not only works well in remote areas, but could work anywhere, including inner cities, where practitioners could set up in schools just as they do in rural villages, says Willard.
Alaska's DHAT program, a partnership between the University of Washington and ANTHC, was created by the consortium and the Federal CHAP Certification Board with support from the W.K. Kellogg Foundation, the Rasmuson Foundation and the Bethel Community Services Foundation.
The Class of 2014 was honored at a luncheon at the National Congress of American Indians' mid-year conference a few days after they graduated.